Psoriatic Arthritis In Psoriasis Patients Research Articles

From Psoriasis to Psoriatic Arthritis: Ultrasound Insights Connecting Psoriasis with Subclinical Musculoskeletal Inflammation and the Path to Psoriatic Arthritis.

This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients. MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established.

PAPRIKA: A Question Bank for Assessing Psoriatic Arthritis Risk in Individuals of Diverse Ancestries.

We aimed to create a question bank about clinical factors for predicting the diagnoses of psoriatic arthritis in patients with psoriasis of various ancestries and skin tones, which can be completed entirely by patients. Utah Psoriasis Initiative participants without a psoriatic arthritis diagnosis at enrollment were observed for diagnosis during the study period. We inferred ancestry from exome sequencing data and performed Cox proportional hazards regression to identify clinical predictors of psoriatic arthritis in different ancestry groups. Based on results and literature review, we developed a question bank for assessing psoriatic arthritis risk among patients with psoriasis in various ancestries. Patient-reported untreated psoriasis induration and history of fingernail psoriasis were associated with psoriatic arthritis in participants of European and non-European ancestry. We developed the Psoriatic Arthritis Prediction and Identification Question Bank for Diverse Ancestries (PAPRIKA) version 1.0, which included questions regarding psoriasis characteristics, arthritis symptoms, comorbidities, family history, and demographics. PAPRIKA is accessible at http://bjfenglab.org/. The clinical features (untreated psoriasis induration and history of fingernail psoriasis) that can predict psoriatic arthritis in European individuals also work for non-European individuals. PAPRIKA can be used to gather psoriatic arthritis predictive data from patients with psoriasis without provider assistance and is relevant for patients across ancestries.

Establishment of Prediction Model for Psoriatic Arthritis Based on Logistic Regression

Background: Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease associated with psoriasis (PsO) that appears approximately 7-8 years after psoriasis and remains undiagnosed in most of patients, which is disabled and difficult to treat. So early risk assessment is particularly important. However, at present, the risk assessment of the status quo is not optimistic. The aim of this study was to establish and validate a prediction model for assessing the risk of PsA in psoriasis patients. Methods: Ambispective cohort study was conducted. Demographic and clinical records were collected and followed up and blindly reviewed. Single and multiple factors analysis were used to analyze the factors influencing PsA, and Logistic regression equation models were developed to verify their predictive value. Results: Among 1141 Pso patients, 221 patients had PsA. Logistic regression equation model showed that Arthralgia (OR= 438.079; 95% CI: 175.154-1095.682), nail dystrophy (OR= 7.453; 95% CI: 4.116-13.498), scalp lesions (OR= 3.047; 95% CI: 1.297-7.159), Inverse (intertriginous) lesions (OR= 2.45; 95% CI: 1.382-4.342) and BMI (OR= 0.909; 95% CI: 0.846-0.977) were identified as potential predictors affecting the risk of transition from PsO to PsA. And the receiver operating characteristic (ROC) curve of PsA was drawn, the area under the curve (AUC) was 0.974 (95% CI 0.963 - 0.985), the prediction sensitivity was 96.40%, the specificity was 92.10%, the calibration curve showed that the predicted results was in good agreement with the observed results. Conclusion: The independent predictors of PsA involve Arthralgia, nail dystrophy, scalp lesions, Inverse (intertriginous) lesions, BMI. The Logistic prediction model based on these predictors has reliable predictive value and can help early clinical assessment and treatment.

Ultrasound-based detection of inflammatory changes for early diagnosis and risk model construction of psoriatic arthritis.

PsA is the most prevalent coexisting condition associated with psoriasis. Early-stage PsA patients always present unspecific and subtle clinical manifestations causing delayed diagnosis and leading to unfavourable health outcomes. The application of US enables precise identification of inflammatory changes in musculoskeletal structures. Hence, we constructed US models to aid early diagnosis of PsA. This was a cross-sectional study carried out in the Department of Dermatology at West China Hospital (October 2018-April 2021). All participants underwent thorough US examinations. Participants were classified into the under 45 group (18 ≤ age ≤ 45 years) and over 45 (age >45 years) group and then randomly grouped into derivation and test cohort (7:3). Univariable logistic regression, least absolute shrinkage and selection operator, and multivariable logistic regression visualized by nomogram were conducted in order. Receiver operating characteristic (ROC), calibration curve, decision curve analysis (DCA) and clinical impact curve analysis (CICA) were performed for model verification. A total of 1256 participants were included, with 767 participants in the under 45 group and 489 in the over 45 group. Eleven and 16 independent ultrasonic variables were finally selected to construct the under 45 and over 45 model with the area under the ROC of 0.83 (95% CI 0.78-0.87) and 0.83 (95% CI 0.78-0.88) in derivation cohort, respectively. The DCA and CICA analyses showed good clinical utility of the two models. The implementation of the US models could streamline the diagnostic process for PsA in psoriasis patients, leading to expedited evaluations while maintaining diagnostic accuracy.

Predicting Psoriatic Arthritis in Psoriasis Patients - A Swiss Registry Study.

Psoriatic arthritis (PsA) is a prevalent comorbidity among patients with psoriasis, heavily contributing to their burden of disease, usually diagnosed several years after the diagnosis of psoriasis. To investigate the predictability of psoriatic arthritis in patients with psoriasis and to identify important predictors. Data from the Swiss Dermatology Network on Targeted Therapies (SDNTT) involving patients treated for psoriasis were utilized. A combination of gradient-boosted decision trees and mixed models was used to classify patients based on their diagnosis of PsA or its absence. The variables with the highest predictive power were identified. Time to PsA diagnosis was visualized with the Kaplan-Meier method and the relationship between severity of psoriasis and PsA was explored through quantile regression. A diagnosis of psoriatic arthritis was registered at baseline of 407 (29.5%) treatment series. 516 patients had no registration of PsA, 257 patients had PsA at inclusion, and 91 patients were diagnosed with PsA after inclusion. The model's AUROCs was up to 73.7%, and variables with the highest discriminatory power were age, PASI, physical well-being, and severity of nail psoriasis. Among patients who developed PsA after inclusion, significantly more first treatment series were classified in the PsA-group, compared to those with no PsA registration. PASI was significantly correlated with the median burden/severity of PsA (P = .01). Distinguishing between patients with and without PsA based on clinical characteristics is feasible and even predicting future diagnoses of PsA is possible. Patients at higher risk can be identified using important predictors of PsA.

The Frequency of Association of Nail Involvement and Psoriatic Arthritis in Psoriasis Patients.

While the relationship between psoriatic arthritis and skin findings is well-known in patients with psoriasis, the relationship between psoriatic arthritis and nail involvement is less known. In this study, it was aimed to examine the frequency of association between nail involvement and psoriatic arthritis in patients with psoriasis. Our study is a retrospective observational study. It was conducted with 250 regis- tered patients who applied to the dermatology polyclinic and clinic of our university hospital. The follow-up forms of the patients were scanned retrospectively and the findings were recorded. The average age of the 250 patients evaluated in this study was 39.62 ± 9.30, and 133 (53.2%) of them were women. The frequency of nail involvement in psoriasis patients was determined to be 36.8% (n=92) and the frequency of arthritis was determined to be 8.8% (n=22). Nail involvement was statisti- cally significantly more common in those with arthritis, and nail involvement was present in all of those with arthritis (P < .001). Nail involvement was significantly more common in those with only arthralgia (P < .001). A significantly higher average of nail psoriasis severity index was found in those with both joint and nail involvement compared to those with only nail involvement (P < .001). There was no statistically significant difference in terms of psoriasis area severity index average (P=.235). Proximal and distal interphalangeal arthralgia and sacroiliac arthralgia were found significantly more frequently in those with nail involvement than in those without nail involvement (respectively P = .007 and P < .001). There was no statistically signifi- cant relationship between nail involvement with the presence of arthritis and the clinical type (respectively P = .288 and P = .955). Joint involvement and nail involvement in patients with psoriasis are closely related, and we think that nail and joint involvement in psoriasis patients should be evaluated together.

Do Patients with Psoriatic Arthritis Have More Severe Skin Disease than Patients with Psoriasis Only? A Systematic Review and Meta-Analysis

Background: Early identification of patients at risk of psoriatic arthritis (PsA) is essential to facilitate early diagnosis and improve clinical outcomes. Severe cutaneous psoriasis has been proposed to be associated with PsA, but a recent assessment of the evidence is lacking. Therefore, in this systematic review, we address the association of psoriasis skin severity with the presence and development of PsA. Summary: We included articles from a review published in 2014 and supplemented these with recent literature by performing an additional systematic search to identify studies published between 1 January 2013 and 11 February 2021. A meta-analysis was performed when sufficient comparable evidence was available. Of 2,000 screened articles, we included 29 in the analysis, of which 16 were identified by our updated search. Nineteen studies reported psoriasis severity as psoriasis area and severity index (PASI), ten studies as body surface area (BSA), and two studies as “number of affected sites.” Most studies show that more extensive skin disease is associated with the presence of PsA. The quantitative pooled analyses demonstrate higher PASI (mean difference [Δ] 1.59; 95% confidence interval [CI] 0.29–2.89) and higher BSA (Δ 5.31; 95% CI 1.78–8.83) in patients with PsA as compared to psoriasis patients without PsA. Results from prospective studies – that assess the risk of future development of PsA in psoriasis patients – were inconclusive. Key Messages: In patients with psoriasis, more severe skin involvement is associated with the presence of PsA, underpinning the importance of optimal dermatology-rheumatology collaboration in clinical care. There are insufficient data to support the use of psoriasis skin severity to predict the future development of PsA in psoriasis patients.

New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

Psoriasis and psoriatic arthritis (PsA) development is sustained by tumor necrosis factor (TNF)α, interleukin (IL)17, and IL23; hence, biologics targeting those cytokines represent useful therapeutic weapons for both conditions. Nevertheless, biologics strongly reduce PsA risk; several studies reported the possibility of new-onset PsA during biologic therapy for psoriasis. The aim of this 1-year prospective study is to evaluate the prevalence of paradoxical PsA in psoriasis patients under biologic therapy and review the existing literature. For each patient, age, sex, psoriasis duration, psoriasis severity, comorbidities, and previous and current psoriasis treatments were collected, and each subject was screened for PsA using the Early ARthritis for Psoriatic patient (EARP) questionnaire every 3 months for 1 year. New-onset PsA was diagnosed in 10 (8.5%) out of 118 patients (three male, 30.0%; mean age 44.5 years) involving every different biologic class (anti-TNF, anti-IL12/23, anti-IL17, and anti-IL23). No significant risk factor for new-onset PsA was identified; no significant difference was found comparing patients who developed PsA and subjects who did not develop PsA regarding psoriasis severity, past/current therapies, and comorbidities. Clinicians must keep in mind the possibility of PsA onset also in patients undergoing biologics so that PsA screening should be strongly recommended at each follow-up.

Psoriatic arthritis in patients with psoriasis: A clinical-epidemiological study at a dermatology center in western Mexico.

Psoriatic arthritis (PsA) is a chronic inflammatory illness. Approximately, 15% of psoriasis patients have undiagnosed PsA. In Mexico, we found no related studies. Our objective was to investigate the clinical-epidemiological characteristics of PsA in psoriasis patients in western Mexico. A cross-sectional study including Mexican patients with clinical and histopathological diagnosis of psoriasis. Physical examination, rheumatoid factor analysis and radiographies of axial and peripheral skeleton were performed. The prevalence of PsA using the CASPAR criteria, age, sex; clinical variants of PsA, psoriasis type and the Psoriasis Area and Severity Index (PASI), were assessed. Descriptive and inferential statistics were used. Of 90 patients with psoriasis, 48 met the criteria for PsA, with a prevalence of 53%, and average age of 50±15years. Predominating were, the female sex in 29 (60%), the axial variant of PsA in 24 (50%), and psoriasis plaques in 40 (83%). The average PASI was 12±11. All cases were rheumatoid factor negative. These variables were not significantly different when comparing subjects with and without PsA, except for the female sex (60% vs. 7%; P<0.001). Patients with psoriasis should intentionally be evaluated jointly Dermatologists and Rheumatologists searching joint involvement given the high prevalence of PsA previously undiagnosed.

16742 Depression as a risk factor for the development of psoriasis

Background: Depression has been linked to increased levels of inflammatory cytokines including TNF-α and IL-6, sharing some inflammatory cytokines associated with psoriasis. Moreover, depression is an independent risk factor for developing psoriatic arthritis in psoriasis patients, suggesting that depression may influence the disease course of psoriasis. Our study investigated whether depression increases the risk of developing psoriasis in the first place.

Psoriatic arthritis epidemiology, comorbiddisease profiles and risk factors: results from a claims database analysis.

ObjectivePsoriasis is a systemic inflammatory disease often accompanied by comorbidities, including metabolic syndrome, cardiovascular diseases and depression. Up to 41% of psoriasis patients develop psoriatic arthritis (PsA), making it one of the most relevant manifestations. A large health claims data set was analysed to determine the rate of PsA development in psoriasis patients. Furthermore, comorbid disease profiles of psoriasis patients with or without PsA were compared, and potential risk factors for the development of PsA were identified.MethodsThis was a non-interventional, retrospective analysis of anonymized insurance health claims data using a subset of the Institute of Applied Health Research Berlin (InGef) database. The primary outcome was the prevalence and incidence of diagnosed PsA among psoriasis patients in Germany. Risk factors for the development of PsA in psoriasis patients were determined by conditional logistic regression analysis.ResultsThe cumulative percentage of patients with existing psoriasis developing concomitant PsA over 4 years was 3.44%, with a mean time to diagnosis of PsA of 1.5 years. Psoriasis patients diagnosed with acute rheumatism (odds ratio: 2.93, 95% CI = 1.76, 4.86; P < 0.001) or pain in unspecific joints (odds ratio: 1.74, 95% CI = 1.01, 2.99; P = 0.047) showed an increased risk for development of PsA later on. Interestingly, fewer than half of the patients with concomitant PsA consulted a rheumatologist.ConclusionsUnspecific arthritic symptoms are likely to precede PsA diagnoses and can develop soon after onset of psoriasis, with accumulating risk over time. There is a high unmet need for early rheumatological assessment of psoriasis patients.

The Relationship Between C-Reactive Protein Level, Disease Severity and Psoriatic Arthritis In Psoriasis Patients

Amaç: Bu çalışmada “Immune Mediated Inflammatory Disease (İmmün Aracılı İltihabi Hastalık)” grubuna dâhil olan psoriasis ve psoriatik artritte, C-reaktif proteinin psoriasis şiddeti ve psoriatik artrit ile ilişkisini tespit etmek amaçlandı. Gereç ve Yöntem: Çalışmaya 18-70 yaş arası psoriatik artriti olan veya olmayan toplam 201 psoriasis hastası ve kontrol grubu olarak 18-70 yaş arası 98 sağlıklı birey alındı. Psoriasis şiddeti psoriasis alan şiddet indeksi ile hesaplandı ve eşzamanlı serum C-Reaktif Protein düzeyi (immunoturbidimetric latex yöntemi ile) bakılıp hastalar fizik tedavi ve rehabilitasyon kliniğinde psoriatik artrit yönünden değerlendirildi. Gruplar arası C-Reaktif Protein düzeyleri karşılaştırıldı. Psoriasis hastalarında C-Reaktif Protein düzeyi ve psoriasis alan şiddet indeksi korelasyonuna bakıldı. Bulgular: C-Reaktif Protein düzeyinin, psoriasis hastalarında normal popülasyona göre yüksek olduğu (p&amp;lt;0,001) ancak psoriasis şiddeti arasında korelasyon olmadığı saptandı (p=0,093) . C-Reaktif Protein değerleri, aktif psoriatik artrit hastalarında kontrol grubuna (p&amp;lt;0,001) ve psoriasis hastalarına (p&amp;lt;0,001) göre yüksek bulundu. C-Reaktif Protein değerleri açısından aktif psoriatik artrit hastaları ile inaktif psoriatik artrit hastaları arasında istatistiksel olarak anlamlı fark bulunmadı (p=0,449). Sonuç: C-Reaktif Protein’in psoriasis hastalarında normal insanlara göre yüksek olmasına rağmen, hastalık şiddetiyle korele olmadığından, psoriasis şiddeti takibinde kullanımının yararlı olmayacağı; ancak psoriasis hastalarında psoriatik artrit gelişimi açısından takipte kullanılanılabileceğini düşünmekteyiz. Aktif ve inaktif psoriatik artrit hastalarında C-Reaktif Protein düzeyi açısından anlamlı fark saptanmaması, psoriatik artritin aktif veya inaktif dönemde olduğunu değerlendirmede tek başına yeterli bir belirteç olmadığı sonucunu doğurmaktadır.

Activated antimicrobial peptides due to periodontal bacteria in synovial fluid – The link between psoriatic arthritis and periodontitis?

BackgroundThe impact of periodontal disease on systemic conditions has not been fully identified yet. Literature shows that the incidence of psoriatic arthritis in psoriasis-patients is higher in presence of periodontitis. To this day, it is not fully clear which pathophysiological mechanism lies behind this correlation. The missing link between these diseases might be the activation of antimicrobial peptides (AMPs) due to DNAs of periodontal bacteria in synovial fluid. HypothesisPeriodontitis is not only a local inflammation but effects systemic conditions as well. We assume that periodontitis is an important risk factor for the development of psoriatic arthritis in patients with psoriasis due to the increase of AMPs triggered by elevated periodontal bacteria DNAs in synovial fluid. ConclusionSystemic inflammation caused by periodontitis, the circulation of inflammatory proteins and the increase of potential pathogenic bacteria in the blood stream as well as in synovial fluid might trigger the over-expression of several immunological factors as AMPs and activate immune cells in all parts of the body.

The impact of smoking on prevalence of psoriasis and psoriatic arthritis.

In this systematic literature review and meta-analysis, we aimed to investigate the impact of cigarette smoking on the prevalence and incidence of psoriasis and psoriatic arthritis (PsA). We performed a systematic literature review using the MEDLINE, EMBASE and Cochrane Central Register databases. The literature included publications from January 1980 to July 2019. The studies that provided clear information on the number of patients with ever smoking data were included in the meta-analysis. The systematic literature review identified 52 and 24 articles for the prevalence of smoking in psoriasis and PsA, respectively. Of these, 16 articles on psoriasis and three and four (general population and psoriasis, respectively) articles on PsA met the criteria and were included in the meta-analysis. The prevalence of ever smoking was increased in psoriasis compared with the general population (OR: 1.84; 95% CI: 1.4, 2.3). For PsA the prevalence of ever smoking was reduced in psoriasis patients (OR: 0.70; 95% CI: 0.60, 0.81), but not changed compared with the general population (OR: 1.10; 95% CI: 0.92, 1.32). This meta-analysis showed that ever smoking increases the risk of psoriasis in the general population, but may reduce the risk of PsA in psoriasis patients. The latter may be also due to the collider effect. Whether smoking cessation neutralizes the risk of developing psoriasis requires a well-defined smoking data collection for the past history and this is currently unavailable in the literature.

Vitamin d deficiency in psoriatic patients -A case control study

Abstract Introduction: Many studies have shown that vitamin D deficiency have been associated with multiple autoimmune conditions like psoriasis, rheumatoid arthritis, diabetes mellitus. Objective: The main purpose of this study was to analyze vitamin D status of psoriasis patients in comparison to healthy controls. Materials and Methods: The study comprised of 50 (30 male & 20 female) clinically confirmed cases of chronic plaque psoriasis of age group (20-60 years) attending outpatient department of Dermatology, venereology, leprosy, Vinayaka Mission’s Medical College & Hospital, Karaikal from 2012 to 2014.At the same time 50 healthy individuals without psoriasis were also investigated (age & sex matched). Results: The mean serum 25-OHD levels in psoriatic patients and controls were 22.308+_2.974 and 33.726 +_2.688 ng/ml respectively. The difference was statistically significant (P= Limitations: Additional studies with bigger numbers of patients are essential to evaluate the pathogenic mechanisms associated with psoriasis and vitamin D. Keywords: Psoriasis, Autoimmunity, Psoriasis Area and severity index, 25-hydroxy vitamin D. Introduction Psoriasis is a chronic, non-contagious skin disease characterized by red, inflamed cutaneous lesions covered with silvery-white scale. It involves the innate immunologic system (keratinocytes, dendritic cells, histiocytes, mastocytes and endothelial cells) and acquired immunologic system (T lymphocytes).[1]Psoriatic plaques are defined histologically by epidermal hyperplasia, epidermal and dermal infiltration by leukocytes and changes in dermal microvasculature.[2] Psoriasis affects both genders equally and can occur at any age, although it most commonly appears for the first time between the ages of 15 and 25. The disease affects the skin and potentially the joints. The prevalence of psoriatic arthritis in psoriasis patients is estimated to be between 25-31%. Vitami

Evaluation of IL-34 in psoriasis and psoriatic arthritis patients: Correlation with disease activity and severity

IntroductionInterleukin-34 (IL-34) is a newly discovered cytokine essential for skin homoeostasis. It is involved in macrophage differentiation, osteoclastogenesis and inflammation. This could suggest a potential role in the pathogenesis of psoriasis and psoriatic arthritis (PsA). Aim of the workTo assess serum IL-34 level in psoriatic patients with and without arthritis and to correlate it with disease activity and severity. Patients and methodsSerum IL-34 level was measured in 45 psoriasis patients (21 had PsA) and 20 healthy controls. Patients were clinically assessed using psoriasis skin area severity index (PASI), composite psoriasis disease activity index (CPDAI) and peripheral joint score (PJS). Radiological assessment of hands and feet was done using modified Sharp-van der Heijde (mSvH) scoring method for PsA. ResultsThe mean age of the PsA patients (47.4±10.2years) was comparable with the psoriasis only patients (42.5±7.5years) and control (43.4±7years). Serum IL-34 was significantly higher among PsA patients compared to those without arthritis and controls (median=2500ng/L, 512ng/L and 325ng/L, respectively). CPDAI was significantly higher in PsA compared to patients without arthritis. PASI scores were comparable between patients. Serum IL-34 level correlated significantly with each of PASI, CPDAI and PJS but not with the mSvH score. Receiver operator characteristic curve analysis revealed that serum IL-34 testing showed excellent diagnostic performance for PsA in psoriasis patients. ConclusionThe markedly elevated IL-34 serum level in PsA patients compared to non-arthritic ones and its remarkable correlation with PsA disease activity, suggest its importance as a marker for arthritis in psoriasis patients.

Sensitivity of the GEPARD Patient Questionnaire to Identify Psoriatic Arthritis in Patients with Psoriasis in Daily Practice: The GEPARD-Life Study

Early detection of psoriatic arthritis (PsA) remains a challenge in clinical practice. Tools such as the German Psoriasis Arthritis Diagnostic (GEPARD) questionnaire have been developed for this purpose. The aim of this study was to determine the performance of the GEPARD questionnaire in the detection of PsA in psoriasis patients following rheumatology evaluation in daily clinical practice in Germany. This was a multicenter study involving 59 dermatology units (university/general hospital/office based), and the GEPARD questionnaire was distributed to psoriasis patients. Patients who had a sum score of ≥4 positive answers were referred to a rheumatologist for evaluation of PsA. We recruited 1,512 patients, of whom approximately 50% were referred. One third of the referred patients were classified as having PsA after rheumatological assessment. Rates of PsA in university/general hospital settings were higher than those observed in a doctor's office-based setting (43.7 vs. 25.8%). The GEPARD questionnaire demonstrated easy screening of psoriasis patients for PsA.

Psoriatic Arthritis in Psoriasis Patients: Evaluation of Clinical and Radiological Features

Psoriatic Arthritis in Psoriasis Patients: Evaluation of Clinical and Radiological Features

Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis.

The objective of this retrospective study is to assess neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as inflammatory markers in patients with psoriasis and psoriatic arthritis (PsA). A hundred and eleven psoriasis patients and 25 PsA patients were compared with 94 healthy controls. Demographic, clinical and laboratory information were collected and analyzed. NLR and PLR were calculated. White blood cell (WBC), neutrophils, eosinophils and NLR were increased in psoriasis patients compared with controls. WBC, neutrophils, NLR, monocytes, platelets and PLR were increased in PsA patients compared with both controls and psoriasis patients. Erythrocyte sedimentation rate (ESR) and C-reactive protein were significantly higher in PsA patients compared with psoriasis patients. Among psoriasis patients, Psoriasis Area and Severity Index (PASI) score correlated positively with platelets, NLR and PLR. These parameters were all significantly higher in moderate to severe psoriasis patients (PASI ≥ 10) compared with mild patients (PASI < 10). Elevated platelets, NLR and PLR were significantly associated with the increased PASI scores in multivariate analysis. NLR, PLR and ESR were statistically significant predictors for the presence of PsA in psoriasis patients. NLR was the strongest predictor (odds ratio = 3.351, P = 0.005). In conclusion, elevated NLR and PLR were significantly associated with psoriasis and PsA. Both NLR and PLR were strong predictors for the presence of PsA among psoriasis patients.

Quantitative tandem mass-spectrometry of skin tissue reveals putative psoriatic arthritis biomarkers.

BackgroundPsoriatic arthritis (PsA) is a distinct inflammatory arthritis occurring in 30% of psoriasis patients. There is a high prevalence of undiagnosed PsA in psoriasis patients; therefore, identifying soluble biomarkers for PsA could help in screening psoriasis patients for appropriate referral to a rheumatologist. Potential PsA biomarkers likely originate in sites of inflammation, such as the skin, and subsequently enter systemic circulation. Our goal was to identify candidate PsA biomarkers by comparing the proteome of skin biopsies obtained from patients with PsA to that from patients with psoriasis without PsA.MethodsSkin biopsies were obtained from involved and uninvolved skin of 10 PsA and 10 age/gender-matched psoriasis patients without PsA (PsC). Using strong cation exchange chromatography, followed by label-free quantitative tandem mass spectrometry, we characterized the proteomes of pooled skin samples. Extracted ion current intensities were used to calculate protein abundance ratios, and these were utilized to identify differentially regulated proteins.ResultsForty-seven proteins were elevated in PsA-derived skin compared to PsC-derived skin. Selected reaction monitoring assays were developed to quantify these potential PsA markers in individual skin samples, and 8 markers were confirmed in an independent sample set. ITGB5 and POSTN were measured in serum samples from 33 PsA and 15 PsC patients, using enzyme-linked immunosorbent assays. ITGB5 was significantly elevated in PsA serum (P < 0.01), and POSTN showed a trend. ITGB5 and POSTN correlated significantly in both patient groups (r = 0.472, P < 0.001).ConclusionProteomic analysis of PsA and PsC skin identified eight new candidate biomarkers. These markers need to be validated with a larger and independent cohort, in order to delineate their clinical utility in PsA patients. These proteins may also uncover unknown aspects of PsA pathobiology.Electronic supplementary materialThe online version of this article (doi:10.1186/1559-0275-12-1) contains supplementary material, which is available to authorized users.