A case of psoriatic arthritis without the appearance of psoriatic skin or nail lesions for 21 years

Objective.A recent genome-wide pooling study noted a significant association of interleukin 23 receptor (IL-23R) and psoriasis. Overxpression of IL-23 has been detected in lesional psoriatic skin, and induces epidermal proliferation. Given the interplay between psoriasis and PsA, we examined the association of IL-23R variants in 2 independent Canadian Caucasian cohorts of patients with psoriatic arthritis (PsA).Methods.We examined 496 PsA probands and 476 controls. Cases and controls were genotyped for a panel of 11 single-nucleotide polymorphisms (SNP) in IL-23R. Allele and haplotype associations were calculated using WHAP software. P values for haplotype associations were calculated using a permutation test.Results.The 381Gln allele of the coding SNP Arg381Gln (rs11209026) was found to be protective in the Canadian population (p = 0.004; corrected p = 0.044).A 2-marker haplotype from SNP rs7530511 and rs11209026 was associated with PsA (p = 0.011). All 3-marker sliding windows containing SNP rs11209026 were associated with PsA (p = 0.02 for all 3 windows). The magnitude of effect of IL-23R association in PsA appears to be similar to that reported in uncomplicated psoriasis.Conclusion.Significant associations between Arg381Gln SNP and haplotypes encoding this variant were noted in PsA. It remains to be determined what contribution of this association, if any, is specifically due to the inflammatory arthritis (PsA) rather than psoriasis.

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Need for Improvement in Current Treatment of Psoriatic Arthritis: Study of an Outpatient Clinic Population

The Journal of Rheumatology ◽

10.3899/jrheum.160973 ◽

2017 ◽

Vol 44 (4) ◽

pp. 431-436 ◽

Cited By ~ 12

Author(s):

Brigitte Michelsen ◽

Andreas P. Diamantopoulos ◽

Hege Kilander Høiberg ◽

Dag Magnar Soldal ◽

Arthur Kavanaugh ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Disease Activity Score ◽

Activity Index ◽

Real Life ◽

Disease Activity Index ◽

Activity Score ◽

Psoriatic Skin ◽

Biologic Treatment ◽

Remission Criteria

Objective.To explore the burden of skin, joint, and entheses manifestations in a representative psoriatic arthritis (PsA) outpatient cohort in the biologic treatment era.Methods.This was a cross-sectional study of 141 PsA outpatients fulfilling the ClASsification for Psoriatic ARthritis (CASPAR) criteria and examined between January 2013 and May 2014. Selected disease activity measures were explored including Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic Arthritis Disease Activity Score (PASDAS), Disease Activity Score for 28 joints (DAS28), Simplified Disease Activity Index (SDAI), and Psoriasis Area Severity Index (PASI). Dermatology Life Quality Index (DLQI), minimal disease activity (MDA), and remission criteria were assessed.Results.Median (range) DAPSA was 14.5 (0.1–76.4), CPDAI 5 (1–11), PASDAS 3.1 (2.1–4.2), DAS28-erythrocyte sedimentation rate (ESR) 3.2 (0.6–6.4), SDAI 8.6 (0.1–39.5), PASI 1.2 (0.0–19.7), and DLQI 2.0 (0–17). The MDA criteria were fulfilled by 22.9% of the patients. DAPSA ≤ 4, CPDAI ≤ 2, PASDAS < 2.4, DAS28-ESR < 2.4, SDAI < 3.3, and Boolean’s remission criteria were fulfilled by 12.1, 9.3, 7.8, 26.2, 21.3, and 5.7% of patients, respectively. The number of satisfied patients was similar regardless of whether the group was treated with tumor necrosis factor inhibitors.Conclusion.Our real-life data indicate that there is still a need for improvement in today’s treatment of PsA. Musculoskeletal inflammatory involvement was more prominent than psoriatic skin involvement. Only a few patients fulfilled the DAPSA, PASDAS, and CPDAI remission criteria, and about a quarter fulfilled the MDA criteria. Considerably fewer patients fulfilled PsA-specific remission criteria versus non-PsA specific remission criteria. Still, patient satisfaction was good and PASI and DLQI were low.

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Infliximab-Induced Aseptic Meningitis during the Treatment of Psoriatic Arthritis

Case Reports in Dermatology ◽

10.1159/000458405 ◽

2017 ◽

Vol 9 (2) ◽

pp. 26-29 ◽

Cited By ~ 2

Author(s):

Yuki Matsuura-Otsuki ◽

Takaaki Hanafusa ◽

Hiroo Yokozeki ◽

Kyoko Watanabe

Keyword(s):

Psoriatic Arthritis ◽

Aseptic Meningitis ◽

Joint Pain ◽

Mononuclear Cells ◽

Polymerase Chain Reaction Amplification ◽

Skin Lesions ◽

Psoriatic Skin ◽

Infliximab Treatment ◽

India Ink ◽

Old Japanese

A 42-year-old Japanese man presented with persistent headache during treatment for psoriatic arthritis (PsA) with infliximab. Treatment with infliximab was initiated 3 years before and the psoriatic skin lesions with arthritis were well controlled. However, after 21 doses of infliximab, the skin lesions and joint pain exacerbated and became intractable. Ten days after the dosage of infliximab was increased, the patient experienced headache and nausea with high fever. He had scaly, well-circumscribed erythemas on his trunk, extremities, and deformed nails. He also had swelling and pain in multiple joints. His complete blood and differential leukocyte counts were normal. The level of C-reactive protein was 16.66 mg/dL, whereas anti-infliximab antibodies were absent. Nuchal rigidity was absent and there were no abnormal neurological findings; however, jolt test results were positive. Results from magnetic resonance imaging were normal, whereas those from cerebrospinal fluid (CSF) examination were almost normal. The CSF contained mononuclear cells and was negative for bacteriological cultures, India ink staining, and polymerase chain reaction amplification of herpesvirus group DNA. Headache and nausea improved 2 months after infliximab was discontinued. The patient failed to respond to infliximab treatment for PsA, and we diagnosed infliximab-induced aseptic meningitis. Infliximab was discontinued and treatment with ustekinumab and methotrexate was initiated. Thereafter, the psoriatic skin lesion and joint pain gradually improved. Infliximab-induced aseptic meningitis may be a differential diagnosis when symptoms of meningitis develop during infliximab administration.

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Safety and Efficacy of Therapies for Skin Symptoms of Psoriasis in Patients with Psoriatic Arthritis: A Systematic Review

The Journal of Rheumatology ◽

10.3899/jrheum.140880 ◽

2014 ◽

Vol 41 (11) ◽

pp. 2301-2305 ◽

Cited By ~ 9

Author(s):

Wolf-Henning Boehncke ◽

David Alvarez Martinez ◽

James A. Solomon ◽

Alice B. Gottlieb

Keyword(s):

Systematic Review ◽

Psoriatic Arthritis ◽

Skin Disease ◽

Psoriatic Skin ◽

Safety And Efficacy ◽

Psoriatic Disease ◽

Skin Symptoms ◽

Guidelines And Recommendations ◽

Systemic Therapies

Numerous guidelines and recommendations exist for the treatment of psoriasis in various populations. One important population is patients with psoriatic arthritis (PsA) who have symptoms of both joint and skin disease. In patients with both facets of psoriatic disease, skin and joints must be treated separately, but also simultaneously. As several systemic therapies are approved for either one or both, the concept of treating both facets with the same drug is feasible. This review summarizes evidence from studies in patients with PsA on the efficacy of these drugs on psoriatic skin disease in these patients.

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Short-Term Total Hip Arthroplasty Outcomes in Patients With Psoriatic Arthritis or Psoriatic Skin Disease Compared to Patients With Osteoarthritis

Arthritis & Rheumatology ◽

10.1002/art.39431 ◽

2016 ◽

Vol 68 (2) ◽

pp. 410-417 ◽

Cited By ~ 5

Author(s):

Lisa A. Mandl ◽

Rebecca Zhu ◽

Wei-Ti Huang ◽

Meng Zhang ◽

Michael M. Alexiades ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Skin Disease ◽

Psoriatic Skin ◽

Short Term ◽

Total Hip

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POS0413 COMPREHENSIVE IMMUNE PROFILING OF PERIPHERAL BLOOD IN PSORIATIC ARTHRITIS (PsA) PATIENTS: EXPANSION OF INTERMEDIATE MONOCYTES AND DECREASED T REG AND CD8 T CELLS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3540 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 436.1-436

Author(s):

A. Grivas ◽

M. Grigoriou ◽

P. Katsimpri ◽

P. Verginis ◽

D. Boumpas

Keyword(s):

T Cells ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Peripheral Blood ◽

Mononuclear Cells ◽

Immune Cell ◽

Psoriatic Skin ◽

Parametric Data ◽

Hla Dr ◽

Intermediate Monocytes

Background:Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis that develops in a subset of patients with psoriasis. According to the current paradigm, cells of the innate and adaptive immunity interact with resident tissue fibroblasts mounting an inflammatory response via complex cytokine networks in the skin and joints in which type 1 and type 17 T cells play a dominant role. The abundance and relative contribution of other peripheral blood immune cells to disease pathogenesis as well the molecular signature of peripheral blood mononuclear cells and tissue fibroblasts remain ill defined.Objectives:To comprehensively characterize immune cell subsets driving inflammation in the peripheral blood of patients with active PsA and their impact on psoriatic skin fibroblasts.Methods:Peripheral blood was collected from PsA patients (n=31) and age-/sex-matched healthy individuals (HI) (n=9), after informed consent. Psoriatic skin biopsies were acquired from a subset of 5 patients and 3 HI. All patients fulfilled the CASPAR criteria for the diagnosis and displayed peripheral polyarthritis of moderate- to high-disease activity. Patients’ demographic and clinical data were recorded at time of sampling. Disease activity was assessed using the Disease Activity Index for Psoriatic arthritis (DAPSA) score. Skin psoriasis activity indices, enthesitis and dactylitis were also recorded. Peripheral blood mononuclear cells (PBMCs) were isolated by ficoll density gradient centrifugation. Flow cytometry was performed using a BD FACS-Aria-III and analyzed using FlowJo software. The antibody staining panel utilized aimed at the identification of the following immune cell subsets: Monocyte subsets (HLA-DR+ CD14+/- CD16+/-), Plasmacytoid dendritic cells (HLA- DR+ CD123+), T helper (CD4+), cytotoxic T (CD8+), regulatory T (CD4+ CD25+ CD127-) and B cells (CD19+). Statistical analyses were performed using GraphPad Prism software. Differences between groups were compared using unpaired T test for parametric data; Mann-Whitney and Kruskal Wallis tests for non-parametric data. The level of significance was set at P<0.05.Results:9 males and 22 females PsA patients are included (mean age 50 years and the mean disease duration 19.2 years for skin disease and 5.9 years for arthritis). The mean DAPSA score was 43.4, suggestive of high disease activity, while 8 (26%) patients displayed clinical enthesitis at time of sampling. Flow cytometry analysis revealed aberrancies in peripheral blood immune cell populations. More specifically, PsA patients displayed a significant increase in intermediate monocyte subset (HLA-DR+ CD14+ CD16+) compared to HI with patients with clinical enthesitis demonstrating a more exaggerated expansion of intermediate monocytes compared to patients without enthesitis. A trend towards increased patrolling monocytes (HLA-DR+ CD14- CD16+) was also noted although this did not reach statistical significance. In contrast, both regulatory T cells and cytotoxic CD8+ T cells were significantly decreased probably due to their selective migration at the sites of inflammation. RNA-seq from whole blood and skin fibroblasts from affected skin are in progress.Conclusion:These data demonstrate significant expansion of intermediate monocytes -more pronounced in the enthesitis affected individuals- and decrease in T regulatory cells and T cytotoxic cells in PsA peripheral blood. Increased antigen presentation and co-stimulation mediated via intermediate monocytes in combination with their proangiogenic properties may contribute to disease pathogenesisReferences:[1]Veale, D. J. & Fearon, U. The pathogenesis of psoriatic arthritis. The Lancet (2018) doi:10.1016/S0140-6736(18)30830-4.Disclosure of Interests:None declared

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Apremilast increases IL-10-producing regulatory B cells and decreases proinflammatory T cells and innate cells in psoriatic arthritis and psoriasis

Rheumatology ◽

10.1093/rheumatology/kez204 ◽

2019 ◽

Vol 58 (12) ◽

pp. 2240-2250 ◽

Cited By ~ 7

Author(s):

Athanasios Mavropoulos ◽

Efterpi Zafiriou ◽

Theodora Simopoulou ◽

Alexandros G Brotis ◽

Christos Liaskos ◽

...

Keyword(s):

Psoriatic Arthritis ◽

B Cells ◽

Cell Subset ◽

Nkt Cells ◽

Pde4 Inhibitor ◽

Psoriatic Skin ◽

Th1 Cells ◽

Regulatory B Cells ◽

Immunological Mechanisms ◽

B10 Cells

Abstract Objectives Psoriatic arthritis (PsA) and psoriasis are immune-mediated inflammatory diseases sharing common immunological mechanisms. Regulatory B cells (Breg cells) producing IL–10 (B10 cells), a critical anti-inflammatory B-cell subset, were found to be decreased in both PsA and psoriasis. Apremilast, a phosphodiesterase-4(PDE4) inhibitor, increases IL-10 and therefore, we examined the effect of apremilast on Breg cells. Methods Fifty patients, including 20 with PsA and 30 with psoriasis, were included in the study. The effect of apremilast on Breg cells at 3, 6 and 12 months post-treatment, was examined by flow cytometry in ODN2006 (TLR9)-stimulated peripheral blood mononuclear cells and magnetically-isolated cells. Th1 cells, Th17 cells and NKT were also measured. Results Ex vivo stimulated cell analysis identified that post-apremilast (IL-10+CD19+) B10 cells were increased in all PsA and psoriasis patients and correlated with psoriatic skin and joint clinical improvement. Apremilast decreased IFNγ(+) T and NKT cells and IL-17(+)NKT cells. B10 cells also inversely correlated with Th1 cells, and IFNγ(+)NKT cells. Conclusion These results suggest that Breg cells are a major target of apremilast in PsA and psoriasis and that apremilast-induced increase of Breg cells is associated with a decrease of Th1 cells, IFNγ-producing NKT cells and IL-17-producing NKT cells.

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Exacerbation of psoriatic skin lesions in a patient with psoriatic arthritis receiving adalimumab

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/j.1365-2710.2008.00915.x ◽

2008 ◽

Vol 33 (3) ◽

pp. 321-325 ◽

Cited By ~ 14

Author(s):

J. Borrás-Blasco ◽

A. Gracia-Perez ◽

C. Nuñez-Cornejo ◽

J. D. Rosique-Robles ◽

A. Mateu-Puchades ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Skin Lesions ◽

Psoriatic Skin

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Variants in linkage disequilibrium with the late cornified envelope gene cluster deletion are associated with susceptibility to psoriatic arthritis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2010.130575 ◽

2010 ◽

Vol 69 (12) ◽

pp. 2199-2203 ◽

Cited By ~ 27

Author(s):

John Bowes ◽

Edward Flynn ◽

Pauline Ho ◽

Batool Aly ◽

Ann W Morgan ◽

...

Keyword(s):

Risk Factor ◽

Psoriatic Arthritis ◽

Gene Cluster ◽

Psoriatic Skin ◽

Envelope Gene ◽

Deletion Mapping ◽

Irish Population ◽

Cornified Envelope ◽

Genotype Frequencies ◽

Increased Risk

ObjectiveA common deletion mapping to the psoriasis susceptibility locus 4 on chromosome 1q21, encompassing two genes of the late cornified envelope (LCE) gene cluster, has been associated with an increased risk of psoriasis vulgaris (PsV). One previous report found no association of the deletion with psoriatic arthritis (PsA), suggesting it may be a specific risk factor for PsV. Given the genetic overlap between PsA and PsV, a study was undertaken to investigate whether single nucleotide polymorphisms (SNPs) mapping to this locus are risk factors for PsA in a UK and Irish population.MethodsThree SNPs with prior evidence of association with susceptibility to PsV were genotyped in 1057 patients with PsA using Sequenom iPlex chemistry and genotype frequencies compared with data available for 5575 healthy controls. Two of the SNPs, rs4112788 and rs4085613, were reported to be highly correlated with the LCE deletion. The third SNP, rs6701216, was previously reported to be associated with PsV in a US population.ResultsAlleles tagging the deletion for both rs4112788 and rs4085613 were found to be enriched in cases compared with controls (69% vs 65%) and significantly associated with increased susceptibility to PsA (ptrend = 0.001, OR 1.19 and ptrend = 0.001, OR 1.18, respectively). No association was observed with rs6701216.ConclusionsThe evidence presented here supports LCE deletion as a risk factor for PsA in a UK and Irish population. It suggests that this locus is a risk factor within a shared aetiological pathway that contributes to psoriatic skin disease in both PsV and PsA.

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Psoriatic onycho-pachydermo-periostitis / Psoriatični onihopahidermoperiostitis

Serbian Journal of Dermatology and Venerology ◽

10.2478/v10249-011-0022-z ◽

2010 ◽

Vol 2 (2) ◽

pp. 54-58

Author(s):

Zorica Perić-Hajzler ◽

Lidija Kandolf-Sekulović ◽

Lidija Zolotarevski

Keyword(s):

Psoriatic Arthritis ◽

Antibody Therapy ◽

Skin Lesions ◽

Treatment Modalities ◽

Psoriatic Skin ◽

Symptom Improvement ◽

Nail Changes ◽

The Family ◽

History Of ◽

Inflammatory Drugs

Abstract Psoriatic onycho-pachydermo-periostitis has been recognized as an uncommon subset of psoriatic arthritis, and to date, only a few cases have been reported. In general, psoriatic onycho-pachydermo-periostitis is regarded as a unique variant of psoriatic arthritis, but its pathology and pathophysiology are not well understood. Although psoriatic onychopachydermo- periostitis is usually found in patients with psoriasis, it can also be found in patients without psoriatic skin lesions. It is characterized by psoriatic nail changes (usually onycholysis), painful swelling of the soft tissue close to the distal phalanges, and radiographic changes of the distal phalanges with periosteal reaction and bone erosions. We present a 58-year-old man with a 3-year history of deformation, thickened nails and pustules on the skin of his fingers and toes, and painful redness of the nail bed accompanied with pain in small joints. The family history was negative. After confirmation of the diagnosis, methotrexate: 15 mg weekly, was initiated which led to symptoms improvement. Treatment of psoriatic onycho-pachydermo-periostitis is difficult. It is based on treatment modalities used for other forms of psoriatic arthritis, such as sulphasalazine, methotrexate, and anti-tumor necrosis factor antibody therapy with adalimumab and etanercept. Nonsteroidal anti-inflammatory drugs are usually ineffective. Retinoids, subungual cyclosporine and corticosteroid therapy also showed inefficient. In our patient, methotrexate has shown efficacy in symptom improvement.

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