scholarly journals Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment

2020 ◽  
Vol 9 (10) ◽  
pp. 3262 ◽  
Author(s):  
Laura Savage ◽  
Ilaria Tinazzi ◽  
Alen Zabotti ◽  
Philip M. Laws ◽  
Miriam Wittmann ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Early Recognition ◽  
Joint Damage ◽  
Integrated Approach ◽  
Musculoskeletal Symptoms ◽  
Early Therapy ◽  
High Prevalence ◽  
Clinical Biomarker ◽  
Inflammatory Changes ◽  
Citrullinated Protein

In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging studies, particularly ultrasound, show a high prevalence of subclinical enthesitis and other inflammatory changes in psoriasis subjects. Since a serum biomarker, such as the case of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis, neither exists nor seems biologically plausible at this point, this article explores how integration of rheumatological and dermatological assessment can be facilitated for the early recognition of potential PsA. Given that scalp disease is a PsA predictor, but may be managed in the community, then a particular need to access this group is needed. An integrated approach between rheumatology and dermatology can involve joint clinics, parallel clinics with discussion of relevant cases or virtual contact between specialties. Early therapy evaluation and integrated strategies have considerable implications for minimizing suffering and joint damage in PsA.

scholarly journals The Digital Way to Intercept Psoriatic Arthritis

2021 ◽  
Vol 8 ◽  
Author(s):  
Ivan Giovannini ◽  
Philipp Bosch ◽  
Christian Dejaco ◽  
Gabriele De Marco ◽  
Dennis McGonagle ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Digital Technology ◽  
Diagnostic Delay ◽  
Joint Damage ◽  
Preventive Treatment ◽  
Musculoskeletal Symptoms ◽  
Daily Routine ◽  
Physician Patient Relationship ◽  
Digital Revolution ◽  
Virtual Visits

Psoriasis (PsO) and Psoriatic Arthritis (PsA) are chronic, immune-mediated diseases that share common etiopathogenetic pathways. Up to 30% of PsO patient may later develop PsA. In nearly 75% of cases, skin psoriatic lesions precede arthritic symptoms, typically 10 years prior to the onset of joint symptoms, while PsO diagnosis occurring after the onset of arthritis is described only in 15% of cases. Therefore, skin involvement offers to the rheumatologist a unique opportunity to study PsA in a very early phase, having a cohort of psoriatic “risk patients” that may develop the disease and may benefit from preventive treatment. Progression from PsO to PsA is often characterized by non-specific musculoskeletal symptoms, subclinical synovio-entheseal inflammation, and occasionally asymptomatic digital swelling such as painless toe dactylitis, that frequently go unnoticed, leading to diagnostic delay. The early diagnosis of PsA is crucial for initiating a treatment prior the development of significant and permanent joint damage. With the ongoing development of pharmacological treatments, early interception of PsA has become a priority, but many obstacles have been reported in daily routine. The introduction of digital technology in rheumatology may fill the gap in the physician-patient relationship, allowing more targeted monitoring of PsO patients. Digital technology includes telemedicine, virtual visits, electronic health record, wearable technology, mobile health, artificial intelligence, and machine learning. Overall, this digital revolution could lead to earlier PsA diagnosis, improved follow-up and disease control as well as maximizing the referral capacity of rheumatic centers.

scholarly journals AB0676 THE ROLE OF ACPA AND ANA IN SPONDYLOARTHRITIS: HOW THE AUTOIMMUNE DYSREGULATION CAN AFFECT THE COURSE OF DISEASE AND THERAPEUTIC SUCCESS OF MONOTHERAPY DMARDS AND bDMARDs

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1633.1-1633
Author(s):  
D. Cici ◽  
C. Rotondo ◽  
A. Corrado ◽  
S. Berardi ◽  
N. Mansueto ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Start Time ◽  
Disease Manifestation ◽  
Therapeutic Success ◽  
Course Of Disease ◽  
Drug Survival ◽  
Comorbidity Index ◽  
Citrullinated Protein ◽  
Axial Involvement

Background:Occasional findings of anti-citrullinated-protein-antibodies (ACPA) and anti-nuclear-antibodies (ANA) were rarely described in literature on Psoriatic Arthritis (PsA) and on Spondyloarthritis (SpA) in general. How these autoimmune dysregulations can affect the course of them is not yet understood.Objectives:The aim of our study is to evaluate if the presence of ACPA and ANA can determine different disease subsets and influence the DMARDs monotherapy (methotrexate) drug survival (DSM) and b-DMARDs multi-failure patients (MF).Methods:We conducted a retrospective study on patients with Psoriatic Arthritis (PsA) and Spondyloarthritis that fulfilled the ASAS and CASPAR criteria. Patients with diagnosis of connective tissue disease and rheumatoid arthritis and patients ≤ 18 years old were excluded from the study. For each patient, the following variables were considered: age, ACPA, ANA, time between arthritis onset and start of DMARDs (start-time), DSM, switch to b-DMARDs (sw-bDMARDs), arthritis subset (oligoarticular (OA), polyarticular (PA), enthesitis (EA), axial involvement (AI)), number of comorbidities (NC), Charlson Comorbidity Index (CCI).Results:150 patients (55% with PsA and 45% with another SpA) were included in the study. No differences were found in age, ANA rate, ACPA rate, start-time, OA, PA, EA, AI, NC and CCI between the PsA and SpA groups.In the whole group of patients, the ACPA+ subjects(11%) had a significant increase of NC (2.47 ± 1.5 vs 1.6 ± 1.4, p=0.035), a trend to higher CCI, to switch to b-DMARDs, and to be MF compared to those without ACPA. In the same group, the ANA+ patients (12%) showed shorter DSM (233.5 wk ± 45.9 vs 548.0 wk ± 56.8, p=0.362) with similar trend in each subgroup (PsA and SpA).In SpA group, the ACPA+ patients(6,3%) had a trend to shorter DSM (269.0 weeks ± 125vs 603.96 wk± 92.8, p=0.492),to higher sw-bDMARDs, and to be MF, higher NC and CCI compared to those without ACPA. No differences in clinical subset (OA, PA, EA, AI) were observed. In the same group the ANA+ patients had significant higher rate of PA (100% vs 65%, p=0.026) rather than OA (0% vs 35%, p=0.025). No significant differences were found in NC, CCI, MF.In the PsA group, ACPA+ patients showed a trend to develop PA and EA subsets, shorter DSM (187.5 wk ± 48.7 vs 299.6 wk ± 31.4, p=0.415), higher rate to sw-bDMARDs and to be MF. The ANA+ PsA patients had higher trend to develop PA and AI subsets rather than OA and EA. All ANA+ patients were MF (100% vs 42%, p=0.046).Conclusion:The ACPA and ANA positivity in PsA and SpA patients could be suggestive of more severe clinical disease manifestation, higher frequency of comorbidities and lower predicted 10-year survival (CCI). Moreover, this autoimmune dysregulation could be associated with worse drug survival in monotherapy with methotrexate and higher chance to be MF. Therefore, they can be taken into account for clinical management of these patients.Disclosure of Interests:None declared

Deep dissecting haematoma in patients with dermatoporosis: implications for home nursing

2021 ◽  
Vol 26 (Sup3) ◽  
pp. S6-S13
Author(s):  
Valentina Vanzi ◽  
Elena Toma
Keyword(s):  
Wound Healing ◽  
Emergency Management ◽  
Lower Limb ◽  
Essential Role ◽  
Early Recognition ◽  
Wound Management ◽  
Home Nursing ◽  
High Prevalence ◽  
Clinical Emergency

Dermatoporosis is a chronic cutaneous insufficiency/fragility syndrome with a high prevalence in older adults. Dermatoporotic skin becomes thin and fragile and tends to tear. It may lead to deep dissecting haematomas (DDHs) as a final stage of dermatoporosis, which is a clinical emergency. Management can be challenging, as patients with lower-limb haematomas are frequently older and affected by multiple comorbidities, or are probably on medications that negatively influence wound healing. This article describes the essential role of nurses in prevention, early recognition and wound management of DDHs in patients with dermatoporosis.

HYPERTENSION – A PUBLIC HEALTH PROBLEM

2019 ◽  
Author(s):  
Adia Pilav ◽  
Emira Tanović-Mikulec ◽  
Suada Branković ◽  
Vedran Đido
Keyword(s):  
Public Health ◽  
High Risk ◽  
Public Health Problem ◽  
Integrated Approach ◽  
Community Level ◽  
Effective Control ◽  
Population Approach ◽  
Hypertension Control ◽  
Adequate Model ◽  
High Prevalence

Aim. The aim of this paper is to present public health importance of hypertension in population as one of the major CVD risk factor as well as a model of integrated approach to hypertension control at community level. Background. In spite of wide knowledge of pathophysiology and epidemiology in development of hypertension, ability to easily diagnose it, availability of efficient medications, hypertension continues to have high prevalence and setting up hypertension controls poses significant public health challenge. High prevalence of hypertension exists in all countries of the world, regardless of socioeconomic status of the country. It is estimated that the number of people with hypertension by 2025 will rise by 15-20%, and the number of sick people will increase up to 1.5 billion people worldwide. Methods. A review of the relevant literature which discusses the importance of defining clear strategies and interventions in the control of hypertension in countries, with particular emphasis on integrated hypertension management that has the greatest impact. Discussion. Effective and efficient hypertension control requires two approaches: population approach and individual approach to high-risk individuals. The balanced combination of population approach and an approach to access high-risk individuals is vital for the effective control of hypertension and cardiovascular diseases. Conclusions. Health systems in every country must be flexible and ready to provide adequate model of integrated approach to hypertension control at community level understanding their own local needs.

Clinical case of recurrent vomiting in a child: diagnostic search from functional gastrointestinal disorders to piloid astrocytoma

2021 ◽  
Vol 19 (1) ◽  
pp. 78-81
Author(s):  
E. N. Voronina ◽  
◽  
D. V. Pechkurov ◽  
A. A. Tyazheva ◽  
E. V. Kozarez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Nutritional Status ◽  
Clinical Case ◽  
Anxiety Symptom ◽  
Functional Gastrointestinal Disorders ◽  
Integrated Approach ◽  
Gastrointestinal Disorders ◽  
Wide Range ◽  
High Prevalence ◽  
Recurrent Vomiting

The urgency of the problem of recurrent vomiting in children is due not only to the high prevalence of this syndrome, but also to a wide range of reasons for its development. The article presents a clinical case of observation of a child with recurrent vomiting syndrome. It shows the dynamics of the disease, the importance of identifying such «anxiety symptom» as the nutritional status violation. In this case, the cause of vomiting of central genesis was not immediately taken into account, although differential diagnosis presupposes an integrated approach, and doctors' oncological alertness should be constantly preserved even in pediatrics.

scholarly journals Recent advances in understanding and managing psoriatic arthritis

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2670 ◽  
Author(s):  
Dafna D. Gladman
Keyword(s):  
Psoriatic Arthritis ◽  
Early Diagnosis ◽  
Clinical Laboratory ◽  
Joint Damage ◽  
Screening Tools ◽  
Therapeutic Interventions ◽  
Joint Disease ◽  
New Therapeutic Approaches ◽  
Recent Advances ◽  
And Function

This article reviews recent advances in psoriatic arthritis (PsA) over the past several years with emphasis on early diagnosis, better understanding of pathogenesis, and new therapeutic approaches. Early diagnosis is important, since people who present late do not fare as well. There are a number of clinical, laboratory, and ultrasound features that can help identify patients destined to develop PsA, and several screening tools have been developed. It is recognized that genetic and epigenetic factors, as well as T cells and cytokines, play a role in the pathogenesis of PsA, and several targets have been identified for therapeutic interventions. New therapies have been developed and tested in PsA and have been found to be highly effective for both skin and joint manifestations of the disease. The expectation is that, in the future, PsA patients will be treated early and more aggressively and that there will not be significant progression of joint damage. Moreover, with effective treatment of the skin and joint disease and management of risk factors for the comorbidities, we can expect to reduce their occurrence and further reduce the excess mortality and reduced quality of life and function in these patients.

scholarly journals Aetiological Factors of Osteoarthritis: A Review Update

2015 ◽  
Vol 2 (1) ◽  
pp. 18-23
Author(s):  
M. Jahidul Islam ◽  
M. Shahadat Hossain ◽  
M. Ruhul Amin ◽  
Monzur Ahmed
Keyword(s):  
United States ◽  
Joint Damage ◽  
The Elderly ◽  
The United States ◽  
Common Type ◽  
High Rate ◽  
Lumbosacral Spine ◽  
First Metatarsal ◽  
High Prevalence ◽  
Wear And Tear

Osteoarthritis (OA) is no longer considered ‘degenerative’ or ‘wear and tear’ arthritis; rather involves dynamic biomechanical, biochemical and cellular process. Indeed, the joint damage that occurs in OA is the result of active remodeling involving all the joint structures. Although articular cartilage is at the center of change, OA is viewed as a disease of the entire joint. Traditionally, OA has been viewed as an inevitable degenerative condition of the cartilage. It is currently viewed as a biomechanical and biochemical inflammatory disease of the entire joints. Osteoarthritis (OA) is the most common type of arthritis. Its high prevalence, especially in the elderly, and the high rate of disability related to disease make it a leading cause of disability in the elderly. Because of the aging of Western populations and because obesity, a major risk factor, are increasing in prevalence, the occurrence of osteoarthritis is on the rise. In the United States, osteoarthritis prevalence will increase from 66–100% by the year 2020. OA affects certain joints, yet spares others. Commonly affected joints include the cervical and lumbosacral spine, hip, knee, and first metatarsal phalangeal joint (MTP). In the hands, the distal and proximal inter-phalangeal joints and the base of the thumb are often affected. Usually spared are the wrist, elbow, and ankle.Journal of Current and Advance Medical Research 2015;2(1):18-23DOI: http://dx.doi.org/10.3329/jcamr.v2i1.22584

scholarly journals Prevention of recurrent endometrial pathology

2019 ◽  
pp. 21-26
Author(s):  
A. L. Tikhomirov ◽  
S. I. Sarsania ◽  
K. S. Tuskayev ◽  
T. A. Yudina
Keyword(s):  
Hyaluronic Acid ◽  
Integrated Approach ◽  
Therapy Resistance ◽  
Chronic Endometritis ◽  
High Prevalence ◽  
Endometrial Pathology

Therapy resistance of endometrial pathology is one of the significant issues for gynaecologists facing this problem. The features of chronic endometritis include high prevalence of infertility and recurrent endomentrial process, due to adhesive process in the uterus. This task requires an integrated approach, including the use of modern anti-adhesive barrier containing hyaluronic acid and carboxymethylcellulose.

Do all anti-citrullinated protein/peptide antibody tests measure the same? Evaluation of discrepancy between anti-citrullinated protein/peptide antibody tests in patients with and without rheumatoid arthritis

2007 ◽  
Vol 67 (4) ◽  
pp. 542-546 ◽  
Author(s):  
B Vander Cruyssen ◽  
L Nogueira ◽  
J Van Praet ◽  
D Deforce ◽  
D Elewaut ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Psoriatic Arthritis ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Human Fibrinogen ◽  
Peptide Antibody ◽  
Test Variability ◽  
Antibody Tests ◽  
Citrullinated Protein

Background:Different methods exist to demonstrate anti-citrullinated protein/peptide antibodies (ACPA).Aims:To evaluate discrepancy between four ACPA tests.Patients and methods:Population 1 consisted of patients with a new diagnostic problem, including 86 patients with rheumatoid arthritis (RA) and 450 patients without RA. Population 2 consisted of 155 patients with RA who had long-standing disease. Population 3 consisted of 188 patients with psoriatic arthritis and in population 4 there were 192 patients with systemic lupus erythematosus. Populations 1 and 2 were tested with the anti-human fibrinogen antibody (AhfibA) test, anti-CCP2 from Eurodiagnostica (CCP2-euro), anti-CCP2 from Pharmacia (CCP2-phar) and anti-CCP3 test by Inova (CCP3). Samples were annotated as discrepant if positive in one and negative in at least one other test. Each discrepant sample was re-analysed in a different run. Populations 3 and 4 were analysed in the CCP2-euro and AhFibA test.Results:In population 1, ACPA positivity was found in 17 of 450 (3.8%) patients without RA; 14 (82%) of these 17 samples were discrepant. In contrast, 61 of 86 (70.9%) patients with RA were ACPA positive of whom 18 of 61 (29.5%) were discrepant (70.9% vs. 29.5%, p<0.001). The discrepancies between tests could be partly attributed to borderline results, inter-assay discrepancy and inter-test variability. They were more prevalent in patients with systemic lupus erythematosus who were ACPA positive than in those with psoriatic arthritis who were ACPA positive.Conclusions:Discrepancy between different ACPA tests was observed attributable to the occurrence of borderline results, inter-assay variability and mainly to inter-test variability. The lowest inter-test discrepancy is observed between tests that use the same substrate.

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