Involvement In Psoriatic Arthritis Research Articles

Chitinase-3-like protein 1 (YKL-40) is a biomarker of severity of joint involvement in psoriatic arthritis.

IntroductionPsoriasis is an inflammatory disease of a complex pathogenesis and arthritis is one of its most common complications. The biological role of chitinase-3-like protein 1 remains unknown. It is suggested that this protein takes part in processes such as proliferation, inflammation and tissue remodelling.AimTo determine whether YKL-40 can be a useful biomarker in psoriatic arthritis.Material and methodsThe study was performed on 42 patients with psoriatic arthritis: 28 men and 14 women, aged from 24 to 71 years. All patients met the diagnostic criteria (CASPAR) for psoriatic arthritis. The severity of psoriatic arthritis was assessed using 28-joint Disease Activity Score with CRP. The assessment of skin lesions was performed by Psoriasis Area and Severity Index (PASI) and, additionally, the Body Surface Area (BSA) was calculated. Blood samples were taken to measure the serum concentration of YKL-40, as well as C-reactive protein, erythrocyte sedimentation rate, white blood cell count and neutrophil count.ResultsYKL-40 serum levels were significantly higher in patients with psoriatic arthritis, compared to the control group. Moreover, a significant positive correlation between the activity of psoriatic arthritis measured by DAS 28 and serum level of YKL-40 was found. There was a positive correlation between serum YKL-40 and BSA, as well as a distinct trend towards significance between YKL-40 and PASI score.ConclusionsYKL-40 can be a useful biomarker for both diagnosing and monitoring joint involvement in psoriatic patients.

Cambios radiográficos en el penacho de la falange distal de las manos en pacientes con psoriasis o artritis psoriásica. Revisión sistemática

Introducción. El penacho de la falange distal de las manos (PFDM) es una estructura ósea que sufre cambios sutiles en diversas enfermedades musculoesqueléticas. Hasta el momento, se desconoce el tipo y frecuencia de las lesiones del PFDM en psoriasis y artritis psoriásica (APs).Objetivo. Determinar en radiografía simple las anormalidades del PFDM en adultos con psoriasis y APs.Materiales y métodos. Se realizó una revisión sistemática buscando alteraciones radiográficas del PFDM en adultos con psoriasis y APs. La prevalencia de los hallazgos fue sintetizada usando un modelo de efectos fijos. Las asociaciones se expresaron como odds ratio (OR) con intervalos de confianza (IC) y valores p.Resultados. Se incluyeron 11 estudios observacionales. La alteración de mayor frecuencia en APs fue la resorción del PFDM con una prevalencia del 16%. El compromiso del PFDM en sujetos con onicopatía psoriásica fue mayor que en sujetos sin compromiso ungueal (OR=2.91; IC95%: 1.04–8.13; p=0.04), siendo las erosiones y la esclerosis los hallazgos de mayor importancia.Conclusión. La evidencia actual acerca del compromiso del PFDM en APs y psoriasis es limitada. Existe relación entre las alteraciones del PFDM y la patología ungueal en donde las erosiones y la esclerosis son las anormalidades más significativas.

Axial involvement in psoriatic arthritis

Axial involvement in psoriatic arthritis

Temporomandibular joint involvement in psoriatic arthritis

Psoriasis is a chronic, papulosquamous, and an inflammatory skin disease. It has been found that between 5% and 24% of patients develop psoriatic arthritis (PA) at the same time after or even prior to skin findings. The involvement of temporomandibular joint (TMJ) is a rare condition. In this report, a-46-year-old male patient was referred to our clinic with the complaint of pain in the bilateral TMJs, and a limited jaw movement. Medical anamnesis revealed he had psoriasis for the last 21 years, and developed a seronegative polyarthritis with destructive changes for 8 years. On extra-oral examination, crepitation at TMJs and limitation of jaw movements was detected. The radiographic examination with cone-beam CT revealed the bilaterally decreased joint spaces, erosion, and the loss of cortical edge of the joint on the condylar heads. The definitive diagnosis of PA was made with the help of patient's history and radiological findings. The uses of non-steroidal anti-inflammatory drugs and occlusal splint have been suggested for conservative treatment.

Increased risk of glomerulonephritis and chronic kidney disease in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study.

Few studies have examined the association between psoriasis and glomerulonephritis (GN) as well as chronic kidney disease (CKD). To determine the risk of CKD in patients with psoriasis and evaluate the impact of the severity of psoriasis, comorbidities and concomitant drugs on the risk of GN and CKD in patients with psoriasis. We identified 4344 patients with psoriasis for the study cohort and randomly selected 13,032 subjects as a control cohort. Each subject was individually followed for up for 5 years to identify those who subsequently developed GN and CKD. After adjustment for traditional CKD risk factors, psoriasis was found to be independently associated with an increased risk of CKD during the follow-up period [hazard ratio (HR) 1.28; 95% confidence interval (CI) 1.14-1.44]. The increased incidence of GN in patients with psoriasis (HR 1.50, 95% CI 1.24-1.81) may contribute to the positive association between psoriasis and CKD. Patients with mild and severe psoriasis had an increased risk of CKD and GN compared with the control cohort; the risk increased with severity. Patients with psoriasis and arthritis exhibited a higher risk of CKD than patients without arthritis (HR 1.62 vs. 1.26). Among drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) have the strongest association with CKD in patients with psoriasis (adjusted odds ratio 1.69, 95% CI 1.14-2.49). Psoriasis was associated with a higher risk of developing CKD and GN. High severity, psoriatic arthritis involvement and concomitant NSAIDs use further increased the risk of CKD in patients with psoriasis.

Drug therapies for peripheral joint disease in psoriatic arthritis: a systematic review.

In 2009, GRAPPA published their first evidence-based recommendations for the treatment of psoriasis and psoriatic arthritis (PsA). Since then, new information has been published and drugs developed. We summarize evidence for the efficacy of available treatments for peripheral joint involvement in PsA. We performed a systematic review of current literature on the efficacy of different therapies, management, and therapeutic strategies for peripheral arthritis involvement in PsA, in order to provide information for the development of the new GRAPPA treatment recommendations.

Serum YKL-40 in psoriasis with and without arthritis; correlation with disease activity and high-resolution power Doppler ultrasonographic joint findings.

YKL-40 may be involved in angiogenesis in psoriasis and psoriatic arthritis (PsA). High-resolution power Doppler ultrasound (PDUS) can detect angiogenesis of synovium in PsA. To assess serum YKL-40 in psoriasis patients with or without PsA, and to correlate its levels with disease activity and high-resolution PDUS findings. In this case-control study, 48 patients with psoriasis (26 of them also had PsA) and 30 controls were assessed by high-resolution PDUS, and assayed for serum levels of YKL-40 by ELISA. Patients were clinically assessed using Composite Psoriatic Disease Activity Index (CPDAI). Total joint score (TJS) was used to assess joint involvement in PsA. A statistically significant elevation was found in YKL-40 levels in psoriatics with or without PsA compared with controls (P<0.001), as well as in PsA (group II) compared to patients without arthritis (group I) (P=0.002). CPDAI, synovial thickness score and colour Doppler ultrasound (CDUS) score were highly significantly higher in group II vs. group I (P<0.001). In all patients, CPDAI, synovial thickness and CDUS score were positively correlated to each other, and each of them was positively correlated to serum YKL-40 levels (P<0.05). In either group I or II, serum YKL-40 levels correlated positively with CPDAI (P<0.05). In group II, TJS, synovial thickness and CDUS score were positively correlated to each other (P<0.05). Serum YKL-40 can be used as a new biological marker for angiogenesis and disease activity in psoriasis with or without PsA. High-resolution PDUS is a non-invasive tool for the evaluation of angiogenesis in PsA patients as well as for the detection of early synovial changes in psoriasis patients without arthritis.

SAT0383 The Functionl Impact of Asymptomatic Axial Involvement in Psoriatic Arthritis

BackgroundSpondylitis associated with peripheral psoriatic arthritis occurs in 40% to 70% of the patients, depending on whether or not radiographs are taken (1). Careful clinical and radiologic assessment, however, reveals...

AB0740 Comparative Study of Patients with Peripheral Psoriatic Arthritis, Axial Psoriatic Arthritis and Axial Spondyloarthritis without Psoriasis

BackgroundAxial involvement in Psoriatic Arthritis (PsA) is reported to be between 40 -70%1. We aimed to compare the disease characteristics and quality of life (QoL) in patients with PsA with...

AB0302 Profile of Joint Involvement over Time in Rheumatoid Arthritis and Psoriatic Arthritis Patients Treated with Anti-TNF in A Real-World Setting

BackgroundUnlike rheumatoid arthritis (RA), the pattern of joint involvement in psoriatic arthritis (PsA) is usually asymmetric. Furthermore, PsA may demonstrate oligoarthritis or polyarthritis, while RA usually manifests in multiple joints.ObjectivesTo...

Impaired Left Ventricular Apical Rotation is Associated with Disease Activity of Psoriatic Arthritis

Although early cardiovascular (CV) involvement has been found in patients with psoriatic arthritis (PsA), few studies have related this to PsA disease activity. The aim of our study was to evaluate left ventricular (LV) mechanics using novel, more sensitive techniques based on assessment of LV rotation for the detection of impaired LV function in patients with PsA correlated with disease-related risk factors. Seventy-six patients with PsA and 24 healthy control subjects were enrolled, including 33 patients without any CV risk factors. All participants underwent conventional echocardiography and 2-dimensional speckle tracking imaging. Global longitudinal, apical circumferential, and radial strain, and apical rotation and maximal untwisting rate during early diastole were measured. Although patients with PsA had normal LV ejection fraction, the myocardial deformation in multidimensional planes was impaired. Based on the cutoff point derived from the apical rotation of control subjects, 81% of the patients had subclinical systolic and/or diastolic dysfunction. Similar prevalence was found in patients without CV risk factors. Spearman correlation demonstrated a relationship between Disease Activity Score in 28 joints (r=0.299, p=0.011), erythrocyte sedimentation rate (r=0.309, p=0.008), and impaired apical rotation, even after adjusting for age and hypertension. No correlation was found between longitudinal, radial, and circumferential strain and disease activity. Subclinical impaired myocardial deformation was common in patients with PsA even without CV risk factors. Apical rotation was associated with the status of PsA disease activity. These new speckle tracking echocardiography techniques can detect subclinical myocardial involvement in PsA.

Evaluation of the novel ultrasound score for large joints in psoriatic arthritis and ankylosing spondylitis: six month experience in daily clinical practice

BackgroundTo evaluate the utility of the recently introduced SOLAR score (sonography of large joints in Rheumatology), which has been validated in RA patients, in a cohort of patients with Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) presenting with involvement of large peripheral joints.MethodsThe recently established SOLAR score has been designed to determine the degree of inflammation in the shoulder, the elbow, the hip and the knee joint in patients suffering from RA. Since large joints are frequently involved in PsA and AS, synovitis and synovial vascularity were scored semiquantitatively (grade 0–3) by grey scale (GSUS) and power Doppler ultrasound (PDUS) utilizing the validated scoring system. Each joint was scanned from different angles, the knee joint for example was divided into four areas to score for synovitis: the suprapatellar longitudinal, the medial longitudinal, the lateral longitudinal, and the posterior region. Each area was scored from 0–3, so a maximum score of 12 could be achieved. PsA and AS patients presenting with peripheral joint disease involving large joints were examined at baseline, 3 and 6 months after initiation of local or systemic therapy (DMARDs/Biologics). For evaluation of the inflammatory status, the erythrocyte sedimentation rate (ESR) was determined.ResultsA cohort of 126 patients were enclosed, and 83 of these were followed for 6 months. At baseline before modification of the therapy, patients received DMARDs (n = 83), DMARDs plus biologics (n = 30), or biologic monotherapy (n = 29). Following intervention, all US scores demonstrated a marked improvement. The GSUS and the PDUS scores for all joint areas, except the PDUS score of the hip, exhibited a significant improvement (p < 0.05), while the GSUS of the knee showed even a highly significant (p < 0.001) change. The ESR displayed a significant decrease from 27 to 19 mm (p < 0.002) representing good treatment response.ConclusionThe SOLAR score, which has been recently introduced for RA patients, is a very suitable instrument for the qualitative and quantitative evaluation of large joint involvement in PsA and AS patients and allows for treatment monitoring.

AB0579 The relationship between visceral adiposity index and disability function in a cohort of psoriatic arthritis patients

BackgroundBackground: : Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease associated with psoriasis. PsA patients have a higher prevalence of some comorbidities (obesity, metabolic syndrome, depression and premature cardiovascular disease)....

SAT0545 Comparing Health-Related Quality of Life across Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis: Analyses from Certolizumab Pegol Clinical Trial Baseline Data

BackgroundInflammatory diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are associated with significant burden on patients’ (pts) function and health-related quality of life (HRQoL). However,...

SAT0289 Mri assessment of spinal involvement in psoriatic arthritis: Extent of disease relates to HLA-B27

BackgroundPsoriatic Arthritis (PsA) is a heterogeneous disease with a variable, sometimes evolving clinical phenotype. An estimated 25-70% of patients may have spinal involvement which varies from largely asymptomatic to severe...

Variants in RUNX3 Contribute to Susceptibility to Psoriatic Arthritis, Exhibiting Further Common Ground With Ankylosing Spondylitis

Psoriatic arthritis (PsA) is a common inflammatory joint disease distinct from other chronic arthritides and frequently accompanied by psoriasis vulgaris. In a first genome-wide association study (GWAS), we were able to identify several genetic risk factors. However, even combined with previously identified factors, the genetic contribution to disease was not fully explained. Therefore, we undertook this study to investigate further 17 loci from our GWAS that did not reach genome-wide significance levels of association in the initial analysis. Twenty-one of 22 single-nucleotide polymorphisms were successfully genotyped in independent cohorts of 1,398 PsA patients and 6,389 controls and in a group of 964 German patients with psoriasis vulgaris. Association with a RUNX3 variant, rs4649038, was replicated in independent patients and controls and resulted in a combined P value of 1.40 × 10(-8) by Cochran-Mantel-Haenszel test and an odds ratio (OR) of 1.24 (95% confidence interval [95% CI] 1.15-1.33). Further analyses based on linkage disequilibrium (LD) at RUNX3 refined the most significant association to an LD block located in the first intron of one isoform. Weaker evidence for association was detected in German patients with psoriasis vulgaris (P = 5.89 × 10(-2) ; OR 1.13 [95% CI 1.00-1.28]), indicating a role in the skin manifestations of psoriasis. Our analyses identified variants in RUNX3 as susceptibility factors for PsA. RUNX3 has already been implicated in susceptibility to ankylosing spondylitis, another spondyloarthritis, although its risk allele is independent from the one for PsA. RUNX-3 is involved in CD8+ T lymphocyte differentiation and is therefore a good candidate for involvement in PsA and psoriasis vulgaris as T cell-mediated diseases.

Psoriatic Arthritis and Sonographic Entheseal Index

To the Editor: We read with great interest the recent article, “Identification of the Clinical Features Distinguishing Psoriatic Arthritis and Fibromyalgia” by Marchesoni, et al 1. However, we have some doubts about their results. They reported that Achilles tendon entheses were not significantly more involved in patients with psoriatic arthritis (PsA), because of the infrequent involvement of this tendon in these patients. This is an intriguing finding. The Achilles tendons are among the most frequent sites of enthesopathic involvement in PsA, and are reported in … Address correspondence to Dr. Ozkan, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Radiology, 46050 Kahramanmaras, Turkey. E-mail: drfozkan{at}yahoo.com

The Radiological Assessment of Axial Involvement in Psoriatic Arthritis

This article summarizes the state of radiological assessment of axial involvement in psoriatic arthritis (PsA). The definition and measurement of axial disease in PsA remain problematic and this situation in turn could affect the choice of approach to evaluate radiological findings of the spine. At present, the radiological assessment has been evaluated by using scoring systems borrowed from ankylosing spondylitis (AS). In particular, the Bath AS Radiology Index (BASRI) and the modified Stoke AS Spine Score (m-SASSS) have been validated for axial PsA. A recent study showed that BASRI and m-SASSS were valid instruments; however, neither score encompassed all radiological features of PsA. Therefore, a new index for assessing radiological axial involvement in PsA was developed--the PsA Spondylitis Radiology Index (PASRI). This new index encompassed a greater range of the spinal radiological features of PsA, providing a greater score range, and it correlated well with anthropometric and patient-reported outcomes. Recently, a study assessed the sensitivity to change of BASRI, m-SASSS, and PASRI, and showed that these 3 instruments provided a moderate sensitivity to change but high specificity to detect the true changes.

A Patient with Psoriatic Arthritis Imaged with FDG-PET/CT Demonstrated an Unusual Imaging Pattern with Muscle and Fascia Involvement: A Case Report.

We describe the case of a patient with known history of psoriasis that presented with 1 year of unexplained fever, muscle weakness and marked weight loss, suspicious for B symptoms of a malignant origin. [(18)F]-Fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) scans demonstrated an unusual serpiginous pattern of uptake in the fascia and muscles as well as lymph node activity. Multiple histological samples, including a final PET-probe guided lymph node surgical resection, excluded malignancy and confirmed the diagnosis of reactive inflammatory changes, with a plausible diagnosis of autoimmune lymphoproliferative syndrome with associated lymphadenitis, fasciitis and myositis, possibly mediated by tumor necrosis factor (TNF) inhibitor. To our knowledge, there is no evidence of a previously reported FDG uptake pattern of fascia and muscle involvement in psoriatic arthritis.

Axial psoriatic arthritis: an intriguing clinical entity or a subset of an intriguing disease?

This article summarizes the state of the art of axial involvement in psoriatic arthritis (axial PsA). The definition and measurement of axial disease in PsA still remain problematic, and this, in turn, could affect the best approach of recognition and treatment of this intriguing subset of the psoriatic disease. Axial PsA has been studied over the last few years looking at the difference in function and radiological finding compared to ankylosing spondylitis (AS), trying to differentiate it from a coincidental AS with psoriasis. Finally, this review has described the diagnosis and treatment of axial PsA reporting the data obtained from the literature.