1
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D'Angelo S, Cantini F, Ramonda R, Cantarini L, Carletto A, Chimenti MS, Delle Sedie A, Foti R, Gerli R, Lomater C, Lubrano E, Marchesoni A, Zabotti A, Salvarani C, Scrivo R, Scarpa R, Tramontano G, Nannini C, Lorenzin M, Fabbroni M, Martinis F, Perricone R, Carli L, Visalli E, Rovera G, Perrotta FM, Quartuccio L, Altobelli A, Costa L, Niccoli L, Ortolan A, Caso F. Effectiveness of Adalimumab for the Treatment of Psoriatic Arthritis: An Italian Real-Life Retrospective Study. Front Pharmacol 2019; 10:1497. [PMID: 31920675 PMCID: PMC6923751 DOI: 10.3389/fphar.2019.01497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Few studies have evaluated the effectiveness of adalimumab in the real-life setting in psoriatic arthritis (PsA). Objective: To evaluate the 2-year retention rate of adalimumab in PsA patients. Potential baseline parameters influencing persistence on treatment were also evaluated. Methods: PsA patients from 16 Italian Rheumatology Units treated with adalimumab as first- or second-line biological therapy were retrospectively evaluated. Adalimumab retention rate was evaluated at 12 and 24 months. Logistic regression was used to evaluate the association between predictor variables and adalimumab retention rate. Results: From 424 patients (53.5% male, aged 48.3 ± 12.8 years) who started treatment with adalimumab, 367 (86.6%) maintained treatment for 12 months and 313 (73.8%) for 2 years. At 24-months, Disease Activity in PsA (DAPSA) remission (defined as ≤4) and Low Disease Activity (LDA) (≤14) were achieved in 22.8% and 44.4% of patients, respectively. Adalimumab treatment significantly decreased the number of tender (7.0 ± 5.7 at baseline vs. 2.3 ± 3.5 at 24 months, p < 0.001) and swollen joints (2.7 ± 2.8 at baseline vs. 0.4 ± 0.9 at 24 months, p < 0.001), DAPSA (25.5 ± 10.9 at baseline vs. 11.0 ± 8.4 at 24 months, p < 0.001), PASI (5.3 ± 5.7 at baseline vs. 2.7 ± 2.8 at 24 months, p < 0.001) and CRP (3.8 ± 6.3 at baseline vs. 1.2 ± 1.7 at 24 months, p < 0.001). Among a range of laboratory and clinical variables, only female gender was associated with improved adalimumab persistence at 24 months (OR: 1.98, 95% CI: 1.2–3.2, p = 0.005). Conclusions: Independent of a range of predictor variables, adalimumab was shown to be effective, while maintaining a high retention rate after 2 years in PsA patients.
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Affiliation(s)
- Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), Potenza, Italy.,Basilicata Ricerca Biomedica (BRB), Potenza, Italy
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosario Foti
- Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute, Università degli studi del Molise, Campobasso, Italy
| | - Antonio Marchesoni
- Department of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Deptartment of Internal Medicine, Azienda USL-IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.,University of Modena and Reggio Emilia, Modena, Italy
| | - Rossana Scrivo
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, Rome, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppina Tramontano
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), Potenza, Italy
| | | | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marta Fabbroni
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Visalli
- Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Guido Rovera
- Rheumatology Unit, Ospedale Mauriziano, Torino, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute, Università degli studi del Molise, Campobasso, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Alessio Altobelli
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, Rome, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Laura Niccoli
- Department of Rheumatology, Hospital of Prato, Prato, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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2
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Chimenti MS, Esposito M, Graceffa D, Teoli M, Peluso G, Birra D, Moretta G, Galossi A, Carboni V, Sensi F, Mazzotta A, Caccavale R, Bernardini N, Sessa P, Richetta A, Del Duca E, Urbani S, Persechino S, De Simone C, Bonifati C, Gremese E, Peris K, Perricone R. PsA-Disk, a novel visual instrument to evaluate psoriatic arthritis in psoriatic patients: an Italian derma-rheuma multicentre study. Ther Adv Chronic Dis 2019; 10:2040622319847056. [PMID: 31205645 PMCID: PMC6535736 DOI: 10.1177/2040622319847056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Consensus among dermatologists and rheumatologists in the diagnosis and
assessment of musculoskeletal diseases in psoriasis (PsO) patients is
needed. This study assesses characteristics of musculoskeletal pain in
patients with PsO for the presence of psoriatic arthritis (PsA) and
evaluation of a novel 16-item visual instrument (PsA-Disk). Methods: Data were collected from eight dermatological/rheumatological centres across
Italy. Patients with PsO completed PEST (Psoriasis Epidemiology Screening
Tool) and PsA-Disk questionnaires during the first visit. A rheumatological
visit was performed to confirm the presence of PsA. Both validity and
reliability of PsA-Disk were assessed. Results: A total of 573 patients with PsO were examined at the first visit, and 120
(21%) were diagnosed with PsA. Patients with PsA compared with patients with
PsO (n = 119) presented statistically significant
differences for: nail involvement, PEST score ⩾3, higher erythrocyte
sedimentation rate (ESR), Nail Psoriasis Severity Index (NAPSI)-feet,
NAPSI-(hands + feet) and PsA-Disk scores (73.9 ± 32.1
versus 58.1 ± 39.8, p < 0.001).
Patients with PsA with knee arthritis had higher PsA-Disk scores (98.4 ± 26
versus 71.5 ± 31.9, p = 0.006) that
were also correlated with number of swollen (r = 0.2,
p < 0.05) and tender joints (r =
0.24, p = 0.021), patient (r = 0.4,
p < 0.001) and physician-pain-visual analogue scale
(VAS; r = 0.33, p < 0.001), patient
global assessment (PGA)-VAS (r = 0.23, p =
0.025), physician-health assessment questionnaire (HAQ; r =
0.38, p = 0.011), Disease Activity Score (DAS)-44
(r = 0.25, p = 0.023) and Disease
Activity in Psoriatic Arthritis (DAPSA; r = 0.31,
p = 0.005). The instrument had excellent reliability in
terms of internal consistency (Cronbach’s alpha = 0.90) and stability
(intraclass correlation = 0.98). Moderate agreement between PsA-Disk and
PEST (Cohen’s kappa = 0.46) was observed, while construct validity appeared
appropriate [PsA + patients: PsA-Disk score (interquartile range; IQR) =71
(50–96); PsA-patients: PsA-Disk score (IQR)=50 (20–90); p
< 0.001]. Conclusion: PsA-Disk may be considered a valid novel instrument aiding both
dermatologists and rheumatologists in the rapid detection and assessment of
musculoskeletal disease characteristics.
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Affiliation(s)
- Maria Sole Chimenti
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Viale Oxford 81, Rome, 00133, Italy
| | - Maria Esposito
- Department of Dermatology, University of Rome, 'Tor Vergata', Rome, Italy
| | - Dario Graceffa
- Istituto Dermatologico San Gallicano, IRCCS, Rome, Italy
| | - Miriam Teoli
- Department of Dermatology, University of Rome, 'Tor Vergata', Rome, Italy
| | - Giusy Peluso
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico Birra
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaia Moretta
- Institute of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Felice Sensi
- Reumatologia, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Rosalba Caccavale
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Sapienza Università di Roma, Polo Pontino, Latina, Italy
| | - Nicoletta Bernardini
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - Paola Sessa
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Antonio Richetta
- Dermatologia, Dipartimento di Medicina Interna e Specialità Mediche Policlinico Umberto I, Rome, Italy
| | - Ester Del Duca
- Department of Dermatology, University of Rome, 'Tor Vergata', Rome, Italy
| | - Sara Urbani
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy
| | - Severino Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, Sapienza Università di Roma, Rome Italy
| | - Clara De Simone
- Institute of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Elisa Gremese
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Perricone
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy
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3
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Merola JF, Shrom D, Eaton J, Dworkin C, Krebsbach C, Shah-Manek B, Birt J. Patient Perspective on the Burden of Skin and Joint Symptoms of Psoriatic Arthritis: Results of a Multi-National Patient Survey. Rheumatol Ther 2019; 6:33-45. [PMID: 30610650 PMCID: PMC6393265 DOI: 10.1007/s40744-018-0135-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Psoriatic arthritis (PsA) and psoriasis (PsO) have a significant impact on HRQOL and work productivity loss. In patients with both PsA and PsO, the full extent of the physical and emotional burden of joint- and skin-related symptoms is less understood from the patient perspective. Methods A cross-sectional study of PsO patients with PsA from the US, France, and Germany was conducted using an online survey. Data on demographics, PsO severity by patient-reported body surface area involvement (BSA), PsA severity by RAPID3, impact of PsO and PsA using Patient Global Assessment (1–5), and novel questions exploring the emotional burden of joint/skin-related symptoms were collected. Multivariate regression analyses examined severity of joint and skin symptoms as predictors of quality of life (QoL), measured by PsAQoL, and Work Productivity and Activity Impairment (WPAI). Results Of the 439 patients, 23.9% had mild (RAPID3 of 0-2) and 76.1% had moderate–severe PsA (RAPID3 of 2.1–10), while 51% had mild and 49% had moderate–severe PsO (≥ 3 palms of the hand for BSA). Multivariate analyses showed that severity of joint symptoms was strongly associated with lower QoL (t = 13.15), followed by impact of skin symptoms (t = 5.11), and age (t = − 4.73), all p < 0.0001. About 57% of all patients reported a DLQI > 5, indicating a moderate-to-extremely large effect of psoriasis on HRQoL. Joint severity and impact of joint symptoms were the strongest predictors of WPAI. Patients also associated skin and/or joint symptoms with a variety of emotions and QoL measures that were not captured on the validated scales (fatigue, how they think of themselves, how others thought of them, making a first impression etc.). Conclusions In this study, both skin and joint symptoms had a broad, meaningful impact on patient QoL, work productivity, daily activities, and emotional well-being. These data highlighted the unique and significant impact of PsA among patients with PsO. Funding Eli Lilly and Company. Electronic supplementary material The online version of this article (10.1007/s40744-018-0135-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - David Shrom
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, USA
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4
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Li TH, Liao HT, Huang YF, Shen YC, Chiu YC, Chen WS, Chen MH, Tsai CY, Chang DM. The current status and unmet needs in the management of psoriatic arthritis: Viewpoint from physicians in Taiwan. J Formos Med Assoc 2018; 117:404-412. [DOI: 10.1016/j.jfma.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/10/2017] [Accepted: 05/04/2017] [Indexed: 12/18/2022] Open
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5
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Potenza MC, Peris K, Berardesca E, Bianchi L, Richetta A, Bernardini N, De Simone C, Teoli M, Zangrilli A, D'epiro S, Orsini D, Narcisi A, Chimenti S, Costanzo A. Use of biological drugs in patients with psoriasis and psoriatic arthritis in Italy: Results from the PSONG survey. Dermatol Ther 2017; 31. [DOI: 10.1111/dth.12565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/31/2017] [Accepted: 09/26/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Maria C. Potenza
- UOC di Dermatologia “Daniele Innocenzi”, Università degli Studi “Sapienza” Roma I facoltà di Medicina e Chirurgia, Polo Pontino; Terracina LT Italy
| | - Ketty Peris
- Istituto di Dermatologia Policlinico Gemelli; Rome Italy
| | | | - Luca Bianchi
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Antonio Richetta
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
- Centro psoriasi, Dipartimento di Medicina Interna e Specialità Mediche, Università “La Sapienza” Policlinico Umberto I; Rome Italy
| | - Nicoletta Bernardini
- UOC di Dermatologia “Daniele Innocenzi”, Università degli Studi “Sapienza” Roma I facoltà di Medicina e Chirurgia, Polo Pontino; Terracina LT Italy
| | | | - Miriam Teoli
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Arianna Zangrilli
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Sara D'epiro
- Centro psoriasi, Dipartimento di Medicina Interna e Specialità Mediche, Università “La Sapienza” Policlinico Umberto I; Rome Italy
| | - Diego Orsini
- Clinica Dermatologica, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso (NESMOS); Università Sapienza- Azienda Ospedaliera Sant'Andrea; Rome Italy
| | - Alessandra Narcisi
- Clinica Dermatologica, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso (NESMOS); Università Sapienza- Azienda Ospedaliera Sant'Andrea; Rome Italy
- Humanitas Clinical and Research Center; Skin Pathology Lab; Rozzano-Milan Italy
| | - Sergio Chimenti
- Clinica Dermatologica, Dipartimento di Medicina dei Sistemi, Universita Tor Vergata; Rome Italy
| | - Antonio Costanzo
- Humanitas Clinical and Research Center; Skin Pathology Lab; Rozzano-Milan Italy
- Dermatology Unit, Department of Biomedical Sciences; Humanitas University; Rozzano-Milan Italy
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6
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Yamamoto T, Ohtsuki M, Sano S, Igarashi A, Morita A, Okuyama R, Kawada A. Epidemiological analysis of psoriatic arthritis patients in Japan. J Dermatol 2016; 43:1193-1196. [DOI: 10.1111/1346-8138.13342] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/22/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology; Fukushima Medical University; Fukushima Japan
| | | | | | | | - Akimichi Morita
- Nagoya City University Graduate School of Medical Science; Nagoya Japan
| | | | - Akira Kawada
- Kinki University Faculty of Medicine; Osaka-Sayama Japan
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7
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Finet A, Viguier M, Chazouillères O, Amatore F, Paul C, Richard MA, Chosidow O, Bachelez H, Sbidian E. Liver test abnormalities in patients admitted for severe psoriasis: prevalence and associated risk factors. J Eur Acad Dermatol Venereol 2016; 30:1742-1748. [PMID: 27226222 DOI: 10.1111/jdv.13674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/22/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Few epidemiologic data are available regarding biologic liver abnormalities during psoriasis flares. OBJECTIVES The aim of this study was to assess the prevalence of biological liver test abnormalities (LTA) in a psoriasis population and the risk factors associated with LTA. METHODS A retrospective cross-sectional study in four hospital dermatology tertiary care centres included patients admitted for severe psoriasis flare between 1st January 2010 and 31st December 2011. During the same period, a control population was selected comprising patients admitted for contact and/or atopic eczema. Data were collected on hospital records and biology software. LTA was defined as serum AST and/or ALT and/or ALP concentration above the upper normal limit (UNL) and/or GGT concentration above 2 UNL. Prevalence of LTA with 95% confidence intervals (95% CI) was compared between the psoriatic and control populations. Factors associated with LTA at P < 0.05 were considered for the final multivariate logistic regression model. RESULTS Two hundred and forty psoriasis patients and 96 eczema control patients were included. One hundred and fifty-five(64.6%) of the psoriasis patients were male, aged 55 years on average (±17.6); 192 (80.0%) had plaque-type psoriasis (PV) and 52 (21.6%) had localized (n = 32) or generalized (n = 20) pustular psoriasis (PP). Prevalence of LTA was 36% (95% CI, 30-42) in the psoriatic population, significantly higher than in controls (17%, 95% CI 9.5-25). Risk factors independently associated with LTA comprised PV (OR 3.79; 95% CI 1.48-9.65), PP (OR 3.80; 95% CI 1.40-10.25) and previously diagnosed liver disease (underlying hepatic steatosis, viral hepatitis or excessive alcohol consumption) (OR 3.88; 95% CI 2.02-7.45). No association was found with systemic antipsoriatic drug therapies. CONCLUSION In severe psoriasis, liver impacting comorbidities and/or specific psoriatic inflammation, the latter mostly in PP cases, more than drug-related liver toxicity, appears to predominantly account for LTA. Clinicians should be aware of this, to avoid unjustified withdrawal of useful systemic drugs.
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Affiliation(s)
- A Finet
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - M Viguier
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - O Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Sorbonne Université, UPMC Univ Paris 06, INSERM, UMR_S 938/CDR Saint-Antoine, Paris, France
| | - F Amatore
- Département de Dermatologie, AP-HM, Hôpital La Timone, Marseille, France
| | - C Paul
- Département de Dermatologie, Hôpital Larrey, Toulouse, France
| | - M A Richard
- Département de Dermatologie, AP-HM, Hôpital La Timone, Marseille, France
| | - O Chosidow
- Inserm, Centre d'Investigation Clinique 1430, Créteil, France
- EA EpidermE 7379, Université Paris-Est Créteil, Créteil, France
- Département de Dermatologie, AP-HP, Hôpital Universitaire Henri Mondor, Créteil, France
| | - H Bachelez
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
- INSERMU1163, Institut Imagine, Necker Hospital, Paris, France
| | - E Sbidian
- Inserm, Centre d'Investigation Clinique 1430, Créteil, France.
- EA EpidermE 7379, Université Paris-Est Créteil, Créteil, France.
- Département de Dermatologie, AP-HP, Hôpital Universitaire Henri Mondor, Créteil, France.
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8
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Abstract
Psoriatic arthritis (PsA) is an inflammatory arthropathy associated with cutaneous psoriasis, which is currently classified as a seronegative spondyloarthropathy. The presence of cutaneous psoriasis is important for correct and early diagnosis of PsA, because the onset of cutaneous lesions usually precedes the appearance of joint manifestation. Thus, dermatologists are able to detect the condition at its inception. PsA has several unique characteristics such as enthesopathy, dactylitis, and abnormal bone remodeling. In particular, dactylitis occurs on the easily observed sites such as digits, and is thus a significant indicator of PsA. It is important to observe not only the fingers but also the toes, because dactylitis involves both digits of the hands and feet. Recently, new ideas regarding the involvement of the interleukin (IL)-23/Th17 axis have emerged, and the dramatic effects of targeting therapies have highlighted the physiological roles of key cytokines such as tumor necrosis factor-α, IL-17A, and IL-23 in psoriasis. As recent insights are shedding light on the pathogenesis of PsA, understanding of the pathogenesis of dactylitis and enthesitis are also progressing. In this article, current views on the optimal management of dactylitis are discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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9
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Yiu ZZN, Warren RB. Efficacy and safety of emerging immunotherapies in psoriasis. Immunotherapy 2015; 7:119-33. [DOI: 10.2217/imt.14.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Psoriasis is a common chronic inflammatory disease of the skin. Current biologic therapies are highly effective in the treatment of psoriasis, transforming the lives of patients with this significantly disabling disease. Advances in the understanding of the immunological pathogenesis of psoriasis have led to the development of new biologic therapies, targeting specific inflammatory cytokines upregulated in psoriasis. These include the IL-17 antagonists, secukinumab, brodalumab and ixekizumab; the IL-23 antagonists, guselkumab and tildrakizumab; and the oral small molecule therapies, tofacitinib and apremilast. Here, we review evidence for the efficacy and safety of these novel psoriasis therapies, providing clinicians with an overview of the next era in immunotherapy for psoriasis.
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Affiliation(s)
- Zenas ZN Yiu
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Richard B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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10
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Chandler DJ, Bewley A. Ustekinumab for the treatment of psoriatic arthritis. Expert Rev Clin Pharmacol 2014; 7:111-21. [DOI: 10.1586/17512433.2014.888310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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11
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Abstract
Psoriatic arthritis (PsA) increases the disease burden associated with psoriasis by further diminishing quality of life, increasing health care costs and cardiovascular risk, and potentially causing progressive joint damage. The presence of PsA influences psoriasis treatment by increasing overall disease complexity and, within the framework of current guidelines and recommendations, requiring the use of conventional disease-modifying anti-rheumatic drugs or tumor necrosis factor-α inhibitors in order to prevent progressive joint damage. Despite its important impact, PsA is still under-diagnosed in dermatology practice. Dermatologists are well positioned to recognize and treat PsA, given that it characteristically presents, on average, 10 years subsequent to the appearance of skin symptoms. Regular screening of psoriasis patients for early evident joint symptoms should be incorporated into daily dermatologic practice. Although drugs effective in PsA are available, not all patients may respond to treatment, and others may lose their initial response over time. New investigational therapies, such as inhibitors of interleukin-17A, interleukin-12/23, Janus kinase 3, or phosphodiesterase-4, may address unmet needs in psoriatic disease, with further research needed to determine the role of these agents in reducing joint damage and other comorbidities.
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Affiliation(s)
- Wolf-Henning Boehncke
- Service de dermatologie, Hôpital Universitaire de Genève, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland,
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Ali FR, Warren RB. Psoriasis and susceptibility to other autoimmune diseases: an outline for the clinician. Expert Rev Clin Immunol 2013; 9:99-101. [PMID: 23390938 DOI: 10.1586/eci.12.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Faisal R Ali
- Dermatology Centre, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
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13
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14
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Foulkes AC, Griffiths CEM, Chinoy H, Warren RB. Unmasking of axial spondyloarthritis and oligoarthritis following discontinuation of tumour necrosis factor inhibitor therapy for psoriasis. J DERMATOL TREAT 2012; 25:61-2. [PMID: 22812533 DOI: 10.3109/09546634.2012.713460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psoriatic arthritis remains a common cause of morbidity in patients with psoriasis. Little is known about the natural history of the disease and dermatologists do not consistently screen for its presence. We describe a patient with severe psoriasis where long-term biologic therapy with a tumour necrosis factor inhibitor was interrupted for clinical reasons, leading to a rapidly evolving axial spondyloarthritis and oligoarthritis. This unusual presentation of psoriatic arthritis may reflect masking of the disease by long-term treatment with a tumour necrosis factor inhibitor. We advocate the use of screening for psoriatic arthritis, including before and during treatment with biologic therapies.
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Affiliation(s)
- Amy C Foulkes
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
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15
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Power of crowdsourcing: novel methods of data collection in psoriasis and psoriatic arthritis. J Am Acad Dermatol 2012; 67:1273-1281.e9. [PMID: 22818792 DOI: 10.1016/j.jaad.2012.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/24/2012] [Accepted: 05/03/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Crowdsourcing is a novel method of collecting research data from diverse patient populations. The quality of research data obtained through crowdsourcing is unknown. OBJECTIVE The primary aim of this pilot study was to examine how data collected from an online crowdsourcing World Wide Web site compare with those from published literature in psoriasis and psoriatic arthritis (PsA). METHODS Crowdsourced data were collected from a health crowdsourcing site from August 23, 2008, to June 27, 2011. The crowdsourced data were compared with findings from systematic reviews, meta-analyses, and clinical trials. RESULTS A total of 160 online patients with psoriasis or PsA were included in the analysis. Among them, 127 patients with psoriasis provided 313 complete responses on psoriasis symptoms and 276 complete responses to psoriasis treatments; 33 patients with PsA provided 91 complete responses on PsA symptoms and 79 responses to PsA treatments. We compared topical treatments, phototherapy, and systemic treatments for psoriasis and PsA from crowdsourced data with the published literature. For the treatment with the largest response rates, equivalency testing was performed comparing crowdsourced data and the published literature. Overall, crowdsourced data were not equivalent to those published in the medical literature. LIMITATIONS Crowdsourcing sites used different outcomes measures from those reported in clinical trials. CONCLUSION Differences existed in assessment of treatment effectiveness between crowdsourced data and those published in the literature. With improvements in the collection of crowdsourced data, crowdsourcing can be a valuable tool for collecting patient data in real-world settings for psoriasis and PsA.
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16
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Laws P, Downs A, Parslew R, Dever B, Smith C, Barker J, Moriarty B, Murphy R, Kirby B, Burden A, McBride S, Anstey A, O’Shea S, Ralph N, Buckley C, Griffiths C, Warren R. Practical experience of ustekinumab in the treatment of psoriasis: experience from a multicentre, retrospective case cohort study across the U.K. and Ireland. Br J Dermatol 2011; 166:189-95. [DOI: 10.1111/j.1365-2133.2011.10638.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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