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Burshtein J, Shah M, Zakria D, Lockshin B, Crowley J, Merola JF, Gordon K, Shahriari M, Korman NJ, Chovatiya R, Kalb R, Lebwohl M. The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel. Dermatol Ther (Heidelb) 2024; 14:323-339. [PMID: 38340237 PMCID: PMC10891030 DOI: 10.1007/s13555-024-01099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition affecting the skin, joints, and several other organ systems with significant disease burden. Bimekizumab is the first monoclonal antibody targeting both interleukin (IL)-17A and interleukin-17F and has demonstrated efficacy for treating moderate to severe psoriasis. Limited guidelines exist for incorporating this drug into clinical practice. The purpose of this study was for a panel of experts in psoriasis management to synthesize current literature and provide consensus statements with guidance on use of bimekizumab. METHODS A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the use of bimekizumab for moderate to severe psoriasis and psoriatic arthritis. A panel of nine dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements on this new medication. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using Strength of Recommendation Taxonomy criteria. RESULTS The literature search produced 102 articles that met criteria. A thorough screening of the studies for relevance to the research question resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 14 consensus statements and recommendations, 12 of which were given a strength of "A", one of which was given a strength of "B", and one of which was given a strength of "C". CONCLUSION Bimekizumab results in rapid and long-lasting clinical improvement for patients with moderate to severe plaque psoriasis and psoriatic arthritis. It has demonstrated superior efficacy when compared to several other biologics. The safety profile is consistent with other biologics, except for an increased incidence of oropharyngeal candidiasis.
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Affiliation(s)
- Joshua Burshtein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Milaan Shah
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danny Zakria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Lockshin
- US Dermatology Partners, Rockville, MD, USA
- Department of Dermatology, Georgetown University Medical Center, Washington, DC, USA
| | - Jeff Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | - Joseph F Merola
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ken Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Robert Kalb
- SUNY at Buffalo School of Medicine and Biomedical Sciences, Department of Dermatology, Buffalo Medical Group, Buffalo, NY, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Farberg AS, Marson JW, Glazer A, Litchman GH, Svoboda R, Winkelmann RR, Brownstone N, Rigel DS. Expert Consensus on the Use of Prognostic Gene Expression Profiling Tests for the Management of Cutaneous Melanoma: Consensus from the Skin Cancer Prevention Working Group. Dermatol Ther (Heidelb) 2022; 12:807-823. [PMID: 35353350 PMCID: PMC9021351 DOI: 10.1007/s13555-022-00709-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Prognostic assessment of cutaneous melanoma relies on historical, clinicopathological, and phenotypic risk factors according to American Joint Committee on Cancer(AJCC) and National Comprehensive Cancer Network (NCCN) guidelines but may not account for a patient's individual additional genetic risk factors. OBJECTIVE To review the available literature regarding commercially available gene expression profile (GEP) tests and their use in the management of cutaneous melanoma. METHODS A literature search was conducted for original, English-language studies or meta-analyses published between 2010 and 2021 on commercially available GEP tests in cutaneous melanoma prognosis, clinical decision-making regarding sentinel lymph node biopsy, and real-world efficacy. After the literature review, the Skin Cancer Prevention Working Group, an expert panel of dermatologists with specialized training in melanoma and non-melanoma skin cancer diagnosis and management, utilized a modified Delphi technique to develop consensus statements regarding prognostic gene expression profile tests. Statements were only adopted with a supermajority vote of > 80%. RESULTS The initial search identified 1064 studies/meta-analyses that met the search criteria. Of these, we included 21 original articles and meta-analyses that studied the 31-GEP test (DecisionDx-Melanoma; Castle Biosciences, Inc.), five original articles that studied the 11-GEP test (Melagenix; NeraCare GmbH), and four original articles that studied the 8-GEP test with clinicopathological factors (Merlin; 8-GEP + CP; SkylineDx B.V.) in this review. Six statements received supermajority approval and were adopted by the panel. CONCLUSION GEP tests provide additional, reproducible information for dermatologists to consider within the larger framework of the eighth edition of the AJCC and NCCN cutaneous melanoma guidelines when counseling regarding prognosis and when considering a sentinel lymph node biopsy.
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Affiliation(s)
- Aaron S Farberg
- Section of Dermatology, Baylor Scott & White Health System, 2110 Research Row, Dallas, TX, 75235, USA. .,Dermatology Science and Research Foundation, Buffalo Grove, IL, USA.
| | - Justin W Marson
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Alex Glazer
- Dermatology Science and Research Foundation, Buffalo Grove, IL, USA
| | - Graham H Litchman
- Department of Dermatology, St. John's Episcopal Hospital, Far Rockaway, NY, USA
| | - Ryan Svoboda
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA
| | - Richard R Winkelmann
- Dermatology Science and Research Foundation, Buffalo Grove, IL, USA.,OptumCare, Los Angeles, CA, USA
| | | | - Darrell S Rigel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Karmacharya P, Chakradhar R, Ogdie A. The epidemiology of psoriatic arthritis: A literature review. Best Pract Res Clin Rheumatol 2021; 35:101692. [DOI: 10.1016/j.berh.2021.101692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Xie X, Wang Y, Yao S, Xia Y, Luo H, Li L, Lu C. Biologics recommendations for patients with psoriasis: a critical appraisal of clinical practice guidelines for psoriasis. J DERMATOL TREAT 2021; 33:2038-2050. [PMID: 33849360 DOI: 10.1080/09546634.2021.1914306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE This review article serves to assess the consistency of recommendations from guidelines on biologic agents for psoriasis, based on the quality evaluation of psoriasis Clinical Practice Guidelines (CPGs). METHODS We conducted a systematic literature search to identify CPGs that provide recommendations on diagnosis and treatment for psoriasis. Four reviewers performed a quality assessment of the included CPGs with the Appraisal of Guidelines Research and Evaluation II (AGREE II) Instrument. RESULTS A total of 51 sets of CPGs from 22 medical societies or separate working groups fulfilled the inclusion criteria. The overall quality of the eligible sets of guidelines was moderate to high, with an overall average score of 55%The highest domain scores were Score and Purpose (70%) and Clarity of Presentation (68%). A total of 95 biologic agent recommendations were extracted from the 18 recommended CPGs.Three biologic agents (Etanercept, Adalimumab, Ustekinumab) were recommended for pediatric patients. Three biologic agents (Adalimumab, Ustekinumab, Secukinumab) were recommended as first-line biologic agents for adults with psoriasis. CONCLUSION The overall methodological quality of CPGs for psoriasis is medium to high. More attention should be paid to applicability in guideline development. The recommendations and the basis for them among various sets guidelines were almost consistent.
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Affiliation(s)
- Xiuli Xie
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Yangyang Wang
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Sha Yao
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yun Xia
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Luo
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lui Li
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chuanjian Lu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
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Sarabia S, Farrer C, Yeung J, Jerome D, Cook RJ, Eder L. Comparative Efficacy of Different Triage Methods for Psoriatic Arthritis - Prospective Study in a Rapid Access Clinic. Arthritis Care Res (Hoboken) 2021; 74:1254-1262. [PMID: 33544974 DOI: 10.1002/acr.24570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/04/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The study aimed to identify the optimal combination of triage methods to identify PsA among psoriasis patients with musculoskeletal symptoms in a rapid access clinic and to describe their outcome after 1 year. METHODS Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal complaints. Each patient was assessed by the following three triage modalities: 1) assessment by an advanced practice physiotherapist; 2) targeted musculoskeletal ultrasound (MSK-US) and; 3) PsA screening questionnaires. The patients were then evaluated by a rheumatologist who determined their disease status and classified them as: "Not PsA", "Possibly PsA" or "PsA". Patients returned for a one year follow up visit and were re-assessed for change in their disease status. Sensitivity and specificity were calculated for each individual modality as well as for combinations of modalities. RESULTS 203 patients with psoriasis and musculoskeletal symptoms were enrolled. 8.8% were classified as PsA and 23.6% as possibly PsA. There was no significant difference in the individual performance of the modalities. The highest sensitivity was seen with MSK-US (89%) and the highest specificity was found with the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire (79%). The addition of MSK-US data improved the performance of the modalities. A total of 9 patients converted to PsA after 1 year. All patient reported outcome measures have significantly improved at one year (P<0.001). CONCLUSION Combining MSK-US with a screening questionnaire for PsA improved the triage of patients with suspected PsA.
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Affiliation(s)
| | - Chandra Farrer
- Division of Rheumatology, Women's College Hospital and the Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Women's College Hospital and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dana Jerome
- Division of Rheumatology, Women's College Hospital and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital and the Department of Medicine, University of Toronto, Toronto, ON, Canada
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Management of psoriatic patients in biologic treatment associated with infectious comorbidities. Postepy Dermatol Alergol 2020; 37:417-421. [PMID: 32792886 PMCID: PMC7394172 DOI: 10.5114/ada.2020.96155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/17/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction Psoriasis is a chronic inflammatory disease affecting about 2% of population, involving both acquired and innate immunity. Psoriasis affects mainly skin, presenting multiple co-morbidities; among them infective ones. Re-activation of tuberculosis or viral hepatitis (HBV and HCV) still represents a therapeutic challenge in patients receiving treatment with biological drugs, as well as HIV infection. For this reason, a multidisciplinary approach with global treatment resulting from active collaboration of different specialists is highly recommended. Aim To investigate the most common infective diseases as co-morbidities associated with psoriasis and to provide algorithms for screening, follow-up and therapeutic management in psoriatic patients. Material and methods We examined the main infectious comorbidities that can affect moderate to severe psoriatic patients, influencing the therapeutic choice as during the biological treatment both viral and tuberculosis re-activation may occur. We have therefore evaluated the main diseases (TB, Hepatitis B and C, HIV) and the monitoring of patients during treatment with biological agents. Results Regular monitoring of psoriatic patients is recommended during long-term treatment with biological drugs in order to identify cases of re-activation of the latent infective agent or de novo acquired infection. Conclusions Here we report the state of art regarding management of psoriatic patients with these co-morbidities suggesting a specific screening and management for infectious diseases in patients with moderate to severe plaque psoriasis.
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Solmaz D, Eder L, Aydin SZ. Update on the epidemiology, risk factors, and disease outcomes of psoriatic arthritis. Best Pract Res Clin Rheumatol 2018; 32:295-311. [PMID: 30527433 DOI: 10.1016/j.berh.2018.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 02/08/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects different structures of the musculoskeletal system in addition to the skin and the nail. The complexity of the disease had been a barrier to understand the pathogenesis and define valid outcome tools; however, our understanding about the disease has considerably increased with time mainly because of the advances in imaging, new discoveries in genetics and underlying inflammatory pathways, and better understanding of the epidemiology of the disease and environmental risk factors. The purpose of this review is to summarize developments and changes in epidemiology, risk factors for developing PsA, and outcome measures with a focus on data obtained in the last 10 years.
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Affiliation(s)
- Dilek Solmaz
- Division of Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada; Izmir Katip Celebi University, Izmir, Turkey.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, The Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sibel Zehra Aydin
- Division of Rheumatology, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada; The Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada.
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8
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Rizzello F, Olivieri I, Armuzzi A, Ayala F, Bettoli V, Bianchi L, Cimino L, Costanzo A, Cristaudo A, D'Angelo S, Daperno M, Fostini AC, Galeazzi M, Gilio M, Gionchetti P, Gisondi P, Lubrano E, Marchesoni A, Offidani A, Orlando A, Pugliese D, Salvarani C, Scarpa R, Vecchi M, Girolomoni G. Multidisciplinary Management of Spondyloarthritis-Related Immune-Mediated Inflammatory Disease. Adv Ther 2018. [PMID: 29516409 PMCID: PMC5910456 DOI: 10.1007/s12325-018-0672-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis and uveitis. Methods A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements. Results Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important. Conclusion The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs. Funding Aristea and Hippocrates.
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Affiliation(s)
- Fernando Rizzello
- IBD Unit, DIMEC, University of Bologna, S Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Ignazio Olivieri
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy
| | - Alessandro Armuzzi
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Fabio Ayala
- UOC di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Vincenzo Bettoli
- Department of Clinical and Experimental Dermatology, O.U. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Luca Bianchi
- U.O.C. Dermatologia, Fondazione Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy
| | - Luca Cimino
- SSD di Immunologia Oculare, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Costanzo
- Unità Dermatologia Dipartimento di Scienze Biomediche Humanitas University, Rozzano, Milan, Italy
- UOC Dermatologia IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Antonio Cristaudo
- UO Dermatologia, MST, Ambientale e Tropicale San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Salvatore D'Angelo
- Istituto Reumatologico Lucano (IReL), Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy.
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy.
| | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Anna Chiara Fostini
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Galeazzi
- Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Michele Gilio
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Department of Health Science, University "Magna Grecia", Catanzaro, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Antonio Marchesoni
- U.O.C. Day Hospital di Reumatologia, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Ambrogio Orlando
- UOSD MICI-A.O. Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | - Daniela Pugliese
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS e Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | | | - Maurizio Vecchi
- Department of Biomedical Science for the Health, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Winkelmann RR, Farberg AS, Glazer AM, Cockerell CJ, Sober AJ, Siegel DM, Leachman SA, High WA, Markowitz O, Berman B, Pariser DM, Goldenberg G, Rosen T, Rigel DS. Integrating Skin Cancer–Related Technologies into Clinical Practice. Dermatol Clin 2017; 35:565-576. [DOI: 10.1016/j.det.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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10
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Eder L, Haddad A, Rosen CF, Lee KA, Chandran V, Cook R, Gladman DD. The Incidence and Risk Factors for Psoriatic Arthritis in Patients With Psoriasis: A Prospective Cohort Study. Arthritis Rheumatol 2016; 68:915-23. [PMID: 26555117 DOI: 10.1002/art.39494] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/27/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis, and to identify risk factors for its development. METHODS The study was designed as a prospective cohort study involving psoriasis patients who did not have a diagnosis of arthritis at the time of study enrollment. Information was collected about lifestyle habits, comorbidities, psoriasis activity, and medications. Patients who developed inflammatory arthritis or spondylitis were classified as having PsA if they fulfilled the criteria of the Classification of Psoriatic Arthritis Study group. The annual incidence of PsA was estimated using an event per person-years analysis. Cox proportional hazards models, involving fixed and time-dependent explanatory variables, were fitted to obtain estimates of the relative risk (RR) of the onset of PsA, determined in multivariate models stratified by sex and controlled for age at onset of psoriasis. RESULTS The data obtained from the 464 patients who were followed up for 8 years were analyzed. A total of 51 patients developed PsA during the 8 years since enrollment. The annual incidence rate of PsA was 2.7 cases (95% confidence interval 2.1-3.6) per 100 psoriasis patients. The following baseline variables were associated with the development of PsA in multivariate analysis: severe psoriasis (RR 5.4, P = 0.006), low level of education (university/college versus high school incomplete RR 0.22, P = 0.005; high school graduate versus high school incomplete RR 0.30, P = 0.049), and use of retinoid medications (RR 3.4, P = 0.02). In multivariate models with time-dependent variables, psoriatic nail pitting (RR 2.5, P = 0.002) and uveitis (RR 31.5, P = 0.0002) were associated with the development of PsA. CONCLUSION The incidence of PsA in patients with psoriasis is higher than previously reported. A severe psoriasis phenotype, presence of nail pitting, low level of education, and uveitis are predictive of the development of PsA in patients with psoriasis.
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Affiliation(s)
- Lihi Eder
- Toronto Western Hospital, Toronto, Ontario, Canada
| | - Amir Haddad
- Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - Richard Cook
- University of Waterloo, Waterloo, Ontario, Canada
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Betteridge N, Boehncke W, Bundy C, Gossec L, Gratacós J, Augustin M. Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol 2016; 30:576-85. [PMID: 26377041 PMCID: PMC5049610 DOI: 10.1111/jdv.13306] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/15/2015] [Indexed: 01/05/2023]
Abstract
Patients with psoriatic arthritis (PsA) may not be optimally treated. The impact of the disease extends beyond skin and joint symptoms, impairing quality of life. This indicates that the adoption of a patient-focused approach to PsA management is necessary. An expert multidisciplinary working group was convened, with the objective of developing an informed perspective on current best practice and needs for the future management of PsA. Topics of discussion included the barriers to current best practice and calls to action for the improvement of three areas in PsA management: early and accurate diagnosis of PsA, management of disease progression and management of the impact of the condition on the patient. The working group agreed that, to make best use of the available of diagnostic tools, clinical care recommendations and effective treatments, there is a clear need for healthcare professionals from different disciplines to collaborate in the management of PsA. By facilitating appropriate and rapid referral, providing high quality information about PsA and its treatment to patients, and actively involving patients when choosing management plans and setting treatment goals, management of PsA can be improved. The perspective of the working group is presented here, with recommendations for the adoption of a multidisciplinary, patient-focused approach to the management of PsA.
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Affiliation(s)
| | - W.‐H. Boehncke
- Department of DermatologyGeneva University HospitalGenevaSwitzerland
- Department of Pathology and ImmunologyUniversity of GenevaGenevaSwitzerland
| | - C. Bundy
- Centre for Dermatology ResearchInstitute for Inflammation and RepairUniversity of Manchester and Manchester Academic Health Sciences CentreManchesterUK
| | - L. Gossec
- Sorbonne UniversitésUPMC Univ Paris 06ParisFrance
- Pitie‐Salpétrière Hospital AP‐HPParisFrance
| | - J. Gratacós
- Rheumatology Service, Hospital Universitari Parc Taulí of SabadellUABBarcelonaSpain
| | - M. Augustin
- University Medical Center Hamburg‐EppendorfHamburgGermany
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Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US Perspectives in the Management of Psoriasis and Psoriatic Arthritis: Patient and Physician Results from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey. Am J Clin Dermatol 2016; 17:87-97. [PMID: 26718712 PMCID: PMC4733141 DOI: 10.1007/s40257-015-0169-x] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP), a population-based survey of patients, dermatologists, and rheumatologists, was conducted for better understanding of the unmet needs of psoriasis and psoriatic arthritis (PsA) patients. Objective To report results from US physicians and patients. Methods Adults were contacted by household telephone, using random digit dialing, and asked to participate if they had ever been diagnosed with psoriasis or PsA. Physicians were identified through national databases and contacted through random sampling methods. Results In the USA, 1005 patients, 101 dermatologists, and 100 rheumatologists were surveyed. PsA had been diagnosed in 270 patients (26.9 %). Of those with psoriasis alone, fewer than 60 % (versus 85.6 % of PsA patients) had seen a healthcare provider within 12 months. Joint pain was reported by 51.8 % of psoriasis patients without a diagnosis of PsA, and 37.6 % of dermatologists cited their greatest challenge in managing PsA patients as being differentiating PsA from other arthritic diseases. Itching was reported by 36 % of psoriasis patients versus 12 % of dermatologists as the most important factor contributing to disease severity. Patients reported lower rates of current treatment than did dermatologists and rheumatologists. Conventional oral and biologic therapies were used by 24.9 and 17.7 % of patients, respectively. Among patients who had received injectable biologics, treatment dissatisfaction was related to long-term safety/tolerability, injection-related anxiety/fear, and cost. Conclusion This large, population-based survey identified unmet needs in the management of psoriasis and PsA patients in the USA, including assessment of disease severity, PsA diagnosis, undertreatment, and satisfaction with therapy.
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Affiliation(s)
- Mark G Lebwohl
- The Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, 5th Floor, 5 East 98th Street, Box 1048, New York, NY, 10029, USA.
| | - Arthur Kavanaugh
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - April W Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
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13
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Cobo-Ibáñez T, Villaverde V, Seoane-Mato D, Muñoz-Fernández S, Guerra M, Del Campo PD, Cañete JD. Multidisciplinary dermatology-rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis: a systematic review. Rheumatol Int 2015; 36:221-9. [PMID: 26438388 DOI: 10.1007/s00296-015-3377-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/25/2015] [Indexed: 01/10/2023]
Abstract
The aim of the study was to analyze the efficacy and satisfaction of multidisciplinary dermatology-rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis (PsA). We conducted a systematic literature search in MEDLINE, EMBASE, and Cochrane Library up to September 2015. Selection criteria include (1) adult patients with moderate-to-severe psoriasis and PsA, (2) assessed in a multidisciplinary consultation, (3) comparison with routine separate consultations, and (4) outcome measures to evaluate efficacy and/or satisfaction. Meta-analyses, systematic reviews, clinical trials, cohort studies, and case series were included. The quality of the studies included was graded according to the Oxford Level of Evidence scale. Of 195 articles, three studies complied with the inclusion criteria: two case series and one descriptive study in which 506 patients were evaluated. Patients were referred to the multidisciplinary consultation from dermatology and rheumatology consultations in all but one study, in which primary care was also involved. The reason for the referral was to confirm the diagnosis and/or treatment. Patients were evaluated on a weekly and monthly basis in two and one study, respectively. The evidence obtained is scarce but suggests the efficacy of multidisciplinary consultations in terms of improved skin and joint symptoms after changing treatment (82-56 %), showing higher scores for this type of consultation compared to the usual [4.91 vs. 2.85 (0-5)] and a high level of satisfaction among patients (94 % "very satisfied"). However, waiting times were higher. With the limited evidence found, multidisciplinary management seems to be more effective and more satisfactory for patients with moderate-to-severe psoriasis and PsA than conventional consultations, though this could not be conclusively demonstrated. The results of this review support the benefit of implementing this type of consultation.
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Affiliation(s)
- Tatiana Cobo-Ibáñez
- Rheumatology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain.
| | - Virginia Villaverde
- Rheumatology Department, Hospital Universitario de Móstoles, Río Júcar s/n, 28935, Móstoles, Madrid, Spain.
| | - Daniel Seoane-Mato
- Research Unit, Spanish Society of Rheumatology, Marqués de Duero 5, 1º, 28001, Madrid, Spain.
| | - Santiago Muñoz-Fernández
- Rheumatology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain.
| | - Mercedes Guerra
- Research Unit, Spanish Society of Rheumatology, Marqués de Duero 5, 1º, 28001, Madrid, Spain.
| | - Petra Díaz Del Campo
- Research Unit, Spanish Society of Rheumatology, Marqués de Duero 5, 1º, 28001, Madrid, Spain.
| | - Juan D Cañete
- Rheumatology Department, Hospital Clinic de Barcelona e IDIBAPS, Calle Villarroel 170, 08036, Barcelona, Spain.
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14
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Carubbi F, Chimenti M, Blasetti G, Cipriani P, Musto A, Fargnoli M, Perricone R, Giacomelli R, Peris K. Association of psoriasis and/or psoriatic arthritis with autoimmune diseases: the experience of two Italian integrated Dermatology/Rheumatology outpatient clinics. J Eur Acad Dermatol Venereol 2015; 29:2160-8. [DOI: 10.1111/jdv.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/29/2015] [Indexed: 01/21/2023]
Affiliation(s)
- F. Carubbi
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences; University of L'Aquila; L'Aquila Italy
| | - M.S. Chimenti
- Rheumatology, Allergology and Clinical Immunology; Department of “Medicina dei Sistemi”; University of Rome Tor Vergata; Rome Italy
| | - G. Blasetti
- Department of Dermatology; University of L'Aquila; L'Aquila Italy
| | - P. Cipriani
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences; University of L'Aquila; L'Aquila Italy
| | - A. Musto
- Rheumatology, Allergology and Clinical Immunology; Department of “Medicina dei Sistemi”; University of Rome Tor Vergata; Rome Italy
| | - M.C. Fargnoli
- Department of Dermatology; University of L'Aquila; L'Aquila Italy
| | - R. Perricone
- Rheumatology, Allergology and Clinical Immunology; Department of “Medicina dei Sistemi”; University of Rome Tor Vergata; Rome Italy
| | - R. Giacomelli
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences; University of L'Aquila; L'Aquila Italy
| | - K. Peris
- Department of Dermatology; Catholic University; Rome Italy
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15
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Sevrain M, Richard MA, Barnetche T, Rouzaud M, Villani AP, Paul C, Beylot-Barry M, Jullien D, Aractingi S, Aubin F, Joly P, Le Maitre M, Cantagrel A, Ortonne JP, Misery L. Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. J Eur Acad Dermatol Venereol 2015; 28 Suppl 5:13-6. [PMID: 24985558 DOI: 10.1111/jdv.12561] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Palmoplantar pustular psoriasis (PPPP) is a variant of psoriasis whose the association with psoriatic arthritis (PsA) has been recently described. There is limited evidence regarding how to best reduce palmoplantar pustular psoriasis severity and to maintain remission once achieved. OBJECTIVE The aim of this study was to elaborate evidence-based recommendations for PPPP treatment supported by a systematic literature review. METHODS A systematic literature search was carried out in Embase, Medline and Cochrane Library databases from 1980 to February 2013 searching for any trial in patients with PPPP assessing therapeutic interventions not including a systemic biotherapy. The selection of articles was limited to human subjects and English or French languages. RESULTS Among the 675 articles identified, 29 including one Cochrane review were analysed. The Cochrane review summarised 23 randomised controlled trials (RCTs) in chronic PPPP until February 2003, including 724 patients. The authors concluded that oral retinoid therapy (acitretin), photochemotherapy or combination of both, low dose of ciclosporin or topical corticosteroids under occlusion appeared to be helpful in relieving symptoms of PPPP. Since the publication of this review, 9 open studies on PPPP treatment have been published. Three new studies evaluated the benefits of PUVA on PPPP. They all showed a better efficacy of PUVA compared to UVB therapy. One open study concluded that a retinoid treatment with an arotinoid ethylesther showed a good efficacy. Five prospective studies (level of evidence of 3) assessed Laser Excimer UVB-NB (Excimer 308 nm) in PPPP. The combined analysis of these studies showed that 64% of patients experienced an improvement of 70% at the end of treatment. CONCLUSION Phototherapy, ciclosporin and topical corticosteroids seem to be able to control PPPP. However, the standard of care for PPPP remains an issue and there is a strong need for reliable RCTs to better define treatment strategies for PPPP.
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Affiliation(s)
- M Sevrain
- Dermatology Department, Morvan University Hospital, Brest, France
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16
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Richard MA, Paul C. Risk factors, diagnosis and management of psoriatic arthritis: systematic literature reviews and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2014; 28 Suppl 5:1-2. [PMID: 24985556 DOI: 10.1111/jdv.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M-A Richard
- Aix-Marseille University, UMR 911, INSERM CRO2, Assistance Publique and Dermatology Department, Timone Hospital, Marseille, France
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17
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Rouzaud M, Sevrain M, Villani A, Barnetche T, Paul C, Richard MA, Jullien D, Misery L, Le Maître M, Aractingi S, Aubin F, Joly P, Cantagrel A, Ortonne JP, Beylot-Barry M. Is there a psoriasis skin phenotype associated with psoriatic arthritis? Systematic literature review. J Eur Acad Dermatol Venereol 2014; 28 Suppl 5:17-26. [DOI: 10.1111/jdv.12562] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 12/22/2022]
Affiliation(s)
- M. Rouzaud
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - M. Sevrain
- Dermatology Department; Morvan University Hospital; Brest France
| | - A.P. Villani
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - T. Barnetche
- Rheumatology Department; Bordeaux University Hospital; Bordeaux France
| | - C. Paul
- Dermatology Department; Paul Sabatier University; UMR CNRS 5165; INSERM 1056; Toulouse France
| | - M.-A. Richard
- Aix-Marseille University; UMR 911; INSERM CRO2; Assistance Publique and Dermatology Department; Timone Hospital; Marseille France
| | - D. Jullien
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - L. Misery
- Dermatology Department; Morvan University Hospital; Brest France
| | | | - S. Aractingi
- Dermatology Department; Cochin Tarnier Hospital; APHP; Paris 5 Descartes University; INSERM UMR S 938; UPMC; CDR Saint-Antoine Hospital; Paris France
| | - F. Aubin
- Dermatology Department; Besançon University Hospital and University of Franche-Comté; Besançon France
| | - P. Joly
- Clinique Dermatologique; Rouen University Hospital; Inserm U905; Institute for Research and Innovation in Biomedicine (IRIB); Rouen University; Normandy France
| | - A. Cantagrel
- Rheumatology Center; Purpan Teaching Hospital; Toulouse France
| | - J.-P. Ortonne
- Dermatology Department; Nice University; L'Archet II Hospital; Nice France
| | - M. Beylot-Barry
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
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18
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Sevrain M, Villani A, Rouzaud M, Barnetche T, Paul C, Richard MA, Beylot-Barry M, Jullien D, Aractingi S, Aubin F, Joly P, Le Maitre M, Cantagrel A, Ortonne JP, Misery L. Treatment (biotherapy excluded) of psoriatic arthritis: an appraisal of methodological quality of international guidelines. J Eur Acad Dermatol Venereol 2014; 28 Suppl 5:33-9. [DOI: 10.1111/jdv.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Sevrain
- Dermatology Department; Morvan University Hospital; Brest France
| | - A.P. Villani
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - M. Rouzaud
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - T. Barnetche
- Rheumatology Department; Bordeaux University Hospital; Bordeaux France
| | - C. Paul
- Dermatology Department; Paul Sabatier University; UMR CNRS 5165; INSERM 1056; Toulouse France
| | - M.-A. Richard
- Aix-Marseille University; UMR 911; INSERM CRO2; Assistance Publique and Dermatology Department; Timone Hospital; Marseille France
| | - M. Beylot-Barry
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - D. Jullien
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - S. Aractingi
- Dermatology Department; Cochin Tarnier Hospital; APHP; Paris 5 Descartes University; INSERM UMR S 938; UPMC; CDR Saint-Antoine Hospital; Paris France
| | - F. Aubin
- Dermatology Department; Besançon University Hospital and University of Franche-Comté; Besançon France
| | - P. Joly
- Clinique Dermatologique; Rouen University Hospital; Inserm U905; Institute for Research and Innovation in Biomedicine (IRIB); Rouen University; Normandy France
| | | | - A. Cantagrel
- Rheumatology Center; Purpan Teaching Hospital; Toulouse France
| | - J.-P. Ortonne
- Dermatology Department; Nice University; L'Archet II Hospital; Nice France
| | - L. Misery
- Dermatology Department; Morvan University Hospital; Brest France
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19
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Villani A, Rouzaud M, Sevrain M, Barnetche T, Paul C, Richard MA, Beylot-Barry M, Misery L, Joly P, Aractingi S, Aubin F, Le Maître M, Cantagrel A, Ortonne JP, Jullien D. Symptoms dermatologists should look for in daily practice to improve detection of psoriatic arthritis in psoriasis patients: an expert group consensus. J Eur Acad Dermatol Venereol 2014; 28 Suppl 5:27-32. [DOI: 10.1111/jdv.12563] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 12/28/2022]
Affiliation(s)
- A.P. Villani
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
| | - M. Rouzaud
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - M. Sevrain
- Dermatology Department; Morvan University Hospital; Brest France
| | - T. Barnetche
- Rheumatology Department; Bordeaux University Hospital; Bordeaux France
| | - C. Paul
- Dermatology Department; Paul Sabatier University; UMR CNRS 5165; INSERM 1056; Toulouse France
| | - M.-A. Richard
- Aix-Marseille University; UMR 911; INSERM CRO2; Assistance Publique and Dermatology Department; Timone Hospital; Marseille France
| | - M. Beylot-Barry
- Dermatology Department; CHU Bordeaux; University Bordeaux; Bordeaux France
| | - L. Misery
- Dermatology Department; Morvan University Hospital; Brest France
| | - P. Joly
- Clinique Dermatologique; Rouen University Hospital; Inserm U905; Institute for Research and Innovation in Biomedicine (IRIB); Rouen University; Normandy France
| | - S. Aractingi
- Dermatology Department; Cochin Tarnier Hospital; APHP; Paris 5 Descartes University; INSERM UMR S 938; UPMC; CDR Saint-Antoine Hospital; Paris France
| | - F. Aubin
- Dermatology Department; Besançon University Hospital and University of Franche-Comté; Besançon France
| | | | - A. Cantagrel
- Rheumatology Center; Purpan Teaching Hospital; Toulouse France
| | - J.-P. Ortonne
- Dermatology Department; Nice University; L'Archet II Hospital; Nice France
| | - D. Jullien
- Dermatology Department; Lyon University; Edouard Herriot Hospital; Lyon France
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