Psoriasis Vulgaris Patients Research Articles

An understanding of interlink of psoriasis with metabolic syndrome- A case control study

Psoriasis is a chronically relapsing, inflammatory, autoimmune, genetically mediated, skin disorder. Most often association of psoriasis with metabolic syndrome has been seen. Components of metabolic syndrome like diabetes, hypertension and obesity are oftenly linked with psoriasis therefore it is crucial to understand this interlink and prompt diagnosis and treatment therefore plays important role to reduce the morbidity and mortality. It has been seen that psoriasis is associated with metabolic syndrome and its components, such as obesity, diabetes and hypertension. These phenotypically diverse conditions are found to share similar pathologic changes owing to similar susceptibility genes and genetic loci. Objectives: 1: Selection of clinically diagnosed cases of psoriasis vulgaris attending the Derma OPD; 2: Evaluation of the psoriasis vulgaris patients on different parameters ; 3: Comparision of the cases with age and sex matched control groups; 4: Study the link of psoriasis vulgaris with metabolic syndrome. Study Design: It is Case Control study (100 cases and 100 controls). Results: Our study shows that in comparision to non-psoriatic patients i.e 12 (12%) metabolic syndrome is present in 37 (37%) of the psoriatic patients attending the OPD during the period of Jan 2017 to Dec 2017 i.e 1 year duration.the result is statistically significant (odds ratio (OR) –3-175, Degree of freedom(df)-1,p value-0.002. c 2 -8.772]. Conclusion: Study shows that psoriasis is highly linked with metabolic syndrome and its components. Keywords: Metabolic Syndrome, TNF alpha, Psoriasis, Hyperlipidemia, Hypertension, BMI, Obesity, Interleukins.

Association of CYP2J2 polymorphism with susceptibility to psoriasis in Turkish population: a case–control study

BackgroundCytochrome P450 2J2 is mostly expressed in extrahepatic tissues; it metabolizes arachidonic acid to epoxyeicosatrienoic acids, with various cardio protective and anti-inflammatory effects. CYP2J2 polymorphism has been identified as a risk factor for cardiovascular diseases, but its association with psoriasis remains unknown. ObjectiveTo evaluate CYP2J2 polymorphism as a risk factor for psoriasis in the Turkish population. MethodsThere were 94 patients with psoriasis and 100 age- and sex-matched healthy controls included in the study. Detailed demographic and clinical characteristics were recorded, and Psoriasis Area and Severity Index (PASI) scores were calculated for psoriasis patients. Venous blood samples were collected from all the participants and CYP2J2 50G>T (rs890293) polymorphism was analyzed using polymerase chain reaction (PCR). ResultsBoth T allele and TT+GT genotype frequencies were increased in psoriasis vulgaris patients compared to the control group (p=0.024 and p=0.029 respectively, OR=2.82, 95% CI: 1.11–7.15) No association between CYP2J2 polymorphism and clinical features of psoriasis was identified. Study limitationsA limited number of patients were included in the study. ConclusionCYP2J2 50G>T (rs890293) polymorphism was associated with an increased risk for PsV in the Turkish population.

The evaluation of oxidative stress in patients with psoriasis vulgaris and atopic dermatitis by measuring the urinary level of 8‐hydroxy‐2′‐deoxyguanosine

AbstractObjectivesRecent studies have revealed the relationship of oxidative stress to various medical disorders, such as cancer and ischemic heart disease. Atopic dermatitis (AD) and psoriasis vulgaris (PV) are chronic inflammatory dermatoses, and oxidative stress is presumed to be involved in the development of these diseases as well as their becoming refractory.MethodsIn this study, we collected urine samples from 40 AD patients, 25 PV patients, and 39 healthy volunteers (HVs). The level of 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) in each urine sample was measured and then compared among the groups. We also evaluated the relationship between the AD and PV severity and the urinary 8‐OHdG level.ResultsWe found that the urinary 8‐OHdG level was significantly higher in the AD and PV groups than in the HV group. We did not, however, identify an association between the 8‐OHdG level and the age, disease duration, or disease severity in the AD or PV groups.ConclusionsOur results demonstrated an association between urinary 8‐OHdG and the development of AD and PV, suggesting that both are oxidative stress‐related diseases. Treatments or lifestyle improvements focused on anti‐oxidation may therefore be vital for preventing these chronic dermatoses from developing and becoming refractory.

Assessment of Galectin-3 Levels in Psoriasis Vulgaris

Background: Galectin-3 is a one of the galectin family and produced by T-lymphocytes and has an important role in the inflammation process. Aim: the aim of this study was to determine the levels of serum galectin-3 in patients with psoriasis Vulgaris, a T-cell-mediated inflammatory disease, and investigate the correlation between these levels and activity of disease. Material and Method: this study included thirty-six patients with psoriasis Vulgaris and 30 healthy subjects. The psoriasis area and severity index (PASI) were calculated and recorded for every patient. The patients were divided into three groups; group I (mild), II (moderate) and III (Severe) according to the PASI scores. ELISA analysis was used to analyze the level of serum galectin-3. Results: level of serum galectin-3 in psoriasis Vulgaris patients was significantly lower than the control group (p=0.001). there was a negative correlation between level of serum galectin-3 and PASI scores (Spearman's rho=-0.749, P

Effect of redox imbalance on protein modifications in lymphocytes of psoriatic patients.

Lymphocytes are one of the most important cells involved in the pathophysiology of psoriasis; therefore, the aim of this study was to assess the redox imbalance and protein modifications in the lymphocytes of patients with psoriasis vulgaris (PsV) or psoriatic arthritis (PsA). The results show a stronger shift in redox status to pro-oxidative conditions (observed as an increased reactive oxygen species level, a decrease in catalase activity and lower levels of glutathione peroxidase and vitamin E compared with healthy controls) in the lymphocytes of PsA than PsV patients. It is also favoured by the enhanced level of activators of the Nrf2 transcription factor in lymphocytes of PsV compared with decreased of these proteins level in PsA. Moreover, the differential modifications of proteins by lipid peroxidation products 4-oxononenal (mainly binding proteins) and malondialdehyde (mainly catalytic proteins with redox activity), promoted a pro-apoptotic pathway in lymphocytes of PsV, which was manifested by enhanced expression of pro-apoptotic caspases, particularly caspase 3. Taken together, differences in Nrf2 pathway activation may be responsible for the differential level of redox imbalance in lymphocytes of patients with PsV and PsA. This finding may enable identification of a targeted therapy to modify the metabolic pathways disturbed in psoriasis.

Interferon Kappa Is Up-Regulated in Psoriasis and It Up-Regulates Psoriasis-Associated Cytokines in vivo.

PurposeThere is increased type I interferon signature in psoriasis patients. Interferon-kappa (IFN-κ) is a member of type I interferon family that is constitutively expressed by keratinocytes. In this study, we investigate whether IFN-κ is involved in psoriasis etiology.Patients and methodsTwenty healthy individuals, 20 psoriasis vulgaris patients and 10 atopic dermatitis (AD) were included for this study. Immunohistochemistry staining, normal human epidermal keratinocytes (NHEK) culture, Ca2Cl-induced differentiation, quantitative reverse transcription (qRT-PCR), ELISA and murine experiments were performed.ResultsWe found IFN-κ protein expression was extremely low in the epidermis of normal skin, but it was significantly increased in the suprabasal layers of epidermal keratinocytes in psoriatic skin lesions. However, its expression in the skin lesions of AD was similar to normal skin. Additionally, IFN-κ protein was detected in sera from psoriasis patients, but not in sera from normal subjects and AD. We further investigated the regulation of IFNk gene expression in NHEK. We found that IFNk was significantly induced by types of nucleic acid pathogen recognition receptor (PRR) agonists in NHEK. While its expression was significantly induced by itself and IFN-γ, it was inhibited by type 2 immunity cytokines IL4 and IL13; other inflammatory cytokines including IL1 super-family members and IL17A did not alter its expression. Addition of recombinant IFN-κ did not affect keratinocytes differentiation. Using the murine experimental model, we demonstrated that subcutaneous administration of recombinant IFN-κ did not increase skin thickness, but significantly increased the transcription of TNFA and IL17A in mice skin.ConclusionIncreased IFN-κ in psoriasis may be caused by injured cells-released nucleic acids, increased IFN-γ and self-activation. Its enhancement may contribute to the etiology of the disease by enhancing TNFA and IL17A gene expression.

Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners

IntroductionPsoriasis is a chronic, multisystem, inflammatory, disfiguring disease with a high negative impact on quality of life due to comorbid psychological, organic, and sexual consequences. AimTo evaluate the psychopathological and sexual aspects of psoriasis vulgaris in patients and their partners compared to healthy controls. MethodsIn the current comparative cross-sectional study, the sample included 220 psoriasis vulgaris patients (110 males and 110 females), their consenting partners, and 220 age- and sex-matched healthy controls. All participants were evaluated for depression and anxiety using the Hospital Anxiety and Depression Scale and for low self-esteem using the Rosenberg's Self-Esteem Questionnaire. Sexual function was assessed in females using the Female Sexual Function Index questionnaire and in males using the International Index of Erectile Function and its abbreviated 5-item version. For male patients suffering from erectile dysfunction, hormonal assessment and penile duplex ultrasound were added. Main Outcome MeasureThe main outcome measures were frequency of depression, anxiety, low self-esteem, and sexual dysfunction in psoriasis vulgaris patients, partners, and controls; the domains of sexual function affected in the studied groups; and the etiology of erectile dysfunction in affected psoriatic males. ResultsFrequency of depression, anxiety, and low self-esteem were significantly higher in psoriasis patients of both sexes compared with controls. Sexual dysfunction followed the same trend of being significantly higher in cases when compared to controls. Females had a significantly higher frequency of sexual dysfunction than males. Sexual dysfunction in both sexes involved multiple domains of the sexual response cycle, with depression and genital affection by psoriasis being risk factors in both sexes and disease severity being an additional risk factor in females. Erectile dysfunction was mainly psychogenic in origin in male patients. Clinical ImplicationsAssessment of psychopathological and sexual comorbidities in psoriasis patients and partners should be an integral part of the management plan and should be added to the guidelines of the disease. Strength & LimitationsThis study is of sufficient power to draw solid conclusions. Assessment of the partners and determination of the sexual domains affected by the disease and nature of erectile dysfunction in males are points of novelty. The cross-sectional design is a limitation of the study. ConclusionPsoriatic patients of both sexes and their partners suffer from a high burden of psychopathological and sexual consequences that are related to disease distribution and severity.Alariny AF, Farid CI, Elweshahi HM, et al. Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners. J Sex Med 2019; 16:1900–1911.

Analysis of nerve growth factor serum levels in psoriasis vulgaris patients

Background: Psoriasis is a complex chronic inflammatory skin disease with multifactorial mechanism affected by immunological, genetic, environmental and nervous system factors which its mechanism is still unknown. The involvement of nervous system in psoriasis is ruled by nerve growth factor (NGF). Increased levels of NGF serum are expected occurring in psoriasis vulgaris.Aim: To determine the differences between NGF serum levels in psoriasis vulgaris patients and controlsMethods: This study is an analytic study with cross sectional design involving 30 psoriasis vulgaris patients and 30 healthy controls. Diagnosis of psoriasis vulgaris was made based on history and clinical examination; we conducted blood sampling and measurement of NGF serum level to the patients and controls. The differences between NGF serum levels in psoriasis vulgaris patients and controlled is analyzed by independent-t test. This research approved by the health research ethics committee of the Faculty of Medicine of Sumatra Utara University/ H. Adam Malik Medan General Hospital.Results: In this study, we found the mean NGF serum level of female psoriasis vulgaris patients (810.30 ± 299.97 pg/ml) was higher compared to male (806.70 ± 256.04 pg/ml). The mean NGF serum of psoriasis vulgaris patients were highest on ages group 15 – 23 years (930.14 ± 69.03 pg/ml). The mean NGF serum level of psoriasis vulgaris without family history (875.38 ± 203.91 pg/ml) was higher compared to patient with a maternal history (600.87 ± 387.45 pg/ml) and paternal history (477.88 ± 406.97 pg/ml). The mean NGF serum level in the psoriasis vulgaris group (808.38 ± 272.48 pg/ml) was higher compared to the control group (524.92 ± 281.22 pg/ml) dengan with p=0.0001.Conclusion: There were significant differences in NGF serum levels between psoriasis vulgaris patients and control.

Down-regulation of tissue levels of serine protease inhibitor (vaspin) in psoriasis vulgaris patients: a possible mechanism of narrowband ultraviolet B radiation.

Vaspin is a serine protease inhibitor of the serpin family which has an anti-inflammatory effect. It has an important role in the pathogenesis of some inflammatory diseases such as psoriasis. There are no previous studies comparing the effect of narrowband ultraviolet B (NB-UVB) radiation on tissue vaspin levels in psoriasis. So we aimed in this case-control study to estimate the possible role of vaspin in the pathogenesis of psoriasis, and to evaluate the effect of NB-UVB radiation on tissue vaspin in psoriasis. This study included 21 non-obese patients with moderate psoriasis and 20 non-obese clinically healthy age and sex matched controls. Patients underwent 24 sessions of NB-UVB radiation. A 4mm punch skin biopsy was taken from all patients before and after treatment and from the controls for estimation of tissue vaspin level by enzyme-linked immunosorbent assay. Vaspin levels was significantly lower in patients before NB-UVB (99.72 pg/mg ± 12.11 pg/mg) compared to controls (257.34 pg/mg ± 28.11 pg/mg) with (P < 0.001). In addition, high significant difference was detected between vaspin levels in patients before (99.72 pg/mg ± 12.39 pg/mg) and after NB-UVB (190.92 pg/mg ± 27.61 pg/mg) with (P < 0.001). In conclusion, improvement of psoriatic plaques by NB-UVB is associated with an upregulation of tissue vaspin levels. Therefore, we suggest that vaspin has an important role in psoriasis pathogenesis.

Skin tissue expression and serum level of thymic stromal lymphopoietin in patients with psoriasis vulgaris

Thymic stromal lymphopoietin (TSLP) is known to be associated with allergic diseases. It is also suggested that TSLP has a role in autoimmune diseases such as psoriasis; however, the associated pathways remain unknown. There is currently little information on TSLP in psoriasis vulgaris. We investigated TSLP expressions on lesional and non-lesional skin of psoriasis vulgaris patients using reverse transcription- polymerase chain reaction. TSLP level was also investigated in serum from psoriasis vulgaris patients compared to healthy control using enzyme-linked immunosorbent assay. TSLP expression was higher in lesional skin (1.90) compared to non-lesional skin (1.76); however, the difference was not statistically significant (P>0.05). TSLP serum levels were significantly higher in psoriasis patients (287.40 pg/dL) as compared to controls (114.70 pg/dL) (P<0.05). This study concluded that TSLP levels in the serum of psoriasis vulgaris patients are higher than controls. TSLP was also found in keratinocyte of psoriasis patients, the expression was higher in the lesional compared to non-lesional skin; however, this difference is statistically insignificant. These findings suggest that TSLP may play a role in the pathogenesis of psoriasis vulgaris, but its exact role remains unclear.

Evaluation of the expression of the stromal cell-derived factor-1 alpha (CXCL 12) in psoriatic patients after treatment with Methotrexate.

CXCL12 has an important role in skin homeostasis and inflammation. In this work, the expression of CXCL12 was evaluated in psoriasis vulgaris, psoriatic arthritis (PsA) patients in relation to disease activity and methotrexate (MTX) therapy. Skin biopsies were obtained from 10 psoriasis vulgaris patients, 10 PsA patients, and 20 controls. The biopsies were repeated 6weeks after MTX therapy. The biopsies were stained immunohistochemically by stromal dermal factor 1 alpha (CXCL 12) antibody. Psoriatic arthritis showed significantly more expression of CXCL 12 than psoriasis vulgaris patients before treatment but not after treatment. There was significant decrease in CXCL 12 expression in the keratinocytes of psoriasis vulgaris patients after MTX therapy than before treatment, P-value was 0.009. There was no significant difference between pre- and post-treatment in the CXCL 12 expression of keratinocytes of PsA patients, P-value was 0.093. The percentage decrease of PASI score after treatment showed a moderate correlation with the percentage decrease of CXCL12 expression of the keratinocytes of the total psoriasis patients, r=0.484, P-value was 0.015. CXCL12 might be involved in the progression of psoriasis vulgaris to PsA. MTX therapy downregulated the expression of CXCL12 of the keratinocytes of psoriasis patients. This downregulation was paralleled by decrease in the PASI score. CXCL12 can be used as a biological marker of disease severity of psoriasis patients.

Immunohistochemical study of psoriatic plaques and perilesional skin in psoriasis vulgaris patients: A pilot study.

Psoriasis vulgaris, a chronic inflammatory skin disorder, is the result of immune mediated processes, genetic background and environmental factors. Prolactin and the vascular endothelial growth factor seem to play a key role in psoriasis pathogenesis regarding hyperproliferation of epidermal keratinocytes and dermal vascular ectasia. The aim of the study was to investigate the expression of tumor necrosis factor-α (TNF-α), vascular endothelial growth factor receptor 2 (VEGFR2) and prolactin receptor (PRLR) in psoriatic skin by immunohistochemical analysis and to evaluate the correlation with disease severity. Two skin biopsies, psoriatic lesion and perilesional skin, obtained by punch biopsy from 19 nontreated psoriasis patients were examined in hematoxylin and eosin staining and immunohistochemistry (IHC) for TNF-α, VEGFR2 and PRLR. The indirect IHC reaction was carried out automatically and visualized by 3,3-diaminobenzidine (DAB) technique. The average number of DAB-positive cells and the intensity of cell staining were quantified on a predefined scale. The results show a significant difference in the quantity and distribution of TNF-α positive cells in the two sample groups. In psoriatic plaque skin, an increased expression of TNF-α was found in the perivascular dermis and epidermic keratinocytes. In perilesional skin the immunostaining was predominant in the basal layer keratinocytes, while in psoriatic plaque, all the layers were positively marked, with stronger expression at the base. A statistically significant difference was found between the intensity of the immunostaining in the two types of tissue. Positive cells for VEGFR2 and PRL were identified in the basal layer keratinocyte cells (VEGFR2), sweat glands and hair outer shaft sheath (PRLR), without significant differences between the two types of samples. Our findings confirm the importance of TNF-α in psoriasis pathogenesis and a positive correlation with lesions severity. No significant differences were found for VEGFR2 and PRLR, but additional studies are necessary to establish their role.

Identification of psoriasis vulgaris biomarkers in human plasma by non-targeted metabolomics based on UPLC-Q-TOF/MS.

The aim of the study was to investigate the endogenous metabolites of patients with psoriasis vulgaris which will be helpful for the diagnosis of the disease and to provide the evidence of pathogenesis and the formulation for the individualized dosage regimen. This study investigated the plasma metabolomic profiling between the psoriasis vulgaris patients (N=12) and the healthy volunteers (N=12) using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF MS) metabolomic techniques. Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to identify and visualize the metabolic data clusters. A total of 22 differential metabolites contributing to the clusters were identified, among which the levels of threonine (p<0.001), leucine (p<0.001), phenylalanine (p<0.001), tryptophan (p=0.018), palmitamide (p<0.001), Linoleic amide (p<0.001), oleamide (p<0.001), stearamide (p<0.001), cis-11- eicosenamide (p< 0.001), trans-13-Docosenamide (p<0.001), uric acid (p=0.034), LysoPC (16:0) (p<0.001), LysoPC (18:3) (p<0.001), LysoPC (18:2) (p=0.024), LysoPC (18:1) (P=0.012) and LysoPC (18:0) (p=0.002) were significantly higher in the plasma of psoriasis vulgaris patients compared with the healthy controls, whereas oleic acid (p<0.001), arachidonic acid (p<0.001) and N-linoleoyl taurine (p<0.001) were significantly lower. These biomarkers are related to glucose metabolism, lipid metabolism, amino acid metabolism, nucleic acid metabolism and so on. The data suggest that psoriasis vulgaris patients may have disrupted lipid and amino acid metabolism, as well as inflammation and functional lesions in the liver and kidney. This study deepens the understanding of psoriasis vulgaris pathogenesis and proposes novel ideas and methods for auxiliary diagnosis and treatment of the disease.

Sustainability and switching of biologics for psoriasis and psoriatic arthritis at Fukuoka University Psoriasis Registry.

Biologics are efficacious for treating psoriasis vulgaris (PsV) and psoriatic arthritis (PsA), but sometimes must be terminated or changed for various reasons including ineffectiveness or adverse events. To find the optimal choice of biologics for treating psoriasis, we analyzed the real-world data on drug survival and the reason for terminating or switching biologics. Medical records from patients with PsV or PsA, who visited the Department of Dermatology, Fukuoka University Hospital from 2010 to 2017, were analyzed. Two hundred and eleven patients received biologics, and 147 patients (69.7%) were treated with only one biologic, while 64 patients (30.3%) were switched to different products. Frequently used biologics in PsV were ustekinumab (UST), infliximab and adalimumab when calculated by patient-year. Tumor necrosis factor inhibitor (TNFi) use decreased while UST and interleukin (IL)-17 inhibitors increased in newly introduced patients. UST showed the highest survival rate as a first-line drug, but the advantage was lost in the second reagent's group. The major reasons for terminating/switching biologics were as follows: primary ineffectiveness (26.4%), secondary loss of efficacy (36.5%), patient's preference, including referral to nearby hospital, or stopped visiting (22.6%), side-effects (7.7%), comorbidities (3.4%) and economic burden (2.4%). In PsA patients, TNFi are more frequently employed than in PsV patients, although switching to UST or IL-17 inhibitors showed an increasing trend. Biologic reagents were changed mostly because of primary or secondary loss of efficacy, which affected drug survival. Further research is needed to find the optimal choice of biologics with larger samples at multiple facilities.

Correlation between Serum Brain-Derived Neurotrophic Factor Level and Depression Severity in Psoriasis Vulgaris Patients.

BACKGROUND:Psoriasis vulgaris is a chronic inflammatory skin disorder that can lead to depression. There is a similarity in neurotrophic substance in the pathogenesis of psoriasis and depression; it’s called brain-derived neurotrophic factor (BDNF). BDNF level imbalance potentially affects the severity of psoriasis and depression.AIM:This study aims to know the correlation between serum BDNF level and depression severity in psoriasis vulgaris patient and also the correlation between serum BDNF level and psoriasis vulgaris severity.METHODS:This is an analytical cross-sectional study that 23 psoriasis vulgaris patients participated. All participants have performed serum BDNF level examination with enzyme-linked immunosorbent assay (ELISA). Depression severity assessed with Beck depression inventory-II (BDI-II) and psoriasis severity assessed with psoriasis area and severity index. Correlation between all variables was analysed with Spearman’s correlation test.RESULTS:Serum BDNF level and depression severity are a strongly negative correlation in psoriasis vulgaris patients (r = -0.667 with significant value p = 0.001). There is a moderate negative correlation between serum BDNF level with psoriasis vulgaris severity (r = -0.595 with significant value p = 0.003).CONCLUSION:In psoriasis vulgaris patients, a low level of serum BDNF may increase depression severity and psoriasis vulgaris severity.

Subclinical synovitis and enthesitis in psoriasis patients and controls by ultrasonography in Saudi Arabia; incidence of psoriatic arthritis during two\xa0years

ObjectiveTo evaluate ultrasonographic subclinical inflammatory synovitis and enthesitis in psoriasis patients, without clinical arthritis or enthesitis compared with healthy controls, with a 2-year follow-up to study the associated incidence of psoriatic arthritis (PsA).MethodsA total of 109 consecutive psoriasis vulgaris patients without clinical signs of PsA and 90 healthy controls were included from two tertiary medical centers. Subjects underwent dermatological examination, PASI score evaluation for severity of psoriasis, musculoskeletal examination using 68/66 joints count for tenderness and swollen joints. Patients were assessed for CRP, musculoskeletal ultrasound (MSUS) in the form of grayscale ultrasound (GSUS), and power Doppler ultrasound (PDUS) for eight entheses and 34 joints to detect MSUS subclinical enthesitis and synovitis. All patients were followed-up for 2 years to detect evolving PsA.ResultsSubclinical enthesitis and synovitis were detected in 39.5% of psoriasis patients and 10% of controls (P < 0.001). CRP was significantly higher in psoriasis patients with MSUS manifestations (P < 0.01). PDUS and GSUS subclinical synovitis and/or enthesitis were detected at least in one site in psoriatic patients more than in controls (P < 0.05). During a 2-year follow-up of patients, the annual PsA incidence was 4.3%. Psoriasis patients who developed PsA showed a higher prevalence of baseline enthesitis, higher PDUS and GSUS synovitis scores, and higher baseline CRP level than those who did not develop PsA.ConclusionsMSUS subclinical synovitis and enthesitis are quite common in psoriasis patients. The incidence of PsA in Saudi’s psoriasis patients was slightly higher than worldwide reports. Subclinical enthesitis, PDUS, and GSUS synovitis could predict PsA development.

Increased dermal expression of chromatin-associated protein HMGB1 and concomitant T-cell expression of the DNA RAGE in patients with psoriasis vulgaris.

PurposePsoriasis vulgaris (PV) is an autoimmune-related chronic inflammatory disease of the skin, with both vascular and metabolic effects. Aggravating factors have been identified that initiate and maintain inflammation, including expression of Th1-, Th17-, and Th22-cell derived cytokines. Recently, we showed that the evolutionarily ancient and highly conserved damage-associated molecular pattern molecule “high mobility group box 1 (HMGB1)” is significantly increased in the serum of PV patients with disease progression and is decreased under standard therapies.Materials and methodsTo better understand the role of HMGB1 in the pathogenesis of PV, we recruited 22 untreated psoriatic patients with either mild or severe disease, defined by the Psoriasis Area Severity Index. We assessed HMGB1 and receptor for advanced glycation end products (RAGE) expression in the skin by immunohistochemistry and analyzed the immune-phenotype of Treg and Th17 cells by flow cytometry.ResultsWe found increased staining for HMGB1 in the dermis of psoriatic plaques in comparison to uninvolved skin of patients with PV. In addition, the major histocompatibility complex class III-encoded DNA and HMGB1 RAGE, induced by HMGB1, were highly expressed on psoriatic CD8+ T cells and CD4+ Treg. High expression of HMGB1 in the lesional skin was associated with even higher expression of its receptor, RAGE, on the cell surface of keratino-cytes in patients with severe PV.ConclusionThe presence of HMGB1 and RAGE signaling may impact orchestration of chronic inflammation in PV which might have implications for Treg and Th17 cells.

Serum adropin levels in psoriasis vulgaris and its relation with metabolic parameters

Background/aim Adropin is a peptide-structure hormone that plays a role in preventing the development of insulin resistance, which has been linked to obesity and metabolic regulation. The purpose of this study is to assess serum adropin levels and their relationship with metabolic parameters in psoriasis vulgaris patients both with and without metabolic syndrome (MetS).Materials and methods Fifty-three patients and 26 healthy controls were included in this study. Serum adropin levels, fasting blood glucose, fasting serum insulin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, and triglyceride levels of all participants were analyzed. Enzyme-linked immunosorbent assay was used to measure serum adropin levels. Results Serum adropin levels were 2.94 ± 0.56 ng/mL in psoriatic patients without MetS, 2.49 ± 0.77 ng/mL in psoriasis patients with MetS, and 3.37 ± 0.71 ng/mL in the control group. Multivariate logistic regression analysis was used to evaluate adropin decreases in psoriasis patients as an independent predictor of the presence of MetS. Conclusion The serum levels of adropin in psoriasis patients were significantly lower in the presence of MetS, and this decrease was more prominent than in those without MetS. Adropin may be a contributing factor for metabolic disorders and the development of MetS in psoriasis patients.

Evaluation of HCP5 and Chemokine C Receptor type 5 Gene Polymorphisms in Indian Psoriatic Patients.

Background:Genetic variations associated with nonprogression of HIV infection to AIDS are enriched in psoriasis patients. HCP5 gene 335 T > G and chemokine C receptor type 5 (CCR5) gene Δ32 polymorphisms are associated with HIV nonprogression phenotype.Aim:The aim of this study was to determine the association of HCP5 gene 335 T > G (rs2395029) and CCR5 gene Δ32 (rs333) polymorphisms with psoriasis vulgaris (PV).Materials and Methods:Genotype of HCP5 gene 335 T > G and CCR5 gene Δ32 polymorphisms were determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism and allele-specific PCR methods, respectively.Results:The frequency of HCP5 gene 335 T > G SNP was ~7 times higher in PV patients than in the control group (P = 1.49 × 10–8; odds ratio [OR] = 10.2; 0.95 confidence interval [CI]: 3.9–26.8). OR for the occurrence of HCP5 335 G allele in either homozygous or heterozygous genotype in PV patients was 13.1 (0.95 CI: 4.7–36.1). The strength of association was higher with moderate-to-severe subgroup (P = 3.29 × 10–9; OR = 18.4; 0.95 CI: 6.2–54.9) than with mild subgroup (P = 2.1 × 10–4; OR = 8.3; 0.95 CI: 2.6–23.3). In addition, the strength of association was higher with Type I (P = 9.53 × 10–8; OR = 15.3; 0.95 CI: 5.1–46.5) than with Type II subgroup (P = 6.8 × 10–6; OR = 11.0; 0.95 CI: 3.6–33.9). Type I gene Δ32 polymorphism was observed neither among psoriatic nor among healthy individuals.Conclusions:Our results indicate that HCP5 gene 335 T > G polymorphism and not CCR5 gene Δ32 polymorphism is associated with the increased risk of developing PV.

Fixed Tapering Dosage of Acitretin in Patients with Psoriasis: A Short-Term Analysis of Clinical Efficacy and its Effects on Biochemical Parameters.

Background:Acitretin is a widely used systemic retinoid in the treatment of psoriasis. Dosage of acitretin in not weight adjusted due to certain interindividual variations.Objective:To evaluate the clinical efficacy and effects on biochemical parameters of fixed tapering dosage of acitretin in patients with psoriasis administered over a period of 4 weeks.Materials and Methods:This was an observational study. The study included patients of psoriasis vulgaris in the age group of 18 and 65 years with a psoriasis area severity index (PASI) score of >10 which was not responsive to topical therapy and phototherapy. Patients were given oral acitretin daily at a dose of 25 mg BD for 2 weeks, which was later tapered to 25 mg OD for another 2 weeks. The clinical efficacy and biochemical parameters were assessed.Results:Out of the 18 patients, PASI 75 was achieved in 66% of the patients by the end of the third week. Significant elevations were noted in serum lipids during 4 weeks, which returned to normal limits or near baseline levels at the end of 4 weeks.Conclusion:Fixed tapering dose of acitretin is effective in psoriasis with minimal clinical and biochemical adverse events