Risk Factors For Psoriatic Arthritis Research Articles

Incidence of psoriatic arthritis in a UK primary care psoriasis population.

To determine the annual incidence of psoriatic arthritis in a UK primary care population with preexisting psoriasis followed prospectively over two years after excluding baseline prevalence of existing disease. TUDOR (Total bUrDen of psORiasis) was a multi-centre, prospective, two-arm parallel-group cluster randomised controlled trial of the early identification of PsA by annual rheumatological assessment (termed Enhanced Surveillance) versus standard care in people with psoriasis identified in primary care. Incidence of psoriatic arthritis is reported at 12- and 24-months using patients from the Enhanced Surveillance arm, which allows the exclusion of patients with prevalent PsA at baseline. Fourteen of 511 participants attending a 12-month screen developed PsA over that interval giving an incidence of 2.74 per 100 patient years (p-yrs) (95% CI: 1.32 to 4.16) and another 7 of 444 participants attending the 24-month visit developed PsA giving an incidence of 1.58 per 100 p-yrs (95% CI: 0.42 to 2.74). The combined incidence over 2 years was 2.20 per 100 p-yrs (95% CI: 1.27 to 3.13). The estimated annual incidence of PsA over a 2-year period was 2.20 per 100 p-yrs, that is in keeping with a higher incidence of PsA than that found when relying on health records alone. Extended follow-up of the TUDOR cohort with accrual of larger numbers of incident cases will allow risk factors for psoriatic arthritis to be explored in more depth.

Risk factors and comorbidities for psoriatic arthritis. Literature review

Introduction: Psoriatic arthritis is a chronic disease involving peripheral arthritis, spondylitis, dactylitis (inflammation of the whole digit) and enthesitis. It is a disease equally prevalent in both genders. Psoriatic arthritis coexists with several conditions, including metabolic syndrome, obesity, cardiovascular disease, inflammatory bowel disease, and liver disease. The reciprocal effects of comorbidities with psoriatic arthritis are demonstrated by recent research. There are several risk factors associated with the condition that might hasten or worsen its symptoms. Aim of the Study: The purpose of this paper is to present a thorough analysis of the research that has been done on comorbidities and risk factors for psoriatic arthritis. With an emphasis on changeable elements that might impact the disease's progression, the goal is to illustrate the multifaceted nature of psoriatic arthritis. The intention is also to highlight comorbidities that need to be considered while treating a patient with the illness. Materials and methods: An analysis of papers available in PubMed and Google Scholar was performed using the following key words: psoriatic arthritis, psoriatic arthritis and lifestyle, psoriatic arthritis and comorbidities, psoriatic arthritis and cardiovascular risk, psoriatic arthritis and gastrointestinal diseases, psoriatic arthritis and physical activity, psoriatic arthritis and diet, psoriatic arthritis and alcohol, psoriatic arthritis and smoking. Conclusions: Psoriatic arthritis is a chronic disease that affects many areas of patients' lives. It is critical to consider the connections that exist between this illness and other comorbidities. In order to provide a patient with this ailment with the best care possible, variables that might exacerbate the illness's progression must also be taken into consideration. Patients' mental health should get particular attention, and lifestyle modifications should be promoted.

Multimorbidity in Psoriasis as a Risk Factor for Psoriatic Arthritis: A Population-Based Study.

To examine multimorbidity in psoriasis and its association with the development of PsA. A retrospective cohort study was performed using the Rochester Epidemiology Project. Population-based incidence (2000-2009) and prevalence (Jan 1, 2010) cohorts of psoriasis were identified by manual chart review. A cohort of individuals without psoriasis (comparators) were identified (1:1 matched on age, sex, and county). Morbidities were defined using ≥2 Clinical Classification Software codes ≥30 days apart within prior five years. PsA was defined using ClASsification of Psoriatic ARthritis (CASPAR) criteria. χ2 and rank-sum tests were used to compare morbidities, and age-, sex-, and race-adjusted Cox models to examine the association of baseline morbidities in psoriasis with development of PsA. Among 817 incident psoriasis patients, the mean age was 45.2 years with 52.0% females, and 82.0% moderate/severe psoriasis. No multimorbidity differences were found between incident psoriasis patients and comparators. However, in the 1,088 prevalent psoriasis patients, multimorbidity was significantly more common compared with 1,086 comparators (OR : 1.35 and OR : 1.48 for ≥2 and ≥5 morbidities, respectively). Over a median 13.3-year follow-up, 23 patients (cumulative incidence: 2.9% by 15 years) developed PsA. Multimorbidity (≥2 morbidities) was associated with a 3-fold higher risk of developing PsA. Multimorbidity was more common in the prevalent but not incident cohort of psoriasis compared with the general population, suggesting patients with psoriasis may experience accelerated development of multimorbidity. Moreover, multimorbidity at psoriasis onset significantly increased the risk of developing PsA, highlighting the importance of monitoring multimorbid psoriasis patients for the development of PsA.

92 Prevalence and incidence of psoriatic arthritis among patients with psoriasis and risk factors for psoriatic arthritis in Republic of Korea: A nationwide database study

92 Prevalence and incidence of psoriatic arthritis among patients with psoriasis and risk factors for psoriatic arthritis in Republic of Korea: A nationwide database study

The optimal use of tildrakizumab in the elderly via improvement of Treg function and its preventive effect of psoriatic arthritis.

As a form of precision medicine, this study aimed to investigate the specific patient population that would derive the greatest benefit from tildrakizumab, as well as the mechanism of action and efficacy of tildrakizumab in reducing the occurrence of psoriatic arthritis (PsA). To achieve this, a multi-center, prospective cohort study was conducted, involving a population of 246 psoriasis patients who had not received any systemic therapy or topical finger therapy between January 2020 and April 2023. Two independent clinicians, who were blinded to the study, analyzed nailfold capillary (NFC) abnormalities, such as nailfold bleeding (NFB) and enlarged capillaries, as well as the incidence of new PsA. Additionally, the factors that determined the response of psoriasis after seven months of tildrakizumab treatment were examined. The study also examined the quantity and role of regulatory T cells (Tregs) and T helper 17 cells both pre- and post-treatment. The severity of psoriasis, as measured by the Psoriasis Area and Severity Index (PASI), was found to be more pronounced in the tildrakizumab group (n=20) in comparison to the topical group (n=226). At 7 months after tildrakizumab treatment, multivariate analysis showed that those 65 years and older had a significantly better response to treatment in those achieved PASI clear or PASI 2 or less (Likelihood ratio (LR) 16.15, p<0.0001; LR 6. 16, p=0.01). Tildrakizumab improved the number and function of Tregs, which had been reduced by aging. Tildrakizumab demonstrated significant efficacy in improving various pathological factors associated with PsA. These factors include the reduction of NFB, enlargement of capillaries, and inhibition of PsA progression. The hazard ratio for progression to PsA was found to be 0.06 (95% confidence interval: 0.0007-0.46, p=0.007), indicating a substantial reduction in the risk of developing PsA. Tildrakizumab's effectiveness in improving skin lesions can be attributed to its ability to enhance the number and function of Tregs, which are known to decline with age. Furthermore, the drug's positive impact on NFB activity and capillary enlargement, both of which are recognized as risk factors for PsA, further contribute to its inhibitory effect on PsA progression.

Nail psoriasis dynamics during biologic treatment and withdrawal in patients with psoriasis who may be at high risk of developing psoriatic arthritis: a post hoc analysis of the VOYAGE 2 randomized trial

BackgroundNail psoriasis is a common, physiologically, and psychologically disruptive, and yet often under-treated manifestation of psoriasis. The objectives of this analysis were to investigate the trajectory of nail psoriasis, a risk factor for psoriatic arthritis (PsA), with guselkumab vs adalimumab treatment followed by withdrawal, and determine characteristics associated with nail response in patients treated with guselkumab.MethodsThis post hoc analysis of the phase III trial VOYAGE 2 included patients with moderate-to-severe plaque psoriasis and baseline nail involvement. Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) were analyzed through week 48 in patients randomized to guselkumab or adalimumab. Multiple logistic regression analyzed factors associated with NAPSI 0/1 at week 24/week 48 following guselkumab treatment. In a separate analysis, patients were stratified by prior biologic experience.ResultsOverall, 272 vs 132 patients receiving guselkumab vs adalimumab had nail psoriasis at baseline. Lower baseline NAPSI and week 16 PASI were associated with achieving NAPSI 0/1 at week 24 (NAPSI, odds ratio 0.685 [95% confidence interval: 0.586, 0.802]; week 16 PASI, 0.469 [0.281, 0.782]) and week 48 (NAPSI, 0.784 [0.674, 0.914]; week 16 PASI, 0.557 [0.331, 0.937]) with guselkumab. Previous biologic experience did not impact NAPSI response. Following treatment withdrawal at week 28, mean NAPSI was maintained in the guselkumab arm (week 24 1.7, week 48 1.9) and increased slightly in the adalimumab arm (week 24 1.4, week 48 2.3). Mean PASI increased across both treatment arms.ConclusionsHigher skin efficacy at week 16 was associated with better nail responses during guselkumab treatment. Nail psoriasis improvements reflected skin improvements. Following guselkumab withdrawal, nail response was maintained longer than skin response. Future studies should investigate whether such improvements in nail response reduce patients’ risk of later PsA development.Trial registrationClinicalTrials.gov, NCT02207244. Registered July 31, 2014.

Identification of variants in genes associated with autoinflammatory disorders in a cohort of patients with psoriatic arthritis

ObjectivesBesides adaptive immunity genes, genetic risk factors for psoriatic arthritis (PsA) include innate immunity loci, which suggests an autoinflammatory disease mechanism, at least in a subset of patients. Here, we...

Systematic review and meta-analysis: risk factors for psoriatic arthritis. Part 2

Psoriasis (PsO) is a chronic immune-mediated disease, in the pathogenesis of which various risk factors (RFs) and genetic predisposition play an important role. The complex interaction of genetic and trigger factors leads to the development of autoimmune and autoinflammatory reactions. Every fourth patient with skin PsO develops psoriatic arthritis (PsA), which, progressing and left untreated, can cause irreversible functional disorders, which necessitates early diagnosis of this disease.Objective: to identify endogenous risk factors for the development of PsA.Material and methods. We searched PubMed (MEDLINE), EMBASE, and Google Scholar databases for articles on endogenous risk factors for the development of PsA that were published over the past 10 years (until March 1, 2021). We searched for currently registered trials in the registers of clinical trials of US (ClinicalTrials.gov), of China (Chinese Clinical Trial Registry) and the WHO International Clinical Trial Registry Platform. The statistical analysis was prepared in accordance with the international guidelines for systematic reviews and meta-analysis (PRISMA) using the Statistic SPSS 26.0 program (USA). Meta-analysis was prepared using RevMan 5 software.Results and discussion. Part 2 of the systematic review included 56 articles on endogenous risk factors for the development of PsA. When preparing a meta-analysis, a statistically significant increase (1.68 times) in the risk of developing PsA in the presence of psoriatic lesions of the scalp was noted (95% confidence interval, CI 1.09–2.61). There was no statistically significant increase in the risk of developing PsA in the presence of inverse PsO. The mean PASI was significantly higher (mean difference 2.64; 95% CI 1.37–3.91) in patients with PsA compared with patients without this disease. Mean duration of illness was also longer (mean difference 2.64 years; 95% CI 1.34–4.50) in patients with PsA than in patients with PsO.Conclusion: PsO and PsA are multifactorial diseases. RFs not only affect their development, but also determine the characteristics of the clinical course, severity, and the presence of complications. Understanding the risk factors of the development of PsA is important for assessing the prognosis, timely diagnosis, and early initiation of therapy, which will prevent severe forms of the disease and disability in patients.

Systematic review and meta-analysis: risk factors for psoriatic arthritis. Part 1.

According to epidemiological and clinical studies, every fourth patient with psoriasis develops psoriatic arthritis (PsA), and in many cases there is a destructive form of arthritis that leads to disability. Late diagnosis of PsA is associated with a significant reduction in the effectiveness of therapy. Therefore, early diagnosis of this disease is so important.Objective: to determine the methods for early detection of PsA, in particular the identification of risk factors (RFs) for its development, which will prevent the progression of the disease and the disability of patients.Materials and methods. The literature review and meta-analysis is presented in two parts. Part 1 of the systematic review included articles on exogenous RFs for the development of PsA published over the past 10 years.PubMed (MEDLINE), EMBASE, and Google Scholar databases were searched for articles published before March 1, 2021. We searched for currently registered trials in the registers of clinical trials of US (ClinicalTrials.gov), of China (Chinese Clinical Trial Registry) and the WHO InternationalClinical Trial Registry Platform. The statistical analysis was prepared in accordance with the international guidelines for systematic reviews and meta-analysis (PRISMA) using the Statistic SPSS 26.0 program (USA).Results and discussion. 957 articles published up to March 1, 2021 were identified. After further analysis, irrelevant articles were excluded. A total of 73 articles were included in the review and analysis, 32 of which were included in Part 1. The most common exogenous RFs are: mechanical injuries, medications, and psychotraumatic situations.Conclusion. PsA is a multifactorial disease. Currently, a large number of exogenous RFs for the development of this disease have been established. Knowledge of RFs and the ability to recognize them will help dermatovenereologists and rheumatologists to effectively assess and predict the patient's condition. Correction of modifiable RFs, early prescription of appropriate therapy will help to reduce the number of PsA cases, the development of functional disorders and prevent the growth of disability. However, studies on the comprehensive assessment of RFs in PsA are still insufficient. Further study of methods for the early diagnosis of PsA is needed in order to optimize its treatment.

Artritis Psoriatika

To know the risk factors, pharmacological treatment and prevention of psoriatic arthritis. Psoriatic arthritis is a chronic musculoskeletal disease associated with psoriasis. at least 5% of psoriasis patients develop psoriatic arthritis. Globally, the incidence of PsA reaches 133 per 100,000 patient subjects. The annual incidence of PsA is about 2.7 cases per 100 people diagnosed with psoriasis. In Asia, PsA cases increased from 2000 to 2013 with a prevalence (per 100,000 population) of 11.12 to 37.75. Based on a study at Sanglah Hospital Bali found PsA patients as much as 6.3% of psoriasis patients. PsA patients may have clinical features such as peripheral arthritis, enthesitis, dactylitis, skin, nail, and axial involvement. Risk factors for psoriatic arthritis include obesity, physical trauma, smoking, location of psoriasis in the body, education level and genetic factors. Pharmacological treatment of PsA based on the latest guidelines from EULAR 2019 and ACR recommendations. These two guidelines discuss pharmacological treatment based on the patient's clinical picture. The goal of pharmacological therapy is to improve the patient's quality of life by improving symptomatic complaints and preventing structural damage. As a prevention, PsA maintains an ideal body weight, reduces cigarette consumption, and performs detection as an early detection.

Risk Factors for Diagnosis of Psoriatic Arthritis, Psoriasis, Rheumatoid Arthritis, and Ankylosing Spondylitis: A Set of Parallel Case-control Studies.

To compare potential risk factors for the diagnosis of psoriatic arthritis (PsA), psoriasis (PsO), rheumatoid arthritis (RA), and ankylosing spondylitis (AS). Four parallel case-control studies were conducted within The Health Improvement Network using data between 1994 and 2015. Patients with PsA, PsO, RA, or AS were identified using validated code lists and matched to controls on age, sex, practice, and year. Risk factors were selected in the time prior to diagnosis. Multivariable logistic regression models were constructed for each disease using automated stepwise regression to test potential risk factors. Patients with incident PsA (n = 7594), PsO (n = 111,375), RA (n = 28,341), and AS (n = 3253) were identified and matched to 75,930, 1,113,345, 283,226, and 32,530 controls, respectively. Median diagnosis age was 48 (IQR 38-59), 43 (IQR 28-60), 60 (IQR 48-71), and 41 (IQR 32-54) years, respectively. In multivariable models, there were some shared and some differing risk factors across all 4 diseases: PsA was associated with obesity, pharyngitis, and skin infections; PsA and PsO were associated with obesity and moderate alcohol intake; PsA and AS were associated with uveitis; and PsA and RA were associated with preceding gout. Both RA and AS were associated with current smoking, former moderate drinking, anemia, osteoporosis, and inflammatory bowel disease. All shared former or current smoking as a risk factor; statin use was inversely associated with all 4 diseases. Shared and different risk factors for PsA, PsO, RA, and AS were identified. Statin use was inversely associated with all 4 conditions.

The Skin May Clear But the Arthritis Won't Disappear: Focusing on Concomitant and New-Onset Psoriatic Arthritis in a Daily Practice Cohort of Psoriasis Patients on Biologic Therapy.

BackgroundPreviously identified risk factors for psoriatic arthritis (PsA); nail dystrophy and scalp lesions are highly prevalent in patients with moderate-to-severe psoriasis. Therefore, these variables may not be useful as predictors for PsA in this population.ObjectiveWe assessed the predictive value of demographic and clinical characteristics for development of PsA in a cohort of patients with moderate-to-severe psoriasis, currently treated with biologics. Furthermore, we reported the incidence of new-onset PsA in this population and described the characteristics of patients that developed PsA during biologic treatment.MethodsDemographics and treatment characteristics of psoriasis patients currently using biologic therapy were extracted from the BioCAPTURE database (n=427). Poisson regression was used to calculate incidence rates. Multivariable logistic regression was performed to identify factors independently associated with PsA onset. Patient and treatment characteristics of patients that developed PsA during biologic treatment were described.ResultsThe incidence of PsA was 1.0 (95% CI 0.8–1.2) per 100 psoriasis-years. Except for a lower risk for PsA in male gender (OR 0.58, 95% CI 0.34–0.98, p-value 0.04), no clinical factors were significantly associated with an altered risk of developing PsA. During biologic therapy, 32 patients (9.4%) newly developed PsA. In this group, 53.8% had PASI<5 at PsA diagnosis. The incidence rate of PsA was 1.6 (95% CI 1.1–2.2) per 100 years on biologic therapy.ConclusionClinical risk factors might be inaccurate to predict PsA onset in patients with moderate-to-severe psoriasis on biologics. Even with low disease activity, psoriasis patients on biologics are still prone to develop PsA.

A study of obesity, BMI, smoking and alcohol as risk factors for psoriatic arthritis

A study of obesity, BMI, smoking and alcohol as risk factors for psoriatic arthritis

Incidence of Psoriatic Arthritis in Patients with Skin Psoriasis and Associated Risk Factors: A Retrospective Population-based Cohort Study in Swedish Routine Clinical Care.

The incidence of psoriatic arthritis in patients with psoriasis is unclear; existing estimates differ by a factor of ten. Complete population-level data is needed to provide accurate estimates with high confidence. A total of 123,814 adults with psoriasis, free from preexisting psoriatic arthritis, were identified in population-based data from secondary care in Sweden during 2007 to 2017. Incidence was calculated as the number of psoriatic arthritis diagnosis events per 100 patient-years. Time to diagnosis was assessed using cumulative incidence and Cox proportional hazards models to identify risk factors. Incidence of psoriatic arthritis in patients with psoriasis was 1.69 per 100 patient-years (95% confidence interval 1.65–1.72) overall, and 1.48, 3.00, and 5.49 per 100 patient-years in patients with mild, moderate and severe psoriasis, respectively. Risk of psoriatic arthritis was 3.2 times higher amongst patients with severe psoriasis compared with mild disease. Dermatologists should regularly assess risk factors for psoriatic arthritis in clinical practice in order to improve the detection of psoriatic arthritis.

Rhumatisme psoriasique en France, du nourrisson à la personne âgée : données de deux études transversales multicentriques

Psoriatic arthritis affects 20-30% of patients with psoriasis. Few epidemiological data are available in France about its prevalence and its association with skin lesions and comorbidities. To assess the epidemiological aspects and the risk factors for psoriatic arthritis in children and adults in France. Two cross-sectional studies were conducted in France in children (χ-Psocar, 23 pediatric dermatology centers belonging to the SFDP, 1 year) and adults (Resopsocar, 29 dermatology centers belonging to GEM RESOPSO, 4 months) to study the link between psoriasis and cardiovascular and metabolic comorbidities. Three hundred and thirteen children (males: 47.6%; mean age: 9.4 yrs) and 1,954 adults (males: 56.0%; mean age: 48.5 yrs) with psoriasis were included, with 4.2% of the children and 21.0% of the adults presenting psoriatic arthritis. Prevalence increased with age: 2.2% of children, 14.2% of adolescents, and over 20% after 40 years. It decreased after the age of 70 years (19.4%). Regardless of age, arthritis was not associated with gender. In the children's group, rheumatism was associated with nail involvement (P=0.04) and disease severity (P=0.0004). Adult rheumatism was associated with generalized plaque psoriasis (P=0.002), disease severity (P<0.0001), and obesity (P<0.0001). Localized plaque psoriasis was less often associated with arthritis (P<0.05). These two cross-sectional studies conducted in 2267 patients in France yielded information on the prevalence of joint involvement from infants to elderly subjects. It is the first study conducted in a single population to provide data for the whole population. Prevalence gradually increases with age, without gender difference, before decreasing in old age. We confirm the association of nail involvement in the first years of life, and of obesity in adults.

Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients.

Psoriatic arthritis (PsA) is a spondyloarthritic condition mainly seen in patients with psoriasis. Psoriatic patients with plaques on the scalp, gluteal fold or nail lesions are known to develop PsA more frequently, but other markers for PsA have not yet been identified. To determine which psoriatic patients are at greatest risk of developing PsA, psoriasis vulgaris (PsV) patients who visited the Department of Dermatology, Fukuoka University Hospital in 2015 were enrolled. Patients with and without PsA were statistically compared with respect to age, sex, age at onset, body mass index (BMI), smoking and drinking habits, familial history of psoriasis and comorbidities. Of 331 patients (237 men, 94 women), 55 had PsA (17%; 39 men, 16 women). PsA patients had significantly higher frequencies of nail lesions (PsA vs PsV-only, 62% vs 29%; P < 0.0001) and hyperuricemia (PsA vs PsV-only, 22% vs 9%; P = 0.01). These were confirmed as independent risk factors for PsA by logistic regression analysis, with odds ratios of 5.05 for nail lesions (P < 0.0001) and 4.18 for hyperuricemia (P < 0.01). There was no difference in age at onset, sex, BMI and incidence of diabetes mellitus, hypertension or dyslipidemia. Hyperuricemia is also known to be more frequent in psoriatic subjects than the normal population. Uric acid crystals are a strong stimulator of innate immunity. Considering that none of our cohort had gouty arthritis, hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects. Hyperuricemia appears to be an independent risk factor for PsA.

The Incidence and Risk Factors for Psoriatic Arthritis in Patients With Psoriasis: A Prospective Cohort Study.

To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis, and to identify risk factors for its development. The study was designed as a prospective cohort study involving psoriasis patients who did not have a diagnosis of arthritis at the time of study enrollment. Information was collected about lifestyle habits, comorbidities, psoriasis activity, and medications. Patients who developed inflammatory arthritis or spondylitis were classified as having PsA if they fulfilled the criteria of the Classification of Psoriatic Arthritis Study group. The annual incidence of PsA was estimated using an event per person-years analysis. Cox proportional hazards models, involving fixed and time-dependent explanatory variables, were fitted to obtain estimates of the relative risk (RR) of the onset of PsA, determined in multivariate models stratified by sex and controlled for age at onset of psoriasis. The data obtained from the 464 patients who were followed up for 8 years were analyzed. A total of 51 patients developed PsA during the 8 years since enrollment. The annual incidence rate of PsA was 2.7 cases (95% confidence interval 2.1-3.6) per 100 psoriasis patients. The following baseline variables were associated with the development of PsA in multivariate analysis: severe psoriasis (RR 5.4, P = 0.006), low level of education (university/college versus high school incomplete RR 0.22, P = 0.005; high school graduate versus high school incomplete RR 0.30, P = 0.049), and use of retinoid medications (RR 3.4, P = 0.02). In multivariate models with time-dependent variables, psoriatic nail pitting (RR 2.5, P = 0.002) and uveitis (RR 31.5, P = 0.0002) were associated with the development of PsA. The incidence of PsA in patients with psoriasis is higher than previously reported. A severe psoriasis phenotype, presence of nail pitting, low level of education, and uveitis are predictive of the development of PsA in patients with psoriasis.

Evidence-based recommendations on the role of dermatologists in the diagnosis and management of psoriatic arthritis: systematic review and expert opinion.

Psoriatic arthritis (PsA) can develop at any time during the course of psoriasis. The aims of these practical recommendations are to help dermatologists identify patients at risk of PsA, to diagnose PsA in collaboration with rheumatologists and to gain a better understanding of initial PsA management. A scientific committee consisting of 10 dermatologists and a rheumatologist selected clinically relevant questions to be addressed by evidence-based recommendations using the DELPHI method. For each question, a systematic literature review was performed in Medline, Embase and the Cochrane Library databases. The levels of evidence of all selected and reviewed articles were appraised according to the Oxford levels of evidence. An expert board of 30 dermatologists reviewed and analysed the evidence and developed recommendations for the selected questions. Agreement among participants was assessed on a 10-point scale, and the potential impact of the recommendations on clinical practice was evaluated. Among the 6960 references identified, 190 relevant articles were included in the reviews. Three recommendations regarding risk factors for PsA and one regarding PsA prevalence were issued. The mean agreement score between participants varied from 7.8 to 9.6. Three recommendations on PsA screening tools that can be used by dermatologists were issued. The mean agreement score between participants varied from 7.7 to 9.4. Initial PsA treatment options according to published guidelines were critically appraised for axial and peripheral involvement and enthesitis/dactylitis. Three recommendations were issued. The mean agreement score between participants varied from 7.6 to 8.7. The systematic literature research and meta-analyses did not provide high-quality evidence to support recommendations regarding PsA screening. Conversely, PsA treatment options were supported by strong evidence. Cooperation between dermatologists and rheumatologists should be emphasized to better identify and manage PsA patients.

C-reactive protein gene and Toll-like receptor 4 gene polymorphisms can relate to the development of psoriatic arthritis

We aimed to determine in psoriatic arthritis (PsA) patients the Toll-like receptor (TLR) 4 and C-reactive gene (CRP) polymorphisms and allele frequency and to investigate the relationship between clinical parameters and gene polymorphisms. We enrolled in this study 31 PsA and 41 healthy control subjects. PsA diagnosis was according to CASPAR criteria. Bath ankylosing spondylitis diseases activity index, Maastricht ankylosing spondylitis enthesitis score, and Bath ankylosing spondylitis functional index were measured. C, A, and T alleles of CRP and A and G alleles of TLR 4 were determined using the analysis of melting curves after real-time PCR. CRP A, C, and T allele frequency in controls was 26.8, 73.2, and 36.6%, respectively. In the PsA patient group, A, C, and T allele frequency was 9.7, 87.1, and 12.9%, respectively. Between control and PsA groups, there was a significant difference in A, C, and T allele frequency (P = 0.008, 0.038, and 0.001, respectively). The frequency of CRP gene polymorphisms (CA, AA, CT, TA, and TT alleles) in the control group was 56.1% and in the PsA group was 22.6%. There was a significant difference between the two groups (P = 0.004). The absence of a CRP gene polymorphism was a risk factor for PsA (odds ratio 4.3, 95% CI; 1.5-12.4, P = 0.005). TLR gene haploid frequency was investigated, and all control subjects had the wild-type AA allele. PsA patient GA allele frequency was 6.5%. There was no significant difference between the two groups (P = 0.182). GA mutant allele frequency was related to PsA (odds ratio 7.03, 95% CI; 0.32-151.9, P = 0.214). We have shown that CRP gene polymorphisms are higher in control subjects than PsA patients, and TLR 4 gene polymorphisms were found to be related to PsA.

SAT0300 Nail psoriasis per se does not predict psoriatic arthritis: Analysis of risk factors in a cohort of italian psoriatic patients

BackgroundNail psoriasis is acknowledged to be associated with Psoriatic Arthritis (PsA). Onycho-Psoriasis (ONPS), however, is extremely common in psoriatic population and correlate poorly with skin involvement. Further, not all clinical...