Psoriatic Arthritis Group Research Articles

THU0624-HPR COMPARISON OF WRIST PROPRIOCEPTION, GRIP STRENGTH AND PINCH STRENGTH IN PATIENTS WITH PSORIATIC ARTHRITIS AND RHEUMATOID ARTHRITIS: PRELIMINARY STUDY

Background:Hand articular damage occurs in rheumatoid arthritis (RA) and functional ability deteriorates as the disease progresses. Limitation of hand motion, oedema, pain etc. factors contribute to reduce grip strength, pinch strength and joint position sense; this problems contribute to function and disability. Following RA, affecting grip and pinch strength (1) and joint position sense (2) was reported former research. But there is a little knowledge about disabilitiy of hand functions in psoriatic arthritis (PsA).Objectives:To compare joint position sense, grip strength and pinch strength in patient with PsA and RA.Methods:In our cross sectional study, 23 RA patients [Mean age; 52.7±12.6, Women:20(87.0%)] who were classified according to the ACR 2010 criteria and 19 PsA patients [Mean age 53.5±12.6, Women:14 (%73.7)] who were classified according to the CASPAR criteria were included.It was recorded demographic and clinical data of patients. Wrist position sense was evaluated by goniometric re-position error test (in 30◦ wrist extansion, 3 repeat). Grip strenght was examined using a hand dynamometer (Lafayette Proffessional Hand Dynamometer, USA) and pinch strength (two point, three point, lateral) was evaluated by pinchmeter (Lafayette,USA).Results:Patients were similar in terms of age, gender, disease duration, morning stiffness duration, pain of hand joints, number of tender and swallen joints and disease activity (p>0.05). RA patients had longer disease duration (p=0.004) and lower ESR levels (p=0.046) compared to PsA. Grip and pinch strength were found similar in both dominant and non-dominant side between RA and PsA patients (Table 1). Wrist joint position error was higher in PsA group in non-dominant side (p=0.011).Table 1.Comparison of Groups for Grip and Pinch Strength and Joint Position SenseVariablesRA(n=23)Median(IQR)PsA(n=19)Median(IQR)p*Grip StrengthDominantNon-dominant20(14/25)20(14/25)25(20/29)21(15/26)0.1090.404Pinch StrengthDominant2 Point3 PointLateralNondominant2 Point3 PointLateral3.1(2.2/3.8)3(2.3/4.0)3.4(3.0/4.2)3(1.9/3.7)2.8(2.3/3.8)2.9(2.5/4.0)3(2.2/3.4)3.4(2.5/4.20)3.5(2.6/4.5)3(2.4/3.7)3.1(2.3/4.2)3.2(2.4/4.2)0.8100.4710.8400.7140.7230.561Joint Position ErrorDominantNon-dominant6(5/7)6(3/8)7(5/9)8(6/11)0.2340.011Data have shown as median (interquartile range 25-75) *Mann Whitney-U TestConclusion:Our study showed that patients with PsA had hand impairment as much as RA patients. We think, hand assessment in patients with PsA rehabilitation programme is essential for clinicians. There is need future studies including asymptomatic healthy group to interpret of results in detailed.

Increased Prevalence of Systemic Lupus Erythematosus Comorbidity in Patients With Psoriatic Arthritis: A Population-based Case-control Study.

To assess the prevalence of systemic lupus erythematosus (SLE) in a psoriatic arthritis (PsA) cohort and to compare it to the general population using the database of a large healthcare provider. We analyzed the database of a PsA cohort (2002-2017), matched for age and sex, with randomly selected controls for demographics, clinical and laboratory manifestations, and dispensed medications. Statistical analysis used t test and chi-square test as appropriate. In the PsA group, incidence density sampling was performed matching PsA patients without SLE as controls to each case of PsA with SLE by age and follow-up time. Univariable and multivariable conditional logistic regression analyses were used to assess factors affecting SLE development. The PsA and control groups consisted of 4836 and 24,180 subjects, respectively, with a median age of 56 ± 15 years, and of whom 53.8% were female. Eighteen patients (0.37%) in the PsA group and 36 patients (0.15%) in the control group were diagnosed with SLE (P = 0.001). SLE patients without PsA had higher anti-dsDNA and anticardiolipin antibodies. The usage of drugs with known potential to induce SLE was higher in the PsA than in the control group. Older age at PsA diagnosis, shorter PsA duration, and statin treatment were associated with SLE in PsA patients. A 2.3-fold increase in the prevalence of SLE in PsA relative to the control group was found. Risk factors for SLE development included older age at PsA diagnosis, shorter PsA duration, and statin treatment. The association between PsA and SLE may affect treatment choices and medication development.

Higher depression rates and similar cardiovascular comorbidity in psoriatic arthritis compared with rheumatoid arthritis and diabetes mellitus.

Background:We explore the spectrum of comorbidities in psoriatic arthritis (PsA) patients in comparison with other high comorbidity-burden diseases like rheumatoid arthritis (RA) and diabetes mellitus (DM).Methods:Two hundred and fifteen PsA patients, cross-sectionally collected from two tertiary hospitals, were compared with 215 RA and 215 DM patients (age/sex-matched, similar disease duration). Cardiovascular risk factors [hypertension, current smoking, hyperlipidaemia, obesity (body mass index (BMI) ⩾30)], coronary artery disease (CAD), stroke, major adverse cardiac events (MACEs; combined CAD and stroke), depression, osteoporosis and malignancies were recorded. Odds ratios (ORs) for stroke, CAD and MACE were adjusted for age, sex, hypertension, smoking, hyperlipidaemia, BMI, glucocorticoids use and those for depression were adjusted for age, sex, disease duration, skin involvement and smoking. Within the PsA group, associations between comorbidities and demographic/clinical features were assessed.Results:Depression [OR (95% confidence interval (CI)): 3.02 (1.57–5.81)], obesity [OR (95% CI): 2.83, (1.65–4.86)] and hyperlipidaemia [OR (95% CI): 1.96 (1.32–2.90)] were more prevalent in PsA compared with RA, while no differences were observed for CAD, stroke, MACE and malignancies. Depression [OR (95% CI): 4.85 (2.37–9.93)] and osteoporosis [OR (95% CI): 6.22 (1.33–29.2)] were more common in PsA than in DM. Hypertension, but not the other cardiovascular risk factors, was more frequent in DM [OR (95% CI) 0.49 (0.33–0.74)]. However, prevalence of stroke, CAD and MACE did not differ between PsA and DM. Within PsA group, depression was associated with age [OR (95% CI): 1.03 (0.99–1.06)], female sex [OR (95% CI): 3.47 (1.51–7.99)] and smoking [OR (95% CI): 2.78 (1.31–5.88)] while MACEs were associated with age [OR (95% CI): 1.08 (1.00–1.17)], male sex [OR (95% CI) for females: 0.26 (0.06–1.23) and hypertension [OR (95% CI): 6.07 (1.12–33.0)]. No differences were recorded in comorbidities between the different PsA phenotypes.Conclusion:Depression was more prevalent in PsA compared with RA and DM, while cardiovascular comorbidity was comparable to both groups, supporting the need for their assessment and management.

Ultrasonographic evaluation of gastrointestinal system involvement in chronic inflammatory rheumatic diseases

Aim: Although chronic inflammatory rheumatic diseases (CIRDs) primarily affect the joints due to arthritis; involvement of other systems and organs is not rare. Ultrasound evaluations are particularly useful in the detection of pathologies observed in the gastrointestinal tract. The aim of this study was to investigate and compare the results of abdominal ultrasonography in gastrointestinal system of some common chronic inflammatory rheumatic diseases.Material and Methods: 96 patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis were included in the study. The data of patients were retrospectively reviewed from patient files and hospital database. Patients with abdominal ultrasound performed for the check-up indication in the last 6 months and updated laboratory tests in the last 1 month were included in the study. The patients were divided into three groups according to the diagnosis and the results were compared.Results: No gastrointestinal system involvement was observed in the patients except liver and gallbladder pathologies. The most frequent liver pathologies were hepatosteatosis (49.0%) and hepatomegaly (41.7%), respectively. The rate of patients with cholecystectomy was 8.3% and 6.3% of the patients had gallstones. When the results were compared between the groups, it was seen that only the incidence of gallstones was significantly higher in the psoriatic arthritis group than in other groups.Conclusion: In the course of chronic inflammatory rheumatic diseases, many organ and system involvement may be observed. Abdominal ultrasound imaging, especially in patients with additional risk factors, may be useful for early detection of many intra-abdominal organ pathologies, especially the gastrointestinal tract.

A potential inflammatory role of IL-31 in psoriatic arthritis: A correlation with Th17 cytokine profile.

The goals of our study were to determine the possible association of interleukin (IL)-31 with Th17 cytokine profile in serum and to quantify retinoic acid-related orphan receptor C (RORC) mRNA expression in psoriatic arthritis (PsA) patients. This cross-sectional study was conducted in 50 patients with PsA and 30 control subjects (CS) matched by age and gender. The cytokine serum levels were quantified by magnetic bead–based assay using the Bio-Plex MAGPIX system, and RORC mRNA expression was determined by quantitative polymerase chain reaction (qPCR). As a result, significant differences in IL-31 were observed between study groups (77.23 pg/mL in PsA vs 64.4 pg/mL in CS, P < 0.001) and Th17 cytokine profile serum levels (IL-17A: 6.36 pg/mL in PsA vs 2.97 pg/mL in CS, P = 0.02; IL-17F: 44.15 pg/mL in PsA vs 23.36 pg/mL in PsA, P = 0.01; IL-17E: 3.03 pg/mL in PsA vs 0.82 pg/mL in CS, P < 0.001; IL-21: 36.45 pg/mL in PsA vs 12.44 pg/mL in CS, P = 0.02); however, significant differences were not observed for IL-23 (31.2 pg/mL in PsA vs 53.26 pg/mL in CS, P = 0.58). Furthermore, positive correlations between IL-31 and Th17 cytokine profile serum levels were found (IL-17A: rs = 0.64, P < 0.001; IL-17F: rs = 0.73, P < 0.001; IL-17E: rs = 0.70, P < 0.001; IL-21: rs = 0.54, P = 0.002; IL-23: rs = 0.5, P < 0.01). Regarding RORC gene expression, the PsA group showed an increase of 6.85-fold compared to the CS group. We did not find any association between the serum levels of cytokines and RORC gene expression. In conclusion, in PsA, there are increased serum levels of IL-31, IL-17A, IL-17F, IL-17E, and IL-21, but not IL-23. Moreover, there was a positive correlation of IL-31 with the Th17 cytokine profile and a high RORC gene expression. Altogether, these findings suggest a proinflammatory contribution of IL-31 in close association with the Th17 cytokine profile in PsA.

The Role of Traditional Risk Factors and Inflammation Activity in Atherosclerosis Development in Psoriatic Arthritis Patients

It is known that patients with autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus) have early atherosclerosis development which might lead to the life threatening complications and death. Epidemiology studies demonstrated the risk of myocardial infarction, cardiovascular death is increased in patients with psoriatic arthritis (PsA), which also can be explained by premature atherosclerosis development but its risk factors (RF) remain unclear.The objective: defining relationship of traditional RF for cardiovascular diseases (CVD) with the activity of the inflammatory process and atherosclerosis in patients with PsA.Materials and methods. The study included 42 patients with PsA and 20 patients with skin psoriasis (PS) who did not have atherosclerotic CVD, diabetes, chronic kidney disease and other serious diseases and did not take statins. The control group consisted of 20 healthy persons who had no signs of rheumatic, infectious and other inflammatory diseases. All enrolled patients underwent complete physical examinations, evaluation of disease activity (DAS28, PASI indexes); laboratory investigations included full blood count and ESR, CRP, plasma lipids and uric acid level. Ultrasound of carotid arteries was performed to evaluate the surrogate atherosclerosis markers – intima-media complex thickness (IMT) and atherosclerotic plaques (AP).Results. It was determined that in patients with PsA, the severity of the atherosclerotic process is more prominent compared to patients with PS (the traditional RF profiles were the same).Сonclusion. The highest level of C-reactive protein, fibrinogen, uric acid, thicker intima-media complex was found in PsA group, which may indicate a pathogenetic association of additional RF with the development of a more aggressive atherosclerotic process.

Immunogenicity and safety of vaccination against seasonal influenza vaccine in patients with psoriatic arthritis treated with secukinumab

ObjectiveTo assess the immunogenicity and safety of vaccination against seasonal influenza in psoriatic arthritis (PsA) patients treated with secukinumab versus healthy controls (HC). MethodsPsA patients administered secukinumab for ≥3 months and HC received the Sanofi Pasteur vaccine composed of 3 antigens (H3N3, H1N1, and B) and underwent clinical and laboratory assessments on the day of vaccination and 4–6 weeks later. Immunogenicity of the vaccine was evaluated by hemagglutination inhibition assay against those 3 antigens. Responders to each antigen were defined by a 4-fold increase in the antigen titer or by seroconversion in patients whose baseline level was <1/40. ResultsThirty-two consecutive PsA patients treated with secukinumab for ≥3 months comprised the study group, 10 of whom received concomitant conventional synthetic disease-modifying drugs, mostly methotrexate. There were 17 age- and gender-matched HC (median age 48.5 years, 6 females). The geometric mean titers of each antigen increased significantly in both groups. The number of responders in each group was similar for H3N2 and H1N1, and significantly higher for B/Brisbane in the PsA group. The proportion of patients with a seroprotective level (a titer >1/40) was high and similar in both groups. There was no correlation between the response rate and age, gender, or selected parameters of disease activity (tender/swollen joint counts, Leeds enthesitis index, physician and patient global assessment, psoriasis area severity index, and C-reactive protein). No disease exacerbation was observed following the vaccination. No serious adverse effects were observed in both groups during the study period. ConclusionSecukinumab treatment does not affect the humoral response to influenza vaccine of patients with PsA.

Usefullnes of atherogenic indices and Ca-LDL level to predict subclinical atherosclerosis in patients with psoriatic arthritis?

BackgroundTo investigate the link between carbamylated low-density lipoprotein (ca-LDL), atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli’s risk indices I and II (CRI I and II) and subclinic atherosclerosis in psoriatic arthritis (PsA).MethodsThirty-ninepatients and 19 age, sex, body mass index matched healthy controls were included. Insulin resistance (IR) was assessed with homeostasis of model assessment-IR (HOMA-IR). Carotid intima-media thickness (CIMT) was measured at both common carotid arteries and mean CIMT was calculated.ResultsThe mean age was 49.50 ± 11.86 years and 64.1% were females in PsA group. In the PsA group, CIMT and HOMA-IR were significantly higher (p = 0.003, p = 0.043, respectively). AIP, AC, TG/HDL, CRI-1, CRI-2 and ca-LDL levels were similar between groups. In PsA group, CIMT was positively correlated with HOMA-IR, TG/HDL and AIP. Although ca-LDL was positively correlated with serum amyloid A (r = 0.744, p < 0.001), no correlation was detected between ca-LDL and CIMT (r = 0.215, p = 0.195). PsA patients with IR tended to have higher ca-LDL levels than patients without IR, but this difference lacked statistical significance (33.65 ± 26.94, 28.63 ± 28.06, respectively, p = 0.237).ConclusionsA significant increase in CIMT was seen in PsA patients without clinically evident cardiovascular disease or any traditional atherosclerosis risk factors. CIMT was correlated with HOMA-IR, TG/HDL and AIP.

Risk of End-Stage Renal Disease in Psoriatic Patients: Real-World Data from a Nationwide Population-Based Cohort Study

Psoriasis is a chronic inflammatory skin disorder mediated by the T-cell–related immune response. Psoriatic patients may have a variety of comorbidities, but their risk of end-stage renal disease (ESRD), particularly according to the subtype of psoriasis, is unclear. We investigated the risk of ESRD in patients with psoriasis according to the subtype of psoriasis and history of systemic therapy for psoriasis. A total of 2,121,228 adults (1,590,921 in the control group and 530,307 in the psoriasis group) were enrolled in this nationwide population-based cohort study until 2015. During follow-up, 1,434 of the subjects in the psoriasis group developed ESRD. After adjusting for confounding factors, psoriasis was associated with the risk of ESRD (hazard ratio (HR) 1.58, 95% confidence interval [95% CI] 1.47–1.68). The psoriatic arthritis group (HR 7.60, 95% CI 1.90–30.41) had a higher risk of ESRD than the control group. Interestingly, no such association was detected in the systemically treated group (HR 1.07, 95% CI 0.80–1.41). Moreover, the acitretin-treated group had a lower risk of ESRD (HR 0.658, 95% CI, 0.494–0.875) than the non-systemically treated group. In conclusion, the risk of developing ESRD in patients with psoriasis differed according to the type of treatment and the presence of arthritis.

The incidence of extra-articular manifestations in southern Chinese patients with inflammatory joint diseases.

Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors. This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded. We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P<.001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P=.019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P<.001) and higher disease activity (OR 3.24-7.42, both P<.05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P=.036) and higher disease activity (OR 1.15, P=.004) were univariate associated factors. These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.

Educational needs in people with ankylosing spondylitis and psoriatic arthritis: a cross-sectional study

To assess the educational needs of people with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), test differences across patient subgroups and identify factors independently associated with their educational needs. This was a cross-sectional analytic study. Patients with AS and PsA completed the Portuguese version of the Educational Needs Assessment Tool (PortENAT). Data were Rasch-transformed before descriptive and inferential analyses were undertaken. Univariable and multivariable analyses were used to determine differences between patient subgroups and factors independently associated with their educational needs. The study included 121 patients with AS and 132 with PsA. The level of educational needs varied by diagnostic group, but higher needs for both subgroups were reported regarding the "Disease process", "Feelings" and "Managing pain" domains. Overall, patients with AS had a higher level of educational needs than those with PsA. In both diagnostic groups, female gender was independently associated with higher educational needs. In the PsA group, a shorter disease duration was independently associated with higher educational needs in the following domains: "Managing pain", "Movement" and "Feelings". Educational needs vary by diagnostic group, gender and disease duration. These differences merit consideration in the design of patient education interventions.

Cardiac and cardiovascular morbidities in patients with psoriatic arthritis: a population-based case control study.

To assess the prevalence of risk factors associated with cardiovascular disease (CVD) and CVD-related morbidity in a large Middle-Eastern psoriatic arthritis (PsA) cohort. A retrospective case control study was conducted using Israel's largest health care provider's patient database from 2000 to 2013. For each patient with PsA, 10 patients with no history of psoriasis or arthritis were matched for age and sex. Analysis of CVD-related risk factors and morbidity included hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus type 2 (DM-2), obesity, smoking, ischemic heart disease (IHD), congestive heart failure (CHF), cerebrovascular accident (CVA), carotid artery disease, peripheral vascular disease (PVD), aortic aneurism, valvular heart disease (VHD), and cardiomyopathy. Statistical analysis was conducted using t test and chi-square tests as appropriate. Univariate and multivariable logistic regression models assessed the association between PsA and CVD-related risk factors and morbidity. Three thousand one hundred sixty-one PsA patients were included, with average age 58 ± 15.0years, of whom 53.4% were women. Increased prevalence of DM-2, HLD, HTN, and obesity (OR 1.7, 1.5, 1.5, 1.5 respectively) was noted in the PsA group. Increased prevalence of IHD (p < 0.0001), PVD (p < 0.0001), CHF (p = 0.002), VHD (p < 0.0001), and cardiomyopathy (p = 0.006) was found in the PsA group compared to the control group even after adjusting for CVD risk factors. A high prevalence of CVD-related risk factors and morbidity was found in this Middle Eastern PsA population, in accordance with data from other geographic regions. These results emphasize the importance of clinician awareness of the increased risk for CVD-related complications in PsA patients.

Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study.

The purpose of the ULISSE study was to evaluate the prevalence of clinical and ultrasonographic (US) entheseal involvement in patients with psoriatic arthritis (PsA), psoriasis, and fibromyalgia syndrome (FMS). In this cross-sectional multicenter study, patients with PsA and psoriasis (not taking systemic therapy) and FMS underwent a clinical evaluation of the entheses, and a B-mode and power Doppler examination of 6 pairs of entheses. The study analyzed 140 patients with PsA, 51 with psoriasis, and 51 with FMS. Clinical and US examinations were performed in 1960 and 1680 entheses in the PsA group, and 714 and 612 entheses both in the psoriasis group and in the FMS group. In both per-patient and per-enthesis evaluation, the frequency of entheseal tenderness was higher in patients with FMS (92% of the patients and 46% of the entheses, compared with 66%/23% in the PsA group and 59%/18% in the psoriasis group). With US examination, signs of entheseal involvement were more frequent in both the per-patient and per-enthesis evaluation in PsA and psoriasis (about 90% of patients in both the PsA and psoriasis groups and 75% of patients in the FMS group had at least 1 site affected, and 54%, 41%, and 27% of the pairs of entheses in, respectively, PsA, psoriasis, and FMS patients showed at least 1 enthesis involved). The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

Взаимосвязь традиционных факторов риска с активностью воспалительного процесса и атеросклерозом у больных псориатическим артритом

The article is devoted to the study of the relationship of traditional risk factors for cardiovascular diseases with the activity of the inflammatory process and atherosclerosis in patients with psoriatic arthritis. The study included 32 patients with PsA who did not have atherosclerotic cardiovascular disease, diabetes, chronic kidney disease and other serious diseases, did not take statins, the control group consisted of 19 patients with psoriasis. It was revealed that in patients with psoriatic arthritis, the severity of the atherosclerotic process is more compared with patients with psoriasis (the risk factors profiles were the same). The highest levels of C-reactive protein, fibrinogen, uric acid, intima-media complex thickness, atherosclerotic plaque frequency were found in patients in the psoriatic arthritis group, which may indicate a pathogenetic association of additional RF with the development of a more common atherosclerotic process.

Outcome of pregnancy in women with psoriatic arthritis compared to healthy controls.

The mean age at onset of psoriatic arthritis (PsA) ranges between the 4th-6th decades of life. However, little is known about fertility and pregnancy outcome in PsA patients. The aim of this study was to examine whether fertility and pregnancy outcome of PsA patients are different from healthy controls and to evaluate PsA and psoriasis disease activity perception during pregnancy and the year postpartum. A questionnaire-based study, including demographic, fertility, pregnancy outcome, and disease activity questions, was conducted in PsA patients and healthy controls. The inclusion criterion was diagnosis of PsA before at least 1 pregnancy. Descriptive statistics are provided. T tests and Pearson chi-square tests were used to analyze the differences between continuous and categorical variables, respectively. The 74 PsA patients and 74 healthy controls were not significantly different in most of the demographic variables. The mean number of pregnancies, children, and infertility diagnosis were not significantly different between the groups. The pregnancy outcomes in the PsA group (n = 151) and in the control group (n = 189) were similar in: live birth (76% vs. 76%, P = 0.3), vaginal delivery (48% vs. 51%, P = 0.6), gestation age (38.5 vs. 38.3, P = 0.3), weight at birth (3.4kg vs. 3.4kg, P = 0.5), low rate of maternal and fetal complications, and the duration and rate of breastfeeding. Most (58%) patients reported favorable joint activity during pregnancy and 50% reported worsening during the 1st postpartum year. PsA patients do not have more infertility or worse pregnancy outcomes compared to healthy controls.

Increased risk for incident thyroid diseases in people with psoriatic disease: A cohort study

The association between psoriasis and thyroid diseases is unclear. To examine the risk for thyroid diseases among psoriasis patients. We used Taiwan's National Health Insurance Research Database to conduct a nationwide cohort study. We examined the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident thyroid diseases in relation to psoriasis and psoriatic arthritis. We identified 13,266 patients with psoriatic arthritis (psoriatic arthritis group), 149,576 with psoriasis alone (psoriasis group), and 162,842 nonpsoriasis controls. Compared with the nonpsoriasis controls, the psoriatic arthritis and psoriasis groups had increased risk for incident hyperthyroidism (aHR 1.32, 95% CI 1.07-1.65 [psoriatic arthritis]; aHR 1.22, 95% CI 1.11-1.33 [psoriasis]) and Graves disease (aHR 1.38, 95% CI 1.07-1.79 [psoriatic arthritis]; aHR 1.26, 95% CI 1.13-1.41 [psoriasis]). Both groups also had increased risk for incident hypothyroidism (aHR 1.74, 95% CI 1.34-2.27 [psoriatic arthritis]; aHR 1.38, 95% CI 1.23-1.56 [psoriasis]) and Hashimoto thyroiditis (aHR 2.09, 95% CI 1.34-3.24 [psoriatic arthritis]; aHR 1.47, 95% CI 1.18-1.82 [psoriasis]). Lack of data on psoriasis severity. People with psoriatic disease are associated with an increased incident thyroid diseases, including hyperthyroidism, hypothyroidism, thyroiditis, Graves disease, and Hashimoto thyroiditis. Endocrinology consultation may be considered when psoriasis patients present with thyroid symptoms.

Prevalence of minimal disease activity in Australian patients with Psoriatic Arthritis: Assessing the outcome of national funding criteria for biologic disease-modifying antirheumatic drug prescribing.

Discrepancies exist between international treatment guidelines and current Australian Pharmaceutical Benefits Scheme (PBS) criteria for funding biologic disease-modifying antirheumatic drug (bDMARD) prescribing in psoriatic arthritis (PsA). We aimed to determine the prevalence of minimal disease activity (MDA) achievement and differences in inflammatory marker levels between PsA patients who have and have not met the Australian PBS criteria for bDMARDs. Consecutive participants diagnosed with PsA were assessed for MDA components and serum inflammatory markers. For those on bDMARDs, joint counts and inflammatory markers at the time of bDMARD qualification were compared with matched rheumatoid arthritis (RA) controls. Minimal disease activity was achieved by 56/105 participants overall. There were no differences in inflammatory marker levels or involved joint count patterns between the PsA and RA groups at the time of bDMARD qualification. Seventy-three percent of the 53 PsA patients on bDMARD achieved MDA, vs 33% in the non-bDMARD group (P<0.001). More bDMARD than non-bDMARD patients achieved four out of seven MDA components. Of those with any enthesitis, its prevalence was higher in the non-bDMARD group (22 vs 10, P=0.009). Regardless of treatment, there was no difference in inflammatory marker levels between those who did and did not achieve MDA. The Australian PBS criteria, funding bDMARD prescribing for PsA, select well for MDA achievers. A high prevalence of MDA non-achievement remains in patients ineligible for bDMARD funding, and enthesitis in this population is more common. Inflammatory markers were not discriminators between treatment or MDA achievement groups.

Evaluation of restless legs syndrome and sleep disorders in patients with psoriatic arthritis.

Restless legs syndrome (RLS) is aneurological disease with achronic course that is characterised by sleep disorders and sensorimotor impairment. The aim of this study was to evaluate the prevalence and severity of RLS in psoriatic arthritis (PSA) patients and those with psoriasis(P). The study included 50patients with psoriasis (28females, 22males), 50PSA patients (33females, 17males) and 50 healthy control subjects (34females, 16males), and all 3groups were matched with respect to age, gender and body mass index (BMI). Evaluations were made using the International RLS Rating Scale, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Insomnia Severity Index, Fatigue Severity Scale (FSS), Beck Depression Index (BDI) and the SF-36 quality of life scores. RLS was determined at ahigher rate in the PSA patients (64.0%), compared to the Pgroup (20.0%, p < 0.001) and the control group (14.0%, p < 0.001). The number of moderate and severe RLS cases was significantly higher in the PSA group (68.7%) compared to the Pgroup (30%, p < 0.001) and the control group (0%, p < 0.001). In regression analysis, an independent correlation was found between the RLS score and PSQI (beta [β] = 0.269, p = 0.002), FSS (β = 0.243, p = 0.003), SF-36 physical score (β = 0.242, p = 0.004) and BDI (β = 0.177, p = 0.036). RLS was determined in PSA patients at ahigher rate than in psoriasis patients. The presence of RLS in PSA and psoriasis patients is related to impairments in sleep and quality of life, fatigue and depression.

Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran.

Background Psoriatic arthritis (PsA) results in an increased burden of psoriasis and impairs both quality of life and an individual's functional capacity. The relationship between nail involvement and PsA in psoriasis is not fully characterized. Aim To evaluate the frequency and characteristics of nail involvement in psoriatic patients and to assess the relationship with joint involvement. Methods A total of 197 patients with moderate-to-severe psoriasis were consecutively invited to participate in this cross-sectional study. The patients are divided into two groups: those with and those without psoriatic arthritis. Results 69.5% of psoriatic (137 out of 197) patients had nail involvement. The most common nail abnormality was onycholysis, followed by pitting and oil droplet changes. Nail involvement was more common in patients with psoriatic arthritis (82.1% versus 57.8%, p=0.001). Conclusion Nail involvement is commonly associated with PsA. Onycholysis, splinter hemorrhage, and oil drop were significantly more common in the PsA group as opposed to patients with just skin findings. In general, psoriatic patients with arthritis had more severe disease.

Comparative Study of Vitamin D Level between Psoriatic Patients and Psoriatic Arthritis Patients

Background Psoriatic arthritis (PsA) is a seronegative (rheumatoid factor-negative) usually Cyclic Citrullinated Peptide (CCP) antibody negative, immunologically triggered, chronic inflammatory joint disease within the framework of psoriasis. Psoriasis affects 2–4% of the general population. It is a common, chronic, relapsing/remitting, immune-mediated systemic disease characterized by skin lesions including red, scaly patches, papules and plaques, which usually itch. Vitamin D is actually a fat-soluble steroid prohormone that has endocrine, paracrine and autocrine functions. Aim of the Work: To investigate the level of serum vitamin D in patients with psoriatic arthritis and compare it with patients with psoriasis to show if there is a role of vitamin D in development of arthritis in psoriatic patients or not. Patients and Methods: This study is a cross sectional study in which fifty patients with psoriatic arthritis and psoriasis age range 16-50 years selected from those attending the outpatient clinic and inpatients of rheumatology, physical medicine &rehabilitation department, Al-Azhar university hospitals from 2017 to 2018 and divided into two groups: Group (A): (25) patients with psoriatic arthritis were diagnosed according to the criteria for psoriatic arthritis classification “CASPAR criteria”. Group (B): (25) patients with skin psoriasis. In this study we measured of 25 hydroxy vitamin D3 using commercial ELISA kits, ESR, CRP, CBC, Blood urea, serum creatinine, Liver enzymes (SGOT & SGPT), Serum uric acid, Fasting blood glucose, RF, urine analysis, ANA, HCV Ab and HIV Ab. Plain x-ray on both hands postero-anterior view, Plain x-ray on lumbosacral spine antero- posterior and lateral views and Plain x-ray on both sacroiliac joints “cone” view. Results: There was female sex predicliction in psoriatic arthritis group. Otherwise, both groups were comparable regarding age, BMI, residence, co-morbid diseases, disease characteristics, and laboratory investigations, except significant increase of WBCs and inflammatory markers (ESR and CRP) in psoriatic arthritis group. Diseases severity was mild in 72%, moderate in 22% and severe in 6.0%; and there was statistically significant increase of moderate and severe disease in PA when compared to psoriasis group. vitamin D was sufficient in 32.0%, insufficient in 34.0% and deficient in 34.0%; and there was no significant difference between psoriasis and PA groups. In addition, vitamin D levels were increased in psoriasis when compared to PA groups. However, the difference was statistically non-significant. No significant relation was found between vitamin D from one side and each of patient characteristics, laboratory investigations (except significant positive correlation with hemoglobin and RBCs), disease characteristics (except significant inverse (negative) correlation with disease duration and disease severity), X-ray findings, and psoriatic arthritis disease activity indices. Conclusion: Vitamin D deficiency/insufficiency was common among psoriasis and psoriatic arthritis patients and the deficiency was significantly and inversely correlated with disease severity (PASI) and disease duration. Thus, is thought to play a role in development (or a consequence) of psoriasis. On the other hand, there was no correlation with PA disease activity and severity indices. Thus, the association seems to be linked to psoriasis proper. Vitamin D supplementation thought to have a potential therapeutic role in treatment of psoriasis.