Pso Patients Research Articles

Interleukin 23 versus interleukin 12/23 inhibitors on preventing incidental psoriatic arthritis in patients with psoriasis? A real-world comparison from the TriNetX Global Collaborative Network

BackgroundManaging psoriasis and its comorbidities, particularly psoriatic arthritis, often involves using IL-23 and IL-12/23 inhibitors. However, the comparative risk of these treatments still needs to be explored. ObjectiveThis study evaluates the risk of developing psoriatic arthritis in patients treated with IL23 inhibitors compared to IL-12/23 inhibitors. MethodsThis retrospective cohort study utilized data from the TriNetX, including adult patients diagnosed with psoriasis. Patients with IL-23 or IL-12/23 inhibitors treatment were included and propensity score matched. The primary outcome was the incidence of arthropathic psoriasis, analyzed using a Cox regression hazard model and Kaplan-Meier estimates. ResultsThe study included matched cohorts of patients treated with IL-23 inhibitors (n=2,273) and IL-12/23 inhibitors (n=2,995). Cox regression analysis revealed no significant difference in the cumulative incidence of arthropathic psoriasis between the IL-23i and IL-12/23i cohorts (p = 0.812). Kaplan-Meier estimates confirmed similar cumulative incidences of arthropathic psoriasis in both cohorts over the study period. LimitationLong-term follow-up studies are required to understand more of the effects of these interleukin inhibitors. ConclusionNo significant difference but a numerically lower risk of PsA in PsO patients treated with IL-23 inhibitors than with IL-12/23 inhibitors, underscoring their comparable efficacy in PsO management and follow-up.

CO91 Systemic Therapy Eligibility Criteria of the International Psoriasis Council (IPC) May Reduce Undertreatment of PsO Patients with Low Body Surface Area Involvement Associated with High Disease Burden

CO91 Systemic Therapy Eligibility Criteria of the International Psoriasis Council (IPC) May Reduce Undertreatment of PsO Patients with Low Body Surface Area Involvement Associated with High Disease Burden

From PsO to PsA: the role of TRM and Tregs in psoriatic disease, a systematic review of the literature.

Psoriasis (PsO) is a chronic skin condition driven by immune mediators like TNFα, INFγ, IL-17, and IL-23. Psoriatic arthritis (PsA) can develop in PsO patients. Although psoriatic lesions may apparently resolve with therapy, subclinical cutaneous inflammation may persist. The role of tissue-resident memory T-cells (TRM), and regulatory T cells (Tregs) that also contribute to chronic inflammation are being explored in this context. This systematic review explores TRM and Tregs in psoriatic disease (PsD) and its progression. A systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed using Pubmed® and Web of Science™ databases on June 3rd 2023, using patient/population, intervention, comparison, and outcomes (PICO) criteria limited to the English language. A total of 62 reports were identified and included. In PsO, chronic inflammation is driven by cytokines including IL-17 and IL-23, and cellular mediators such as CD8+ and CD4+ T cells. TRM contributes to local inflammation, while Tregs may be dysfunctional in psoriatic skin lesions. Secukinumab and guselkumab, which target IL-17A and the IL-23p19 subunit, respectively, have different effects on CD8+ TRM and Tregs during PsO treatment. Inhibition of IL-23 may provide better long-term results due to its impact on the Treg to CD8+ TRM ratio. IL-23 may contribute to inflammation persisting even after treatment. In PsA, subclinical enthesitis is perceived as an early occurence, and Th17 cells are involved in this pathogenic process. Recent EULAR guidelines highlight the importance of early diagnosis and treatment to intercept PsA. In PsA, CD8+ TRM cells are present in synovial fluid and Tregs are reduced in peripheral blood. The progression from PsO to PsA is marked by a shift in immune profiles, with specific T-cells subsets playing key roles in perpetuating inflammation. Early intervention targeting TRM cells may hold promising, but clinical studies are limited. Ongoing studies such as IVEPSA and PAMPA aim to improve our knowledge regarding PsA interception in high-risk PsO patients, emphasizing the need for further research in this area. Early intervention is crucial for PsO patients at high risk of PsA; T cells, particularly type 17 helper T cells, and CD8+ cells are key in the progression from PsO-to-PsA. Early targeting of TRM in PsD shows promise but more research is needed.

Metabolic Syndrome in Psoriasis Patients-an Observational Study.

Our observational study included on 54 patients with PsO, evaluated into the Dermatology Department of the Emergency County Hospital Craiova, Romania, between August 2023 and January 2024, and 40 controls. Our research proposed determining the prevalence of MetS in a cohort of PsO patients, and its relationship to subclinical atherosclerosis, evaluated by carotid ultrasound. Metabolic syndrome (MetS) was established according to National Cholesterol Education Program (NCP) Adult Treatment Panel (ATP) III criteria for MetS for 35 of the patients (64.81%) vs. 11 of the control group (27.5%), p=0.0003. An overview of each component of MetS depending on the diagnostic criteria for MetS showed that waist and total cholesterol exerted significant differences. Carotid ultrasound evaluation revealed an increased ITM, of over 0.9mm, for 19 (35.18%) or PsO patients, significantly increased compared to controls, as well as the presence of carotid plaques in significantly different percentages (37.03% PsO vs. 17.5% controls, p=0.001). We also noted that for patients with MetS, US examination displayed increased results for IMT compared to those without MetS. The prevalence of carotid atheroma plaque was augmented in patients with MetS and PsO. In our PsO group IMT exerted a positive inter-relation with: age, MetS, blood glucose, disease duration, and PASI. Important to note is that after multiple linear regression analysis, age and MetS were independent indicators of IMT (p=0.02 for age and p=0.001 for MetS). Our findings sustain a firm relationship between MetS and psoriasis and the major consequence of this observation is the inherent risk of cardiovascular events.

Frequency of ANA and ANA/DFS70 in patients diagnosed with psoriasis compared with healthy population and its association with disease severity

IntroductionPsoriasis (PsO) is a chronic multisystemic disease with an inflammatory phenotype involving skin compromise; PsO has no autoantibodies as biomarkers and is considered a seronegative disease. Otherwise, the correlation with autoantibodies such as antinuclear antibodies (ANA) has been described. Anti-DFS70 antibody presence has been proposed as essential in the exclusion process of systemic autoimmune rheumatic diseases (SARD) as a negative biomarker. ObjectiveTo evaluate ANA and ANA/DFS70 positivity and the autoantibody profile in a sizeable PsO population compared to healthy controls (HC) and its association with disease severity. Methodology and methodsA cross-sectional study was carried out in Colombian adult patients with a confirmed diagnosis of PsO and HC. Patient data from the PsO Clinic of the Dermatology Service of the Hospital Militar Central. ANA-HEp2 antibodies were determined by indirect immunofluorescence (IIF). Two confirmatory tests were performed on positive results (pattern AC-2) for the determination of ANA/DFS70-Knocked out for the psip gene) and CytoBead ANA/DFS70 by IIF. Data analysis was evaluated by bivariate statistics based on variables nature and normality tests. Subsequently, a binary logistic regression model was performed. The institutional ethics committee approved the study. ResultsPsO group were 79 patients; 45 (57%) were female, with a mean age of 52.3±17.9 years old, the vulgar PsO presentation was 97.5%, and 13.9% had psoriatic arthritis (PsA). Severe disease (PASI>10 points) was reported in 11.4%. The total number of positive ANA patients was 35 (44.3%). There was a significant difference between ANA positivity and BMI (p=.045) and severe disease (PASI>10) (p=.036). ANA positivity in PsO patients with higher ESR (AOR 1.08 CI95% 1.01–1.16 p=.044) and an association with PASI>10 points (AOR 7.34 CI95% 1.14–18.4 p=.038). Positive ANAS was present in seven (11.5%) HC. ANAS/DFS70 positivity was observed in only one PsO patient and three HC patients. ConclusionThe presence of ANAS in patients with PsO is significantly higher compared to the control group and is associated with greater severity of disease, higher levels of inflammatory markers, predominantly titer 1/80, and the AC4-fine granular pattern. The ANAS/DFS70 frequency in PsO patients was low, similar to that described in other references in the literature. The presence of ANAS/DFS70 in HC is confirmed with a higher frequency.

Assessment of Frontal Hemispherical Lateralization in Plaque Psoriasis and Atopic Dermatitis

Background: Each brain hemisphere plays a specialized role in cognitive and behavioral processes, known as hemispheric lateralization. In chronic skin diseases, such as plaque psoriasis (Pso) and atopic dermatitis (AD), the degree of lateralization between the frontal hemispheres may provide insight into specific connections between skin diseases and the psyche. This study aims to analyze the hemispherical lateralization, neurovegetative responses, and psychometric characteristics of patients with Pso and AD. Methods: The study included 46 patients with Pso, 56 patients with AD, and 29 healthy control (Ctrl) subjects. The participants underwent frontal electroencephalogram (EEG) measurement, heart rate variability (HRV) assessment, and psychological tests. Statistical analyses were performed using ANOVA, with Bonferroni correction applied for multiple comparisons. Results: This study shows a significant right-lateralized prefrontal activity in both AD patients (p < 0.001) and Pso patients (p = 0.045) compared with Ctrl, with no significant difference between the AD and Pso groups (p = 0.633). AD patients with right-hemispheric dominant prefrontal activation exhibited increased inhibition and avoidance markers, while Pso patients showed elevated sympathetic nervous system activity. Conclusion: Psychophysiological and psychometric data suggest a shared prevalence of right-hemispheric dominance in both AD and Pso patient groups. However, the findings indicate distinct psychodermatological mechanisms in AD and Pso.

Psychosocial stress affects the change of mental distress under dermatological treatment-A prospective cohort study in patients with psoriasis.

Psoriasis is a chronic-inflammatory, immune-mediated disease leading to a state of increased systemic inflammation. Mental comorbidities often occur in the patients and may additionally affect the therapy outcome. Currently, it is unknown whether the disease severity, psychosocial stress or health-related quality of life determines the manifestation of anxiety/depression, or vice versa, in psoriasis. The interplay between these variables during the dermatological treatment of psoriasis remains to be elucidated in order to initiate appropriate psychological interventions and to identify patients at risk for comorbid anxiety/depression. In a prospective cohort study, the impact of disease severity, health-related quality of life and psychosocial stress on anxiety/depression were examined during the dermatological treatment in patients with moderate to severe psoriasis (patients with psoriasis=PSO). Patients were examined before (T1) and about 3months after (T2) the beginning of a new treatment episode, in most cases by means of systemic therapy. Data were analysed, exploratory, using Bivariate Latent Change Score Models and mediator analyses. Assessments included patient-reported outcomes (Hospital Anxiety and Depression Scale/HADS, Perceived Stress Scale/PSS, Childhood Trauma Questionnaire/CTQ, Dermatology Life Quality Index-DLQI, Body Surface Area-BSA), at both T1 and T2. 83 PSO patients (37.3% women, median age 53.7, IQR 37.8-62.5, median BSA 18.0, IQR 9.0-40.0) with complete data of HADS and DLQI were included. In the total group, a higher anxiety/depression at T1 was associated with a lower improvement in psoriasis severity in the course of the dermatological treatment (γBSA =0.50, p<0.001). In subgroups of PSO with low/high CTQ scores, anxiety/depression at T1 had no impact on the change in psoriasis severity. Only by tendency, in CTQ subgroups, a higher psoriasis severity at T1 was linked with a higher improvement in anxiety/depression at T2 (low/high CTQ, γHADS =-0.16/-0.15, p=0.08). An improvement in the health-related quality of life was positively associated with an improvement in anxiety/depression (Pearson's r=0.49, p=0.02). Here, the reduction of acute psychosocial stress seems to be a decisive factor, mediating this association (β=0.20, t [2,60]=1.87; p=0.07, 95% CI -0.01, 0.41). The results allude, that the initial severity of anxiety/depression may presumably have an impact on the treatment outcome in the total group. In contrast, analysing subgroups of patients with high/low childhood trauma, the impact of the initial disease severity on the course of anxiety/depression after a switch to a new dermatological treatment could not be conclusively ruled out. The latter results from the latent change score modelling should be treated cautiously because of the small sample size. A common aetiopathological mechanism for psoriasis and anxiety/depression might be assumed with impact of dermatological treatment on both. The change in perceived stress seems to play an important role in the manifestation of anxiety/depression, substantiating the need for adequate stress management in patients with increased psychosocial stress during their dermatological treatment.

Frequency of ANA and ANA/DFS70 in patients diagnosed with psoriasis compared with healthy population and its association with disease severity

IntroductionPsoriasis (PsO) is a chronic multisystemic disease with an inflammatory phenotype involving skin compromise; PsO has no autoantibodies as biomarkers and is considered a seronegative disease. Otherwise, the correlation with autoantibodies such as antinuclear antibodies (ANA) has been described. Anti-DFS70 antibody presence has been proposed as essential in the exclusion process of systemic autoimmune rheumatic diseases (SARD) as a negative biomarker. ObjectiveTo evaluate ANA and ANA/DFS70 positivity and the autoantibody profile in a sizeable PsO population compared to healthy controls (HC) and its association with disease severity. Methodology and methodsA cross-sectional study was carried out in Colombian adult patients with a confirmed diagnosis of PsO and HC. Patient data from the PsO Clinic of the Dermatology Service of the Hospital Militar Central. ANA-HEp2 antibodies were determined by indirect immunofluorescence (IIF). Two confirmatory tests were performed on positive results (pattern AC-2) for the determination of ANA/DFS70-Knocked out for the psip gene) and CytoBead ANA/DFS70 by IIF. Data analysis was evaluated by bivariate statistics based on variables nature and normality tests. Subsequently, a binary logistic regression model was performed. The institutional ethics committee approved the study. ResultsPsO group were 79 patients; 45 (57%) were female, with a mean age of 52.3±17.9 years old, the vulgar PsO presentation was 97.5%, and 13.9% had psoriatic arthritis (PsA). Severe disease (PASI>10 points) was reported in 11.4%. The total number of positive ANA patients was 35 (44.3%). There was a significant difference between ANA positivity and BMI (p=.045) and severe disease (PASI>10) (p=.036). ANA positivity in PsO patients with higher ESR (AOR 1.08 CI95% 1.01–1.16 p=.044) and an association with PASI>10 points (AOR 7.34 CI95% 1.14–18.4 p=.038). Positive ANAS was present in seven (11.5%) HC. ANAS/DFS70 positivity was observed in only one PsO patient and three HC patients. ConclusionThe presence of ANAS in patients with PsO is significantly higher compared to the control group and is associated with greater severity of disease, higher levels of inflammatory markers, predominantly titer 1/80, and the AC4-fine granular pattern. The ANAS/DFS70 frequency in PsO patients was low, similar to that described in other references in the literature. The presence of ANAS/DFS70 in HC is confirmed with a higher frequency.

Rheumatoid factor and anti-citrullinated protein antibodies (ACPA) in psoriatic arthritis (PsA), and skin psoriasis: Relevance and clinical implications

Aim of the workAnti-citrullinated protein antibodies (ACPAs), is a highly specific markers for rheumatoid arthritis, can also be found in psoriatic arthritis (PsA). This work aimed to look into the frequency of rheumatoid factor (RF) and ACPA in PsA and psoriasis patients without clinical evidence of arthritis (PSO), and to correlate findings with demographics, disease characteristics, laboratory findings, and radiological damage in PsA. Patients and methods: The study included 78 PsA patients, 47 PSO patients, and 69 normal controls. Full clinical assessments, RF and ACPA assays, and modified radiological Steinbroker score (Mss) for PsA were performed. Results: The age of the patients was 45.6 ± 8.7 years and the M:F 59:66 (M:F 0.9:1). Positive RF was not significantly different between PsA and PSO groups (p = 0.35), but positive ACPA was significantly more common in PsA patients (p < 0.001) than in PSO and controls. No significant difference was observed between the PSO and controls (p = 0.08). In PsA, RF titers correlated significantly with ESR (p = 0.002), swollen joint count (SJC)(p = 0.02), tender joint count (TJC)(p = 0.02), and mSS (p = 0.001), while in the PSO RF correlated significantly with ESR (p = 0.011) and CRP levels (p = 0.02). In the PsA, ACPA titer significantly correlated with CRP levels (p < 0.001), SJC (p = 0.002), TJC (p = 0.003), mSS (p < 0.001) and PASI (p < 0.001), but with none of these in the PSO. Conclusion: PsA patients have more frequent positive RF and ACPA than PSO patients. ACPA values are significantly correlated with markers of inflammation, swollen and tender joint count and radiological damage in PsA and not in PSO patients.

139 Blocking Interleukin-17 in Psoriasis: Real-world Experience from the PsoPlus Cohort

Real-world studies on the use of biologics in psoriasis (Pso) are increasing, but still scarce. Next, interleukin-17 inhibitors (IL-17i) trough concentrations (Ct) seem promising for clinical decision making, however its value in daily practice has yet to be proven. Objectives were to report on IL-17i effectiveness, treatment modifications, and Ct use in our clinic. Data was collected from IL-17i treated Pso patients followed up in the PsoPlus clinic at the Dermatology department, Ghent University Hospital, Belgium.

POS1102 THE PREVALENCE OF INFLAMMATORY BACK PAIN IN PATIENTS WITH SKIN PSORIASIS WITHOUT PSORIATIC ARTHRITIS. DATA FROM DERMATOLOGICAL REAL-WORLD SETTING.

BackgroundPsoriasis (PsO) is an inflammatory disease associated with psoriatic arthritis (PsA). PsA affects peripheral and axial joints1,2. Psoriasis can precede the onset of PsA by approximately 3 to 8 years, axial involvement often undiagnosed3. There are limited data about the prevalence of inflammatory back pain (IBP) in PsO patients (pts) without clinical symptoms of PsA4.ObjectivesTo study the prevalence of IBP in PsO pts without PsA symptomsMethods108 PsO pts without PsA over a 10-month period (March 2021 to December 2021) were incluided. Participants filled out a questionnaire on IBP. Additionaly the prevalence of stiffness in the back and neck was estimated. IBP was defined as an affirmative answer to the question ‘Did you suffer from low back pain for ≥3 months?’ and IBP criteria was based on criteria ASAS (the ASsessment in Ankylosing Spondylitis) and was confirmed if at least 3 out of the following 4 criteria were present: (a) onset before age 40, (b) insidious onset, (c) improvement with exercise, (d) associated with morning stiffnessResultsIt was found that more than 40% of patients complained of pain or stiffness in the back. Stiffness and pain in the neck were observed in every fourth patient on average. Of those patients who complained of pain in the back or neck, 37% noted that they had pain at rest (when they get up in the morning or lie down for a long time), and 21.3% had inflammatory pain at night (when patients are forced to woke up, they needed to do exercises) (Table 1). It was found that the risks of developing spondylitis with neck pain, neck stiffness, back pain, back stiffness were higher in 4,549 times (95% CI [1,720; 12,031]), in 19,444 times (95% CI [6,480; 58,343]) 15 times (95% CI [4.646; 48.427]) and 34.857 times (95% CI [7.583; 160.230]), respectively.ConclusionIBP was found in more than 40% PsO patients. Every fourth PsO patients complained of stiffness and pain in the neck. The presence of these symptoms significantly increased the risk of developing PsA with spondylitis. The presence of IBP should be taken into account for early diagnosis of PsA in the dermatological practice.

POS1078 COMPARISON OF PATIENTS WITH AXIAL PsA AND PATIENTS WITH axSpA AND CONCOMITANT PSORIASIS

BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory disease affecting the peripheral and axial musculoskeletal system as well as skin and nails. Diagnostic criteria of axial PsA (axPsA) are not well defined. Treatment strategy is mostly based on evidence generated for axial spondyloarthritis (axSpA), as only rare clinical trial data for axPsA exist. However, it is still unclear whether axSpA with concomitant psoriasis (axSpA/pso) is the same as axPsA.ObjectivesTo compare PsA patients with axial manifestations with axSpA patients with concomitant psoriasis.MethodsRABBIT-SpA is a prospective longitudinal cohort study including PsA and axSpA patients enrolled at start of a new conventional treatment or b/tsDMARD treatment. Two definitions of axPsA were used:Clinical definition: documentation of axial manifestation as diagnosed by a rheumatologistRadiographic definition: presence of sacroiliitis according to modified NY criteria (mNYc).axSpA patients were stratified into axPsA/pso (with psoriasis either in patient history or present) and axSpA.ResultsPsoriasis was documented in 182/1407 axSpA patients (13%). Of 1355 PsA patients, 295 (22%) fulfilled the clinical definition of axPsA. Using the radiographic definition, 127 (9%) PsA patients fulfilled mNYc, 230 (17%) did not fulfil mNYc and 998 (74%) did not undergo radiographic evaluation.AxSpA/pso patients differed from axPsA regardless of the definition (Table 1). axPsA patients were older, less often HLA-B27 positive, and peripheral manifestations were much more often present in axPsA than in axSpA/pso. Uveitis and inflammatory bowel disease were more common in axSpA/pso.Table 1.Baseline characteristics of axSpA/pso patients and clinical resp. radiographic defined axPsA.axSpA/psoaxPsA/clinaxPsA/radN182295127female gender, n (%)80 (44)178 (60.3)80 (63)age, mean (SD)47 (12.8)51.1 (11.3)51.6 (11.4)HLA-B27 positive, n (%)106 (67.1)44 (22.7)28 (32.9)CRP mg/l, mean (SD)8.7 (14.6)7.1 (11.8)6.9 (11.5)CRP ≥5 mg/l, n (%)70 (42.4)106 (40)50 (45.9)uveitis ever, n (%)26 (14.3)10 (3.4)7 (5.5)IBD ever, n (%)13 (7.1)14 (4.7)7 (5.5)≥3 comorbidities, n (%)48 (26.4)117 (39.7)48 (37.8)peripheral manifestations, n (%)65 (36.3)251 (85.1)109 (85.8)enthesitis, n (%)29 (16.2)77 (26.4)32 (25.4)number of sites with enthesitis, mean (SD)0.5 (1.6)0.9 (2.2)0.9 (1.9)affected joints, n (%)53 (29.6)234 (80.1)102 (80.3)number of affected joints, mean (SD)1.4 (3.7)6.8 (8.4)5 (5.9)physician global disease activity, mean (SD)5.6 (2.1)5.6 (1.9)5.6 (2)patient global disease activity, mean (SD)5.4 (2.6)5.9 (2.3)5.8 (2.2)patient pain, mean (SD)5.5 (2.6)5.7 (2.3)5.7 (2.2)sakroiliitis, n (%)124 (84.4)97 (56.1)127 (100)clinical axial definition, n (%)n.d.295 (100)97 (76.4)In contrast, disease activity measured by physician global as well as patient global, and patient pain were similar in axSpA/pso and axPsA.ConclusionRegardless whether clinical or radiographic definitions of axPsA were used, differences to axSpA/pso patients were identified. These data indicate a need for a specific diagnostic, and a potentially more targeted treatment approach for axPsA.Disclosure of InterestsAnne Regierer Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Weiß Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Xenofon Baraliakos: None declared, Frank Behrens: None declared, Denis Poddubnyy: None declared, Georg Schett: None declared, Hanns-Martin Lorenz: None declared, Matthias Worsch: None declared, Anja Strangfeld Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.

Suppression of IL-12/IL-23 p40 subunit in the skin and blood of psoriasis patients by Tofacitinib is dependent on active interferon-γ signaling in dendritic cells: Implications for the treatment of psoriasis and interferon-driven diseases.

Interleukin (IL)‐12 and IL‐23 are pro‐inflammatory cytokines produced by dendritic cells (DCs) and associated with Psoriasis (Pso) and Psoriatic Arthritis (PsA) pathogenesis. Tofacitinib, a Janus kinase inhibitor, effectively suppresses inflammatory cascades downstream the IL‐12/IL‐23 axis in Pso and PsA patients. Here, we investigated whether Tofacitinib directly regulates IL‐12/IL‐23 production in DCs, and how this regulation reflects responses to Tofacitinib in Pso patients. We treated monocyte‐derived dendritic cells and myeloid dendritic cells with Tofacitinib and stimulated cells with either lipopolysaccharide (LPS) or a combination of LPS and IFN‐γ. We assessed gene expression by qPCR, obtained skin microarray and blood Olink data and clinical parameters of Pso patients treated with Tofacitinib from public data sets. Our results indicate that in DCs co‐stimulated with LPS and IFN‐γ, but not with LPS alone, Tofacitinib leads to the decreased expression of IL‐23/IL‐12 shared subunit IL12B (p40). In Tofacitinib‐treated Pso patients, IL‐12 expression and psoriasis area and severity index (PASI) are significantly reduced in patients with higher IFN‐γ at baseline. These findings demonstrate for the first time that Tofacitinib suppresses IL‐23/IL‐12 shared subunit IL12B in DCs upon active IFN‐γ signaling, and that Pso patients with higher IFN‐γ baseline levels display improved clinical response after Tofacitinib treatment.

The difference of lipid profiles between psoriasis with arthritis and psoriasis without arthritis and sex-specific downregulation of methotrexate on the apolipoprotein B/apolipoprotein A-1 ratio

BackgroundMethotrexate (MTX) has a protective effect against cardiovascular diseases (CVD), but the mechanism is unclear.ObjectiveTo investigate the effect of MTX on lipid profiles and the difference between psoriasis without arthritis (PsO) and psoriatic arthritis (PsA).MethodsIn this prospective study, we recruited 288 psoriatic patients (136 PsA and 152 PsO) who completed 12 weeks of MTX treatment. Total cholesterol (TC), triglycerides (TG), lipoprotein A [LP(a)], high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL), apolipoprotein A1 (ApoA1), and ApoB were measured.ResultsCompared with sex- and age-matched healthy controls, psoriatic patients had significantly (p < 0.0001) higher levels of proatherogenic lipids and lower levels of anti-atherogenic lipids. PsA patients had a higher ApoB/ApoA1 ratio than PsO patients (p < 0.05). Stepwise regression analysis found a positive correlation between the inflammatory marker hCRP and the Psoriasis Area Severity Index (PASI), ApoB/ApoA1 ratio, BMI, and smoking. ApoB was positively associated with concomitant arthritis, diabetes, and hypertension. MTX decreased the levels of pro-atherogenic and anti-atherogenic lipids. However, a significant reduction of the ApoB/ApoA1 ratio by MTX was only observed in male patients.ConclusionPsA patients had a significantly higher percentage of concomitant disease than PsO. The decrease of MTX on CVD might be related with sex.Trial registrationChiCTR2000036192

Blood-Based Immune Profiling Combined with Machine Learning Discriminates Psoriatic Arthritis from Psoriasis Patients.

Psoriasis (Pso) is a chronic inflammatory skin disease, and up to 30% of Pso patients develop psoriatic arthritis (PsA), which can lead to irreversible joint damage. Early detection of PsA in Pso patients is crucial for timely treatment but difficult for dermatologists to implement. We, therefore, aimed to find disease-specific immune profiles, discriminating Pso from PsA patients, possibly facilitating the correct identification of Pso patients in need of referral to a rheumatology clinic. The phenotypes of peripheral blood immune cells of consecutive Pso and PsA patients were analyzed, and disease-specific immune profiles were identified via a machine learning approach. This approach resulted in a random forest classification model capable of distinguishing PsA from Pso (mean AUC = 0.95). Key PsA-classifying cell subsets selected included increased proportions of differentiated CD4+CD196+CD183-CD194+ and CD4+CD196-CD183-CD194+ T-cells and reduced proportions of CD196+ and CD197+ monocytes, memory CD4+ and CD8+ T-cell subsets and CD4+ regulatory T-cells. Within PsA, joint scores showed an association with memory CD8+CD45RA-CD197- effector T-cells and CD197+ monocytes. To conclude, through the integration of in-depth flow cytometry and machine learning, we identified an immune cell profile discriminating PsA from Pso. This immune profile may aid in timely diagnosing PsA in Pso.

Novel application of optical coherence tomography and capillaroscopy in psoriatic arthritis in relationship to psoriasis and hand osteoarthritis.

ObjectivesNailfold video capillaroscopy (NVC) and angiographic optical coherence tomography (OCTA) have potential in diagnosing PsA and differentiating it from psoriasis vulgaris (PsO) and hand OA. We aimed to assess the diagnostic properties of NVC and OCTA in patients with PsA compared with patients with PsO and hand OA based on nailfold capillary patterns.MethodsPatients with DIP joint PsA and nail involvement (n = 50), PsO with nail involvement (n = 12) and OA (n = 13) were included in this cross-sectional study. Capillaries were evaluated semi-quantitatively and qualitatively. Differences in capillary findings between groups were assessed using mixed linear models. Binary logistic regression analyses were performed to determine the probability for PsA diagnosis based on capillaroscopy findings.ResultsBelow mean capillary density and reduced nailfold blood flow in OCTA images distinguished PsA from both PsO (P = 0.004 and P = 0.052, respectively) and OA (P = 0.024 and P < 0.001, respectively). Qualitative analysis revealed that glomerular capillaries were found in only 3% of PsA patients but in 13% of PsO patients (P = 0.003). Furthermore, crossed vessels were seen in only 55% of PsA patients and 71% of PsO patients (P = 0.043). NVC microhaemorrhage was dominant in PsA patients (13%) and significantly different from OA patients (P <0.05). No capillary pattern was associated with an increased probability of the PsA diagnosis.ConclusionA pathognomonic pattern for PsA diagnosis was not identified; however, we demonstrated some characteristic capillaroscopy findings for PsA, such as decreased capillary density, reduced blood flow and fewer crossed vessels in OCTA and presence of NVC microhaemorrhages.

Early Origins of Psoriatic Arthritis: Clinical, Genetic and Molecular Biomarkers of Progression From Psoriasis to Psoriatic Arthritis.

Greater than 90% of patients with psoriatic arthritis (PsA) first develop their arthritis on a background of known psoriasis (Pso). Thus, having skin/nail Pso certainly is an important risk factor for PsA but as PsA develops in <30% of those affected with Pso, the presence of Pso alone is insufficient as a means of identifying which patients with Pso will develop PsA. It is hoped that with further molecular assessment of Pso patients who do not have any evidence of inflammatory musculoskeletal disease compared to those with early PsA features, that the “at risk” profile of Pso patients destined to develop PsA can be refined such that disease prevention studies can be designed and a new era of treatment for PsA can emerge. In this article, the early stages in the development of PsA are outlined and what is currently known about clinical features, genetic factors and soluble or tissue biomarkers associated with the development of PsA in patients with Pso is reviewed in detail. Finally, proposals are outlined regarding the approaches required in order to address this important research area.

Switching infliximab in psoriatic patients during COVID-19 pandemics: A real-life retrospective study comparing intra-versus interclass switching strategies.

During this pandemic, dermatological infusion centers were partially unavailable, suspended or even reconverted to guest COVID‐19 patients, consequently infliximab (IFX) infusions became challenging for their both logistic arrangement and also for patients' COVID‐19 phobia. This 48 weeks follow‐up retrospective observational study included 37 PsO patients that underwent IFX SB2 during pandemic in two primary dermatological referral centers. In 23 (62.1%) we had to switch from IFX to other biologics, not motivated by adverse reactions, contraindication or even loss of response but only to pandemic related conditions. Nine patients underwent interclass switching and 15 underwent intraclass switching; interestingly 2 patients that underwent adalimumab SB‐5 switched back to IFX. Interclass switching was privileged in elder patients and smokers. All patients at week 48 achieved PASI 100. Intra‐ and interclass switchings are both safe and effective strategies in psoriatic patients with COVID‐19 phobia and/or difficulties to undergo infliximab infusions.

Reaching Treatment Goals in Psoriasis with Conventional Systemic Drugs: How Long Are We Willing to Wait?

Objectives: The purpose of this study was to investigate the attainment of treatment goals according to the European Consensus Programme (ECP-TGs) from 2011 in patients with moderate to severe psoriasis (Pso) treated with the first conventional systemic therapy and to identify factors that might compromise the attainment of these treatment goals. Methods: In a multicenter, prospective observational study, patients with moderate to severe Pso, defined as either body surface area (BSA) >10% or psoriasis area severity index (PASI) >10 and dermatology life quality index (DLQI) >10, received a conventional systemic therapy that could be modified at each follow-up visit over the course of 18 months. All subjects signed an informed consent form, were ≥18 years of age as well as systemic therapy naïve, and had regular study visits at months 3, 6, 9, 12, and 18 after baseline. Among others and in addition to demographic and disease-related characteristics at baseline, we documented BSA, PASI, DLQI, and the physician-reported attainment of treatment goals at each follow-up visit. Factors related to a failure in achieving the ECP-TGs (i.e., either Δ PASI ≥75 or Δ PASI ≥50 and <75 with a DLQI ≤5) at month 18 were investigated by multiple logistic regression. Descriptive results are presented as the mean ± SD for interval data, and absolute as well as relative frequencies for nominal data. For this part of the analysis, data at baseline and months 6, 12, and 18 are presented. Results: A total of 133 Pso patients with a mean age and disease duration of 49.5 ± 14.4 and 15.6 ± 12.8 years, respectively, were included in the analysis; 54.1% (n = 72) were male. The mean baseline disease-related outcomes were: BSA: 21.5 ± 15.8%, PASI: 13.7 ± 7.14, and DLQI: 12.0 ± 6.11. The most common conventional systemic therapies initiated at baseline were fumaric acid esters (n = 74, 55.6%), methotrexate (n = 46, 34,6%), and ciclosporin (n = 6, 4.5%). The ECP-TGs were achieved by 58 patients (43.6%) at month 6, 86 patients (64.7%) at month 12, and 97 patients (72.9%) at month 18. An optimized reduced logistic regression model identified the presence of onycholysis/nail dystrophy at two or more digits to be associated with failing to attain the ECP-TGs (OR 10.7, 95% CI 2.5–46.7, p = 0.002). Conclusion: Patients with onycholysis/nail dystrophy at two or more digits were identified as having a higher risk of not achieving ECP-TGs under conventional systemic therapy. The ECP-TGs from 2011 were attained by 43.6% of our patients 6 months after starting conventional systemic therapies. In the era of safe, fast, and efficacious Pso therapies, much higher treatment goals might be achieved during therapy. New treatment goals are only of use if patients and dermatologists strive to attain them.

Prevalence of comorbidities in atopic dermatitis and psoriasis in the French population

BackgroundAtopic dermatitis (AD) and psoriasis (Pso) are highly prevalent chronic inflammatory skin diseases. They share similarities regarding severity and impact on quality of life but display differences regarding risk factors, comorbidities, and pathogenesis. ObjectiveThis study sought to assess the prevalence of AD and Pso among the French population, along with associated comorbidities, and to compare these data with those of the age- and gender-adjusted French population with neither AD nor Pso. MethodsThe survey was conducted by a polling institute between September 1 and November 30, 2016, with proportional quota sampling being applied to render the study population representative of the French population. In all, 20 012 individuals were selected from among 900,000 internet users aged≥15years. ResultsOverall, 20,012 adults (48.8% men; 51.2% women) completed a digital questionnaire. The prevalence of AD was 4.65% [95% confidence interval (CI) 4.36%–4.94%] and that of Pso was 4.42% [95% CI: 4.14%–4.71%]. More AD patients presented≥1 comorbidity compared to subjects without AD (57.04% vs. 49.2%, P<0.0001) and more Pso patients presented≥1 comorbidity compared to subjects without Pso (60.68% vs. 49.05%, P<0.0001). After adjustment for gender and age, hypertension and dyslipidemia, a greater prevalence of osteoarticular, respiratory and psychiatric diseases was noted in both AD and Pso patients, whereas increased prevalence of obesity was seen only in Pso patients. The prevalence of components of metabolic syndrome was higher among Pso than AD patients. ConclusionFurther studies are required to consolidate these findings, to better characterize the entire spectrum of AD and Pso comorbidities, and to better identify determinants and risk factors, along with targeted therapies.