Psoriasis Patients Research Articles

Comorbidity structure in psoriasis patients according to dermatology department data

Comorbidity structure in psoriasis patients according to dermatology department data

Key genes and immune infiltration patterns and the clinical implications in psoriasis patients.

Psoriasis is an immune-mediated skin disease, closely related to immune regulation. The aim was to understand the pathogenesis of psoriasis further, reveal potential therapeutic targets, and provide new clues for its diagnosis, treatment, and prevention. Expression profiling data were obtained from the Gene Expression Omnibus (GEO) database for skin tissues from healthy population and psoriasis patients. Differentially expressed genes (DEGs) were selected for Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA) analysis separately. Machine learning algorithms were used to obtain characteristic genes closely associated with psoriasis. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of the characteristic genes for psoriasis. The Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT) algorithm was used to calculate the proportion of immune cell infiltration. Correlation analysis was used to characterize the connection between gene expression and immune cell, Psoriasis Area and Severity Index (PASI). A total of 254 DEGs were identified in the psoriasis group, including 185 upregulated and 69 downregulated genes. GO was mainly enriched in cytokine-mediated signaling pathway, response to virus, and cytokine activity. KEGG was mainly focused on cytokine-cytokine receptor interaction and IL-17 signaling pathway. GSEA was mainly in chemokine signaling pathway and cytokine-cytokine receptor interaction. The machine learning algorithm screened nine characteristic genes C10orf99, GDA, FCHSD1, C12orf56, S100A7, INA, CHRNA9, IFI44, and CXCL9. In the validation set, the expressions of these nine genes increased in the psoriasis group, and the AUC values were all>0.9, consistent with those of the training set. The immune infiltration results showed increased proportions of macrophages, T cells, and neutrophils in the psoriasis group. The characteristic genes were positively or negatively correlated to varying degrees with T cells and macrophages. Nine characteristic genes were highly expressed in the moderate to severe psoriasis group and positively correlated with PASI scores. High levels of nine characteristic genes C10orf99, GDA, FCHSD1, C12orf56, S100A7, INA, CHRNA9, IFI44, and CXCL9 were risk factors for psoriasis, the differential expression of which was related to the regulation of immune system activity and PASI scores, affecting the proportions of different immune cells and promoting the occurrence and development of psoriasis.

The Hidden Costs of Psoriasis: A Population-Based Study Evaluating How Psoriasis Severity Impacts Work Absenteeism.

Psoriasis patients experience physical and emotional burdens, which may lead to work-related productivity loss. This loss carries professional and financial repercussions. It is unknown whether the extent of psoriasis affects work absenteeism. This study aims to compare work absenteeism between employed adults with mild versus moderate-to-severe psoriasis. A national, cross-sectional study using the 2009 to 2019 Medical Expenditure Panel Survey evaluated 5,209,956 (weighted) adults aged ≥ 22 years. Work absenteeism was compared between adults with mild (4,521,687 weighted) and moderate-to-severe psoriasis (688,269 weighted). Work absenteeism, as measured by the average number of episodes per year that someone was absent from work for at least a half day, was significantly higher in patients with moderate-to-severe psoriasis than in patients with mild disease (4.4 episodes vs 2.8 episodes, P=0.002). Multivariable logistic regression models showed moderate-to-severe patients were 2.68 times more likely (95% CI:1.72-4.21; P<0.001) to take a half-day or more off from work than those with mild disease after adjusting for age, sex, race, ethnicity, poverty, cognitive limitations, insurance, education, and comorbidities. Disease severity directly impacts work absenteeism in psoriasis patients. Early diagnosis and treatment with appropriate therapies are needed to reduce disease severity and limit economic loss and professional ramifications associated with psoriasis. J Drugs Dermatol. 2024;23(8):640-644.  doi:10.36849/JDD.7550.

Predictors of disease severity, length of hospitalization, and recurrence in inpatients with single-organ cutaneous small vessel vasculitis.

There is a lack of systematic studies on single-organ cutaneous small vessel vasculitis (SOCV). To evaluate prognostic clinical and laboratory parameters, including systemic immune-inflammation biomarkers (SIIB) in SOCV inpatients. This study investigated the clinical and laboratory data of 178 inpatients. Blood tests were performed at baseline. SIIB were assessed based on neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV). Univariable and multivariable statistics were performed. Both NLR and PIV were significantly higher in SOCV patients than in healthy controls. However, the SIIB values observed in SOCV patients were as high as those in psoriasis patients. On logistic regression analysis, disease manifestation on the upper extremities strongly predicted the absence of severe disease (OR: 0.31, 95%CI: 0.13 to 0.73; p = 0.0071). Moreover, older age (OR: 2.3, 95%CI: 1.11 to 4.77; p = 0.025) and severe disease (OR: 2.4, 95%CI: 1.16 to 4.94, p = 0.018) were significant independent predictors of longer hospital stay, whereas female sex was an independent protective factor for longer hospitalization (OR: 0.52, 95%CI: 0.28 to 0.96, p = 0.038). Lower serum C3 was a strong independent predictor of disease recurrence (OR: 13.9, 95%CI 3 to 63.4; p = 0.0007). The increase in SIIB observed in patients with SOCV reflects that systemic inflammatory alterations also play a role in SOCV patients. We identified several clinical and laboratory-based independent predictors of SOCV severity, length of hospitalization, and disease recurrence that may aid prognostication of SOCV patients.

Risk of developing inflammatory arthritis in patients with psoriasis initiating treatment with biologics: A population-based analysis

BackgroundThe relationship between biologic treatments for psoriasis (PsO) and development of inflammatory arthritis in patients is not fully understood. ObjectiveAnalyze the effects of biologic treatment on development of inflammatory arthritis in PsO patients. MethodsThis retrospective study assessed PsO patients identified in the Optum Clinformatics® Data Mart database from Jan 2007 to Mar 2023 with no baseline diagnosis of inflammatory arthritis. Patients were stratified based on the class of initial biologic treatment (IL-23, IL-12/23, IL-17, or TNF inhibitor) and followed for up to 3 years or development of inflammatory arthritis. Risk of developing inflammatory arthritis was assessed using a multivariate Cox proportional hazard models using IL-23 inhibitors as reference. ResultsIncidence rates of developing inflammatory arthritis expressed as events/100 person-years were 4.99, 7.29, 6.06, and 9.39 for IL-23, IL-17, IL-12/23, and TNF inhibitors respectively. Adjusted hazard ratios were significantly higher for patients receiving IL-17 (1.44; p=.0294) and TNF (1.90; p<.0001) inhibitors when compared to patients receiving IL-23 inhibitors. LimitationsLimitations include those associated with medical coding errors and the potential for protopathic bias. ConclusionPatients receiving IL-23 inhibitors are at lower risk for developing inflammatory arthritis or PsA compared to those receiving IL-17 and TNF inhibitors.

Decreased expression of galectin-3 in the epidermis of psoriasis patients.

Conventional histopathological features of psoriasis and atopic dermatitis often overlap. We aimed to investigate Galectin-3 (Gal-3) expression in psoriatic skin lesions and its potential as an immunohistochemical marker for distinguishing between psoriasis and atopic dermatitis on a pathological basis. Based on immunohistochemical analysis, we assessed Gal-3 expression in formalin-fixed, paraffin-embedded tissue sections from 21 patients with psoriasis and 15 patients with atopic dermatitis. Quantitative analysis of expression intensity was performed using the average density (average optical density) method. We analysed the relationship between Gal-3 expression and clinical characteristics, as well as conventional histopathological features. Patients with psoriasis exhibited significantly decreased Gal-3 expression in the epidermis (0.11±0.05) compared to the atopic dermatitis group (0.36±0.15) and healthy controls (0.49±0.13) (p<0.0001). Reduction in Gal-3 expression in the psoriatic epidermis around areas of neutrophil aggregation was more pronounced than around areas of non-neutrophil aggregation (0.07±0.02 vs 0.16±0.05, p<0.01). In both psoriasis (r=-0.48, p<0.05) and atopic dermatitis groups (r=-0.70, p<0.01), Gal-3 expression negatively correlated with epidermal thickness. When epidermal thickness was matched between the two groups, the decrease in epidermal Gal-3 expression remained significant in the psoriasis group compared to the atopic dermatitis group (0.14±0.05 Vs 0.30±0.07, p<0.01). Patients with psoriasis show specific downregulation of epidermal Gal-3, correlating with epidermal thickness and neutrophil-related factors. Gal-3 may serve as an auxiliary discriminative marker between psoriasis and atopic dermatitis, potentially associated with keratinocyte proliferation and neutrophil function.

Major adverse cardiovascular events are more frequent in psoriasis patients compared to controls, despite statin therapy: An observational retrospective cohort study

Major adverse cardiovascular events are more frequent in psoriasis patients compared to controls, despite statin therapy: An observational retrospective cohort study

Real-life Effectiveness and Safety of Guselkumab in Moderate-to-Severe Plaque Psoriasis: A 104-Week Retrospective Single-Center Study.

Guselkumab is a monoclonal antibody approved for treating moderate-to-severe plaque psoriasis. Long-term data on the effectiveness and safety of guselkumab in a real-world setting are still limited. We conducted a 104-week monocentric retrospective study on 102 psoriasis patients, all treated with guselkumab for at least 16 weeks. At each visit, we used the Psoriasis Area and Severity Index (PASI): effectiveness endpoints were the percentages of patients achieving 75%/90%/100% (PASI 75/90/100) improvement in PASI compared with baseline. The Kaplan-Meier curve was used to assess the drug survival. At week 16, PASI 90 and PASI 100 were achieved by 49.02% and 32.35% of patients. At week 52, PASI 90 and PASI 100 were achieved by 71.58% and 55.79% of patients. After 2 years, PASI 90 and PASI 100 were achieved by 79.63% and 61.11% of patients. Obese and overweight patients had comparable PASI 90 and PASI 100 responses throughout the study. At week 104, no significant differences were observed between bio-na&iuml;ve and bio-experienced patients regarding all effectiveness endpoints. No significant safety signals were reported in our study. After 24 months, 91.57% of our cohort was still on treatment with guselkumab. Our findings, although limited by the study's retrospective nature, confirm that guselkumab is a safe and effective therapeutic option for a "real-life" cohort of patients with psoriasis. J Drugs Dermatol. 2024;23(8):632-639.&nbsp; doi:10.36849/JDD.7486R1.

The Impact of Statins on Disease Severity and Quality of Life in Patients with Psoriasis: A Systematic Review and Meta-Analysis.

Psoriasis, a chronic autoimmune condition, imposes significant burdens on patients' well-being. While corticosteroid medications are commonly used, their prolonged use presents risks. Statins, known for their immunoregulatory and anti-inflammatory properties, have emerged as potential alternatives. Previous reviews indicated that statins might improve psoriasis symptoms but showed inconsistent results and lacked meta-analyses that generated pooled effect estimates. Therefore, this study addresses this gap by providing a comprehensive overview of the impact of statins on psoriasis severity and quality of life (QoL) for patients with psoriasis. A thorough search of four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct) was conducted for relevant studies published before April 2024. Seven studies involving 369 patients were included. This meta-analysis showed a statistically significant reduction in PASI scores at week 8 with statin treatment (MD = -1.96, 95% CI [-3.14, -0.77], p = 0.001). However, no statistically significant difference was found between statins and placebo at week 12 (MD = 0.19, 95% CI [-0.18, 0.55]). Additionally, DLQI scores indicated a significant improvement in quality of life with statins compared to placebo (MD = -3.16, 95% CI [-5.55, -0.77]). Statins can improve disease severity and quality of life in psoriasis patients, suggesting the potential benefits of statin therapy. However, further research is needed to determine the optimal treatment duration, address outcome heterogeneity, and explore additional benefits such as cholesterol and triglyceride reduction.

JNJ-77242113, a highly potent, selective peptide targeting the IL-23 receptor, provides robust IL-23 pathway inhibition upon oral dosing in rats and humans

The interleukin (IL)-23 pathway is a pathogenic driver in psoriasis, psoriatic arthritis, and inflammatory bowel disease. Currently, no oral therapeutics selectively target this pathway. JNJ-77242113 is a peptide targeting the IL-23 receptor with high affinity (KD: 7.1 pM). In human cells, JNJ-77242113 potently and selectively inhibited proximal IL-23 signaling (IC50: 5.6 pM) without impacting IL-12 signaling. JNJ-77242113 inhibited IL-23–induced interferon (IFN)γ production in NK cells, and in blood from healthy donors and psoriasis patients (IC50: 18.4, 11 and 9 pM, respectively). In a rat trinitrobenzene sulfonic acid-induced colitis model, oral JNJ-77242113 attenuated disease parameters at doses ≥ 0.3 mg/kg/day. Pharmacologic activity beyond the gastrointestinal tract was also demonstrated. In blood from rats receiving oral JNJ-77242113, dose-dependent inhibition of ex vivo IL-23–stimulated IL-17A production was observed. In an IL-23–induced rat skin inflammation model, JNJ-77242113 inhibited IL-23–induced skin thickening and IL-17A, -17F and -22 gene induction. Oral dosing of JNJ-77242113 in healthy human volunteers inhibited ex vivo IL-23–stimulated IFNγ production in whole blood. Thus, JNJ-77242113 provided selective, systemic IL-23 pathway inhibition in preclinical models which translated to pharmacodynamic activity in healthy human volunteers, supporting the potential for JNJ-77242113 as a selective oral therapy for IL-23–driven immune-mediated diseases.

In vivo terahertz sensing of psoriasis and eczema patients

In this study we present the first in vivo clinical study of patients with eczema and psoriasis using terahertz (THz) sensing. Eczema and psoriasis patients were measured using a handheld THz scanner, both before and after the application of moisturiser. We show that THz sensing can distinguish between dry and healthy skin in different regions of the body. Furthermore, the impact of applying moisturiser on the skin can also be observed and potentially evaluated using THz light.

Genetic polymorphisms to identify patients with an optimal response to tildrakizumab in psoriasis patients from real-life clinical practice.

Detecting the association of genetic variants to the response of biological therapy represents an important advance in developing a personalized therapy. The aim of this work was to study the association of polymorphisms with an optimal response to tildrakizumab in patients with psoriasis in a real-life clinical practice. Ninety patients with plaque psoriasis recruited from-Spanish hospitals receiving tildrakizumab for at least 24 weeks were genotyped for 180 polymorphisms. Optimal response to tildrakizumab was evaluated by absolute PASI ≤1 at 6 and 12 months. Polymorphisms corrected for weight and disease duration with an FDR <0.15 were included in a multiple regression model. Sixty three percent of patients achieved an absolute PASI ≤1 at 6 months, while 71% did so after 12 months. Disease duration (>27 years) and weight (>76 kg) were associated with treatment response; after correcting by these factors, no association (FDR >0.15) was found for any polymorphism and response to tildrakizumab at 6 months. The analysis at 12 months identified the genotype GG for rs610604 (TNFAIP3), CT for rs9373839 (ATG5), and delCTGT/delCTGT for rs72167053 (PDE4D) as risk factors to not achieve an optimal response (PASI ≤1), while CT for rs708567 (IL17RC) was protective, independently of weight and disease duration (FDR <0.15). The final multivariable model at 12 months showed an AUC of 0.90 (95% CI 0.82 to -0.98). We identified a set of polymorphisms that could be helpful to identify psoriatic patients with an optimal response to tildrakizumab at 12 months in real-world practice conditions.

EMPATHY Life in Psoriasis: Embracing Patients' Well-Being in Their Journey of Moderate-to-Severe Psoriasis.

Background: Psoriasis is a chronic inflammatory skin condition that affects millions of individuals worldwide, impacting their physical and emotional well-being. The management of psoriasis requires effective communication and a strong physician-patient relationship. Objective: We aim to develop a novel algorithm to enhance patient well-being and care in moderate-to-severe psoriasis, considering the time constraints that dermatologists have in public hospitals. Methods: This project employed a multidisciplinary approach, involving collaboration between 14 experienced dermatologists (referred to as Key Opinion Leaders: KOLs) and a psychologist. During three separate meetings (an initial virtual session, a face-to-face meeting, and a final virtual meeting), an algorithm (Embracing Patients' Well-being in their Journey of Moderate-to-Severe psoriasis: EMPATHY), describing the patient's reception through the entire first visit and follow-up visits, was developed and refined. Results: The EMPATHY algorithm provides a step-by-step approach from the moment the patient arrives at reception, through the first visit and on to subsequent visits. This algorithm fills a critical gap in the existing guidelines by specifically addressing how to foster empathy during psoriasis patient visits within time-limited consultations. The algorithm outlines patient-centered strategies at each visit. Key aspects include creating a welcoming environment, active listening, respecting privacy, tailoring communication styles, and managing patient expectations. Conclusions: The EMPATHY algorithm represents a novel and promising approach to improving patient care and well-being in moderate-to-severe psoriasis. Developed together by dermatologists and a psychologist, this algorithm offers healthcare providers practical guidance for managing both initial and follow-up patient visits. While further validation is necessary, the potential for adapting the EMPATHY algorithm to diverse healthcare settings and patient populations holds promise for improving patient outcomes across various chronic conditions.

Evaluation of β2-microglobulin in the condition and prognosis of psoriasis patients

Background Numerous studies have linked the inflammatory pathway in psoriasis and metabolic disease, while no specific marker defined it. It is worth exploring the association of β2-microglobulin (β2M) in psoriasis severity and comorbidities. Objectives To investigate the correlation between blood β2M level and psoriasis severity, to explore the inflammatory factors influencing the occurrence of psoriasis comorbidities such as arthritis, diabetes, and hypertension. Methods Ninety-seven psoriasis patients were analyzed in the cohort retrospective study during 12 weeks. Results Significantly higher levels of blood β2M and ESR were observed in the group that patients’ PASI ≥10 than in the group that PASI <10. Blood β2M level had strong significantly positive correlations with the PASI in Pearson’s correlation analysis. In the model that systemic inflammatory factors to find psoriasis comorbidity risk factors, logistic regression analysis showed that blood β2M level was the significant risk factor associated with diabetes and hypertension. High-sensitivity C-reactive protein (hsCRP) was the significant risk factor associated with arthritis. Conclusions Patients with a severer psoriasis tended to have higher blood β2M levels and severer inflammatory state. In the systemic inflammation indexes, the level of blood β2M affected the risk of hypertension and diabetes, and hsCRP affected the risk of arthritis in patients with psoriasis.

Do Psoriasis and Atopic Dermatitis Affect Memory, Attention, Stress and Emotions?

Psoriasis and atopic dermatitis are chronic skin diseases found all over the world that cause a lot of suffering to patients. The aim of this study was to answer the following questions: whether people suffering from psoriasis and AD have greater problems with recognizing emotions, the effectiveness of attention and memory processes, and whether they use different strategies of coping with stress than healthy people. This study involved 90 patients, including 30 patients with psoriasis, 30 patients with AD and 30 healthy patients, aged 21 to 63 years, including 54 women and 36 men. This study used a battery of the CANTAB Cognitive Tests, Mini-COPE Questionnaire Inventory, Toronto Alexithymia Scale TAS Questionnaire, Psoriasis Area and Severity Index, and Eczema Area and Severity Index. People with psoriasis and AD had higher total scores on the alexithymia scale and had greater difficulty in identifying and verbalizing emotions. People with psoriasis and AD are less likely to choose the correct stimulus and achieve a shorter length of the sequence that should be remembered. Psoriasis patients with more severe symptoms are less likely to use the strategy of a sense of humor in stressful situations. AD patients with more severe symptoms are less likely to use strategies of operative thinking, denial and self-blame, and the strategy of seeking instrumental support is used more often. Patients with psoriasis and AD require a holistic approach; in addition to dermatological treatment, psychological support, psychotherapeutic support and possible psychiatric treatment are recommended.

Associations of different inflammatory factors with atherosclerosis among patients with psoriasis vulgaris.

This study aimed to measure the associations between different inflammatory factors, namely interleukin (IL)-17A, tumor necrosis factor (TNF)-α, and high-sensitivity C-reactive protein (hs-CRP), and atherosclerosis in patients with psoriasis vulgaris. A cross-sectional study was conducted at two hospitals in Hanoi, Vietnam. A total of 125 patients with psoriasis vulgaris and 50 healthy controls were recruited. Clinical characteristics and atherosclerosis were assessed. IL-17A, TNF-α, and hs-CRP levels were measured. Psoriasis vulgaris patients with atherosclerosis had higher levels of hs-CRP (median = 1.22; interquartile range-IQR = 0.34-12.11) and IL-17A (median = 1.30; IQR = 0.43-4.28), but a lower level of TNF-α (median = 0.54; IQR = 0.13-3.41) compared to those without atherosclerosis (p < 0.05). Only LogIL-17A was positively related to atherosclerosis in psoriasis patients (Odds Ratio-OR = 2.16, 95% CI = 1.06-4.38, p < 0.05). After excluding systemically treated patients, LogIL-17A and Log TNF-α were associated with the likelihood of atherosclerosis (p < 0.05). This study suggests a link between elevated levels of IL-17A and TNF-α and subclinical atherosclerosis. Further investigation on a larger scale is required to establish the causality of this relationship.

Skin microbiome changes in patients with atopic dermatitis and psoriasis

Aims: The main aim of our study was identification of skin microbiome changes in patients with atopic dermatitis and psoriasis. The focus of our research were microorganisms of Staphylococcus spp. genus. Materials and methods: The study included 34 patients with atopic dermatitis and 41 patients with psoriasis. The enrollment period lasted for 3 months. The material for cultivation was taken from 4 skin areas: lesion and normal skin of dry body skin sites (medial surface of forearm for patients with atopic dermatitis and extensor surface of elbow joint for patients with psoriasis) and scalp. Further evaluation was carried out using cultural and molecular biological research methods. The obtained data were statistically processed. Results: The study included 34 patients with atopic dermatitis and 41 patients with psoriasis. Mean SCORAD for atopic dermatitis group was 51,5912,75 and mean PASI for psoriasis group was23,7214,14. Mean SCORAD for atopic dermatitis patients who carries toxigenic S.аureus strains was 57,439,75, in group without toxigenic S.аureus strains mean SCORAD was statistically significant lower - 37,908,63 (р=0,054). Mean SCORAD for atopic dermatitis patients who carries S.epidermidis commensal strain was 51,312,75, difference between this group and toxigenic S.аureus strains group of patients was insignificant (р=0,18). Mean PASI for psoriasis patients who carries toxigenic S.аureus strains was 26,412,76, mean PASI for psoriasis patients who carries S.epidermidis commensal strain was 20,99,07. Difference between S.epidermidis group and toxigenic S.аureus strains group of patients was statistically insignificant (р=0,53) with tendency to more severe disease in group of toxigenic S.аureus strains carriers. Conclusions: This study reveals some aspects of skin colonization by microorganisms belonging to Staphylococcus spp genus in patients with atopic dermatitis and psoriasis. We identify some correlations between severity of inflammatory disease and characteristics of microorganisms strain.

Inflammatory Cytokines and Clinical Outcome Following Biological Therapy in Adult Bio-Naïve Psoriasis Patients.

Inflammatory cytokines may hold the key to the clinical evolution of psoriasis. The aims of this study are to find a correlation between levels of inflammatory cytokines such as TNF-α, IL-23, IL-17A, and IL-17F and disease duration and severity scores in psoriasis; to test if the decrease in any of the aforementioned cytokines is correlated with an amelioration in disease severity scores; and to analyze if any of the four biologic agents used are linked with a greater decrease in overall cytokine levels. We enrolled 23 adult patients under treatment with ixekizumab, secukinumab, guselkumab, or adalimumab and measured psoriasis disease severity scores PASI (Psoriasis Area Severity Index) and DLQI (Dermatology Life Quality Index), as well as the levels of the aforementioned cytokines at the start of therapy and after 3 months of continuous treatment. Inclusion criteria were the presence of psoriasis, age above 18 years and the need to initiate biological therapy (lack of response to standard treatment). Biological therapies resulted in an amelioration of PASI and DLQI scores, as well as levels of TNF-α, IL-23 and IL-17F. Disease duration and PASI and DLQI scores did not correlate with cytokine levels except DLQI and IL-23 score, in a paradoxically inversely proportional manner. IL-23, in particular, could be a useful biomarker for checking treatment response in psoriasis.

Relationship of psoriatic arthritis with nail and scalp involvement in Turkish psoriasis patients: Multicentered cross-sectional study.

Psoriasis is a common multisystem inflammatory disease, and arthritis is an essential component of the disorder, requiring early diagnosis and prompt treatment for successful management. In this study, we aimed to investigate the relationship between nail and scalp involvement and other covariates with psoriatic arthritis (PsA). This cross-sectional study, conducted from June 2021 through December 2021, included 763 patients from 11 different centers in Turkey. The severity of involvement was evaluated using psoriasis area severity index (PASI), nail psoriasis severity index (NAPSI), and psoriasis scalp severity index (PSSI) scores. Predictors for PsA were evaluated using univariate and multivariate logistic regression models. PsA (n = 155, 21.5%) was significantly more common in patients having a family history of psoriasis (43.2% vs 30.9%, P = .004), nail involvement (68.4% vs 52.3%, P < .001), and coexistence of nail and scalp involvement (53.7% vs 39.6%, P = .002). Furthermore, patients with PsA had considerably higher PASI (7 vs 5.6, P = .006), NAPSI (5 vs 2, P < .001), and PSSI scores (7 vs 4, P = .002) and longer disease duration (months) (126 vs 108, P = .009). In multivariate analysis, female gender [OR: 3.01, 95% CI (1.861-4.880), P < .001], nail involvement [OR: 2.06, 95% CI (1.293-3.302), P = .002)], and body mass index (BMI) [OR: 1.06, 95% CI (1.017-1.100), P = .005] were identified as independent predictors for PsA. Female gender, nail involvement, and high BMI are significant predictors for PsA and warrant detailed rheumatological assessment. Notably, being female is the strongest predictor of increased risk of PsA in our survey. Scalp involvement appears not to be associated with PsA. Also, the presence of PsA seems related to a more severe skin involvement phenotype.

Factors associated with a better treatment efficacy among psoriasis patients: a study based on decision tree model and logistic regression in Shanghai, China

BackgroundMany effective therapies for psoriasis are being applied in clinical practice in recent years, however, some patients still can’t achieve satisfied effect even with biologics. Therefore, it is crucial to identify factors associated with the treatment efficacy among psoriasis patients. This study aims to explore factors influencing the treatment efficacy of psoriasis patients based on decision tree model and logistic regression.MethodsWe implemented an observational study and recruited 512 psoriasis patients in Shanghai Skin Diseases Hospital from 2021 to 2022. We used face-to-face questionnaire interview and physical examination to collect data. Influencing factors of treatment efficacy were analyzed by using logistic regression, and decision tree model based on the CART algorithm. The receiver operator curve (ROC) was plotted for model evaluation and the statistical significance was set at P < 0.05.ResultsThe 512 patients were predominately males (72.1%), with a median age of 47.5 years. In this study, 245 patients achieved ≥ 75% improvement in psoriasis area and severity index (PASI) score in week 8 and was identified as treatment success (47.9%). Logistic regression analysis showed that patients with senior high school and above, without psoriasis family history, without tobacco smoking and alcohol drinking had higher percentage of treatment success in patients with psoriasis. The final decision tree model contained four layers with a total of seventeen nodes. Nine classification rules were extracted and five factors associated with treatment efficacy were screened, which indicated tobacco smoking was the most critical variable for treatment efficacy prediction. Model evaluation by ROC showed that the area under curve (AUC) was 0.79 (95%CI: 0.75 ~ 0.83) both for logistic regression model (0.80 sensitivity and 0.69 specificity) and decision tree model (0.77 sensitivity and 0.73 specificity).ConclusionPsoriasis patients with higher education, without tobacco smoking, alcohol drinking and psoriasis family history had better treatment efficacy. Decision tree model had similar predicting effect with the logistic regression model, but with higher feasibility due to the nature of simple, intuitive, and easy to understand.