scholarly journals Clinical and Social Aspects of Psoriatic Arthritis in Pediatrics

2021 ◽  
Vol 20 (5) ◽  
pp. 426-429
Author(s):  
Andrey L. Bakulev ◽  
Ekaterina E. Talnikova
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Signs ◽  
Social Aspects ◽  
Comorbid Conditions ◽  
Pediatric Dermatology

Psoriatic arthritis is pending issue in modern pediatric dermatology. This review highlights issues of epidemiology, clinical signs, classification, diagnosis, management of comorbid conditions of psoriatic arthritis, as well as social aspects of the disease.

scholarly journals Detectability of the peripheral and axial manifestations of psoriatic arthritis in patients with psoriasis in dermatological practice

2019 ◽  
Vol 13 (4) ◽  
pp. 48-54
Author(s):  
M. N. Chamurlieva ◽  
E. Yu. Loginova ◽  
T. V. Korotaeva
Keyword(s):  
Back Pain ◽  
Psoriatic Arthritis ◽  
Early Diagnosis ◽  
Clinical Signs ◽  
Severity Index ◽  
The Body ◽  
Inflammatory Back Pain ◽  
Patient Complaints ◽  
Asas Criteria ◽  
Mechanical Back Pain

Psoriatic arthritis (PsA) is a heterogeneous disease manifested by peripheral arthritis, dactylitis, spondylitis, and enthesitis. PsA is often undiagnosed by dermatovenerologists because of the difficulty in identifying a variety of clinical signs. The early diagnosis of PsA and the accurate assessment of all its symptoms are necessary for the timely choice of optimal therapy.Objective: to assess the detectability of clinical signs of PsA in patients with psoriasis in dermatological practice.Patients and methods. The investigation enrolled 103 patients (47 men and 56 women) (mean age, 44.0±13.7 years) with psoriasis (its mean duration, 10.7±10.2 years), the average prevalence and severity according to the Body Surface Area (BSA) and the Psoriasis Area and Severity Index (PASI) were 9.3±13.6% and 15.4±12.5 scores, respectively. All the patients completed the Psoriasis Epidemiology Screening Tool (mPEST) and were examined by a dermatovenerologist and a rheumatologist. The diagnosis of PsA was based on the Classification Criteria for Psoriatic Arthritis (CASPAR). The investigators evaluated arthritis, dactylitis, enthesitis, and inflammatory back pain (IBP) according to the rheumatological standards: IBP by the Assessment of SpondyloArthritis International Society (ASAS) criteria, and enthesitis by the Leeds Enthesitis Index (LEI).Results and discussion. Sixty-one (59.2%) of the 103 patients with psoriasis were found to have PsA on the basis of the CASPAR criteria and the rheumatologist's examination. The dermatovenerologist diagnosed arthritis in a significantly smaller number of cases than did the rheumatologist: in 15 (24.6%) and 35 (57.4%) of the 61 patients (p<0.001), respectively. The dermatovenerologist and the rheumatologist demonstrated no significant differences in their clinical evaluation of dactylitis: it was detected in 37 (60.7%) and 40 (65.6%) of the 61 patients, respectively (p=0.32). Based on patient complaints and mPEST findings, the dermatovenerologist recorded pain in the calcaneal region in 32 (52.5%) patients. The rheumatologist identified ulnar, knee, and calcaneus enthesitis in 11 (18%), 8 (13.1%), and 25 (41%) patients, respectively. Based on complaints and mPEST findings, the dermatovenerologist detected back pain in 30 (49.2%) of the 61 patients. The rheumatologist diagnosed IBP in 21 (70%) of these 30 patients and mechanical back pain in 9 (30%). Thus, IBP was noted in 34.4% of PsA patients. Tendonitis was undiagnosed by the dermatovenerologist; the rheumatologist identified wrist tendonitis in 13 (21.3%) of the 61 patients with PsA.Conclusion. Dermatovenerologists frequently underestimate damage to the spine and entheses in patients with psoriasis. The introduction of the ASAS criteria for IBP and methods for assessing enthesitis in dermatological practice can improve the early diagnosis of axial lesion in PsA in patients with psoriasis.

scholarly journals POTENTIALS OF MODERN ULTRASOUND TECHNIQUES IN THE DIAGNOSIS OF PSORIATIC ARTHRITIS

2021 ◽  
Vol 19 (2) ◽  
pp. 141-146
Author(s):  
Yu. Yu. Liashko ◽  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Axial Skeleton ◽  
Pathological Process ◽  
Laboratory Diagnostics ◽  
Non Invasive ◽  
Early Stages ◽  
Instrumental Methods ◽  
Early Psoriatic Arthritis

Psoriatic arthritis is a heterogeneous disease characterized by the involvement of the axial skeleton and peripheral joints and / or entheses in the pathological process. The problems of diagnosing early psoriatic arthritis are not limited to the heterogeneity of clinical manifestations of the disease. Unlike rheumatoid arthritis, there are no biomarkers for the detection of early psoriatic arthritis, and therefore verification of the diagnosis depends on the identification of specific clinical signs. Finally, the absence of psoriasis in the presence of typical clinical signs of arthritis does not permit to confirm the diagnosis in the early stages. Considering numerous difficulties of clinical and laboratory diagnostics of psoriatic arthritis, great attention is paid to non-invasive instrumental methods for diagnosing the disease at early stages. The article provides up-to-date information on the potentials of ultrasound techniques in the diagnosis of early psoriatic arthritis.

Alefacept treatment in psoriatic arthritis: Reduction of the effector T cell population in peripheral blood and synovial tissue is associated with improvement of clinical signs of arthritis

2002 ◽  
Vol 46 (10) ◽  
pp. 2776-2784 ◽  
Author(s):  
Maarten C. Kraan ◽  
Arno W. R. van Kuijk ◽  
Huibert J. Dinant ◽  
Amber Y. Goedkoop ◽  
Tom J. M. Smeets ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
T Cell ◽  
Synovial Tissue ◽  
Cell Population ◽  
Peripheral Blood ◽  
Clinical Signs ◽  
Effector T Cell

scholarly journals OP0224 FILGOTINIB TREATMENT LEADS TO RAPID AND SUSTAINED REDUCTIONS IN INFLAMMATORY BIOMARKERS IN PATIENTS WITH MODERATE TO SEVERE PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 140.1-140
Author(s):  
D. D. Gladman ◽  
W. Jiang ◽  
A. Hertz ◽  
V. Malkov ◽  
O. K. Yoon ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Proinflammatory Cytokines ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Matrix Remodeling ◽  
Research Support ◽  
Serum Samples ◽  
Cytokines And Chemokines ◽  
Clinical Signs And Symptoms

Background:Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease characterized by musculoskeletal and cutaneous inflammation. In the recent EQUATOR study (NCT03101670), patients (pts) with active PsA receiving the oral, selective Janus kinase 1 (JAK1) inhibitor filgotinib (FIL) had significant and sustained improvements versus placebo (PBO) in clinical signs and symptoms. We present here updated results of the EULAR 2019 presentation of EQUATOR on circulating biomarkers in PsA.Objectives:To evaluate the impact of FIL on the levels of circulating proinflammatory cytokines and chemokines, adhesion molecules, and markers of matrix remodeling in EQUATOR pts with active PsA.Methods:EQUATOR was a 16-week, double-blind, multicenter, Phase 2 study in pts with active PsA. Pts were randomized 1:1 to FIL 200 mg (n=65) or PBO (n=66) once daily. Serum samples (FIL n=60 and PBO n=61) were collected at baseline (BL) and at Weeks 1, 4, and 16. The association of BL biomarkers with PsA disease characteristics was analyzed by Spearman’s rank-order correlation. Biomarker changes from BL were assessed in time-paired serum samples using multiplex and high sensitivity ELISA-based assays. Analytes were grouped by hierarchical clustering; treatment effect on a biomarker was defined as a difference in change from BL between pts receiving FIL versus PBO. Improvements in PsA clinical signs and symptoms were determined by assessing changes from BL in a number of clinical disease activity scores including psoriatic arthritis disease activity score (PASDAS), psoriasis area and severity index (PASI) and disease activity index for psoriatic arthritis (DAPSA) scores.Results:BL levels of numerous biomarkers were associated (p<0.05) with clinical measures of PsA. Several clusters of biomarkers were identified based on the rate and magnitude of FIL treatment response. Cluster 1 included biomarkers with substantial reductions from BL with FIL by week 1, such as the acute phase proteins CRP and SAA (>50%), and the inflammatory mediators IL-6, CXCL10, and IL-23 (>25%). Cluster 2 included biomarkers of cell adhesion (ICAM-1, VCAM1) with a 5%–15% reduction from BL with FIL by week 1. Cluster 3 included biomarkers of matrix remodeling (MMP1, SC1M) with a delayed >25% reduction from BL with FIL that was significant by Week 4. Finally, Cluster 4 included biomarkers with a modest (5%–10%) increase from BL with FIL (Eotaxin, IL-15, and adiponectin). Spearman rank correlation analyses showed that at BL, many biomarkers were positively associated with disease scores, and tended to segregate between psoriasis weighted scores such as PASI and arthritis weighted scores such as DAPSA. The observed decrease in proinflammatory cytokines were associated with on-treatment improvements from BL in disease score for pts receiving FIL.Conclusion:Compared with PBO, FIL significantly decreased BL levels of circulating biomarkers associated with PsA disease activity, including proinflammatory cytokines and chemokines, adhesion molecules, and markers of matrix remodeling. The observed decreases in circulating proinflammatory cytokines and biomarkers of both bone pathobiology and psoriatic disease suggest that FIL improves PsA clinical signs and symptoms at a molecular level. These findings are consistent with reduced disease activity in pts with PsA and suggest that FIL treatment leads to a rapid and sustained reduction of inflammation in PsA.Acknowledgments:This study was funded by Gilead Sciences, Inc. Editorial support was provided by Fishawack Communications Inc and funded by Gilead Sciences, Inc.Disclosure of Interests:Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Wendy Jiang Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Angie Hertz Shareholder of: Gilead Sciences Inc, Employee of: Gilead Sciences Inc, Vlad Malkov Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Oh Kyu Yoon Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Mona Trivedi Shareholder of: Amgen and Gilead Sciences, Employee of: Gilead Sciences, Muhsen Alani Employee of: Gilead Sciences, Lene Vestergaard Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Robin Besuyen Shareholder of: Galapagos, Employee of: Galapagos, René Galien Shareholder of: Galapagos, Employee of: Galapagos, Amer M. Mirza Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Vinod Chandran Grant/research support from: Abbvie, Celgene, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lily, Janssen, Novartis, Pfizer, UCB, Employee of: Spouse employed by Eli Lily

scholarly journals Psoriasis and Psoriatic Arthritis in ChildhoodPsoriasis and Psoriatic Arthritis in Childhood

2020 ◽  
Vol 19 (6) ◽  
pp. 444-451
Author(s):  
Nikolay N. Murashkin ◽  
Alexander I. Materikin ◽  
Eduard T. Ambarchian ◽  
Roman V. Epishev ◽  
Leonid A. Opryatin ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Damage ◽  
Joint Stiffness ◽  
Efficacy And Safety ◽  
Comorbid Conditions ◽  
Inflammatory Skin Disease ◽  
Pediatric Practice ◽  
Treatment Onset ◽  
Systemic Agents ◽  
Early Psoriatic Arthritis

Psoriasis is chronic inflammatory skin disease that can develop at any age. Approximately 20–30% of all patients report about first rashes before the age of 18. Psoriatic arthritis is one of psoriasis comorbid conditions. Its signs can range from mild to extremely severe destructive forms. Arthralgia, joint stiffness and swelling are the most common symptoms. Early psoriatic arthritis treatment onset allows to control joint damage which usually occurs during the first 2 years of the disease. The moderate and severe course of psoriasis and psoriatic arthritis may require systemic therapy, however, there is not much data on the efficacy and toxicity of systemic agents in the pediatric practice. This article provides the review of studies on etanercept efficacy and safety in children with psoriatic arthritis.

scholarly journals AB0578 SUBCLINICAL ENTHESITIS IN PSORIASIS patiEntS AS prediCtor OF ARTHRITIS (EPESCA STUDY): PRELIMINARY RESULTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1326.2-1326
Author(s):  
E. Di Donato ◽  
A. Becciolini ◽  
S. DI Nuzzo ◽  
N. Chernyschova ◽  
C. Commisso ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Structural Damage ◽  
Clinical Symptoms ◽  
Broad Band ◽  
Power Doppler ◽  
Diagnostic Delay ◽  
Clinical Signs ◽  
Plantar Fascia ◽  
Doppler Signal ◽  
P Value

Background:Enthesitis is one of the typical pathological signs of spondyloarthritis such as psoriatic arthritis (PsA) and it seems to be the Primum movens of the disease. Clinical assessment of enthesitis showed to be less sensitive, compared to ultrasound (US) evaluation, in identifying enthesitis in patients with PsA [1].OMERACT defined US enthesitis as: “hypoechoic and/or thickened insertion of the tendon close to the bone (within 2 mm from the bony cortex), which exhibits Doppler signal if active and that may show erosions, enthesophytes/calcifications as a sign of structural damage” [3]The reported prevalence of subclinical enthesitis in psoriasis (PsO) patients in different countries ranges between 7% and 20% [2].Objectives:The main objective of this study was to estimate, by US evaluation, the prevalence of subclinical enthesitis in PsO patients without any clinical signs of enthesitis. Secondary objectives were to analyze differences, in terms of age, sex, BMI, PsO onset and diagnosis, among patients with enthesitis (active or not active), enthesopathy and without any alteration of enthesis.According to the OMERACT definition of ultrasound enthesitis, patients were divided into 4 groups: patients with active enthesitis (AE) defined as the presence of power-Doppler signal in a hypoechoic and/or thickened insertion of the tendon close to the bone; patient with enthesitis (En) defined as hypoechoic and/or thickened insertion of the tendon close to the bone without PD signal; patients with enthesopathy (Ep) defined as the presence of structural damage (erosions, enthesophytes/calcifications); patients without any alteration of enthesis (WE).Methods:Patients with at least 18 years and a diagnosis of PsO made by a Dermatologist were included. Exclusion criteria were the presence of clinical symptoms or signs of articular or entheseal involvement, diagnosis of arthritis and therapy with bDMARDs or tsDMARDs.All patients underwent US examination on grey scale and Power Doppler (PD) ultrasonography of 6 sites (Achilles, quadriceps, distal and proximal patellar, plantar fascia and triceps enthesis) bilaterally. Ultrasound was performed by an experienced sonographer, using a Logiq P9 equipped with 6-12 MHz broad band linear transducer. Data were reported as frequencies and median with interquartile range. To check differences among these four groups, we used chi-square test or Kruskall-Wallis test. P-value ≤ 0.05 is considered statistically significant.Results:We enrolled 124 consecutive psoriasis patients (47 [37.9%] female) with median age 57.7 (45.3-66.5) years, median disease duration 20.4 (10.1-30.8) years, median BMI 27 [24-29]. Patients with AE, En, Ep were 20.2% (25/124), 49.2% (61/124) and 18.5% (23/124), respectively.Patients WE (12.1%, 15/124) showed significantly lower BMI, younger age and shorter diagnostic delay compared to the other patients.All signs of enthesopathy/enthesitis were more frequently observed at Achilles (33.1%, 41/124), triceps (23.4%, 29/124), quadriceps (20.2%, 25/124), distal patellar (18.5%, 23/124) and proximal patellar (4.8%, 6/124) enthesis.Conclusion:Subclinical enthesitis is quite common in PsO patients, and about 20% showed active enthesitis. The enthesopathy seems to be more frequent in patients with increased delay in PsO diagnosis, older age and higher BMI.References:[1]Bandinelli F. et al. Ultrasound detects occult entheseal involvement in early psoriatic arthritis independently of clinical features and psoriasis severity. Clin Exp Rheumatology. Mar-Apr 2013;31(2):219-24.[2]Zuliani F. et al. Ultrasonographic detection of subclinical enthesitis and synovitis: a possible stratification of psoriatic patients without clinical musculoskeletal involvement. Clin Exp Rheumatol Jul-Aug 2019;37(4):593-599.[3]Balint P. V. et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis 2018 Dec;77(12):1730-1735.Disclosure of Interests:None declared.

The Swedish Early Psoriatic Arthritis Registry 5-year Followup: Substantial Radiographic Progression Mainly in Men with High Disease Activity and Development of Dactylitis

2015 ◽  
Vol 42 (11) ◽  
pp. 2110-2117 ◽  
Author(s):  
Mats Geijer ◽  
Ulla Lindqvist ◽  
Tomas Husmark ◽  
Gerd-Marie Alenius ◽  
Per T. Larsson ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Structural Damage ◽  
Radiographic Progression ◽  
Clinical Signs ◽  
Tender Joint Count ◽  
Radiographic Damage ◽  
Radiographic Findings ◽  
Men And Women ◽  
Radiographic Score

Objective.To describe early radiographic findings in patients from the Swedish psoriatic arthritis (SwePsA) registry, progression of destruction, correlations with clinical disease variables, and predictors of destruction.Methods.Hand and foot radiographs were available for 72 of 197 SwePsA patients followed for 5 years. Clinical data were collected according to the SwePsA protocol.Results.Disease characteristics and clinical improvement were similar in men and women. Radiographic abnormalities were more pronounced in men. Total Wassenberg radiographic score at baseline was 0 in 45% of men and 51% of women. One man and one woman had a score > 10. At 5 years, total score was 0 in 14% of men and 40% of women (p = 0.018); 17% of men and 7% of women had scores > 10. Mean total scores for men and women had increased. Baseline erythrocyte sedimentation rate was associated with baseline total radiographic score. In men, swollen joint count was positively, and in women tender joint count negatively, correlated to total radiographic score. After 5 years, only male scores, mainly hand scores, significantly correlated with 28-joint Disease Activity Score and Disease Activity Index for Psoriatic Arthritis scores, swollen joint count, and dactylitis. Achieving remission or minimal disease activity after 5 years protected against structural damage, mainly in men.Conclusion.Radiographic progression in early PsA was generally slow but substantial. Male sex appears to be a risk factor for early radiographic damage while the presence of baseline radiographic damage and dactylitis developing during followup seem to predict further destruction. Hand and foot radiograph scoring cannot be substituted with clinical signs.

scholarly journals Specialized dermatological-rheumatological patient management improves diagnostic outcome and patient journey in psoriasis and psoriatic arthritis: a four-year analysis

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Jana Ziob ◽  
Charlotte Behning ◽  
Peter Brossart ◽  
Thomas Bieber ◽  
Dagmar Wilsmann-Theis ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Interdisciplinary Approach ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Classification Criteria ◽  
Close Collaboration ◽  
Patient Journey ◽  
Before And After

Abstract Background Management of psoriasis patients with arthralgia suffering from suspected psoriatic arthritis (PsA) requires an interdisciplinary approach involving dermatologists and rheumatologists. The aim of the study was to analyze the specialized dermatological-rheumatological management of these patients before and after foundation of a PsA center. Methods A retrospective cohort study of all dermatological-rheumatological consultations during two periods was conducted. Period one, from April 1st, 2016 to February 28th, 2018 versus period two, from March 1st, 2018 to January 31st, 2020, after foundation of a PsA center. Clinical data on patient characteristics including psoriasis subtypes, clinical symptoms and signs, disease activity scores, classification criteria and comorbidities as well as patient journey were extracted and analyzed. Results Four hundred four consultations were studied. Close collaboration in a PsA center lead to a relevantly shortened patient journey concerning rheumatological complaints: period 1: median (IQR): 36.0 (10.0–126.0) months, period 2: median (IQR): 24.0 (6.0–60.0) months. Established scores and classification criteria such as GEPARD or CASPAR did not assist in diagnosis of PsA. Arthralgia (p = 0.0407), swollen joints (p = 0.0151), morning stiffness (p = 0.0451) and dactylitis (p = 0.0086) helped to distinguish between osteoarthritis and PsA. Conclusions Clinical signs and symptoms, scores and classification criteria usually assessed were less helpful than expected in diagnosis of PsA. Close collaboration in a specialized PsA center yielded the fastest way of diagnosis.

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