Psoriatic Area And Severity Index Research Articles

Galectin-1 in Psoriatic arthritis, Psoriasis, Rheumatoid arthritis and its relation with disease activity and skin lesion

Immune mediated inflammatory diseases (IMIDs) are a diverse range of diseases that affect joints with early overlapping symptoms. Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are the most common disorders sharing immune-pathogenic mechanisms that cause peripheral arthritis. Psoriasis (Ps) is a chronic inflammatory autoimmune skin disease characterized by epidermal hyperplasia with significant invasion by inflammatory cells. New biomarkers are required to enable an early diagnosis and differentiation between different types of IMIDs. In autoimmune disorders, galectin 1 (Gal-1) is a recognized as negative immune system regulator. This study aimed to determine the possibility of using gal-1 as a diagnostic marker to differentiate between RA and PsA with polyarthritis pattern, and between PsA and Ps, and to assess its relationship with disease activity and with skin lesion. In this case-control study included 40 PsA patients with polyarthritis pattern, 40 psoriatic patients, 40 RA patients and 20 normal controls. Gal-1 levels were measured in serum and skin biopsy and disease Activity Score (DAS-ESR) was assessed. Serum gal-1 level was significantly higher in RA group in comparison to PsA, psoriatic and control. In addition, compared to the normal group, psoriatic skin lesions from PsA and Ps patients had lower levels of gal-1. Serum gal-1 levels in the RA group did not correlate with other factors such as age, disease duration, deformity, extra-articular symptoms, or DAS-ESR. Furthermore, there was no correlation between the skin's level of gal-1 and psoriatic area and severity index (PASI) score, body surface area (BSA). In conclusion, serum Gal-1 concentration may serve as a diagnostic biomarker to distinguish between RA and PsA. However, it cannot assess activity or severity of RA, and cannot differentiate psoriatic lesion either from only Ps or PsA.

Serum Levels of 25-Hydroxyvitamin D in Chronic Plaque Psoriasis

Background: Psoriasis is an immune mediated inflammatory disease that involves the innate and acquired arm of immunologic system. The regulatory role for vitamin D in immune system is suggested by presence of vitamin D receptors on activated lymphocytes and suppressive or inhibiting effect of 1,25-dihydroxyvitamin D in different autoimmune diseases. Hence, the current proposed study aims to study the 25-hydroxyvitamin D status of patients with psoriasis.
 Objective: The primary objective of this study was to analyze the 25-hydroxyvitamin D status of patients with chronic plaque psoriasis in comparison to healthy control subjects.
 Materials and Methods: A comparative cross-sectional study, including forty patients with chronic plaque psoriasis and forty age- and sex-matched control subjects, was conducted from April 2021 to December 2022, at our dermatology department. After informed consent, all patients were subjected to detailed clinical and anthropometric examination. Serum concentration of 25-hydroxyvitamin D was evaluated in chronic plaque psoriasis cases and healthy control subjects. Data was be analyzed as per standard statistical protocol.
 Results: The mean serum 25-hydroxyvitamin D level in psoriatic group and control group were 18.02 (±SD 9.82) ng/ml and 24.47 (±SD 6.77) ng/ml, respectively. (p=.001) Serum 25-hydroxyvitamin D was negatively correlated with Psoriatic area and severity index (PASI) score (r=-.11). However, this correlation was not significant (p=.493).
 Conclusion: Serum 25-hydroxyvitamin D levels were significantly lower in psoriatic patients than in control subjects.

Development and In Vitro/In Vivo Evaluation of pH-Sensitive Polymeric Nanoparticles Loaded Hydrogel for the Management of Psoriasis.

Methotrexate (MTX), the gold standard against psoriasis, poses severe problems when administered systemically viz increased toxicity, poor solubility and adverse reactions. Hence, a topical formulation of MTX for the management of psoriasis can be an effective approach. The present study aimed to develop an MTX based nanoparticle-loaded chitosan hydrogel for evaluating its potential efficacy in an imiquimod-induced psoriatic mice model. MTX-NPs loaded hydrogel was prepared and optimized using the o/w emulsion solvent evaporation method. Particle size, zeta potential, entrapment efficiency, in vitro drug release, ex vivo permeation, skin irritation and deposition studies were performed. Psoriatic Area and Severity Index (PASI) score/histopathological examinations were conducted to check the antipsoriatic potential of MTX-NPs loaded hydrogel using an imiquimod (IMQ)-induced psoriatic model. Optimized MTX-NPs showed a particle size of 256.4 ± 2.17 nm and encapsulation efficiency of 86 ± 0.03%. MTX-NPs loaded hydrogel displayed a 73 ± 1.21% sustained drug release in 48 h. Ex vivo permeation study showed only 19.95 ± 1.04 µg/cm2 of drug permeated though skin in 24 h, while epidermis retained 81.33% of the drug. A significant decrease in PASI score with improvement to normalcy of mice skin was observed. The developed MTX-NPs hydrogel displayed negligible signs of mild hyperkeratosis and parakeratosis, while histopathological studies showed healing signs of mice skin. So, the MTX-NPs loaded hydrogel can be a promising delivery system against psoriasis.

Terrestrosin D ameliorates skin lesions in an imiquimod-induced psoriasis-like murine model by inhibiting the interaction between Substance P and Dendritic cells

BackgroundPsoriasis is a psychosomatic immune skin disease with psychological factors contributing to the disease. Substance P (SP) is highly expressed in the psoriatic lesions of patients and is involved in pathological disease progression. Tribulus terrestris L. has been used as a Chinese herbal medicine for disease prevention for thousands of years. Terrestrosin D (TED) has been identified as the effective monomeric component of Tribulus terrestris L.. PurposeWe investigated whether TED could reverse imiquimod-induced psoriatic lesions, and then, investigated its potential mechanism of action both in vivo and in vitro. Methods5% imiquimod cream was applied onto the backs of mice for 6 days to induce psoriasis-like skin lesions. The psoriatic area and severity index (PASI) was then used for scoring disease severity. Pathological changes and Ki-67 expression levels in skin lesions were measured using hematoxylin and eosin (H&E) and immunofluorescence staining after TED administration. The in vivo and in vitro expression levels of inflammatory cytokines, the ratio of DCs, and SP were measured using ProcartaPlex Mouse Cytokine panels, flow cytometry, and western blotting. Behavioral assessments were determined using the open field and elevated plus-maze (EPM) test. ResultsTED decreased PASI scores, epidermal thickness, Ki-67 expression levels, the ratio of DCs in the spleen, and secretion of IL-12p70, IL-18, and TNF-α in imiquimod-induced psoriasis-like murine models. Furthermore, TED increased IL-10 secretion levels, improved behavior, and down-regulated the expression levels of SP. Additionally, TED inhibited the in vitro maturation and activation of SP-induced CD11c+ DCs and the release of IL-12p70 and IL-23. ConclusionTED reduced DCs maturation, down-regulated the expression levels of inflammatory factors, and improved skin lesions and behavior of psoriasis-like murine models by inhibiting the interaction between Substance P and Dendritic cells.

25240 Cosentyx (secukinumab) for the treatment of adult onset pityriasis rubra pilaris: A single arm, open-label exploratory study

This prospective, single-arm, open label pilot study evaluated the clinical efficacy of secukinumab therapy in adult onset pityriasis rubra pilaris (PRP). A total of 10 patients with PRP were included. Baseline characteristics, Dermatology Life Quality Index (DLQI) score, Psoriatic Area and Severity Index (PASI) score, Physician Global Assessment (PGA), and adverse events were collected. Reduction in PASI score by ≥75% of baseline value and by ≥90% of baseline value were calculated at week 12 and week 28.

Serum Adiponectin Level in Patients with Psoriasis and its Correlation with the Clinical Severity

Background: Psoriasis is a common chronic immune mediated papulosquamous disease that affects 2-3% of the population. The exact cause of psoriasis is still unclear, but it is considered a disease of dysregulated inflammation which is driven and maintained by interaction among multiple components of immune system in genetically predisposed individuals. Adipose tissue is an active endocrine organ contributing to the regulation of multiple metabolic pathways via self-produced bioactive products called adipokine. Adiponectin of adipose origin has the highest circulating concentration among the known adipokines. Adiponectin regulates skin inflammation especially IL-17-related psoriasiform dermatitis. Objective: This study was aimedto estimate the serum level of Adiponectin and detect its correlation with activity of psoriatic patients. Patients and Methods: This case control study included a total of 50 patients with psoriasis and 50 healthy individuals, attending at Outpatient Clinic, Department of Dermatology, Venereology and Andrology in collaboration with Department of Clinical Pathology, Faculty of Medicine, Zagazig University Hospitals. This study was conducted between November 2019 to November 2020. Psoriasis severity was classified according to psoriatic area and severity index (PASI) score. Serum level of adiponectin was determined by ELISA for both groups. Results: The results revealed that control group had significantly higher level of adiponectin than psoriasis patients. There was a negative significant correlation between adiponectin and Psoriasis Area and Severity Index (PASI score) (p <0.001**). Sensitivity of adiponectin in diagnosis of psoriasis was 94%, specificity was 90% and accuracy was 92%. Conclusion: Adiponectin measurement in serum of patients with psoriasis provides a tool for monitoring disease activity.

Alteration of tissue expression of human beta defensin-1 and human beta defensin-2 in psoriasis vulgaris following phototherapy

ABSTRACTWe compared the expression profiles of antimicrobial peptides (AMPs) in psoriatic skin before and after narrow band ultraviolet B (nb-UVB) phototherapy and compared the levels to healthy controls. We studied 15 male and 12 female patients with psoriasis vulgaris, and 11 female and nine male control individuals. The patient group was treated with 24–36 sessions of nb-UVB phototherapy. Immunohistochemical staining for human beta defensin 1 (hBD-1) and human beta defensin 2 (hBD-2) expression of lesioned and control skin was performed prior to and following phototherapy. After phototherapy, the psoriatic area and severity index (PASI) decreased significantly in the treated patients compared to controls. The hBD-1 level was significantly higher in psoriasis patients than healthy controls. We found no statistically significant difference in hBD-1 and hBD 2 levels before and after phototherapy in the patient group. Although hBD-1 plays a role in psoriasis, levels of human beta defensin 1 and 2 are not affected significantly by phototherapy.

Development of Topical Gel of Methotrexate Incorporated Ethosomes and Salicylic Acid for the Treatment of Psoriasis.

There is an unmet need for optimized drug delivery system of psoriasis therapy because of various issues like adverse reaction, permeation problem associated with convention treatment (oral and topical) available for psoriasis. The goal was to develop an ethosomal gel of methotrexate (MTX)-incorporated ethosomes and salicylic acid (SA) and to evaluate and study its ethosomal gel potential in Imiquimod-induced psoriasis animal model to treat symptoms of psoriasis. MTX-SA ethosomal gel was prepared by the cold method given by Touitou et al. and optimized by comparing it with MTX ethosomal gel and drug solution. Particle size, zeta potential, entrapment efficiency, and ex-vivo study were selected as the critical quality checking attributes. Psoriatic Area and Severity Index (PASI) score & histopathological examination were done for checking Antipsoriatic potential of MTX-SA ethosomal gel by using the imiquimod-induced psoriasis model. Optimized MTX-SA exhibited a particle size of 376.04 ± 3.47nm, EE(Entrapment efficiency) of 91.77 ± 0.02%. At the end of 24h, MTX-SA ethosomal gel exhibited a slow and prolonged release of MTX (26.13 ± 1.61% versus 6.97 ± 0.06%) compared to MTX drug solution. It also attributes of 43% retention study as compared to drug solution (13%). Besides, it essentially decreased the PASI score with the recuperation of normalcy of the mice's skin, while the MTX-SA gel displayed indications of gentle hyper and parakeratosis toward the completion of investigation when contrasted with the blank gel. The developed MTX-SA ethosomal gel formulation can be a promising alternative to existing MTX formulation in topically treating psoriasis.

Efficacy of short-term naturopathy and yoga interventions on palmoplantar psoriasis

Psoriasis is a chronic inflammatory disease, associated with a higher risk of cardiovascular, metabolic, and renal disease, and patients may experience significant impairment of health-related quality of life even with localized disease. According to a study conducted on 3065 patients, plantar lesions were seen in 91.9% of patients and palmar lesions in 55.6% of patients. Our patient is a 47-year-old married man, with a history of erythema, scaling, itching pain often associated with bleeding on the affected area of both palms and soles since 6 months. After obtaining informed consent, he was admitted to our inpatient Department of Government Yoga and Naturopathy Hospital. Since naturopathic interventions aimed to put right the lifestyle improvement, he underwent treatments such as neutral enema, mud therapy, diet therapy, acupuncture, and yoga therapy at our inpatient department (IPD). Considering the basic principle of naturopathy, i.e., accumulation of morbid matter, one of the main causes of disease has been taken into an account for planning the line of treatment. Pre-blood investigations include resting blood pressure, pulse rate, respiratory rate, fasting blood glucose level, and serum cholesterol level. The patient was asked to fill the Psoriatic Area and Severity Index (PASI) was used as a tool to measure the severity of the lesions and the area affected. Pre- and post-assessments were done using PASI. Immediately after 2 days of intervention, the pain and the itching in the affected area was subsided, and after 15 days of intervention, our patient was provided with exclusive juice diet with 6 servings per day. After 20 days of intervention, the PASI Scoring was reduced from 8.8 to 2. A 20-day naturopathic intervention has shown clinically significant change in the severity of psoriatic lesions in our case.

Impact of Ixekizumab Treatment on Itch and Psoriasis Area and Severity Index in Patients with Moderate-to-Severe Plaque Psoriasis: An Integrated Analysis of Two Phase III Randomized Studies.

IntroductionWe evaluated baseline itch and its impact on the efficacy of ixekizumab (IXE) in clearing psoriasis and improving quality-of-life measures, and we explored the relationship between itch and psoriatic skin improvement.MethodsData were analyzed from two double-blind, randomized, controlled phase III studies (UNCOVER-2/3) comparing etanercept (ETN), IXE, and placebo (PBO) in patients with moderate-to-severe plaque psoriasis. Long-term analysis included UNCOVER-3 data from week 0 to week 156.ResultsAt week 12, a clinically meaningful improvement in itch [Itch Numeric Rating Scale (NRS) reduction ≥ 4] was seen in 70.0%, 88.6%, and 90.8% of the IXE-treated patients in the baseline Itch NRS 4–6, 7–8, and 9–10 groups, respectively (all itch severity groups p < 0.001 versus ETN and PBO). Also, 68.9%, 67.1%, and 73.6% of the IXE-treated patients in the baseline Itch NRS 4–6, 7–8, and 9–10 groups, respectively, showed an improvement of ≥ 90.0% in the Psoriatic Area and Severity Index (PASI) at week 12 as compared to the baseline (PASI 90) (all itch severity groups p < 0.001 versus ETN and PBO). For most patients, itch reduction preceded psoriatic plaque improvement. Sustained effects of IXE on itch and PASI were observed during 3 years of treatment.ConclusionsRegardless of baseline itch severity, IXE treatment provided a rapid improvement in itch followed by clinically meaningful improvements in psoriasis.FundingEli Lilly and Company.Trial registrationClinicalTrials.gov identifiers, NCT01597245 and NCT01646177.Electronic supplementary materialThe online version of this article (10.1007/s13555-018-0267-9) contains supplementary material, which is available to authorized users.

Study of Keratinocyte Proliferation, Apoptosis and Dermal Inflammation in Psoriatic Skin Lesions Before and After Methotrexate Therapy: Which Change Is Contributing More to Clinical Severity of the Disease?

Objective: The pathogenesis of psoriasis involves T-cell mediated immunologic response, keratinocytes hyperproliferation, and resistance to apoptosis. Methotrexate is one of the most reliable modalities in the treatment of psoriasis that target those changes. The study of those variables before and after methotrexate therapy may answer the question: Which of those variables contributes more to the clinical severity of the disease and is more valuable to be targeted in psoriasis treatment. Patients and Methods: A total of 50 cases of psoriasis vulgaris were included, 25 patients received methotrexate therapy. Skin biopsies of psoriatic skin lesions before and after treatment were examined histologically for measurement of epidermal thickness and grading of dermal inflammation. Immunostaining for Ki-67 and p53 was done for assessment of keratinocyte proliferation and apoptosis. Results were correlated with clinical severity of the disease, assessed by psoriatic area and severity index (PASI) score. 15 biopsies of normal skin were included as control. Results: Dermal inflammation, Ki-67%, and p53% were significantly higher in psoriatic skin lesion than in normal skin. Those changes were significantly correlated with PASI score. Multiple logistic regression models revealed that Ki-67 was the most significant variable contributing to clinical severity. One unit change in ki-67% can explain 1.2 unit changes in PASI score with 97% sensitivity, 40% specificity and 25% cut-off value. PASI score, dermal inflammation, Ki-67% and P53% were significantly reduced after methotrexate therapy. No significant difference was detected between the percent reduction in PASI score (81%) and that of Ki-67% (70%). Conclusion: Keratinocyte proliferation was the most significant variable contributing to the clinical severity of psoriasis and it was the single parameter that showed parallel changes to PASI score after methotrexate therapy. Keratinocyte proliferation may be considered as the stimulus that induces all other pathological and clinical changes in psoriasis and should be targeted by therapy.

Sirolimus treatment for cirrhosis or hepatocellular carcinoma patients accompanied by psoriasis after liver transplantation: A single center experience.

There is currently no consensus on the most suitable therapeutic approach for psoriasis (PS) co-existing with posthepatic cirrhosis (PCs) and hepatocellular carcinoma (HCC) following liver transplantation (LT). The present study provides an analysis of the therapeutic experience of such patients. Five LT recipients (two with PC and three with HCC) with accompanying PS were included. The induction program consisted of methylprednisolone plus basiliximab treatment. The initial postoperative treatment scheme consisted of tacrolimus (FK506) plus mycophenolate mofetil (MMF) and hormone; the latter was withdrawn 1 week after LT. The patients with PC had been using FK506 with or without a postoperative MMF program; the patients with HCC and recurrence of PS had been switched to a sirolimus (SRL)-based replacement therapy. Furthermore, all patients received anti-hepatitis B virus (HBV) therapy. The patients were followed up after 8.3±1.5 years. There was a positive correlation between HBV-DNA copy numbers, and psoriatic area and severity index (PASI) scores (r=0.97; P=0.006). The PASI scores were decreased significantly at 6 months following surgery compared with pre-transplantation (P<0.05). The patients who had received the FK506-based treatment experienced PS recurrence two years post-transplantation. The PASI scores increased significantly (P<0.05) and then declined gradually, maintaining a stable level (P<0.05) by 1 year after switching to the SRL-based treatment. The patients who had received the SRL-based treatment exhibited no recurrence of PS. The results of the present study suggest that SRL therapy provides a promising novel treatment method for patients with PS following LT that may be superior to tacrolimus treatment. When co-existing HBV is present pre-transplantation, regular injection of human hepatitis B immunoglobulin should be used to prevent the HBV from relapsing or aggravating the PS.

Study of Keratinocyte Proliferation, Apoptosis and Dermal Inflammation in Psoriatic Skin Lesions Before and After Methotrexate Therapy: Which Change Is Contributing More to Clinical Severity of the Disease?

Objective: The pathogenesis of psoriasis involves T-cell mediated immunologic response, keratinocytes hyperproliferation, and resistance to apoptosis. Methotrexate is one of the most reliable modalities in the treatment of psoriasis that target those changes. The study of those variables before and after methotrexate therapy may answer the question: Which of those variables contributes more to the clinical severity of the disease and is more valuable to be targeted in psoriasis treatment. Patients and Methods: A total of 50 cases of psoriasis vulgaris were included, 25 patients received methotrexate therapy. Skin biopsies of psoriatic skin lesions before and after treatment were examined histologically for measurement of epidermal thickness and grading of dermal inflammation. Immunostaining for Ki-67 and p53 was done for assessment of keratinocyte proliferation and apoptosis. Results were correlated with clinical severity of the disease, assessed by psoriatic area and severity index (PASI) score. 15 biopsies of normal skin were included as control. Results: Dermal inflammation, Ki-67%, and p53% were significantly higher in psoriatic skin lesion than in normal skin. Those changes were significantly correlated with PASI score. Multiple logistic regression models revealed that Ki-67 was the most significant variable contributing to clinical severity. One unit change in ki-67% can explain 1.2 unit changes in PASI score with 97% sensitivity, 40% specificity and 25% cut-off value. PASI score, dermal inflammation, Ki-67% and P53% were significantly reduced after methotrexate therapy. No significant difference was detected between the percent reduction in PASI score (81%) and that of Ki-67% (70%). Conclusion: Keratinocyte proliferation was the most significant variable contributing to the clinical severity of psoriasis and it was the single parameter that showed parallel changes to PASI score after methotrexate therapy. Keratinocyte proliferation may be considered as the stimulus that induces all other pathological and clinical changes in psoriasis and should be targeted by therapy.

RESULTS OF EVALUATING THE EFFICACY OF SECUKINUMAB VERSUS ADALIMUMAB IN TREATING PSORIATIC ARTHRITIS BY USING THE MATCHING-ADJUSTED INDIRECT COMPARISON METHOD

To date there have been no results of a direct comparison of the efficiency of using tumor necrosis factor-α inhibitors, secukinumab (SCM) and adalimumab (ADA) in particular, to treat psoriatic arthritis (PsA). This suggests that there is a need to apply the Matching-Adjusted Indirect Comparison (MAIC) method that will be able to choose a treatment option for PsA. Objective: to compare the efficacy of SCM andADAby using the MAIC method in patients with active PsA. Patients and methods. The results of usingADAin the Adalimumab Effectiveness in Psoriatic Trial (ADEPT), a randomized clinical trial (RCT), and SCM in the FUTURE 2 RCT were compared according to theAmericanCollegeof Rheumatology (ACR) and Psoriatic Area and Severity Index (PASI) criteria. The analysis based on the MAIC principles included aggregated data on 151 patients with active PsA from the ADEPT RCT and 189 patients from the FUTURE 2 RCT. Results. At 16 weeks, ACR20/50/70 responses were observed in 74.4/50.1/18.5% of the patients treated with SCM 150 mg, in 65.5/50.1/50.1% of those treated with SCM 300 mg, and in 55.6/32.5/20.5% of those receivingADA, respectively. Both doses of SCM had a significant advantage over the dose ofADAaccording to ACR20 and ACR50 responses. A PASI75 response forADAand SCM 150/300 mg was observed in 60.9 and 59.5/64.1% of the patients; and a PASI90 response was seen in 39.1 and 47.7/40.8% of the patients, respectively. At 24 weeks of treatment, ACR20, ACR50, and HAQ-DI responses in patients receiving SCM 150 and 300 mg were significantly higher than in PsA patients takingADA. No statistically significant differences were observed in ACR70 response rates. The ratio of ACR20 and ACR50 indicators was similar after 48 weeks of treatment initiation. Assessment of the dynamics of psoriasis yielded similar results. Conclusion. Patients with active PsA demonstrated the advantage of therapy with SCM 150 and 300 mg over that withADA. There was a greater improvement in quality of life in patients with PSA treated with SCM.

A novel nanogel formulation of methotrexate for topical treatment of psoriasis: optimization, in vitro and in vivo evaluation

Context: Although several formulation strategies have been developed for the treatment of psoriasis, there is an unmet need for optimization of its therapy.Objective: The objective was to develop a nanogel composed of methotrexate (MTX)-loaded nanostructured lipid carrier (MTX-NLC) and to evaluate its potential in imiquimod-induced psoriasis model to ameliorate symptoms of psoriasis.Materials and methods: MTX-NLC nanogel was prepared by hot-homogenization method and optimized by Design of Experiments. Particle size, polydispersity index (PDI) and entrapment efficiency were selected as the critical quality attributes. Antipsoriatic potential of MTX-NLC nanogel was evaluated by Psoriatic Area and Severity Index (PASI) score and histopathological examination in the imiquimod-induced psoriasis model.Results and discussion: Optimized MTX-NLC exhibited particle size of 278 ± 10 nm, PDI of 0.231 ± 0.05 and EE of 22.29 ± 1.23%. At the end of 48 h, MTX-NLC gel exhibited slow and prolonged release of MTX (47.32 ± 0.94% versus 94.23 ± 0.79%) compared to MTX gel. Furthermore, it significantly reduced the PASI score with recovery of normalcy of the mice’s skin, while the MTX gel exhibited signs of hyper and parakeratosis at the end of the study.Conclusion: The developed MTX-NLC gel formulation can be a promising alternative to existing MTX formulation in treating psoriasis.

Expression of Tumor Necrosis Factor Alpha-Induced Protein 3 mRNA in Peripheral Blood Mononuclear Cells Negatively Correlates with Disease Severity in Psoriasis Vulgaris

Psoriasis vulgaris is considered a chronic inflammatory disease, but its immunopathogenesis has not been well understood. The tumor necrosis factor alpha-induced protein 3 (TNFAIP3) gene functions in negative-feedback regulation of inflammation, and its single nucleotide polymorphism is associated with psoriasis. However, the relationship between the expression level of the TNFAIP3 gene in immune cells and psoriasis is not known so far. In the present study, TNFAIP3 mRNA expression levels in peripheral blood mononuclear cells from 44 patients with psoriasis vulgaris and 30 healthy controls were determined using real-time reverse transcription-PCR analysis. We found that expression of TNFAIP3 mRNA in all patients negatively correlated with the psoriatic area and severity index (PASI) (r = -0.5126; P = 0.0004) as well as with the percentage of body surface area affected by psoriasis (r = -0.5013; P = 0.0005). Patients were divided into mild and severe groups based on the mean PASI score. Expression of TNFAIP3 mRNA in the mild group was higher than that in the severe group (P = 0.0064). Moreover, compared with that in healthy controls, the expression of TNFAIP3 mRNA in the mild group was significantly upregulated (P = 0.0004), but the expression of TNFAIP3 mRNA in the severe group was not. These results suggest that the expression level of TNFAIP3 plays an important role in the pathology of psoriasis vulgaris and that the loss of upregulation of TNFAIP3 expression may contribute to the severity of psoriasis vulgaris.

Carotid intima-media thickness and serum leptin in psoriasis

Psoriasis, a chronic inflammatory immune disorder, has been linked to increased cardiovascular mortality and morbidity. Leptin, an obesity-related peptide, has been shown to exert direct effects on the vascular endothelium and on vascular smooth muscle cells. Carotid intima-media thickness (IMT) measurement is a promising tool for detecting atherosclerosis in its pre-occlusive/subclinical phase. The objective of the study was to evaluate carotid IMT and serum leptin levels in psoriatic patients as an indicator of subclinical atherosclerosis. The study was conducted in 50psoriatic patients and 10healthy controls. The clinical severity of skin affection in psoriatic patients was estimated using the psoriatic area and severity index (PASI). Serum leptin levels (ng\ml) and lipid profiles [including serum triglyceride (TG), serum low density lipoproteins (LDL) and serum high density lipoproteins (HDL)] were measured from blood samples. Carotid IMT was measured using carotid duplex ultrasonography. Psoriatic patients showed significantly higher leptin levels and higher IMT than controls. The mean of the intima-media thickness of the four vessels examined (MIMT) showed a positive correlation with patients' mean ages, disease duration, body mass index, PASI scores, systolic blood pressure, diastolic blood pressure, leptin levels, LDL levels and triglyceride levels and no correlation with the mean HDL level. Psoriasis is an independent risk factor for subclinical atherosclerosis. This cardiovascular impairment is influenced mainly by disease severity, serum TG levels and serum leptin levels.

Low‐dose, short‐term ciclosporin (Neoral®) therapy is effective in improving patients’ quality of life as assessed by Skindex‐16 and GHQ‐28 in mild to severe psoriasis patients

Therapies for psoriasis have focused not only on ameliorating the severity of the skin lesions, but also on the quality of life (QOL). Here, the efficacy of low-dose, short-term administration of ciclosporin (Neoral®, as CyA) was investigated. Forty-one psoriasis patients were given CyA orally (3 mg/kg per day) twice daily before breakfast and dinner until the psoriatic area and severity index (PASI) scores decreased by at least 75%. Surveys were conducted before and after the therapy to ascertain QOL, itch, nail condition, joint pain, stress associated with topical application and therapy satisfaction. QOL was assessed by using the Japanese version of Skindex-16 specific to skin diseases, and the Japanese version of the GHQ-28, which assesses mental health. Data collected from 35 patients were analyzed. Remission was achieved in 26 patients (74%), and the average length required to achieve remission was 101.5 days. The average PASI score significantly decreased from 17.8 to 3.3 after the therapy. Remission lasted 6 months or longer in 40% of the patients. The average length of time before restarting systemic therapy was 182.0 days. This duration for patients with PASI scores of <13 was 287.5 days while for patients with PASI scores of ≥13, it was significantly shorter at 120.1 days. Five adverse events were recorded in three patients, but were not serious. The total Skindex-16 score significantly decreased especially in the "emotions' and "functioning" categories. GHQ scores also significantly decreased in "somatic symptoms,""anxiety and insomnia," and "depression". With regard to patients' satisfaction with their therapy, 88.5% of the patients reported "satisfied" or "slightly satisfied". These results demonstrate that low-dose, short-term administration of CyA (3 mg/kg per day) is one of the best therapies for psoriasis patients with PASI scores of <13, while QOL assessment is a very useful tool for evaluating the value of therapy.

Infliximab in the Management of Psoriasis in Patients Previously Treated with Other Biologic Agents

Objective To determine the efficacy of infliximab in psoriatic patients with moderate to severe disease who failed to respond, relapsed, or experienced an adverse event with other biologics. Methods We evaluated 19 patients with plaque-type psoriasis. Ten also suffered from psoriatic arthritis. All subjects had been previously treated with one or more biologics and discontinued treatment either because of no response or adverse events from the precedent therapy. We evaluated the Psoriatic Area and Severity Index (PASI) score as a response to treatment. Results Overall, there was a statistically significant reduction in PASI (P = 0.002). At week 14, 88% had achieved PASI 50, 61% PASI 75, and 44% PASI 90. At this time point, no patient had discontinued treatment for any reason. Before completion of the first year of treatment, four patients discontinued infliximab because they had not seen any response. At week 78, the result remained the same as at week 14, taking into consideration the bias caused by some patients' discontinuation. Two patients discontinued because of serious adverse events. Conclusions In the small cohort of patients with moderate to severe psoriasis refractory to other biologics, infliximab is an important and safe therapeutic pathway. Differences in chemical structure, mode of action, or immunogenicity could explain the successful change to infliximab. The expanding use of biologics in clinical dermatology will allow us to describe and delineate more fully the benefit of switching from one biologic agent to another.

Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation

Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation