scholarly journals POS0947 PSORIATIC ARTHRITIS WITH HYPERURICEMIA: MORE PERIPHERAL, DESTRUCTIVE AND CHALLENGING TO TREAT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 736.2-737
Author(s):  
L. Widawski ◽  
T. Fabacher ◽  
J. E. Gottenberg ◽  
L. Spielmann ◽  
P. M. Duret ◽  
...  

Background:Gout and psoriatic arthritis (PsA) can co-exist in the same patient. These 2 diseases seem strongly linked, but the pathophysiological mechanisms of this link have not yet been defined. Hyperuricemia could be an important determinant of PsA1.Objectives:To study the impact of hyperuricemia on clinical presentation, severity and associated comorbidities of PsA.Methods:We conducted a retrospective bicenter case–control study in Strasbourg and Colmar, France. Patients with PsA (according to “L40.5 arthropathic psoriasis” ICD-10 coding) and at least one available serum urate level measurement, were included from 2009 to 2019. Demographic, comorbidities, clinical and radiographic data were collected. Hyperuricemia was defined as serum urate level ≥ 360 µmol/L. We defined “good responders to ongoing PsA treatment” as patients with no outbreak of PsA, biological inflammatory syndrome and therapeutic modification at the last follow-up. Patients with “destructive” disease had one or more erosion(s) seen on standard X-ray, ultrasonography, MRI or TDM.Results:We included 242 patients. 73 (30.2%) had hyperuricemia and 15 (6.2%) met criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more often male (72.6% vs. 39.1%, p = 1.6x10-06), had higher BMI (30.9 vs. 28.7 kg/m2, p = 0.015) and had more comorbidities (Charlson Comorbidity Index: 2.6 vs. 1.8, p = 0.005). In hyperuricemic versus normo-uricemic patients, PsA started at an older age (47.5 vs 43 years, p = 0.016); PsA was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs. 37.4%, p = 0.032). Median uricemia was higher in patients with destructive than non-destructive PsA (321 vs 288.8 μmol/l, p = 0.0038), and hyperuricemia was more frequent with than without joint destruction (37.6% vs 25.8%, p = 0.047). The multivariate analysis confirmed hyperuricemia associated with peripheral joint involvement (OR 2.98, p = 0.025) and less good response to PsA treatment (OR 0.35, p = 0.024).Figure 1.Description of normo- and hyperuricemic psoriatic arthritisCRF: moderate to severe chronic renal failure. MACEs: major adverse cardiovascular events. HBP: high blood pressure. MetS: metabolic syndrome. PsA: psoriatic arthritisConclusion:Patients with hyperuricemic PsA have less good response to PsA treatment than those with normo-uricemia and more peripheral and destructive joint damage. Recognition of PsA in which hyperuricemia would play an aggravating role could modify the management. This would justify a diagnostic reassessment in case of doubt, the possible introduction of hypouricemic treatment and the careful use of NSAIDs in the context of multiple morbidities.References:[1]Felten R, Duret P-M, Gottenberg J-E, Spielmann L, Messer L. At the crossroads of gout and psoriatic arthritis: « psout ». Clin Rheumatol. Febr 2020.Acknowledgements:We thank all participating patients. We also thank the medical secretaries for their help with the ICD-10 extraction, and Dr Thomas Lavaux for helping with serum urate tests at Strasbourg University Hospital.Disclosure of Interests:None declared

2020 ◽  
Author(s):  
Rubén Queiro ◽  
Juan D Cañete ◽  
María Montoro ◽  
Susana Gómez ◽  
Ana Cábez

Abstract Background Patient reported outcomes measures, such as those provided by the the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients’ lives. The objective of the study was to describe demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state.Methods Post-hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal Disease Activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen´s kappa index.Results One hundred and twenty-two (54.7%) patients reached a PsAID <4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID <4 (k=0.53), fair between MDA and PsAID <4 (k=0.36), and moderate between DAPSA remission and PsAID <4 (k= 0.46), was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI: 0.20-0.79, p=0.009), family history of PsA (OR 0.25, 95%CI: 0.09-0.72, p=0.010), and higher C-reactive protein (OR 0.92, 95%CI: 0.85-0.99, p=0.036) were significantly less likely to reach a PsAID < 4.Conclusions There is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history), seem to be associated with lower odds of reaching a low disease impact.


2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Rafaela Silva Guimaraes Gonçalves ◽  
Alice Heaney ◽  
Stephen P. McKenna ◽  
Jonas Braynner Carvalho ◽  
Maria Eduarda Lima Vidal ◽  
...  

Abstract Introduction Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that can cause joint destruction and impair quality of life. The Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) was the first disease-specific tool for determining the impact of the disease on the quality of life of people with PsA. Objectives The primary objective was to develop and validate a Brazilian Portuguese version of the PsAQoL. Methods The UK PsAQoL was translated into Brazilian Portuguese using two translation panels. This translation then checked for face validity and construct validity with new samples of patients. Finally, a test-retest validation study was conducted with 52 patients with PsA. The survey included the Nottingham Health Profile (NHP) as a comparator instrument. Results Internal consistency and reproducibility were both excellent for the new adaptation (0.91 and 0.90 respectively Scores on the PsAQoL were found to correlate as expected with the comparator measure and the instrument was able to detect differences in score related to perceived severity of PsA, general health status and presence of a flare. Conclusion The Brazilian PsAQoL was found easy to understand and complete and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine PsA practice and clinical trials.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Rubén Queiro ◽  
Patricia Tejón ◽  
Pablo Coto ◽  
Sara Alonso ◽  
Mercedes Alperi ◽  
...  

It has been shown that males with spondyloarthritis tend to suffer from more severe spinal disease while females are more likely to have peripheral joint involvement. Nevertheless, gender-related differences have not been thoroughly explored in psoriatic arthritis (PsA). In PsA, males accumulate more peripheral and axial joint damage compared to women. However, it is not clear whether these findings are secondary to differences in occupational physical activity, hormonal changes, or other factors. The present study analyzed the differences in clinical expression of PsA between men and women. We have also evaluated the possible existence of gender-linked differences in the distribution of genes and polymorphisms within the major histocompatibility complex and whether patients’ age at the onset of psoriasis established any differences in these aspects. Women suffered more polyarthritis, greater functional impairment, and a larger number of swollen joints during followup. We appreciated a differential expression of certain MHC genes according to gender and age at onset of psoriasis. Our results point to the need to include patient’s age at the onset of psoriasis and gender as key stratification elements in future studies of genetic associations in PsA.


2019 ◽  
Vol 60 (1) ◽  
Author(s):  
Yasemin Ulus ◽  
Yesim Akyol ◽  
Ayhan Bilgici ◽  
Omer Kuru

Abstract Background Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. Methods Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. Results Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients’ fatigue scores were significantly higher than controls’ (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). Conclusion It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.


2020 ◽  
Vol 9 (4) ◽  
pp. 205846012092079
Author(s):  
Leena Laasonen ◽  
Ulla Lindqvist ◽  
Lars Iversen ◽  
Leif Ejstrup ◽  
Thorarinn Jonmundsson ◽  
...  

Background Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis (PsA). Purpose To describe the radiological features in PAM and explore whether existing scoring systems for radiological damage in psoriatic arthritis are applicable for PAM. Material and Methods Radiographs were scored according to the modified Sharp-van der Heijde (mSvdH) and the Psoriatic Arthritis Ratingen Score (PARS) systems for PsA. Results At inclusion, 55 PAM patients (49% women, mean age 58 ± 12 years) had conventional radiographs of both hands and feet. A total of 869 PAM joints were detected and 193 joints with ankylosis. The mean total mSvdH score was 213.7 ± 137.8 (41% of maximum) with a higher score for hands than for feet: 136.6 ± 90.1 vs. 79.1 ± 60.9. However, the total score was relatively higher in the feet than in the hands when compared to the highest possible scoring (47% vs. 38% of max). The mean total PARS score was 126.3 ± 79.6 (35% of max). Scoring for joint destruction was higher than for proliferation (22% vs. 11% of max). Strong correlation was found between mSvdH and PARS (r2 = 0.913). A significant correlation was found between scoring and duration of arthritis and the Health Assessment Questionnaire. History of smoking, BMI, and gender did not influence the scoring values. Conclusions The two scoring systems studied may not be ideal to indicate progression of PAM in advanced disease since they reach ceiling effects rather early. Therefore, reporting early signs suggestive of PAM, e.g. signs of pencil-in-cup deformities or osteolysis, is crucial. This would reveal the presence of PAM and might lead to improved treatment in order to minimize joint damage.


2021 ◽  
Vol 8 ◽  
Author(s):  
Josephine Mistegård ◽  
Bjorn Gudbjornsson ◽  
Ulla Lindqvist ◽  
Leena Laasonen ◽  
Leif Ejstrup ◽  
...  

Objective: Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis due to excessive bone erosion causing joint destruction and decreased functional capacity. The aim of this study was to investigate the prevalence of comorbidities among patients with PAM and the association between comorbidities and joint involvement.Methods: A total of 66 patients aged ≥18 years from the Nordic countries with past or present psoriasis along with at least one mutilated joint were included in the present study.Results: The median number of comorbid conditions per patient was 1 [interquartile range (IQR) 0–2] and 16.7% reported three or more comorbidities. The most frequent comorbidity was hypertension (36.4%). The median number of mutilated joints per patient was 3 (IQR 1–8.3; range 1–38).Conclusion: Two thirds of the patients with PAM reported comorbid conditions and the most frequent was hypertension which affected more than a third of the patients. However, this study was unable to detect any association between comorbidities and the severity of PAM.


2021 ◽  
Vol 59 (3) ◽  
pp. 275-281
Author(s):  
Yu. L. Korsakova ◽  
T. V. Korotaeva ◽  
E. Yu. Loginova ◽  
E. E. Gubar ◽  
E. A. Vasilenko ◽  
...  

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis associated with psoriasis (Ps); it belongs to the group of spondyloarthritis and is accompanied by damage to both the spine and peripheral joints, as well as the development of enteritis and dactylitis. In addition to skin and joint damage, PsA has numerous comorbid conditions that are pathogenetically related to the underlying disease, such as inflammatory bowel disease (IBD) and autoimmune eye disease, as well as cardiovascular diseases, obesity and metabolic syndrome, diabetes, osteoporosis, malignancies, mental disorders, and various concomitant diseases. We present data of the prevalence of these pathological conditions among the cohort of PsA patients included in the Russian register.Objective – to study the prevalence of comorbid and concomitant diseases in PsA patients.Materials and methods. The Russian multicenter, observational study with retrospective and prospective data collection of PsA patients included 614 patients with the established diagnosis psoriatic arthritis, corresponding to the CASPAR criteria, from 39 subjects of the Russian Federation, female/male – 331 (54%)/283 (46%). The average age was 45.2±0.52 years, duration of PsA – 5.7±0.27 years, Ps – 15.71±0.56. Duration of observation period: January 2016 – November 26, 2019. The diagnosis of comorbid and concomitant diseases was confirmed by medical specialists in accordance with the ICD-10 code. The analysis of the frequency and structure (%) of these diseases was carried out.Results. The majority of PsA patients had limited Ps: the area of Ps skin lesion (BSA, Basic Surface Area) was less than 3% in 372 (61.5%) patients, BSA from 3% to 10% – in 185 (30.6%), BSA>10% – in 47 (7.8%). Comorbid and concomitant diseases were detected in 297 (48%) of 614 patients. 183 (61.6%) patients had 2 or more diseases in addition to Ps and PsA. Diseases of the circulatory system were detected in 229 (77.1%) PsA patients with comorbid and concomitant diseases (arterial hypertension – in 194 (65.3%), coronary heart disease – in 22 (7.4%)). Diseases of the endocrine system, metabolic disorders were detected in 156 (52.5%) patients with PsA (diabetes mellitus in 44 (14.8%), hyperlipidemia in 44 (14.8%), metabolic syndrome in 36 (12.1%), obesity in 7 (2.4%), and others). Gastrointestinal diseases were observed in 62 (20.9%) patients. Diseases of the biliary system – in 33 (11.1%) patients. Diseases of the musculoskeletal system and connective tissue that are not associated with PsA – in 44 (14.8%). Diseases of the genitourinary system – in 23 (7.7%) patients. Respiratory diseases – in 17 (5.7%) patients. Infectious diseases – in 11 (3.7%). Eye diseases were detected – in 10 (3.4%) patients. Hematological diseases were diagnosed in 6 (2.0%) patients. Depression – in 4 (1.3%) patients.Conclusions. Among 297 patients with PsA with comorbid and concomitant diseases, diseases of the circulatory system are the most common (in 77.1%), less often – diseases of the endocrine system, metabolic disorders (in 52.5%) and diseases of the digestive system (in 32%). Uveitis (2.7%), IBD (1.3%), and depression (1.3%) were rarely detected in our cohort. The majority of patients in the Russian registry had mild forms of Ps (61.5%), and severe Ps (BSA>10%) was observed only in 7.8%. Thus, PsA is associated with a high prevalence of comorbid and concomitant diseases, especially cardiovascular. When choosing a treatment, these diseases should be taken into account. In connection with the new possibilities of therapy, it is necessary to evaluate the potential impact of therapy on patients with comorbid and concomitant diseases in real clinical practice.


2020 ◽  
Author(s):  
Rubén Queiro ◽  
Juan D Cañete ◽  
María Montoro ◽  
Susana Gómez ◽  
Ana Cábez

Abstract Background Patient reported outcomes measures, such as those provided by the the Psoriatic Arthritis Impact of Disease ( PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients’ lives. The objective of the study was to describe demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state. Methods Post-hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal Disease Activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen´s kappa index. Results One hundred and twenty-two (54.7%) patients reached a PsAID <4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID <4 (k=0.53), fair between MDA and PsAID <4 (k=0.36), and moderate between DAPSA remission and PsAID <4 (k= 0.46), was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI: 0.20-0.79, p=0.009), family history of PsA (OR 0.25, 95%CI: 0.09-0.72, p=0.010), and higher C-reactive protein (OR 0.92, 95%CI: 0.85-0.99, p=0.036) were significantly less likely to reach a PsAID < 4. Conclusions There is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history), seem to be associated with lower odds of reaching a low disease impact.


Author(s):  
Rini Mayasari Rini Mayasari

ABSTRACT   Free sex is a relationship that is done by men and women without matrimony. Various forms of sexual behavior, such as intimate dating, courtship, to have sexual contact. Factors associated with sex behavior among others, is the lack of knowledge about free sex, free sex impact, forms of promiscuity, perversion LGBT, and disease-free sex. This study design is the technique of sampling using quantitative indirectly using a questionnaire tools shaped questionnaires. Be knew overview of students' knowledge about sex in high school / vocational Lubuk Linggau Year 2016. The study population was high school class XII students in schools in the city Lubuklingga 2016. The sample in this study is the high school class XII students in 9 schools there in Lubuklinggau of 167 people. Results of univariate analysis showed respondent knowledge about free sex amounted to 48 people (28,74%), students with sufficient knowledge of 54 people (32,33%), and students with less knowledge of 65 people (38, 93%). Students with a good knowledge about the impact of free sex amounted to 57 (34,13%), students with sufficient knowledge of 69 people (41,31%), and students with less knowledge 41 (24,56%). Students with a good knowledge about the form of free sex amounted to 58 students (34,73%), students with sufficient knowledge totaled 49 peoples (29,34%), and students with less knowledge of 60 people (35,93%). Students with a good knowledge about LGBT amounted to 54 (32,34%), students with sufficient knowledge amounted to 68 peoples (40.71%), and students with less knowledge amounted 45 peoples (26,95%). Students with a good knowledge about the disease free sex amounted to 22 peoples (13,17%), students with sufficient knowledge of 39 peoples (23,35%), and students with less knowledge amounted to 106 peoples (63,48%).     ABSTRAK   Seks bebas merupakan hubungan yang dilakukan oleh laki-laki dan perempuan tanpa adanya ikatan perkawinan. Berbagai bentuk tingkah laku seksual, seperti berkencan intim, bercumbu, sampai melakukan kontak seksual. Faktor-faktor yang berhubungan dengan perilaku seks bebas antara lain adalah kurangnya pengetahuan tentang seks bebas, dampak seks bebas, bentuk-bentuk seks bebas, penyimpangan LGBT, dan penyakit seks bebas. Desain penelitian ini adalah teknik pengambilan sampel menggunakan teknik kuantitatif yaitu secara tidak langsung menggunakan alat bantu angket berbentuk kuisener. Di ketahuinya gambaran pengetahuan siswa tentang seks bebas di SMA/SMK Kota Lubuk Linggau Tahun 2016. Populasi penelitian ini adalah siswa kelas XII SMA di sekolah yang ada di Kota Lubuklingga tahun 2016. Sampel pada penelitian ini adalah siswa kelas XII SMA di 9 sekolah yang ada di Kota Lubuklinggau yang berjumlah 167 orang. Hasil analisis univariat menunjukan respondent pengetahuan tentang seks bebas berjumlah 48 orang (28,74%), siswa dengan pengetahuan cukup 54 orang (32,33%), dan siswa dengan pengetahuan kurang 65 orang (38,93%). Siswa dengan pengetahuan baik tentang dampak perilaku seks bebas berjumlah 57 orang (34,13%), siswa dengan pengetahuan cukup 69 orang (41,31%), dan siswa dengan pengetahuan kurang 41 orang (24, 56%). Siswa dengan pengetahuan baik tentang bentuk perilaku seks bebas  berjumlah 58 siswa (34,73%), siswa dengan pengetahuan cukup  berjumlah 49orang (29,34%), dan siswa dengan pengetahuan kurang berjumlah 60 orang  (35,93%). Siswa dengan  pengetahuan baik tentang LGBT berjumlah 54 orang (32,34%), siswa dengan pengetahuan cukup berjumlah 68 orang (40,71%), dan siswa dengan  pengetahuan kurang berjumlah 45orang (26,95%). Siswa dengan pengetahuan baik tentang penyakit seks bebas berjumlah 22 orang (13,17%), siswa dengan pengetahuan cukup 39 orang (23,35%), dan siswa dengan pengetahuan kurang berjumlah 106 orang (63,48%).  


Sign in / Sign up

Export Citation Format

Share Document