Personal History Of Psoriasis Research Articles

Psoriatic Arthritis: Differential Features at the Time of Clinical Presentation in a Large Cohort of Patients with Polyarthralgia.

Most patients with psoriatic arthritis begin with cutaneous psoriasis, which is why all early detection strategies are based on screening in the dermatological consultation and referral to a rheu matologist. However, there are cases of patients who consult initially for musculoskeletal symptoms, mostly joint pain, regardless of family and/or personal history of psoriasis. This study aimed to esti mate the frequency of psoriatic arthritis in a cohort of patients who consulted for polyarthralgia and to determine the differential features, at the time of clinical presentation, in relation to both patients with final diagnosis other than psoriatic arthritis and patients with diagnosis of rheumatoid arthritis. Consecutive patients with polyarthralgia (including arthralgia of the hands) were included. Clinical examination, laboratory tests, ultrasound with power Doppler of both hands, and radiography of both hands and feet were performed at baseline. All patients were followed up and the definitive diagnosis of psoriatic arthritis was established. A total of 1055 were included, 88 (8.3%) ended with diagnosis of psoriatic arthritis. Diagnosis of psoriatic arthritis was positively associated with a family history of psoriasis (odds ratio=4.14), pso riasis (odds ratio=78.94), radiographic erosions (odds ratio=5.74), and ultrasound with at least 1 joint with positive power Doppler (odds ratio=7.11). In comparison with rheumatoid arthritis patients, diagnosis of psoriatic arthritis was positively associated with psoriasis (odds ratio=433.42) and family history of psoriasis (odds ratio=41.63). On the other hand, it was negatively associated with positivity, for both rheumatoid factor (odds ratio=0.03) and anti-cyclic citrullinated peptide antibodies (odds ratio=0.06). The frequency of psoriatic arthritis was 8.3% and was associated with a personal and/or family history of psoriasis, radiographic erosions, and inflammatory involvement by Power Doppler Ultrasound (PDUS). In comparison with rheumatoid arthritis patients, psoriatic arthritis was associated with a personal and/or family history of psoriasis, while the presence of both rheumatoid factor and/ or anti-cyclic citrullinated peptide antibodies was shown to be a protective factor for the diagnosis of psoriatic arthritis.

Study of the genetic polymorphisms of the promoter region of TNF- in Thi-Qar patients affected by psoriasis

Background: The relationship of factor polymorphisms has been portrayed in different investigations of tumor corruption (TNF-) and incendiary pathologies, for example, psoriasis vulgaris and joint pain psoriatic, despite the fact that the outcomes are variable as indicated by the number of inhabitants in birthplace of the example. Objective: To analyze the polymorphisms of the promoter region of the TNF-gene in patients with moderate-severe psoriasis and establish the possible genotypic differences with those found in a group of healthy volunteers. Material and methods: 89 patients with moderate-severe psoriasis and 76 controls were selected no family or personal history of psoriasis. Polymorphisms of the promoter region of the TNF- gene in both groups. Results: We observed a higher prevalence of genotype with both alleles in the wild. in position -238 (GG, 86.5% vs 70.4% respectively) and -1031 (TT, 80.2% vs 45.8% respectively) in the group of patients with psoriasis when compared to the control group. The differences found in position -308 and -857 were not significant. Conclusion: There are differences in polymorphisms at positions -238 and -1031 between patients. with moderate-severe psoriasis and healthy volunteers, which supports the importance of the role of TNF- in the physiopathology of this entity.

Time to transition from psoriasis to psoriatic arthritis: A population-based study

ObjectiveTo identify demographic and clinical characteristics associated with time between psoriasis and psoriatic arthritis (PsA). MethodsA retrospective, population-based cohort of incident PsA patients ≥18 years (2000–17) from Olmsted County, MN was identified. PsA patients were divided into two groups: patients with concurrent psoriasis and PsA (within 1 year), and patients with psoriasis before PsA (>1 year). Patients with PsA prior to psoriasis were excluded. Age- and sex-adjusted logistic regression models were used to examine factors associated with the time between psoriasis and PsA diagnosis. ResultsAmong 164 patients with incident PsA, 158 had a current or personal history of psoriasis. The mean (SD) age at PsA diagnosis was 46.3 (12.0) years, and 46% were females. The median (interquartile range) time from psoriasis to PsA was 35.5 (0.8–153.4) months. 64 patients (41%) patients had concurrent psoriasis and PsA while 94 (59%) had onset of psoriasis before PsA. The estimated age at onset of psoriasis symptom (OR per 10-year decrease = 1.63, 95% CI: 1.26–2.11) and psoriasis severity (OR = 3.65, 95% CI: 1.18–11.32 for severe vs. mild) were associated with having a psoriasis diagnosis more than one year prior to incident PsA. ConclusionIn this population-based study, approximately 60% of the patients had psoriasis before PsA, and the rest had concurrent psoriasis and PsA. Patients with lower age at psoriasis onset or severe psoriasis were more likely to have a longer time to transition from psoriasis to PsA.

AB0738 SAPHO OR PSORIATIC ARTHRITIS?: EVALUATION OF CASPAR CRITERIA IN A COHORT WITH SAPHO.

Background:SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is an acronym created with the aim of encompassing within the same entity the findings present in a heterogeneous group of patients with various osteoarticular and cutaneous disorders. For years it has been debated whether it is an entity itself or if, on the contrary, it is a specific phenotype of psoriatic arthritis.Objectives:Determine the relationship between SAPHO syndrome and psoriatic arthritis by comparing the classic criteria of SAPHO with CASPAR in patients previously diagnosed with SAPHO.Methods:A retrospective study where patients with a diagnosis of SAPHO in the same center (1984-2018) were reviewed. Of a total of 95 patients that met the criteria of Benhamou et al., 46 were excluded due to lack of information to complete the minimum necessary data, so 39 patients were finally included in the study. Demographic data were registered, age at diagnosis, CASPAR criteria (active psoriasis, history of own or familial psoriasis, nail psoriasis, negative RF, dactylitis and new formation/juxta-articular bone proliferation), classical criteria of SAPHO and HLAB27. For the statistical analysis, a Chi-square is applied to determine the differences between the groups with / without CASPAR criteria.Results:Of the sample of 39 subjects diagnosed with SAPHO, 15 patients (38%) met CASPAR criteria (4M/11W), with a median age at diagnosis of 42 years (range 21-50). Of them, 8 (60%) had active cutaneous psoriasis, 10 (73%) had a family or personal history of psoriasis, 6 (40%) had psoriatic nail dystrophy, 14 (93%) had negative FR, 3 (20%) had presented some episode of dactylitis and 10 (73%) had juxta-articular new bone formation. Of the 15 patients who met CASPAR criteria, 9 (67%) had synovitis, 2 (13%) acne, 4 (26%) pustulosis, 13 (87%) hyperostosis and 12 (80%) osteitis. HLAB27 was positive in 1 patient (2.5%) of the group that met CASPAR criteria. Of the patients who did not fulfill CASPAR criteria (9M/15W), the median age at diagnosis was 44.5 years (range 10-70). None of them had active cutaneous psoriasis, psoriatic nail distrophy or dactylitis, 1 (4%) had a family or personal history of psoriasis, all had RF- and 3 (12.5%) had juxta-articular bone new formation (Table 1). Synovitis was observed more frequently in patients who met CASPAR criteria than in those who did not (67% vs 25%, p 0.01). In contrast, osteitis was present more frequently in patients who did not meet CASPAR criteria (80% vs 96% p 0.05) and pustulosis, although it was not statistically significant (50% vs 26%, p 0.07). Among patients who did not meet CASPAR criteria only 1 met the 5 classic SAPHO criteria and another 3 met 4.Table 1.Conclusion:Approximately one third (38%) of patients diagnosed with SAPHO meet criteria for psoriatic arthritis, the most notable variables being active psoriasis or a history of psoriasis. Synovitis manifests more frequently in patients with CASPAR criteria and osteitis more present in patients who did not meet them.Acknowledgments:Rheumatology Service of the Germans Trias i Pujol HospitalDisclosure of Interests:None declared

Anti-Saccharomyces cerevisiae IgG and IgA antibodies are associated with systemic inflammation and advanced disease in hidradenitis suppurativa

Anti-Saccharomyces cerevisiae IgG and IgA antibodies are associated with systemic inflammation and advanced disease in hidradenitis suppurativa

Acute generalized exanthematous pustulosis and psoriasis: what can be learned from comorbidities.

Acute generalized exanthematous pustulosis (AGEP) is a rare pustular severe cutaneous adverse reaction. Differentiating between AGEP and pustular psoriasis may represent a diagnostic challenge. We sought to evaluate the prevalence of comorbidities in a series of patients with AGEP compared to a series of patients with psoriasis vulgaris and to a series of patients with drug-related psoriasis. Medical records of 14 patients with AGEP, 33 patients with psoriasis vulgaris, and 18 patients with drug-related psoriasis were reviewed. The presence of comorbidities was recorded, and a comparative analysis was performed. A personal history of psoriasis was present in 4 (28%) patients with AGEP compared to 12 (66%) patients with drug-related psoriasis (Pv=0.03). The prevalence of psoriasis-related morbidities was significantly lower in the AGEP group compared to the psoriasis group and to the drug-related psoriasis group (Pv<0.01, 0.05, respectively). Each of the psoriasis-related morbidities had significantly lower prevalence in the AGEP group compared to the psoriasis group and to the drug-related psoriasis group (Pv<0.01). In conclusion, differences between AGEP, psoriasis vulgaris, and drug-related psoriasis regarding the prevalence of psoriasis-related morbidities may assist differentiation in borderline cases.

Current treatment options for psoriatic arthritis: spotlight on abatacept.

Psoriatic arthritis (PsA) is a chronic inflammatory disease of joints, tendon sheaths, and entheses affecting patients with established skin psoriasis, or, less frequently, patients without a personal history of psoriasis with a positive familial history. Many treatment options are now available to deal with the different aspects of the disease, including traditional and biological disease-modifying antirheumatic drugs and the recently released targeted synthetic disease-modifying antirheumatic drugs. However, ~40% of patients still fail to achieve a meaningful clinical response to first-line biologic therapy advocating the development of novel medications. It is now well accepted that T-cells participate in the immunopathogenesis of several autoimmune diseases. For this reason, the potential intervention on T-cells represented an attractive therapeutic target for a long time, becoming a clinical reality with the development of abatacept. Abatacept is a biologic agent selectively targeting the T-cell costimulatory signal delivered through the CD80/86-CD28 pathway and was approved in December 2005 by the US Food and Drug Administration and in May 2007 by European Medicines Agency for the treatment of patients with rheumatoid arthritis in combination with methotrexate. Based on the relevant role of T-cells in PsA pathogenesis and following the positive results obtained in a phase III clinical trial, abatacept recently received approval for treatment of patients with PsA. In this review, we will focus on the current knowledge about the emerging role of abatacept in treatment of PsA.

Personal history of psoriasis and risk of nonmelanoma skin cancer (NMSC) among women in the United States: A population-based cohort study

Toour knowledge, no prospective studies have examined the association between personal history of psoriasis and risk of nonmelanoma skin cancer. We sought to examine this association based on 2 prospective cohorts, the Nurses' Health Study and Nurses' Health Study II. Diagnoses of nonmelanoma skin cancer, including basal cell carcinoma and squamous cell carcinoma (SCC), were obtained by self-reported questionnaires. Information on clinician-diagnosed psoriasis and diagnosis year was collected and validated with a supplementary questionnaire. After 2,487,941 and 2,478,148 person-years of follow-up, we documented 1725 SCC cases and 16,075 basal cell carcinoma cases, respectively. For the combined cohorts, personal history of psoriasis was associated with an elevated risk of SCC, with a multivariate-adjusted relative risk (RR) of 1.51 (95% confidence interval [CI] 1.11-2.05). The associations appeared stronger with increasing psoriasis severity, with RR of 1.42 (95% CI 0.94-2.15) in the mild psoriasis group and RR of 1.99 (95% CI 0.74-5.32) in the moderate to severe psoriasis group (P trend=.03). There was no association between psoriasis and the risk of basal cell carcinoma (RR 0.95; 95% CI 0.75-1.18). Lack of treatment data may bias the result. Personal history of psoriasis may be associated with an increased risk of SCC. Further investigations are warranted to understand the underlying mechanisms.

Paradoxical reactions induced by tumor necrosis factor-alpha antagonists: A literature review based on 46 cases.

Anti-tumor necrosis factor (TNFα) agents have acquired a prominent place in the treatment options for inflammatory disorders. Among the side effects of these agents are the so-called paradoxical reactions which have increasingly been reported in recent years. A review of literature was carried out using Medline (PubMed) database from January 2010 to December 2014 to collect all published articles on cases of anti-TNFα-induced psoriasis and psoriatic arthritis. Published articles were identified, reviewed and the relevant data extracted. A total of 22 studies (46 patients) fulfilled the inclusion criteria and were selected for analysis. Of the 46 patients, 45 (97.8%) developed psoriasis and 1 (2.1%) psoriatic arthritis. The mean age of patients was 47 years; three (6.5%) patients had a past history of psoriasis. Infliximab caused cutaneous reactions in the most number, 26 (56.5%) cases. Thirty seven (80.4%). patients developed primary plaque-type psoriasis. Women accounted for 86.9% of patients. There was complete resolution of psoriasis in 12 (26%) patients despite differences in the therapeutic approach. Cessation of the incriminated drug led to resolution of cutaneous lesions in 5 (10.8%), switching to another TNFα antagonist led to resolution in 6 (13%) and one (2.1%) patient improved despite continuation of the drug. As for the lone case of psoriatic arthritis, drug withdrawal did not result in improvement; only switching to another anti-TNFα agent helped. Since our sample was small, it was not adequately powered to draw any firm conclusions. However, in this analysis, we found that paradoxical reactions occurred predominantly in adult women, there were only isolated cases with a personal history of psoriasis, infliximab was responsible for most cases of these reactions and the most prevalent form was plaque-type psoriasis. The decision whether to continue or discontinue the triggering anti-TNFα agent should be individualized as results are highly variable.

Abstract 874: Personal history of psoriasis and risk of incident cancer among women: the Nurses’ Health Study

Abstract Background: Psoriasis has long been hypothesized to pose an increased risk of cancer due to the chronic, inflammatory state induced by psoriasis. Most prior studies on psoriasis and cancer were based on clinical settings, and the interest has been remarkably focused on the association between systemic therapies, typically only used in moderate-to-severe psoriasis, and risk of psoriasis. The evidence linking psoriasis with cancer is still controversial and few data are available from prospective studies. We systemically examined the association between a personal history of psoriasis and risk of incident cancer (other than skin basal cell carcinoma and squamous cell carcinoma). Methods and Findings: A total of 64,990 participants were included from the Nurses’ Health Study (1996-2012). Diagnoses of cancers were obtained by biannual self-reported questionnaires and all cancers were confirmed. Clinician-diagnosed psoriasis and diagnosis year were collected in 2008 and validated with a supplementary questionnaire. We included 2180 cases with psoriasis and most had mild disease (92%). During 957,359 person-years’ follow-up, 8,348 incident cancers were documented. We did not find an altered risk of total cancer associated with personal history of psoriasis (multivariate-adjusted hazard ratio [HR] = 1.02; 95% CI: 0.89-1.17). However, for individual cancers, a personal history of psoriasis was associated with an increased risk of melanoma (HR = 1.94, 95% CI: 1.20-3.12) and kidney cancer (HR = 2.50, 95% CI: 1.27-4.92). The associations appeared stronger among psoriasis with 1 or more palm body surface area (BSA, P for trend 0.003 for melanoma and 0.0004 for kidney cancer), but remained significant even after exclusion of psoriasis with more than two palms’ BSA involvement. Conclusions: We suggest a positive association between a personal history of psoriasis and risk of melanoma and renal cancer, which appears not be entirely a result of greater medical scrutiny or use of systemic therapies. Personal history of psoriasis and risk of first primary cancerNo psoriasis (935,227 person-years)Psoriasis (22,132 person-years)Age-adjusted RRMultivariable-adjusted RRTotal cancer (other than keratinocyte carcinoma)81392091.06 (0.92-1.21)1.02 (0.89-1.17)Breast cancer4034860.91 (0.73-1.12)0.89 (0.71-1.10)Colorectal cancer697201.19 (0.76-1.86)1.11 (0.71-1.73)Non-Hodgkin lymphoma527131.01 (0.58-1.75)1.03 (0.59-1.78)Endometrial cancer51570.60 (0.28-1.26)0.54 (0.26-1.15)Lung cancer429141.23 (0.72-2.09)1.05 (0.61-1.79)Melanoma380182.00 (1.25-3.21)1.94 (1.20-3.12)Bladder cancer23271.20 (0.57-2.55)1.10 (0.52-2.35)Ovarian Cancer19461.25 (0.55-2.81)1.28 (0.56-2.88)Thyroid cancer15351.37 (0.56-3.33)1.36 (0.56-3.32)Kidney cancer13792.74 (1.40-5.39)2.50 (1.27-4.92)Other Cancers841241.03 (0.69-1.54)0.97 (0.65-1.46) Citation Format: Wen-Qing Li, Jiali Han, Eunyoung Cho, Shaowei Wu, Hongji Dai, Martin Weinstock, Abrar Qureshi. Personal history of psoriasis and risk of incident cancer among women: the Nurses’ Health Study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 874. doi:10.1158/1538-7445.AM2015-874

A case of persistent fever

Objective: Clinical case report. Methods: Description of a clinical case of a patient with dragged febrile syndrome and whose diagnosis was challenged by an unusual feature. Results: A male patient of 36 years old, with personal history of psoriasis (located on the scalp and nails) is followed in consultation of autoimmune diseases for psoriatic arthritis on suspicion. He was previously admitted in 2004 because of a febrile syndrome (axillary temperature between 38–39 °C), which lasts 10 days and is accompanied by arthritis. Other complaints were denied. Several exams were made, of which stood out: negative blood cultures, sputum bacteriological examination (including negative culture for Koch's bacillus), negative selorogies for HBV, HCV, HIV, CMV, Weil-felix, Huddleson, EBV, Widal and VDRL; normal lumbar punction; negative Antinuclear Antibodies (ANAs); abdominal ultrasound revealed discrete liver enlargement; echocardiography: slight pericardial effusion with mild mitral regurgitation; thoracic CT: fibrotic changes in the upper lobe of the right lung; bone scintigraphy that revealed high uptake of the sacroiliac joints, especially at the level of the tarsus, and 5th distal inter phalange joint. A probable diagnosis of psoriatic arthritis is established due to the presence of sacroiliitis and began therapy with methotrexate 15 mg per week, salazopyrin 5 g per day and deflazacort 6 mg per day. Four years later, by keeping the same complaints of poly-arthralgias, began etanercept with mild improvement. Ten months after restart the fever and arthritis, this time accompanied by evanescent, salmon-colored, macular eruption and odynophagia, there by establishing the diagnosis of Adult Still's disease. He initiated treatment with anakinra 100 mg per day having good results. Conclusion: Sacroiliitis is a typical manifestation of psoriatic arthritis, but may be present in a small percentage of patients with Adult Still's disease.

Subcorneal Pustular Dermatosis in Association with Chronic Lymphocytic Leukaemia

Sir,Subcorneal pustular dermatosis (SPD) is a chronic,relapsing, pustular eruption, the aetiology and patho-genesis of which are unknown. It has previously beenreported in association with rheumatoid arthritis (1),Crohn’s disease (2), pyoderma gangrenosum, Sweet’ssyndrome and other neutrophilic dermatoses, benignmonoclonal gammopathies (3) and IgA myeloma (4).Here we describe a patient with SPD in association withchronic lymphocytic leukaemia (CLL) and discuss thepossibility of a pathogenetic link. No cases havepreviously been reported of SPD and CLL.CASE REPORTA 78-year-old woman was referred to the DermatologyDepartment in August 1996 with a pruritic rash affect-ing her scalp, axillae, inguinal and infra-mammaryflexures. She had no personal or family history ofpsoriasis. Examination showed erythema, papules andpustules. A biopsy was inconclusive, showing in someareas hyperkeratotic, parakeratotic and mildly acan-thotic epidermis with spongiosis and focal neutrophilexocytosis, while in other areas there were well-formedsubcorneal pustules. Special stains were negative forbacteria and fungi. The patient was treated with topicalsteroids, emollients, tar preparations and calcipotriol,each with little benefit. She then received oral acitretin(10–25 mg daily for a total of 29 months), bath PUVA(twice weekly for 3 months) and oral methotrexate (upto 20 mg once weekly for 6 months); each produced atbest a short-lived partial improvement in the rash.In September 1999 the patient had a widespreaderythematous pustular eruption affecting the trunk andlimbs with a flexural distribution. She was systemicallywell and denied any joint or gastrointestinal symptoms.On this occasion, a mild lymphocytosis (white cellcount 11.8610