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Singla S, Eder L, Kaeley G, Aydin SZ. The Use and Availability of Musculoskeletal Ultrasonography for Psoriatic Disease Among Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Members and the Unmet Needs. Clin Ther 2023; 45:822-825. [PMID: 37419859 DOI: 10.1016/j.clinthera.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/09/2023]
Affiliation(s)
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gurjit Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida
| | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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2
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Huang YS, Huang YH, Lin CH, Kuo CF, Huang YJ. Ultrasound Can Be Usefully Integrated with the Clinical Assessment of Nail and Enthesis Involvement in Psoriasis and Psoriatic Arthritis. J Clin Med 2022; 11:jcm11216296. [PMID: 36362523 PMCID: PMC9657153 DOI: 10.3390/jcm11216296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: This study aimed to examine and compare the findings of nail and enthesis ultrasonography in patients with psoriasis and psoriatic arthritis. Methods: We identified 154 patients with psoriatic arthritis and 35 patients with psoriasis who were treated at Chang Gung Memorial Hospital, Taiwan, between September 2018 and January 2019. Results: There were significant differences in the Nail Psoriasis Severity Index scores and Glasgow Ultrasound Enthesitis Scoring System scores between patients with psoriasis and those with psoriatic arthritis. B-mode ultrasonography revealed that onychopathic changes were more common in the psoriasis group. The psoriatic arthritis group showed a higher proportion of lower-limb enthesopathy, with significant differences in distal patellar ligament thickness and Achilles tendon thickness. Conclusion: The findings of nail ultrasonography were more severe in psoriasis cases, and the ultrasonographic findings of enthesopathy of the lower limb were more severe in cases of psoriatic arthritis.
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Affiliation(s)
- Yu-Shin Huang
- School of Medicine, Chang Gung University, Taoyuan City 33305, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Chiung-Hung Lin
- School of Medicine, Chang Gung University, Taoyuan City 33305, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Chang-Fu Kuo
- School of Medicine, Chang Gung University, Taoyuan City 33305, Taiwan
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Yun-Ju Huang
- School of Medicine, Chang Gung University, Taoyuan City 33305, Taiwan
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- Correspondence: ; Tel.: +886-3-3281200
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Gudu T, Ng B, Jethwa H, Graham C, Kudva V, Rammanohar J, Zhang C, Sapsford M, Jadon DR. Improving Imaging Modalities in Early Psoriatic Arthritis: The Role of Ultrasound in Early Diagnosis of Psoriatic Arthritis. Front Med (Lausanne) 2022; 8:804695. [PMID: 35071281 PMCID: PMC8776996 DOI: 10.3389/fmed.2021.804695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Despite recent advances, early diagnosis of psoriatic arthritis (PsA) remains a challenge in clinical practice. Ultrasound (US) could be a useful tool for the diagnosis and management of PsA. The objective of this review was to determine the role of US in early diagnosis of PsA. Methods: We have performed a literature review aiming to evaluate studies on US findings in psoriasis and their predictive value of progression to PsA, as well as studies on US features specific for PsA in comparison with other conditions. Results: A total of 40 studies were included. Sixteen studies assessed US findings in psoriasis, of which only 3 prospectively evaluated the role of US in predicting progression to PsA. Patients with PsA had a greater frequency of US abnormalities, in particular enthesitis and Power Doppler(PD) signal compared to patients with psoriasis only. In the longitudinal studies, psoriatic patients with higher enthesopathy scores at baseline were more likely to progress to PsA. Twenty-four studies evaluated US abnormalities in PsA and compared them to other conditions. Most specific US features that distinguish PsA from psoriasis were PD signal and erosions in joints and entheses. Extra-synovial changes, including peri-tendinous dermal soft tissue oedema with associated PD signal and flexor tendon enthesopathy, as well as thickening of the pulleys in the flexor tendons were highly characteristic for PsA, as they were frequently found in PsA patients, but in none of the RA patients. US-detected entheseal abnormalities in particular erosions and PD signal were more frequent in patients with PsA compared to fibromyalgia. Conclusion: Despite the wide use of US in PsA, more research is needed to identify predictive factors of progression to PsA in patients with psoriasis, as well as to determine most specific US features that differentiate PsA from other conditions.
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Affiliation(s)
- Tania Gudu
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Beverly Ng
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hannah Jethwa
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Catherine Graham
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Veda Kudva
- Queen Mary University, London, United Kingdom
| | | | - Chen Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mark Sapsford
- Department of Rheumatology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Deepak R Jadon
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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4
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Lehner C, Spitzer G, Langthaler P, Jakubecova D, Klein B, Weissenbacher N, Wagner A, Gehwolf R, Trinka E, Iglseder B, Paulweber B, Aigner L, Couillard-Després S, Weiss R, Tempfer H, Traweger A. Allergy-induced systemic inflammation impairs tendon quality. EBioMedicine 2022; 75:103778. [PMID: 35007819 PMCID: PMC8749446 DOI: 10.1016/j.ebiom.2021.103778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023] Open
Abstract
Background Treatment of degenerating tendons still presents a major challenge, since the aetiology of tendinopathies remains poorly understood. Besides mechanical overuse, further known predisposing factors include rheumatoid arthritis, diabetes, obesity or smoking all of which combine with a systemic inflammation. Methods To determine whether the systemic inflammation accompanying these conditions contributes to the onset of tendinopathy, we studied the effect of a systemic inflammation induced by an allergic episode on tendon properties. To this end, we induced an allergic response in mice by exposing them to a timothy grass pollen allergen and subsequently analysed both their flexor and Achilles tendons. Additionally, we analysed data from a health survey comprising data from more than 10.000 persons for an association between the occurrence of an allergy and tendinopathy. Findings Biomechanical testing and histological analysis revealed that tendons from allergic mice not only showed a significant reduction of both elastic modulus and tensile stress, but also alterations of the tendon matrix. Moreover, treatment of 3D tendon-like constructs with sera from allergic mice resulted in a matrix-remodelling expression profile and the expression of macrophage-associated markers and matrix metalloproteinase 2 (MMP2) was increased in allergic Achilles tendons. Data from the human health study revealed that persons suffering from an allergy have an increased propensity to develop a tendinopathy. Interpretation Our study demonstrates that the presence of a systemic inflammation accompanying an allergic condition negatively impacts on tendon structure and function. Funding This study was financially supported by the Fund for the Advancement of Scientific Research at Paracelsus Medical University (PMU-FFF E-15/22/115-LEK), by the Land Salzburg, the Salzburger Landeskliniken (SALK, the Health Care Provider of the University Hospitals Landeskrankenhaus and Christian Doppler Klinik), the Paracelsus Medical University, Salzburg and by unrestricted grants from Bayer, AstraZeneca, Sanofi-Aventis, Boehringer-Ingelheim.
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Affiliation(s)
- Christine Lehner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria; Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dominika Jakubecova
- Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine, St. Johanns University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sebastien Couillard-Després
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Richard Weiss
- Department of Biosciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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5
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Bolkan Günaydın E, Aladağ P, Tecer D, Yenice IS, Adışen E, Göğüş FN. Ultrasonographic evaluation of subclinical enthesitis in patients with psoriasis. Int J Rheum Dis 2020; 23:744-752. [PMID: 32266787 DOI: 10.1111/1756-185x.13835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 12/01/2022]
Abstract
AIM The primary objective of this study was to assess the ultrasonographic signs of subclinical enthesitis in patients with psoriasis. Secondary objective was to examine the associations between the clinical assessments of enthesitis, severity of psoriasis, and the ultrasonographic signs of enthesitis. METHOD This study included 30 patients with psoriasis who did not have clinically detectable arthritis or enthesitis and 30 healthy volunteers as a control group. In the patient group, PASI, NAPSI, MASES, and SPARCC scores were calculated, and in the control group, MASES and SPARCC scores were calculated. Acute, chronic, and total enthesitis scores were calculated by ultrasonographic examination of the enthesis points that are assessed during calculation of SPARCC score, performed by a researcher blinded to the clinical assessments. RESULT In the ultrasonographic assessment, total enthesitis score was significantly higher in the patient group compared with the control group (P = .04). There was no significant difference between the groups regarding acute or chronic enthesitis scores. NAPSI, PASI, MASES, or SPARCC scores did not show correlation with the ultrasonographically acute, chronic, or total enthesitis scores. There was a low-level correlation between MASES and SPARCC scores in the patient group, which was statistically significant (P = .03). No significant correlation was found between other clinical scores. There was no significant difference between patient and control groups in terms of MASES and SPARCC scores. CONCLUSION Entheseal changes may be frequently observed in patients with psoriasis who are asymptomatic. Musculoskeletal ultrasonography (MUS) may be utilized to detect such abnormalities at the early period.
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Affiliation(s)
- Elzem Bolkan Günaydın
- Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Perihan Aladağ
- Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Duygu Tecer
- Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Işıl Saadet Yenice
- Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Esra Adışen
- Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Feride Nur Göğüş
- Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
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6
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Pistone G, Gurreri R, Tilotta G, Castelli E, Bongiorno MR. Secukinumab efficacy in the treatment of nail psoriasis: a case series. J DERMATOL TREAT 2018; 29:21-24. [DOI: 10.1080/09546634.2018.1529381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Giuseppe Pistone
- Department of Dermatology, University of Palermo, Palermo, Italy
| | - Rosario Gurreri
- Department of Dermatology, University of Palermo, Palermo, Italy
| | - Giovanna Tilotta
- Department of Dermatology, University of Palermo, Palermo, Italy
| | - Elena Castelli
- Department of Dermatology, University of Palermo, Palermo, Italy
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8
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Giuseppe P, Nicola P, Valentina C, Elena C, Salvatrice C, Rosario G, Rita BM. A Case of Moderate Hidradenitis Suppurativa and Psoriasis Treated with Secukinumab. Ann Dermatol 2018; 30:462-464. [PMID: 30065588 PMCID: PMC6029963 DOI: 10.5021/ad.2018.30.4.462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a disorder of the apocrine gland causing a chronic, recurrent and painful inflammation. It is a disabilitating condition and, though many therapeutic options are available, the response is often ineffective in most cases and patients can present many recurrences with physical and psychological sequelae. Recent data had shown increased interleukin (IL)-17 serum levels in patients with HS. Psoriasis is a chronic immune-mediated inflammatory disorder and new evidences have shown the role of Th17 cells in its pathogenesis and the therapeutic efficacy of anti-IL-17 antibodies. We present a case of a patient suffering from psoriasis and HS successfully treated with anti-IL-17 antibodies for both conditions. This is the first case report of HS treated with secukinumab.
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Affiliation(s)
- Pistone Giuseppe
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Pardo Nicola
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Caputo Valentina
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Castelli Elena
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Curiale Salvatrice
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Gurreri Rosario
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Bongiorno Maria Rita
- Section of Dermatology, Department of Biomedicine, Internal Medicine and Specialties (Di.Bi.MIS), University of Palermo, Palermo, Italy
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9
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Mease PJ, Coates LC. Considerations for the definition of remission criteria in psoriatic arthritis. Semin Arthritis Rheum 2017; 47:786-796. [PMID: 29566966 DOI: 10.1016/j.semarthrit.2017.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Psoriatic arthritis (PsA) is an autoimmune disease that can cause progressive structural damage of the joints and irreversible disability. The potentially achievable results of biologic therapy for PsA has led to the view that disease remission should be the goal of treatment. However, the heterogeneity of disease manifestations and need for validated outcome measures makes defining remission in PsA challenging. This article evaluates proposed criteria for defining remission in PsA and discusses how these criteria can be applied in clinical practice. METHODS A primary literature search was conducted in PubMed to identify articles discussing potential PsA treatment goals or targets, including minimal disease activity. English-language publications from the last 10 years were included in this assessment. RESULTS There are 5 clinical domains in PsA that must be considered when evaluating remission: synovitis, enthesitis, dactylitis, spondylitis, and psoriasis/nail psoriasis. Due to variability in the completeness of remission and time to achieve remission with different therapies between these domains, remission should be measured clinically through a combination of objective measures, or a composite assessment tool. Composite measures are more efficient than unidimensional instruments in measuring remission, but remission rates differ between the available composite indices. CONCLUSION Although the concept of remission as a treatment goal in PsA is gaining acceptance among rheumatologists, further work is necessary to develop a broadly acceptable definition of remission.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, United States of America.
| | - Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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10
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Zabotti A, Bandinelli F, Batticciotto A, Scirè CA, Iagnocco A, Sakellariou G. Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology (Oxford) 2017; 56:1518-1532. [PMID: 28521047 DOI: 10.1093/rheumatology/kex179] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Indexed: 12/15/2022] Open
Abstract
Objective To systematically review the role of musculoskeletal US in patients suffering from PsA or psoriasis (Pso) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. Methods A systematic literature review was conducted through medical databases (MEDLINE via PubMed, Embase) and the grey literature up to September 2015 to inform a new study of the Musculoskeletal Ultrasound Study Group of the Italian Society for Rheumatology. All articles reporting data on musculoskeletal US in PsA or Pso were included and extracted according to the underlying clinical question. Results A total of 86 publications were included. The prevalence of US abnormalities showed a wide range for each examined feature (e.g. 37-95% for entheses thickness of the lower limbs). The performance of US for diagnosis of disease or elementary lesions was variable across studies, but no study evaluated the overall performance of US in addition to clinical findings for diagnosing PsA. Considering US in defining PsA and Pso prognosis, several works focused on US of entheses of lower limbs in Pso, while for the monitoring of PsA activity five different scoring systems were identified. Last, the results of the role of US in guiding intra-articular interventions were controversial for the clinical outcomes, but in favour of US for accuracy. Conclusion despite the recognized importance of US in the management of PsA and Pso, this review clearly demonstrated the need of pivotal research in order to optimize the use of US in the diagnosis and monitoring of psoriatic disease.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine
| | - Francesca Bandinelli
- Rheumatology Unit, Azienda Sanitaria di Firenze, S. Giovanni di Dio Hospital, Florence
| | | | - Carlo Alberto Scirè
- Epidemiology Unit of the Italian Society for Rheumatology (SIR), Milan.,Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Ferrara
| | - Annamaria Iagnocco
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin
| | - Garifallia Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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11
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Michelsen B, Diamantopoulos AP, Soldal DM, Hammer HB, Kavanaugh A, Haugeberg G. Achilles enthesitis defined by ultrasound is not associated with clinical enthesitis in patients with psoriatic arthritis. RMD Open 2017; 3:e000486. [PMID: 28879054 PMCID: PMC5574441 DOI: 10.1136/rmdopen-2017-000486] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/31/2017] [Accepted: 06/25/2017] [Indexed: 01/01/2023] Open
Abstract
Objective To compare clinical and ultrasonographic (US) evaluation of Achilles enthesitis in patients with psoriatic arthritis (PsA). Methods The Achilles insertion of outpatients with PsA was examined by clinical assessment of tenderness and US evaluation of (1) inflammatory activity (defined as the presence of power Doppler signal, tendon thickening and/or hypoechogenicity) and (2) structural damage (defined as the presence of erosions, calcifications and/or enthesophytes). Univariate and multivariate logistic regression analyses were performed0.4 to explore the associations between clinical characteristics and US scores. Results 282 Achilles tendons in 141 patients with PsA were assessed. Mean (SD) age was 52.4 (10.2) years, disease duration 9.5 (6.6) years and 50.4% were females. Palpatory tenderness was found in 88 (31.2%), US-verified inflammatory activity in 46 (16.3%) and structural damage in 148 (52.5%) of the Achilles. Total US scores, as well as their components, were similar for patients with and without palpatory tenderness. None of the clinical characteristics were associated with inflammatory activity. Age, body mass index (BMI), regular physical exercise and current use of biological disease-modifying antirheumatic drugs (bDMARDs) were associated with structural damage. Conclusion There appears to be a lack of association between clinical and US signs of Achilles enthesitis in PsA. Age, BMI, regular physical exercise and current use of bDMARDs were associated with structural damage on US.
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Affiliation(s)
- Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | | | - Arthur Kavanaugh
- Department of Rheumatology, Allergy and Immunology, University of California, San Diego, USA
| | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, Martina Hansens Hospital, Oslo, Norway
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12
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Cunha JS, Amorese-O’Connell L, Gutierrez M, Qureshi AA, Reginato AM. Ultrasound Imaging of Nails in Psoriasis and Psoriatic Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0067-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Gutierrez M, Kaeley GS, Bertolazzi C, Pineda C. State of the art of ultrasound in the assessment of psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 2016; 13:439-447. [DOI: 10.1080/1744666x.2017.1262765] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| | - Gurjit S Kaeley
- College of Medicine, University of Florida, Jacksonville, USA
| | - Chiara Bertolazzi
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
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14
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Pistone G, Gurreri R, Bongiorno M. Assessment of etanercept efficacy in the treatment of psoriatic arthritis: ultrasonography of Achilles tendon. J Eur Acad Dermatol Venereol 2015; 30:e194-e195. [DOI: 10.1111/jdv.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Pistone
- Department of Dermatology; University of Palermo; Via Del Vespro no. 131 90127 Palermo Italy
| | - R. Gurreri
- Department of Dermatology; University of Palermo; Via Del Vespro no. 131 90127 Palermo Italy
| | - M.R. Bongiorno
- Department of Dermatology; University of Palermo; Via Del Vespro no. 131 90127 Palermo Italy
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15
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Abstract
Dermatoses have been better characterized as hypochromic vitiligo in subjects with dark skin or the acquired racquet nails associated with hyperparathyroidism. The innate immunity has a central role in the new classification of auto inflammatory diseases, neutrophilic dermatoses, neutrophilic urticaria or pseudo-neutrophilic urticaria. Comorbidities have been studied e.g. cardiovascular co morbidities for psoriasis, IBD associated with hidradenitis suppurativa or neurological disorders associated with pemphigoid. Bullous pemphigoid could be renamed as cutaneous pemphigoid, it can be induced by drugs especially gliptins. Genetic predispositions are analyzed in auto inflammatory diseases, psoriasis (HLA), drug eruptions (HLA or cytokines). Telaprevir often induces rashes, which can be severe but other treatments against hepatitis C as interferon can also induce debilitating rashes, some eligible for drug tolerance induction. European guidelines for the definition, classification, diagnosis of chronic spontaneous urticaria have been published. Severe cutaneous adverse drug reactions may be associated with severe systemic symptoms such as organ involvement in AGEP or the occurrence of a shock in DRESS. Allover Europe, there is now an epidemic of contact allergies to methylisothiazolinone (MIT), contained in cosmetics, wet wipes but also in paints. MIT should be tested at 2.000 ppm in water, included in the standard series for patch tests. Its role has to be evoked in any case localized on the face or hand, airborne or generalized eczema. Among infectious diseases, skin manifestations due to Parvovirus have been specified, a febrile rash can be related to dengue infection or to Zika virus.
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Affiliation(s)
- A Barbaud
- Département de dermatologie et allergologie, bâtiment des spécialités médicales, hôpitaux de Brabois, centre hospitalo-universitaire de Nancy, 54500 Vandœuvre-les-Nancy, France.
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16
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Ultrasound in psoriatic arthritis. Can it facilitate a best routine practice in the diagnosis and management of psoriatic arthritis? Clin Rheumatol 2015; 34:1847-55. [DOI: 10.1007/s10067-015-3053-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
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