Musculoskeletal pain in psoriasis - relation to inflammation and additional value of ultrasound in psoriatic arthritis classification

Fatigue and the Impact of Musculoskeletal Pain on Quality of Life in Pediatric Patients With Psoriasis

Background and aims

Musculoskeletal pain associated to psoriasis without the presence of psoriatic arthritis is a poor explored issue in pediatric population. The aim of this study was to compare the health-related quality of life (HRQoL) and fatigue scores of pediatric patients with psoriasis and healthy peers and estimate the impact of musculoskeletal pain.

Methods

The pediatric Gait Arms Legs and Spine (pGALS) questions were used to screen for musculoskeletal pain. General HRQoL was measured using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL 4.0) and fatigue was assessed using the PedsQL-Multidimensional Fatigue Scale (PedsQL-MFS).

Results

Fifty psoriatic patients (12.1years old; IQR 9-15) and 50 controls (12.3 years old; IQR 8.8-15.9) were evaluated. Patients with psoriasis had long disease duration of 6.9 years (IQR 3.7-9.5) and predominantly low disease activity (PASI 3.2, IQR 0.8-6; BSA 3.0, IQR 1-8), mainly treated with topical therapy. The PedsQL 4.0 total score of psoriatic patients with musculoskeletal pain was poorer than controls with pain. Fatigue by PedsQL-MFS was also worse in patients with psoriasis and pain. The risk of impaired HRQoL was 7.7 times higher in the presence of musculoskeletal pain (OR = 7.71, 95%CI 1.66-35.78); other variables such as age, sex and severity of psoriasis did not increase the risk of HRQoL impairment.

Conclusions

Musculoskeletal pain and fatigue may provide clues for systemic impairment in pediatric psoriatic disease and calls for effective systemic treatment to reduce disease burden and accumulated damage.

Glycosylation Pattern of Serum Clusterin in Psoriatic Arthritis and Rheumatoid Arthritis-The Search for New Diagnostic Glycomarkers

Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are connective tissue autoimmune diseases. The present study aimed to check whether serum clusterin (CLU) concentration and its glycosylation pattern may be markers differentiating these diseases-blood sera of patients with PsA (n = 37), RA (n = 34), and healthy subjects (control, n = 21) were examined. CLU concentration was measured using the ELISA test. Glycosylation was analyzed using lectin-ELISA with sialo-specific lectins from Maackia amurensis (MAA) and Sambucus nigra (SNA) recognizing sialic acid (SA) α2,3- and α2,6-linked, respectively, and fucose-specific lectins from Lotus tetragonolobus (LTA), Ulex europaeus (UEA), and Lens culinaris (LCA) specific to fucose α1,3-linked, α1,2-linked, and core fucose, respectively. Significantly higher CLU concentrations were observed in the PsA than in the RA patients. The expression of α2,6-linked SA was significantly higher in the PsA and RA patients than in the control. The expression of SNA-reactive SA was visibly higher in the PsA compared to the RA and control group but insignificant. Negative significant correlations between CLU concentrations and its glycans reactivity with LTA and UEA were also observed. Significantly higher serum CLU concentration, accompanied by a high expression of SNA-reactive SA and a reduced degree of Lewisx and Lewisy antennary fucosylation, may constitute a promising panel of parameters differentiating PsA from RA.

From Psoriasis to Psoriatic Arthritis: Ultrasound Insights Connecting Psoriasis with Subclinical Musculoskeletal Inflammation and the Path to Psoriatic Arthritis

PURPOSE OF REVIEW

This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients.

RECENT FINDINGS

MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established.

50 years of spondyloarthritis: a look back and a look ahead

PURPOSE OF REVIEW

It is now 50 years since the concept of spondyloarthritis was introduced by Moll, Wright and co-authors from Leeds, UK. This review will review the original concept and mark significant milestones over the last 50 years while looking ahead to developments in the future.

RECENT FINDINGS

While the diseases included under this rubric in the original description may have changed the core conditions remain and are still characterized by axial inflammation as a common feature. Imaging, animal models, genetics and immunology have contributed to our knowledge of the pathogenesis and classification of these diseases and have led to the development of more effective treatments.

SUMMARY

Future developments, facilitated by large research consortia, will help build on our current knowledge and will help clarify disease heterogeneity and provide insights into new therapeutic pathways.

Regular Exercise Improved Fatigue and Musculoskeletal Pain in Young Adult Psoriatic Patients without Psoriatic Arthritis

Fatigue and musculoskeletal pain are also frequent in patients with psoriasis (PsO) without arthritis (PsA). The current study aimed to assess the impact of an intervention program based on aerobic training to reduce fatigue and musculoskeletal pain in patients with PsO without PsA. A total of 118 male patients with PsO volunteered in the current interventional study and were randomly allocated to the experimental (n = 59) or control group (n = 59). The intervention consisted of a 16-week aerobic training program on a treadmill, three sessions per week, consisting of a warm-up, 35-50 min treadmill exercise (increasing 5 min/4 weeks) at a work intensity of 50-65% of peak heart-rate (increasing 5%/4 weeks), and cooling-down. The functional assessment of chronic illness therapy fatigue scale (FACIT-Fatigue), health assessment questionnaire disability index (HAQ-DI), and visual analog scale (VAS) were compared pre and post intervention. Nutritional intake, maximal aerobic power, lipid profile, serum markers of muscle damage, and body composition were also assessed. When compared to baseline, FACIT-Fatigue, HAQ-DI, and VAS scores were significantly improved without increasing markers of muscle damage. Fat mass percentage, lipid profile, and maximal oxygen consumption were also improved. In conclusion, a 16-week aerobic training program at moderate intensity was safe, well tolerated, and effective in psoriatic patients without PsA. Long-term follow-up studies are required to examine whether these promising results may improve clinical outcomes.

Utility of Musculoskeletal Ultrasound in Psoriatic Arthritis

PURPOSE

Psoriatic arthritis (PsA) is a chronic autoimmune disease that causes a variety of musculoskeletal abnormalities. Musculoskeletal ultrasound in PsA is becoming increasingly popular, both in clinical practice and research. This narrative reviews recent literature on the utility of ultrasound in PsA.

METHODS

A search of PubMed was used to identify publications written in English, with titles containing the term psoriatic arthritis and either ultrasound, ultrasonography, or sonographic. A total of 178 publications were identified; those that were not relevant (n = 59), were not original research (n = 45), or that had small (<30) sample sizes (n = 34) were excluded, leaving 40 studies for review of the use of ultrasound in various aspects of PsA. Publications with similar findings were grouped into seven domains: (1) the use of ultrasound findings compared to clinical assessment; (2) the use of ultrasound in the assessment of enthesitis; (3) the use of ultrasound in the assessment of nails; (4) the use of ultrasound as a screening tool in patients with psoriasis at risk for PsA; (5) the use of ultrasound in differentiating PsA from other similar conditions; (6) the use of ultrasound as a measure of disease activity; and (7) the use of ultrasound compared to MRI.

FINDINGS

In recent studies, ultrasound measures of inflammation tended to agree with objective clinical findings of disease, such as swollen joint counts, while being less influenced by subjective measures, such as pain. Ultrasound has utility in the assessment of enthesitis and psoriatic nail disease in PsA, and as an overall measure of disease activity. Ultrasound-based outcomes measures have been used in observational studies and in clinical trials involving PsA, and may have utility as a measure of treatment response. The findings from recent studies suggest that ultrasound may have utility in improving the accuracy and precision of screening programs designed to identify subclinical PsA in cohorts of patients with psoriasis; however, cost-efficacy remains to be determined. Beyond screening, ultrasound may have utility in the diagnosis of PsA in patients with suspected inflammatory arthritis, and ultrasound measures of inflammation agree with MRI measures of inflammation, meaning that incorporating ultrasound into clinical practice might help to overcome the barriers associated with MRI.

IMPLICATIONS

As ultrasound technology continues to advance, and associated costs decrease, it is likely that ultrasound will become more integrated into the clinical journeys of patients with PsA.

Increase in axial spondyloarthritis diagnoses after the introduction of the ASAS criteria: a systematic review

To explore the proportion of axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) diagnoses within all newly referred patients visiting rheumatology outpatient clinics. And more specifically, to analyze whether there is an effect of the introduction of the ASAS and CASPAR classification criteria for axSpA and PsA. We systematically searched Embase, Medline Ovid, Cochrane Central and Web of Science from database inception to November 2022. Articles that investigated new onsets of axSpA and PsA in adults from rheumatology clinics were included. In total, 170 out of 7139 studies were found eligible for full-text review, after which 33 unique studies were included. Seventeen studies reported new onsets of axSpA, and 20 studies of PsA. The pooled proportion of axSpA within all newly referred patients was 19% (95% CI 15-23%) and 18% (95% CI 14-22%) for PsA. The proportion of axSpA before 2009 was 3% (95% CI 0-6%) and increased up to 21% (95% CI 14-28%) after 2009. For PsA, limited data were available in order to analyze the proportions of PsA before 2006. Overall, heterogeneity was high (I² > 95%, p < 0.001) that was most likely caused by geographical area, study design, setting and use of different referral strategies. The pooled proportion of axSpA and PsA among patients referred to the rheumatology outpatient clinic was 19 and 18%, respectively. Although the proportion of diagnosed axSpA patients seemed to increase after the introduction of the ASAS criteria, due to the large heterogeneity our findings should be interpreted with caution.