151
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Affiliation(s)
- Philip Mease
- Division of Rheumatology Research, Swedish Medical Center.
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152
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Young MS, Furfaro N. The rheumatology/dermatology collaboration. Dermatol Nurs 2006; Suppl:10-22. [PMID: 17444251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Psoriatic arthritis (PsA) of often has a destructive course, characterized by progressive damage to bone and joints. Consequently, prompt detection is critical, allowing effective, disease-modifying treatment to be administered at the earliest possible point in the progression of the disease. The collaboration between dermatologic and rheumatologic professionals in the early diagnosis, and subsequent management, of PsA is explored, with a focus on case studies that illustrate the potentialfor such collaboration.
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153
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Abstract
Psoriasis is a chronic skin disorder affecting approximately 1% to 3% of the world's population. A considerable proportion of patients with psoriasis will develop a form of inflammatory arthritis known as psoriatic arthritis whose prevalence is poorly defined. Significant advances have been made in determining the pathophysiology of both of these diseases, with recent findings strongly implicating T cells and inflammatory cytokines such as tumor necrosis factor alpha in their pathogenesis. There exists an increasing array of therapies to benefit both skin and musculoskeletal manifestations. Newer therapies, such as the biologics, are providing more targeted approaches with potentially fewer systemic toxicities, providing control of disease symptoms and inhibiting progressive joint damage in those with arthritis, as well as improving long-term function and quality of life.
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Affiliation(s)
- Wendy A Myers
- Psoriasis Center of Excellence, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
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154
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Ouédraogo DD, Palazzo E, Nlomé-Nzé M, Somogyi N, Ballard M, Hayem G, Meyer O. Predominant cervical involvement in patients with psoriatic arthritis: report of two cases. Joint Bone Spine 2006; 74:175-8. [PMID: 16987680 DOI: 10.1016/j.jbspin.2006.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 04/20/2006] [Indexed: 10/24/2022]
Abstract
Cervical spine involvement is common but usually delayed in patients with psoriatic arthritis. We report two cases with early and predominant involvement of the upper cervical spine. Synovitis of the atlanto-odontoid joint and fusion of multiple facet joints were noted in one patient. In the other patient, the main finding was atlanto-axial subluxation with erosions of the odontoid process and anterior arch of C1. No abnormalities were noted in the peripheral joints, sacroiliac joints, or thoracolumbar spine. Analgesics and conventional antiinflammatory agents were only minimally effective. TNFalpha antagonist therapy (infliximab followed by etanercept) in one patient and phenylbutazone therapy in the other improved the symptoms and led to shrinkage of the pannus.
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155
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Gladman DD, Mease PJ. Towards international guidelines for the management of psoriatic arthritis. J Rheumatol 2006; 33:1228-30. [PMID: 16821263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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156
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Nash P. Therapies for axial disease in psoriatic arthritis. A systematic review. J Rheumatol 2006; 33:1431-4. [PMID: 16724371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Prevalence rates for axial involvement in psoriatic arthritis (PsA) vary from 40% to 74% depending upon criteria for diagnosis. In the absence of trial evidence to assess axial involvement in PsA, the GRAPPA group, by consensus, has suggested that outcome measures and therapies for axial disease in ankylosing spondylitis (AS) be used. This systematic review addresses the management of axial disease in PsA, and provides treatment recommendations based on the AS literature.
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Affiliation(s)
- Peter Nash
- Department of Medicine, University of Queensland, Cotton Tree, Australia.
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157
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Ritchlin CT. Therapies for psoriatic enthesopathy. A systematic review. J Rheumatol 2006; 33:1435-8. [PMID: 16724370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Enthesitis is defined as inflammation at sites of tendon, ligament, joint capsule, or fascia insertion sites to bone, and is a hallmark feature of psoriatic arthritis. Several outcome measures have been developed to assess enthesitis, but none have been validated in psoriatic arthritis. In this evidence-based review, we assess the limited data on treatments for enthesitis and make recommendations for further studies in psoriatic enthesitis.
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Affiliation(s)
- Christopher T Ritchlin
- Clinical Immunology Research Unit, University of Rochester Medical Center, Rochester, New York 14642, USA.
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158
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Kavanaugh AF, Ritchlin CT. Systematic review of treatments for psoriatic arthritis: an evidence based approach and basis for treatment guidelines. J Rheumatol 2006; 33:1417-21. [PMID: 16724373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by the association of arthritis and psoriasis. In addition to a heterogeneous and variable clinical course, PsA is complex and multifaceted and may include prominent involvement in the peripheral and axial diarthrodial joints, the skin and nails, and in periarticular structures such as entheses. A central mission of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is to develop guidelines, based upon the best scientific evidence, for the optimal treatment of patients with PsA. We outline the specific methods and procedures used in this evidence-based, systematic review of treatments for PsA, which we hope will provide a basis for future treatment guidelines.
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159
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Woods AC, Mant MJ. Amelioration of severe psoriasis with psoriatic arthritis for 20 years after allogeneic haematopoietic stem cell transplantation. Ann Rheum Dis 2006; 65:697. [PMID: 16611874 PMCID: PMC1798128 DOI: 10.1136/ard.2005.039479] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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160
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Kanekura T, Hiraishi K, Kawahara K, Maruyama I, Kanzaki T. Granulocyte and Monocyte Adsorption Apheresis (GCAP) for Refractory Skin Diseases Caused by Activated Neutrophils and Psoriatic Arthritis: Evidence that GCAP Removes Mac-1-Expressing Neutrophils. Ther Apher Dial 2006; 10:247-56. [PMID: 16817789 DOI: 10.1111/j.1744-9987.2006.00369.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the present study, we have shown that granulocyte and monocyte adsorption apheresis (GCAP), an extracorporeal apheresis instrument whose column contains cellulose acetate (CA) beads, is useful for skin diseases attributable to activated granulocytes and psoriatic arthritis (PsA). We assessed the clinical effectiveness of GCAP and investigated the mechanisms underlying the adsorption of pathogenic granulocytes. The effect of GCAP was assessed in 14 patients with neutrophilic dermatoses and 16 with PsA. The mechanisms by which the instrument adsorbs activated granulocytes were investigated using an in vitro mini-column system that mimics the GCAP. Skin lesions and arthropathy improved in 22 of 29 patients (75.9%) and 14 of 18 (77.8%), respectively. Mac-1 (CD11b/CD18) expression on the peripheral neutrophils, increased compared with normal subjects, was reduced by GCAP. In the mini-column system, CA beads adsorbed 50% neutrophils; and adsorption was inhibited significantly by treating plasma with EDTA and blood cells with antihuman CD11b monoclonal antibody. GCAP was useful for treating neutrophilic dermatoses and PsA. GCAP adsorbs Mac-1-expressing neutrophils to the CA beads by the binding of complement component (iC3b) on CA beads and CD11b expressed on activated neutrophils.
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Affiliation(s)
- Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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161
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Arndt K. Ask the doctor. I was recently diagnosed with psoriatic arthritis. It comes and goes, but I still run and lift weights. So far, it hasn't inhibited my activities, but I'd like to know whether it's a serious condition and if it can get worse. Harv Health Lett 2006; 31:8. [PMID: 19256024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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162
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Jahangier ZN, Jacobs JWG, Kraan MC, Wenting MJG, Smeets TJ, Bijlsma JWJ, Lafeber FPJG, Tak PP. Pretreatment macrophage infiltration of the synovium predicts the clinical effect of both radiation synovectomy and intra-articular glucocorticoids. Ann Rheum Dis 2006; 65:1286-92. [PMID: 16627543 PMCID: PMC1798328 DOI: 10.1136/ard.2005.042333] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore whether pretreatment features of synovial tissue in patients with gonarthritis could predict the clinical effect of radiation synovectomy with yttrium-90 (90Y) and glucocorticoids or with intra-articular glucocorticoids alone. METHODS A synovial biopsy was carried out blindly 2 weeks before treatment in 66 patients with persistent gonarthritis, who were randomised to treatment either with 90Y and triamcinolone or with placebo and triamcinolone. Immunohistochemistry was used to detect T cells, macrophages, B cells, plasma cells, fibroblast-like synoviocytes, adhesion molecules and pro-inflammatory cytokines. Stained sections were evaluated by digital image analysis. Individual patient improvement was expressed using a composite change index (CCI; range 0-12). Successful treatment was defined as CCI > or = 6 after 6 months. RESULTS Patients with rheumatoid arthritis, psoriatic arthritis, undifferentiated arthritis and other causes of gonarthritis were included. The overall response rate was 47%. Clinical efficacy in both therapeutic groups was similar and not dependent on diagnosis. No significant differences were noted between baseline microscopic features of synovial tissue inflammation in patients with rheumatoid arthritis and in those with non-rheumatoid arthritis (ie, all diagnoses other than rheumatoid arthritis). The number of macrophages in the synovial sublining was significantly higher in responders than in non-responders (p = 0.002), independent of treatment group and diagnosis. The clinical effect was positively correlated with pretreatment total macrophage numbers (r = 0.28; p = 0.03), sublining macrophage numbers (r = 0.34; p = 0.005) and vascular cell adhesion molecule 1 expression (r = 0.25; p = 0.04). CONCLUSION The observations support the view that intra-articular treatment either with 90Y and glucocorticoids or with glucocorticoids alone is especially successful in patients with marked synovial inflammation.
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Affiliation(s)
- Z N Jahangier
- Department of Rheumatology & Clinical Immunology, F02.127, University Medical Center Utrecht, Box 85500, 3508 GA Utrecht, The Netherlands.
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163
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Braun J, Wassenberg S. Outcome-Parameter bei Psoriasisarthritis. Z Rheumatol 2006; 65:110, 112-8, 120-3. [PMID: 16501924 DOI: 10.1007/s00393-006-0046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The most important and most commonly occurring form of psoriasis is psoriasis vulgaris. In the specialism of rheumatology palmoplantar pustulosis is also important. The outcome is influenced mainly by how severe and how widespread the manifestations affecting the skin and nails are. All manifestations affecting the joints and occurring in association with psoriasis are subsumed under the term 'psoriatic arthritis' (PsA). Asymmetric oligoarthritis, enthesitis and inflammatory spinal manifestations are especially frequent. PsA is a rheumatic illness with widely varying clinical pictures, most patients having signs and symptoms resembling those of spondyloarthritides (SpA) and other features of rheumatoid arthritis (RA) and/or of arthrosis/osteoarthritis (OA). Clinical features that are particularly typical of PsA are ray-wise joint involvement, dactylitis and osteodestructive and osteoproliferative joint destruction. Dactylitis, asymmetric joint involvement and enthesitis also occur in other SpA. It is becoming increasingly important to define outcome parameters for use in PsA against the backdrop of new forms of treatment. In the case of clinical outcome basic distinctions must be made between clinical signs and symptoms, function and structure. In PsA the sometimes significant manifestations affecting skin and nails must also be considered. The outcome parameters used thus far have varied very widely. The extent and intensity of involvement of the peripheral joints and insertions of tendons and of spinal involvement are particularly important in PsA. In addition, functional impairments, quality of life and parameters concerned with work must be considered. There are hardly any measuring instruments specific to PsA; many have been developed and used primarily for SpA or RA.
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Affiliation(s)
- J Braun
- Rheumazentrum Ruhrgebiet, Herne.
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164
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Abstract
This article focuses on measures that are used to evaluate disease activity, damage, and function in three major inflammatory musculoskeletal disorders. The instruments used in rheumatoid arthritis, where most of the methodologic work has been done, are extensively discussed and instruments for the respective domains in psoriatic arthritis and ankylosing spondylitis are likewise presented.
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Affiliation(s)
- Daniel Aletaha
- Department of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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165
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Cleland LG, James MJ. Marine oils for antiinflammatory effect -- time to take stock. J Rheumatol 2006; 33:207-9. [PMID: 16465648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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166
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Madland TM, Björkkjaer T, Brunborg LA, Fröyland L, Berstad A, Brun JG. Subjective improvement in patients with psoriatic arthritis after short-term oral treatment with seal oil. A pilot study with double blind comparison to soy oil. J Rheumatol 2006; 33:307-10. [PMID: 16465662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To investigate effects of short-term oral treatment with seal oil in patients with psoriatic arthritis (PsA). METHODS Forty-three patients with polyarticular PsA were randomized to receive oral treatment for 2 weeks with either seal oil or soy oil in a double blind controlled trial. Clinical and biochemical variables were assessed at baseline, after treatment, and 4 weeks post-treatment. Patients were allowed to continue nonsteroidal antiinflammatory drugs (NSAID) and disease modifying antirheumatic drugs (DMARD) during the study. RESULTS Forty patients completed the study, 20 in each treatment group. Patients in the seal oil group reported a significant improvement in global assessment of the disease 4 weeks post- treatment (p < 0.01), and both groups showed a trend toward improvement in tender joint count, but the differences between the groups were not significant. There was a fall in the ratio of n-6 to n-3 fatty acids and in arachidonic acid (AA) to eicosapentaenoic acid (EPA) in serum after treatment with seal oil (p < 0.01). Twenty-one percent of all patients had elevated values of calprotectin in feces suggestive of asymptomatic colitis. CONCLUSION Treatment with seal oil was followed by a modest improvement in patient's global assessment of the disease and a trend towards a decrease in number of tender joints. There was a shift in fatty acid composition in serum toward a putative antiinflammatory profile. Oral treatment with seal oil may have NSAID-like effects in PsA.
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Affiliation(s)
- Tor Magne Madland
- Section for Rheumatology and Gastroenterology, Institute of Medicine, University of Bergen, Norway.
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167
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Abstract
Psoriatic arthritis (PsA) is a potentially debilitating disease that may affect small and large peripheral joints, entheses and the axial skeleton. The different clinical manifestations of PsA have been accounted for by various proposals of subdividing the patients into different subgroups. According to the predominant clinical symptoms, most patients can be classified as belonging to the spectrum of spondyloarthritides (SpA) or rheumatoid arthritis (RA). The conventional therapeutic approach comprises non-steroidal anti-inflammatory drugs, systemic and intra-articular corticosteroids, and disease-modifying antirheumatic drugs such as sulfasalazine, methotrexate, ciclosporin and leflunomide. Similar to RA, recent trials in PsA have shown excellent results with the tumour necrosis factor (TNF) blockers etanercept, infliximab and adalimumab, which have positive effects not only on joints, but also on the skin when affected by psoriasis, quality of life, function and slowing of disease progress, as evidenced radiologically. Anti-TNF therapy has been generally safe in clinical trials of PsA. Taken together, there has been definite recent progress in the treatment of PsA, especially for severely affected patients.
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Affiliation(s)
- Jan Brandt
- Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652 Herne, Germany.
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168
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Abstract
The successful use of biologicals in the treatment of rheumatoid arthritis, psoriatic arthritis and spondyloarthritis has had a major impact on the management of these conditions. The challenge in the development of gene therapy as an alternative to these current treatments is to demonstrate that such therapy is more advantageous for patients from the therapeutic and safety points of view. Also, it will need to be demonstrated that gene therapy for the arthritides is economically feasible and that patient populations worldwide will be able to access these treatments.
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Affiliation(s)
- Yuti Chernajovsky
- William Harvey Research Institute, Barts and The London, Queen Mary's School of Medicine and Dentistry, University of London, London, UK.
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169
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Gladman DD, Mease PJ, Krueger G, van der Heidje DMFM, Antoni C, Helliwell PS, Kavanaugh AF, Nash P, Ritchlin CT, Strand CV, Taylor W. Outcome measures in psoriatic arthritis. J Rheumatol 2005; 32:2262-9. [PMID: 16265714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Recent advances in biologic therapies have provided hope for patients with psoriatic arthritis (PsA). However, studies have been hampered by the lack of acceptable and validated outcome measures. This article reviews outcome measures used in the assessment of both skin and joints in PsA, and provides a summary of the Psoriatic Arthritis Workshop during OMERACT 7. A set of domains to be included in the assessment of patients with PsA was derived, and a research agenda was developed.
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Affiliation(s)
- Dafna D Gladman
- University of Toronto, Psoriatic Arthritis Program, University Health Network, Toronto, Canada.
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170
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Abstract
PURPOSE OF REVIEW This paper will review the data published in 2004 on the treatment of psoriatic arthritis, which arthritis affects 6 to 39% of all patients with psoriasis. RECENT FINDINGS New data from placebo-controlled trials of anti-tumor necrosis factor agents, etanercept, infliximab, and adalimumab continue to show sustained effectiveness of these therapies in their ability to control the symptoms and signs of both arthritis and psoriasis, improve quality of life and function, and inhibit disease progression as measured by radiologic changes. Medications that inhibit T cells have been approved for the treatment of psoriasis and have been studied in psoriatic arthritis. The effectiveness of one of these agents, efalizumab, did not achieve statistical significance in the treatment of psoriatic arthritis. The results of a trial with a second agent, alefacept are pending public review. SUMMARY There has been a persistent increased focus on the diagnosis and treatment of psoriatic arthritis as newer and more effective drugs than traditional disease-modifying agents have become available.
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Affiliation(s)
- Philip J Mease
- Seattle Rheumatology Associates, Swedish Medical Center, Rheumatology Research Division, and University of Washington School of Medicine Seattle, Washington 98104, USA.
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171
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Abstract
UNLABELLED Psoriatic arthritis is a chronic, heterogeneous disease whose pathogenesis is unknown, although genetic, environmental, and immunologic factors play major roles. Psoriatic arthritis can follow an aggressive clinical course, and differentiating it from other arthropathies is sometimes difficult. Diagnosis of psoriatic arthritis is based on history, physical examination, the usual absence of rheumatoid factor, and characteristic radiographic features. At least 40% of patients with psoriatic arthritis develop radiographically detectable joint destruction; therefore, proper diagnosis and early treatment can have a significant impact on disease course and outcome. Understanding the pathogenesis of psoriatic disease has led to the use of several biologic agents that work by modulating T-cell signaling or by inhibiting key cytokines involved in inflammation, such as tumor necrosis factor (TNF). TNF inhibitors have demonstrated excellent efficacy in resolving skin and joint disease in patients with psoriatic arthritis and have been shown to be safe agents in various inflammatory disorders. This article reviews the diagnostic and treatment challenges of psoriatic arthritis as they relate to pathogenesis and burden of disease. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should have acquired a more comprehensive knowledge of our current understanding of the classification, clinical presentation, etiology, pathophysiology, differential diagnosis, and treatment of psoriatic arthritis.
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Affiliation(s)
- Philip Mease
- Seattle Rheumatology Associates, Swedish Hospital Medical Center, Division of Clinical Research, WA 98104, USA.
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172
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Kavanaugh A, Cassell S. The assessment of disease activity and outcomes in psoriatic arthritis. Clin Exp Rheumatol 2005; 23:S142-7. [PMID: 16273798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Psoriatic Arthritis (PsA) is a common condition that significantly impacts affected patients. The introduction of novel therapeutic agents for PsA has generated considerable interest in both clinical trials and in clinical care. Thus, there is a great need for standardized outcome measures to assess the activity of disease and the response to therapy. Because psoriasis is a heterogeneous and multi-faceted condition, defining outcome measures has been a challenge. To date, such measures have largely been adapted from related diseases, as described in this essay. Further research is needed to further develop outcome measures for PsA to facilitate optimal treatment of patients with PsA.
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Affiliation(s)
- A Kavanaugh
- Center for Innovative Therapy, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0943, USA.
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173
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Abstract
Outcome measures in psoriatic arthritis (PsA) have been primarily borrowed from the assessment of rheumatoid arthritis and ankylosing spondylitis, although several specific measures for PsA have been established. The advent of new therapeutic agents for the treatment of PsA has made the need for specific outcome measures for PsA more critical to evaluate the heterogeneous manifestations of this disease and features that are unique to its assessment. Several outcome measures have been validated for use in PsA clinical trials while others are being evaluated by groups such as The Group for Assessment of Psoriasis and Psoriatic Arthritis for future use in clinical trials.
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Affiliation(s)
- Soumya M Reddy
- Division of Rheumatology, New York University School of Medicine and Hospital for Joint Diseases, Peter D. Seligman Center for Advanced Therapeutics, 246 E. 20th St., Suite 101, New York, NY 10003, USA.
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174
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Abstract
Previously, psoriatic arthritis was considered an uncommon, generally benign variant of ankylosing spondylitis or rheumatoid arthritis, with few therapeutic options. It is now recognized as a distinct, potentially serious disorder that can be effectively managed with a number of new agents.
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Affiliation(s)
- William J Taylor
- Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand
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175
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Zimmerman GM, Savage LM, Chandler DC, Maccarone Buonfigli M. Psoriatic arthritis and psoriasis: role of patient advocacy organisations in the twenty first century. Ann Rheum Dis 2005; 64 Suppl 2:ii93-100. [PMID: 15708949 PMCID: PMC1766887 DOI: 10.1136/ard.2004.033225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
All the psoriatic arthritis and psoriasis patient advocacy organisations are devoted to promoting public awareness and patient education; supporting access to effective treatments and physicians committed to the welfare of patients; working with physicians and other organisations to facilitate development of new treatments; and supporting research for more effective treatments and a cure for psoriasis and psoriatic arthritis. They have participated in the remaking of health politics in the late twentieth century. This was an era in which small patient support and advocacy groups were transformed into sophisticated national health organisations integral to the formation of national health policy and research, treatment, and education funding by working with physicians, legislators, pharmaceutical companies, third party payors, and the media. As we enter the twenty first century, some of these groups have done critical surveys of patients and physicians to discern needs that are redirecting their programming and reshaping directions in the field. Many national leagues have united to form international organisations. Although differences in their national healthcare systems, the age of their organisations, and the diseases they cover are reflected in the focus of their individual activities, much unites them. Whatever their size, as their roles have come to be recognised in the healthcare community, the patient advocacy organisations welcome being invited to the decision making table. This report describes a sampling of these organisations.
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Affiliation(s)
- G M Zimmerman
- National Psoriasis Foundation, Portland, Oregon 97223, USA.
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176
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Abstract
Psoriatic arthritis is a multisystem disorder which, from a measurement standpoint, demands consideration of its cutaneous manifestations and both axial and peripheral musculoskeletal involvement. Measurements of various aspects of impairment, ability/disability, and participation/handicap are feasible using existing measurement techniques, which are for the most part valid, reliable, and responsive. Nevertheless, there remain opportunities for the further development of consensus around core set measures and responder criteria, as well as for instrument development and refinement, standardised assessor training, cross-cultural adaptation of health status questionnaires, electronic data capture, and the introduction of standardised quantitative measurement into routine clinical care.
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Affiliation(s)
- N Bellamy
- CONROD, University of Queenland, Mayne Medical School, Herston Road, Brisbane, Queensland 4006, Australia.
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177
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Abstract
OBJECTIVE To develop a consensus based set of core domains for outcome studies in psoriatic arthritis. METHODS A list of 26 potential domains was prepared through literature review and email discussions amongst the GRAPPA steering committee members and scored by rheumatologists identified through membership of the CASPAR study and the steering committee. Each participant was emailed an up to date review of outcome measures in psoriatic arthritis and asked to distribute 100 points amongst each potential domain. In two subsequent rounds the group median, interquartile range, and earlier responses were emailed to each respondent to provide an opportunity to revise their scoring. RESULTS Thirty two participants responded to the first round, of whom 30 responded to the third round. For DC-ART, the highest scoring domains were actively inflamed joint count, radiological damage score, patient global assessment, pain, physical function, acute phase response, and quality of life (scores 7 to 12). For SMARD, the highest scoring domains were pain, patient global assessment, physical function, quality of life, and active joint count (scores 10 to 18). For clinical record keeping, three domains scored highly at 10 (pain, patient global assessment, and active joint count). For rehabilitation, the highest scoring domains were physical function, quality of life, pain, patient global assessment, work limitations, and work incapacity (scores 10 to 15). CONCLUSION Amongst rheumatologists with an interest in psoriatic arthritis, a reduced list of potential standard outcome domains have been defined by Delphi consensus methods.
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Affiliation(s)
- W J Taylor
- Rehabilitation Teaching and Research Unit, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand.
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178
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van der Heijde D, Braun J, Landewé R, Davis J, Sieper J, van der Linden S, Dougados M. ASessment in Ankylosing Spondylitis (ASAS) international working group: a model for psoriatic arthritis and psoriasis? Ann Rheum Dis 2005; 64 Suppl 2:ii108-9. [PMID: 15708922 PMCID: PMC1766884 DOI: 10.1136/ard.2004.030858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D van der Heijde
- Divison of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
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179
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Abstract
Psoriatic arthritis is a progressive and often destructive form of seronegative inflammatory arthritis that is associated with psoriasis. It can be difficult to diagnose because it can present in a number of different ways, often indistinguishable from noninflammatory arthropathies such as osteoarthritis as well as inflammatory arthritis such as gout. Severe arthritis may be observed in the absence of psoriasis, or mild arthritis may be seen in the presence of moderate-to-severe psoriasis. A high index of suspicion, screening of psoriasis patients, and close follow-up and evaluation with rheumatology often is needed to make the diagnosis. Early recognition of the disorder and timely therapy can prevent long-term complications, such as permanent joint destruction and disability. With the advent of biologic agents, we are better equipped to manage psoriatic arthritis today. Because dermatologists are on the front-line of psoriasis management, we are perfectly poised to identify and help improve care for patients who suffer from both psoriasis and psoriatic arthritis.
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Affiliation(s)
- Abrar A Qureshi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA.
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180
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Abstract
Psoriasis and psoriatic arthritis (PsA) are not uncommon among the pediatric population. Recognizing and treating these chronic disorders in children present unique challenges for the dermatologist. Paucity of clinical trials and a dearth of available treatment modalities, many of which carry significant risk or adverse effects, can make treating pediatric psoriasis and PsA a daunting task. This review attempts to define and consolidate the current state of knowledge with regards to this disease spectrum. The need for further clinical trials to investigate treatment options in the pediatric population is also discussed.
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Affiliation(s)
- Debra Lewkowicz
- Clinical Research Center, UMDNJ--Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA
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181
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Abstract
Although there is still some controversy about the existence of psoriatic arthritis as a specific form of inflammatory arthritis associated with psoriasis, epidemiological, and clinical studies support the unique features of psoriatic arthritis. Because of lack of diagnostic or classification criteria, the disease has been thought of as uncommon. Over the past several decades, it has become clear that the disease leads to serious disability and even increased mortality. Traditional medications have not been effective in preventing the progression of joint damage. New medications, including biologics, have emerged with the potential to control the inflammation and arrest the progression of joint damage.
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MESH Headings
- Adalimumab
- Alefacept
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antimalarials/administration & dosage
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/pathology
- Arthritis, Psoriatic/physiopathology
- Arthritis, Psoriatic/therapy
- Azathioprine/therapeutic use
- Cyclosporine/therapeutic use
- Etanercept
- Gold Sodium Thiomalate/administration & dosage
- Humans
- Immunoglobulin G/therapeutic use
- Infliximab
- Isoxazoles/therapeutic use
- Leflunomide
- Receptors, Tumor Necrosis Factor/therapeutic use
- Receptors, Tumor Necrosis Factor, Type I
- Recombinant Fusion Proteins/therapeutic use
- Sulfasalazine/therapeutic use
- Tumor Necrosis Factor Decoy Receptors
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Affiliation(s)
- Dafna D Gladman
- Center for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario.
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182
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Abstract
BACKGROUND Significant advances in the pharmacologic treatment of psoriasis, most notably the introduction of the biologic agents efalizumab and alefacept, have occurred recently. In addition, another biologic agent, etanercept, was recently approved for the treatment of psoriasis and psoriatic arthritis, thus adding to the list of biologic agents approved for the treatment of these disease states. A review was conducted by the Drug Information Service of a pharmacy benefits manager (PBM) to determine the relative merits and place in therapy of commonly used systemic agents for the treatment of psoriasis and psoriatic arthritis. OBJECTIVE To provide readers with a comprehensive clinical monograph on psoriasis and psoriatic arthritis agents, written with a managed care perspective, as used in actual drug formulary decision making by a PBM. METHODS The drug formulary of this PBM is designed to provide health plans with an evidence-based review of drugs, therapeutic classes, and disease states with a managed care focus. For each therapeutic class or disease review, an extensive and thorough literature search of MEDLINE is conducted for efficacy, safety, effectiveness, and humanistic and economic data. Drug/disease-state databases (UpToDate online, MICROMEDEX), U.S. Food and Drug Administration clinical reviews, key Internet sites, medical/pharmacy-related news sites, clinical guidelines, and AMCP dossiers are also reviewed. Formulary drug monographs produced by the Drug Information Service of the PBM include a critical analysis and summary of disease-oriented and patient-oriented clinical outcomes, effectiveness, and humanistic data. Additional data considered and included in the formulary review process are clinical attributes, patent expirations/generic competition, off-label or pending indications, and pharmacoeconomic data. RESULTS The biologic agents do not appear to be as efficacious as traditional systemic therapies but are associated with fewer long-term toxicities that often limit treatment duration with traditional systemic agents. Although no head-to-head comparisons between alefacept and efalizumab exist, efalizumab appears to offer slightly higher efficacy rates, while alefacept has a longer duration of action. Etanercept at the higher approved dose appears more efficacious compared with efalizumab or alefacept for the treatment of psoriasis, and it is the only biologic currently approved for the treatment of psoriatic arthritis. Efalizumab and alefacept are generally well tolerated, but rebound flare of psoriasis is associated with efalizumab, thus requiring continuous treatment to avoid a flare in disease. Efalizumab and etanercept can be self-administered by the patient, while alefacept and infliximab require administration by a health care professional. CONCLUSIONS Systemic therapy is reserved for patients with moderate-to-severe psoriasis or patients with psoriatic arthritis. The biologic agents are not as efficacious as traditional therapies but, due to better tolerability, are gaining acceptance in the treatment of psoriasis and psoriatic arthritis. The biologic agents differ in efficacy rates and are generally well tolerated. Clinical attributes, overall efficacy, and economic costs associated with the biologic agents will be significant factors in selecting agents for the treatment of psoriasis and psoriatic arthritis.
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Affiliation(s)
- Vicki S Fisher
- WellPoint Pharmacy Management, 5415 West Old Fort Dr., Spokane, WA 99208, USA.
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183
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Abstract
Psoriatic arthritis is an inflammatory arthritis that is commonly associated with psoriasis. While traditionally viewed as being a benign disease, recent evidence indicates the potential for a significant amount of morbidity and disability, making early recognition and intervention important. Treatment includes both traditional immunomodulatory agents as well as the recently available biologic response modifiers.
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Affiliation(s)
- Eric M Ruderman
- Department of Medicine, Northwestern University Feinberg School of Medicine, 240 East Huron Street, McGaw 2300, Chicago, IL 60611, USA.
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184
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Abstract
Psoriatic arthritis is an inflammatory arthritis associated with the skin disorder psoriasis. The exact etiology of psoriatic arthritis is unknown, although more than 40% of people with the cutaneous disease of psoriasis are estimated to also have joint involvement. This article presents an overview of psoriatic arthritis, including the origin, genetic influence, and immunologic factors involved in its evolution. The clinical features of psoriatic arthritis are also reviewed in this article, and a discussion of the diagnosis and treatment is included.
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185
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Dalbeth N, Yeoman S, Dockerty JL, Highton J, Robinson E, Tan PL, Herman D, McQueen FM. A randomised placebo controlled trial of delipidated, deglycolipidated Mycobacterium vaccae as immunotherapy for psoriatic arthritis. Ann Rheum Dis 2004; 63:718-22. [PMID: 15140780 PMCID: PMC1755035 DOI: 10.1136/ard.2003.007104] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the hypothesis that PVAC, delipidated, deglycolipidated heat killed Mycobacterium vaccae, is an effective and safe treatment for psoriatic arthritis (PsA). This treatment has shown promising results in psoriasis. METHODS 36 patients with PsA in two centres were studied in this double blind, placebo controlled, randomised trial. Patients were randomised to receive two intradermal injections of 50 micro g PVAC or placebo and were followed up for 24 weeks. The primary end point was the Psoriatic Arthritis Response Criteria (PsARC), a composite measure based on changes in joint tenderness and swelling scores and physician and patient global assessments. RESULTS The PsARC response at either 12 or 24 weeks was achieved by 9/18 (50%) placebo and 9/18 (50%) PVAC patients (p = 1.0). No significant differences in the Psoriasis Activity and Severity Index (PASI), patient or physician global assessments, CRP, or Health Assessment Questionnaire score over time were found between the two groups. However, changes in the pain visual analogue scale over time did differ between the two groups (p = 0.006): at 24 weeks the mean score in the PVAC group had declined by 19.2 mm and in the placebo group had increased by 4.8 mm. PVAC was well tolerated with no increased incidence of adverse events compared with placebo. CONCLUSIONS PVAC was not shown to be as effective as immunotherapy for PsA. The striking response to placebo in this study reinforces the importance of adequately controlling therapeutic trials in PsA.
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Affiliation(s)
- N Dalbeth
- Department of Rheumatology, Auckland Healthcare, Auckland, New Zealand.
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186
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Rutkowska-Sak L. [Spondyloarthropathies in childhood]. Pol Merkur Lekarski 2004; 17:76-80. [PMID: 15559619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In this paper the author presents the own and other authors' current opinions about the classification, pathophysiology, clinical picture, differential diagnosis, treatment and prognostic problems in the course of juvenile spondyloarthropathies.
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187
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Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician 2004; 69:2853-60. [PMID: 15222650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The spondyloarthropathies include ankylosing spondylitis, reactive arthritis (including Reiter's syndrome), psoriatic arthritis, inflammatory bowel disease-associated spondyloarthropathy, and undifferentiated spondyloarthropathy. These diseases are linked by their association with the HLA-B27 gene and by the presence of enthesitis as the basic pathologic lesion. Additional clinical features include inflammatory back pain, dactylitis, and extra-articular manifestations such as uveitis and skin rash. The history and physical examination are the major diagnostic tools, although radiographic evidence of sacroiliitis is helpful. Therapeutic options include nonsteroidal anti-inflammatory drugs, sulfasalazine, methotrexate, and tumor necrosis factor-alpha inhibitors. Early recognition and appropriate treatment can help to limit disability.
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MESH Headings
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/physiopathology
- Arthritis, Psoriatic/therapy
- Arthritis, Reactive/diagnosis
- Arthritis, Reactive/physiopathology
- Arthritis, Reactive/therapy
- Diagnosis, Differential
- Humans
- Inflammatory Bowel Diseases/complications
- Spondylitis/diagnosis
- Spondylitis/etiology
- Spondylitis/physiopathology
- Spondylitis/therapy
- Spondylitis, Ankylosing/diagnosis
- Spondylitis, Ankylosing/physiopathology
- Spondylitis, Ankylosing/therapy
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Affiliation(s)
- Rajesh K Kataria
- Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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188
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Mohren M, Daikeler T, Benz D, Günaydin I, Kanz L, Kötter I. Myeloablative immunosuppressive treatment with autologous haematopoietic stem cell transplantation in a patient with psoriatic arthropathy and monoclonal gammopathy of undetermined significance. Ann Rheum Dis 2004; 63:466-7. [PMID: 15020351 PMCID: PMC1754961 DOI: 10.1136/ard.2003.010702] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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189
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Waage AM, Monsbakken JA. [Climate treatment of psoriasis]. Tidsskr Nor Laegeforen 2004; 124:981; author reply 981-2. [PMID: 15060655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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190
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Abstract
Granulocyte and monocyte adsorption apheresis (GCAP) is a new extracorporeal apheresis treatment modality that removes pathogenic granulocytes. Recently, we found that GCAP is useful for treating pyoderma gangrenosum and pustular psoriasis. We thought that this treatment may also be effective for treating other disorders attributable to activated granulocytes and studied the efficacy of GCAP in 4 patients with psoriatic arthritis. Treatment with GCAP resulted in remarkable clearing of joint pain, suggesting that GCAP is valuable for treating arthritis as well as skin disorders. We present a detailed description of these patients and this novel therapy.
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Affiliation(s)
- Takuro Kanekura
- Department of Dermatology, University Faculty of Medicine, Kogoshima, Japan.
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191
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Mørk C, Ozek M, Wahl AK. [Psoriasis and psoriatic arthritis--is climate therapy a treatment or a leisure activity?]. Tidsskr Nor Laegeforen 2004; 124:60-2. [PMID: 14716397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND For many years, Norwegian patients with psoriasis or arthritic psoriasis have been offered climate therapy. In 2002, Rikshospitalet University Hospital's department for treatment abroad organised this treatment for the first time for a group of patients with combined psoriasis and arthritic psoriasis. MATERIAL AND METHODS In 50 patients, psoriasis severity (psoriasis area and severity index, PASI 0-72) was assessed at start and end of treatment in Turkey. Patients reported joint pain (VAS 0-100), skin (DLQI-N 0-29), arthritic psoriasis-related quality of life (ADI-N 0-33) and functional status of arthritis (MHAQ 1-4) at arrival, one week and two months after treatment. Standard response mean (difference/SD difference) was used to evaluate clinical relevance. RESULTS Disease activity was mild at start of treatment. The clinical relevance for the change in skin and arthritis related quality of life was considered high one week after treatment and moderate after two months. Change in psoriasis, pain and functional status of the joints had little clinic relevance. A statistical significant score improvement was found for PASI (6.0 vs. 2.0), DLQI-N (8.4 vs. 2.2 vs. 4.6), ADI-N (9.9 vs. 4.8 vs. 7.0) and MHAQ (1.6 vs. 1.3 vs. 1.4), all means. No significant change in pain score was demonstrated for those having arthritic psoriasis. INTERPRETATION If climate therapy should be implemented as supplemental therapy, we recommend recruitment of patients with severe to moderate psoriasis and arthritic psoriasis and inclusion of an analysis of cost-effectiveness.
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Affiliation(s)
- Cato Mørk
- Hudavdelingen, Rikshospitalet, 0027 Oslo.
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192
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Abstract
Joint diseases are common among patients with psoriasis. Psoriatic arthritis, the most important of these, can be defined as a rheumatoid factor-negative inflammatory arthritis associated with psoriasis and has emerged as a specific disease independent from rheumatoid arthritis. Psoriatic arthritis is divided into several clinical subsets, which is helpful in differentiating it from other types of inflammatory arthritis. The prevalence of arthritis in patients with psoriasis may be far higher than the previously accepted average of 7%. In a recent study of 5,795 members of the Nordic Psoriasis Associations, the prevalence was found to be 30%. Arthritis has a significant impact on quality of life in patients with psoriasis. These factors should be recognised as they have implications for therapy, since a number of drugs can delay or stop joint damage when given in time. This also applies to the new biologic agents, although at present these therapies are generally restricted to patients non-responsive to other available drugs. Alone or in combination, the new drugs may achieve higher response rates and have better safety profiles than older therapies. However, long-term experience is still lacking and, unfortunately, the new drugs will be far from affordable by all for some time to come.
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Affiliation(s)
- Hugh Zachariae
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
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193
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Prlic HM, Lehman AJ, Cibere J, Sodhi V, Varma S, Sukumaran T, Esdaile JM. Agreement among Ayurvedic practitioners in the identification and treatment of three cases of inflammatory arthritis. Clin Exp Rheumatol 2003; 21:747-52. [PMID: 14740454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To conduct a preliminary investigation into the consistency of approach between three Ayurvedic medicine experts on treatments for inflammatory polyarthritis. METHODS A convenience sample of three experienced Ayurvedic practitioners was recruited. These practitioners independently assessed three subjects with inflammatory polyarthritis for health status, treatment history, and lifestyle, conducted a physical examination, and then independently determined the treatment plan. The treatment plan was recorded on standardized collection forms. The subject examination order was randomized for each practitioner. Following completion of the assessments, a facilitated discussion among the practitioners permitted each to discuss all aspects of the recommended therapies. Proceedings were audio-taped and the content analyzed. RESULTS All three practitioners agreed upon a unified concept of Ayurvedic disease origin, disease diagnosis, and treatment approach for each patient. Seven specific treatment groupings (i.e. modalities) emerged: diet, exercise, relaxation, analgesic, anti-inflammatory, immune-enhancing, and detoxification/cleansing. Based on the single visit, the practitioners agreed upon 17 of 21 treatment groups for the three patients. CONCLUSION Despite Ayurvedic medicine's individualized approach, considerable agreement existed among the practitioners studied. The identified Ayurvedic treatment approaches require investigation in a controlled clinical setting.
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Affiliation(s)
- H M Prlic
- Arthritis Research Centre of Canada, Vancouver, Canada
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194
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Abstract
Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. It can be difficult to diagnose and symptoms might vary from being mild to chronic and progressive. Julie Holdsworth discusses the objectives of care management for patients with psoriatic arthritis and explains the rationale for the drugs used to treat this disease.
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195
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[From ointments through light and baths to "biologicals". The therapy of psoriasis becomes even more individual]. MMW Fortschr Med 2003; 145:14. [PMID: 14603599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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196
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Coaccioli S, Di Cato L, Bruni PL, Papini M, Puxeddu A. [A proposal of questionnaire for evaluation of the quality of life in patients with psoriatic arthritis]. Recenti Prog Med 2003; 94:380-6. [PMID: 12942799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The need for a global assessment of the health state of patients affected by psoriatic arthritis (APs) which takes into account not only bio-clinical aspects but also other relevant results such as physical, mental and social wealth, was the main reason for the development of an original questionnaire capable of assessing the social and psychological impact of both the affections [psoriasis (Ps) and APs] considered individually and in their summing up of effects. Our study assessed 56 consecutive patients affected by APs under treatment in the Medical and Skin Disease Departments of the "Santa Maria" Perugia University Hospital of Terni, within a time span of 14 months. A questionnaire divided in five parts (a general part and four special parts, assessing, psychological, social, rheumatological and social, economic and therapeutic issues) was proposed to each patient under observation. The questionnaire can be self-filled in by the patient more than once and has been statistically validated for internal consistency, reproduciability and comparability with control groups. The patients with APs consider "bad" their diseases (50%) and develop depression (50%); the social life are troubled by Ps (49%) alone, in comparison with APs (22%); 70% of patients agrees with therapy and is willing to sustain an extra-expense of 500 euro per year.
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Affiliation(s)
- Stefano Coaccioli
- Clinica Medica e Modulo di Reumatologia, Università, Perugia, Azienda Ospedaliera Santa Maria, Terni.
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197
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Yosipovitch G, Tang MBY. Practical management of psoriasis in the elderly: epidemiology, clinical aspects, quality of life, patient education and treatment options. Drugs Aging 2003; 19:847-63. [PMID: 12428994 DOI: 10.2165/00002512-200219110-00003] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psoriasis in the elderly will constitute a significant challenge for the practising physician in this new millennium. Special considerations for the elderly include drug-induced or drug-aggravated psoriasis, especially for patients receiving polypharmacy or with recent worsening or poor response to conventional therapy. Other frequently encountered forms of psoriasis in the elderly include psoriatic arthritis and its complications, inverse psoriasis and potentially life-threatening complications such as erythrodermic or acute pustular psoriasis, where early recognition and systemic therapy is critical. Faced with an array of topical and systemic drug therapy options, it is of paramount importance that the physician remains focused on the holistic management of the patient, in order to achieve optimal compliance and benefit. This can be achieved through careful attention to quality-of-life issues, especially since many elderly patients may have other medical, social and economic comorbidities that can further negatively affect their overall quality of life. It is also essential that the severity of psoriasis be assessed on a more balanced, holistic scale that incorporates both physical and psychological parameters, such as the Salford Psoriasis Index. The patient and caregiver education should be multi-faceted, regularly conducted and practically orientated. Treatment goals should be kept simple and individualised for each patient, based on concomitant comorbidities, potential adverse effects, existing quality of life, self-care capability, drug history, caregiver situation, financial needs, feasibility for follow-up and patient's preferences. Topically applied medications, such as topical corticosteroids, salicylic acid, tar and dithranol preparations, calcipotriol and tazarotene, are the favoured first-line therapeutic options in the elderly. Narrowband ultraviolet B phototherapy is also well established as a standard therapy for psoriasis. Systemic therapy with agents such as methotrexate, acitretin and cyclosporin should be judiciously reserved for severe, extensive cases in view of their lower therapeutic index in the elderly. The ambulatory psoriasis treatment centre is an integral part of the overall cost-effective management of patients with psoriasis that can function as a 'one-stop' treatment and resource centre for the elderly patient.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology, Wake Forest Medical Center, Winston Salem, North Carolina 27157, USA
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198
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Allanore Y. [Psoriatic arthritis]. Ann Dermatol Venereol 2002; 129:1401-4. [PMID: 12536183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Y Allanore
- Service de Rhumatologie A, Pr Kahan, Hôpital Cochin, AP-HP, Université Paris V, 27, rue du Faubourg Saint-Jacques 75014 Paris.
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200
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Antoni C, Dechant C, Hanns-Martin Lorenz PD, Wendler J, Ogilvie A, Lueftl M, Kalden-Nemeth D, Kalden JR, Manger B. Open-label study of infliximab treatment for psoriatic arthritis: clinical and magnetic resonance imaging measurements of reduction of inflammation. Arthritis Rheum 2002; 47:506-12. [PMID: 12382299 DOI: 10.1002/art.10671] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate infliximab efficacy and safety in disease-modifying antirheumatic drug-unresponsive psoriatic arthritis (PsA). METHODS In a 54-week, open-label, compassionate-use study, 10 patients received intravenous infliximab (5 mg/kg; weeks 0, 2, 6; individualized dosing after week 10). Patients continued their current therapy (stable dose) until week 10. Assessments were performed at weeks 2, 6, 10, and 54. Magnetic resonance imaging (MRI) objectively measured joint inflammation at weeks 0 and 10. RESULTS Patients achieved a 20% improvement according to the American College of Rheumatology (ACR) criteria (ACR20) in all patients by week 2; 8 patients improved 70% (ACR70) at week 10; 6 patients maintained ACR70 after week 54. Week 10 MRI revealed an 82.5% mean reduction in inflammation from baseline, and psoriasis area and severity index scores were reduced by 71.3% +/- 16.7%. There were no significant adverse events, severe infections, or infusion reactions. CONCLUSION Infliximab was effective, safe, and well tolerated in PsA. Arthritis and psoriasis improved in all patients during the 54-week evaluation. Further investigation of the use of infliximab for PsA and psoriasis is warranted.
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Affiliation(s)
- Christian Antoni
- Department of Medicine III, Friedrich-Alexander-University, Erlangen, Germany.
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