1
|
Merilleno ASP, Rivera FD, Temblique MSP. Association between the disease severity and quality of life of patients with psoriasis in a tertiary government hospital in the Philippines: A retrospective cross-sectional study. JAAD Int 2024; 16:42-45. [PMID: 38774347 PMCID: PMC11107253 DOI: 10.1016/j.jdin.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Affiliation(s)
- Arbie Sofia P. Merilleno
- Department of Dermatology, Rizal Medical Center, Pasig, Philippines
- Research and Innovation Institute and Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
2
|
Loo WY, Tee YC, Han WH, Faheem NAA, Yong SS, Kwan Z, Pok LSL, Yahya F. Predictive factors of psoriatic arthritis in a diverse population with psoriasis. J Int Med Res 2024; 52:3000605231221014. [PMID: 38206198 PMCID: PMC10785733 DOI: 10.1177/03000605231221014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE We aimed to analyze the clinical characteristics of patients with psoriasis and determine the predictive factors of psoriatic arthritis (PsA). METHODS This retrospective cohort study was performed among patients with psoriasis. Demographic and clinical data were collected. Psoriasis treatment was categorized as topical agents, phototherapy, oral therapy, and biologics. Predictive factors of PsA development were determined using logistic regression analyses. RESULTS We included 330 patients with psoriasis, and 83 (25%) patients developed PsA. Thirty-eight (45.8%) patients who developed PsA were Malay, 24 (28.9%) were Chinese, and 21 (25.3%) were Indian. The mean age of patients with PsA was 54.2 (±15.8) years, and the duration from diagnosis of psoriasis to diagnosis of PsA was 36 (3.5-114) months. Predictive factors for developing PsA were female sex (odds ratio [OR] = 3.33, 95% confidence interval [CI] 1.78-6.22), presence of nail involvement (OR = 5.36, 95% CI 2.50-11.51), severe psoriasis (OR = 27.41, 95% CI 7.58-99.11), and oral systemic therapy prior to PsA diagnosis (OR = 4.09, 95% CI 2.04-8.22). CONCLUSION Patients with psoriasis who are female, have nail involvement, severe skin psoriasis, and require oral systemic therapy for psoriasis may have an increased risk of developing PsA.
Collapse
Affiliation(s)
- Wai Yang Loo
- Division of Rheumatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| | - Ying Chew Tee
- Division of Rheumatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| | - Winn Hui Han
- Division of Dermatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| | | | - Shin Shen Yong
- Division of Dermatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| | - Zhenli Kwan
- Division of Dermatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| | - Lydia Say Lee Pok
- Division of Rheumatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| | - Fariz Yahya
- Division of Rheumatology, Department of Medicine, Universiti Malaya, Kuala Lumpur
| |
Collapse
|
3
|
Ollech A, Rotenberg M, Tirosh I, Bar-Ilan E, Solomon M, Greenberger S, Pavlotsky F. Pediatric Psoriasis with or without Arthritis: Does It Make a Difference? J Clin Med 2023; 13:242. [PMID: 38202250 PMCID: PMC10779743 DOI: 10.3390/jcm13010242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Psoriasis and psoriatic arthritis can present simultaneously or separately in children and may pose a diagnostic challenge. OBJECTIVE To compare the dermatological manifestations in pediatric psoriatic patients with and without arthritis. METHODS A retrospective case-control study of psoriatic patients ≤ 18 years old at Sheba Medical Center was conducted between 2011 and 2021. Patients with psoriatic arthritis versus psoriasis-only were compared according to body surface area (BSA) involvement, cutaneous distribution, severity of skin disease, response to treatment and related side effects. RESULTS The study cohort included 29 psoriatic arthritis and 64 psoriasis-only patients matched by age and sex. The psoriasis-only group had a significantly higher mean BSA (19.7%, SD ± 18.7) than the psoriatic arthritis group (6.1%, SD ± 11.4), (p = 0.029). The skin distribution differed with the psoriasis group showing more involvement of the extremities, scalp, trunk, and genitals. Both groups primarily experienced partial responses to methotrexate, whereas the psoriasis group mainly saw complete responses to biologics. Adverse events were rare, with a higher incidence in the psoriasis group. CONCLUSION This retrospective study highlights the differences in cutaneous disease characteristics, severity, and treatment response in pediatric patients with psoriasis and psoriatic arthritis, providing valuable insights for diagnosis and disease course in the pediatric population.
Collapse
Affiliation(s)
- Ayelet Ollech
- Pediatric Dermatology Unit, Dermatology Department, Sheba Medical Center, Ramat Gan 5262160, Israel (S.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (F.P.)
| | - Mor Rotenberg
- Department of Dermatology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Irit Tirosh
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (F.P.)
- Pediatric Rheumatology Unit, Edmond and Liliy Safra Medical Center, Jerusalem 9112102, Israel
| | - Efrat Bar-Ilan
- Pediatric Dermatology Unit, Dermatology Department, Sheba Medical Center, Ramat Gan 5262160, Israel (S.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (F.P.)
| | - Michal Solomon
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (F.P.)
- Department of Dermatology, Sheba Medical Center, Tel Hashomer 5262160, Israel
| | - Shoshana Greenberger
- Pediatric Dermatology Unit, Dermatology Department, Sheba Medical Center, Ramat Gan 5262160, Israel (S.G.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (F.P.)
| | - Felix Pavlotsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (F.P.)
- Department of Dermatology, Sheba Medical Center, Tel Hashomer 5262160, Israel
- Psoriasis and Phototherapy Center, Sheba Medical Center, Tel Hashomer 5262160, Israel
| |
Collapse
|
4
|
Augustin M, Lindner L, Kühl L, Weiss A, Rustenbach SJ, Stephan B, Feuchtenberger M, Mrowietz U, Thaçi D, Staubach P, Baraliakos X, Strangfeld A, von Kiedrowski R, Behrens F, Regierer AC. Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries. J Dtsch Dermatol Ges 2023; 21:1170-1176. [PMID: 37653583 DOI: 10.1111/ddg.15178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease affecting the musculoskeletal system, skin and nails. The aim is to characterize sociodemographic and clinical patient profiles documented in dermatologic and rheumatologic care. PATIENTS AND METHODS Data of 704 patients with PsA from the dermatological Psoriasis Registry PsoBest (PB) and 1066 patients from the rheumatological disease registry RABBIT-SpA (RS) were analyzed. Comparable anamnestic and clinical variables were identified and descriptively analyzed. RESULTS The mean age was 51.7 years in PB and 51.9 in RS. Disease duration of psoriasis was longer, mean cutaneous severity was higher in PB. However, more patients in RS vs. PB had tender joints and swollen joints. Mean Dermatology Life Quality Index was higher in PB and mean Health Assessment Questionnaire in RS. Patient reported global disease activity and pain were lower in PB. IL-23 inhibitors were used more frequently in PB, and TNF inhibitors in RS. CONCLUSIONS Clinical specialization was associated with different clinical and treatment patterns of PsA. This may indicate a selection by dominant manifestation of psoriatic disease and potentially by effects of health care access. Psoriatic arthritis should be treated in a multidisciplinary approach considering all facets of this complex disease.
Collapse
Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lisa Lindner
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
| | - Laura Kühl
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja Weiss
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
| | - Stephan Jeff Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ulrich Mrowietz
- Psoriasis Center, Department of Dermatology, Venereology and Allergy, University Medical Center Schleswig-Holstein Kiel, Campus Kiel, Germany
| | - Diamant Thaçi
- Excellence Center for Inflammation Medicine, University Medical Center Schleswig-Holstein Lübeck, Campus Lübeck, Germany
| | - Petra Staubach
- Department of Dermatology University Medical Center Mainz, Mainz, Germany
| | | | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
- Medical Clinic with focus on rheumatology and clinical immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Frank Behrens
- Rheumatology, University Hospital, Fraunhofer Institute for Translational Medicine & Pharmacology ITMP, Goethe University and Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt am Main, Germany
| | | |
Collapse
|
5
|
Augustin M, Lindner L, Kühl L, Weiss A, Rustenbach SJ, Stephan B, Feuchtenberger M, Mrowietz U, Thaçi D, Staubach P, Baraliakos X, Strangfeld A, von Kiedrowski R, Behrens F, Regierer AC. Charakterisierung von Patienten mit Psoriasisarthritis in der dermatologischen und rheumatologischen Versorgung: Analyse von zwei Registern: Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries. J Dtsch Dermatol Ges 2023; 21:1170-1178. [PMID: 37845069 DOI: 10.1111/ddg.15178_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/13/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrund und ZielsetzungDie Psoriasisarthritis (PsA) ist eine chronische systemische Entzündungskrankheit, die den Bewegungsapparat, die Haut und die Nägel betrifft. Ziel ist es, soziodemografische und klinische Patientenprofile zu charakterisieren, die in der dermatologischen und rheumatologischen Versorgung dokumentiert werden.Patienten und MethodikEs wurden die Daten von 704 PsA‐Patienten aus dem dermatologischen Psoriasis‐Register PsoBest (PB) und 1066 Patienten aus dem rheumatologischen Krankheitsregister RABBIT‐SpA (RS) analysiert. Vergleichbare anamnestische und klinische Variablen wurden identifiziert und deskriptiv ausgewertet.ErgebnisseDas Durchschnittsalter betrug 51,7 Jahre bei PB und 51,9 Jahre bei RS. Die Krankheitsdauer der Psoriasis war länger und der mittlere Schweregrad der Hauterkrankung war bei den Patienten in PB höher, jedoch hatten mehr Patienten in RS schmerzende und geschwollene Gelenke. Der mittlere Dermatology Life Quality Index war bei den Patienten in PB höher und der mittlere Health Assessment Questionnaire bei den Patienten in RS. Die von den Patienten angegebene globale Krankheitsaktivität und die Schmerzen waren in PB geringer. IL‐23‐Inhibitoren wurden in PB häufiger eingesetzt, TNF‐Inhibitoren bei RS.SchlussfolgerungenDie klinische Spezialisierung wurde mit unterschiedlichen Krankheitsbildern und Behandlungsmustern der PsA in Verbindung gebracht. Dies könnte auf eine Selektion nach der vorherrschenden Manifestation der Psoriasis‐Erkrankung und möglicherweise auf Auswirkungen des Zugangs zur Gesundheitsversorgung hinweisen. Die PsA sollte in einem multidisziplinären Ansatz behandelt werden, der alle Facetten dieser komplexen Erkrankung berücksichtigt.
Collapse
Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Lisa Lindner
- Deutsches Rheuma-Forschungszentrum, Programmbereich Epidemiologie, Berlin
| | - Laura Kühl
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Anja Weiss
- Deutsches Rheuma-Forschungszentrum, Programmbereich Epidemiologie, Berlin
| | - Stephan Jeff Rustenbach
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Brigitte Stephan
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | - Ulrich Mrowietz
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Diamant Thaçi
- Exzellenzzentrum Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | | | | | - Anja Strangfeld
- Deutsches Rheuma-Forschungszentrum, Programmbereich Epidemiologie, Berlin
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin
| | | | - Frank Behrens
- Rheumatologische Universitätsklinik, Fraunhofer-Institut für Translationale Medizin & Pharmakologie ITMP, Goethe-Universität und Fraunhofer-Exzellenzcluster Immunvermittelte Erkrankungen CIMD, Frankfurt am Main
| | | |
Collapse
|
6
|
Lu C, Yang F, Liu H, Dou L, Wang Y, Li H, Duan X, Wu L, Wang Y, Zhang X, Xu J, Su J, Xu D, Zhao J, Wu Q, Li M, Leng X, Zeng X. Chinese Registry of Psoriatic Arthritis (CREPAR): I. Clinical characteristics of Chinese patients with psoriatic arthritis. Int J Rheum Dis 2023; 26:1737-1744. [PMID: 37424174 DOI: 10.1111/1756-185x.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/17/2022] [Accepted: 06/17/2023] [Indexed: 07/11/2023]
Abstract
AIM To describe the clinical characteristics of Chinese patients with psoriatic arthritis (PsA) using the data recorded in the Chinese Registry of Psoriatic Arthritis (CREPAR). METHODS This is a cross-sectional study based on the CREPAR registry, which is a prospective registry founded in December 2018. Data regarding clinical characteristics and treatment of patients were collected during every visit. Data recorded at enrollment were extracted, analyzed, and compared with data in other registries or cohorts. RESULTS A total of 1074 patients were registered from December 2018 to June 2021. Of these, 929 (86.5%) patients had a history of peripheral arthritis, and 844 patients (78.6%) had peripheral arthritis at enrollment, of which polyarthritis is the most common subtype. Axial involvement was present in 39.9% of patients, and 50 (4.7%) patients had axial involvement only. More than half of the patients (55.4%) had at least two musculoskeletal presentations at enrollment. The prevalence of low disease activity and remission according to DAPSA were 26.4% and 6.8%, respectively. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological DMARDs were used in 64.9% and 29.1% of patients, respectively. Among patients with different musculoskeletal presentations, patients with dactylitis had the highest proportion of nonsteroidal anti-inflammatory and csDMARD use. The proportion of patients receiving bDMARDs was highest in axial PsA. CONCLUSION The CREPAR registry has provided information on Chinese patients with PsA. Compared with data in other registries or cohorts, the disease activity of patients in CREPAR was higher, and the proportion of bDMARD use was lower.
Collapse
Affiliation(s)
- Chaofan Lu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Fan Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Huilan Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lei Dou
- Department of Rheumatology and Immunology, The Second People's Hospital of Wuhu, Wuhu, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongbin Li
- The Division of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xinwang Duan
- Department of Rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, The People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yongfu Wang
- Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Xiuying Zhang
- Department of Rheumatology, ZiBo Central Hospital, Zibo, China
| | - Jian Xu
- Department of Rheumatology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinmei Su
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qingjun Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaomei Leng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| |
Collapse
|
7
|
Korsakova YL, Korotaeva TV, Loginova EY, Gubar EE, Vorobyeva LD, Glukhova SI, Nasonov EL. [A new integral enthesial-comorbididity index of psoriatic arthritis activity]. TERAPEVT ARKH 2023; 95:404-409. [PMID: 38158993 DOI: 10.26442/00403660.2023.05.202197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 01/03/2024]
Abstract
AIM To develop an integral index of psoriatic arthritis (PsA) activity. MATERIALS AND METHODS 117 patients with PsA (M/F - 63/54) were included. Patients' age 44±11 years, psoriasis (Ps) duration - 213±153 months, PsA duration - 73.4±78.5 months. Patients underwent standard clinical examination of PsA activity: tender (out of 68) and swollen (out of 66) joint counts (TJC, SJC), LEI, tenderness of the plantar fascia (PF), skin lesion severity (BSA), presence of nail Ps, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), DAPSA, FACIT-F. Parametric and nonparametric statistic methods, correlation and ROC analysis were used. RESULTS Mean DAPSA was 38±21, TJC - 14.2±10.6, SJC - 10.6±8.3, ESR - 30.5±29.5 mm/h, CRP - 23.3±29 mg/l, LEI - 1.2±1.5, FACIT-F - 32±11, BMI - 27.4±6.2 kg/m2. The following significant positive correlations were revealed: between DAPSA and BMI, patients' age, ESR, PsA and Ps duration, TJC, SJC, LEI, presence of PF enthesitis, skin lesion severity, presence of nail Ps. A negative correlation between FACIT-F and male sex was found. Based on the predictive model of parameters, the Entesial-Comorbid Index of PsA (ECIPsA) was created: 3.81×LEI+13.72×PF+0.54×Age-0.25×FACIT-F+7.36×BSA+7.94×PsA duration+5.5×Nail Ps+0.32×BMI-3.52, namely LEI - Leeds Enthesial Index; PF - pain in the PF; patient's age; FACIT-F - fatigue scale; BSA<3%=0, ≥3%=1; PsA duration≤2 years=0, >2 years=1; presence of nail Ps=1, absence=0; ECIPsA≥28 corresponds with high PsA activity according to DAPSA≥28. ROC analysis of sensitivity and specificity of the prognostic model demonstrated high correctness of the index: the area under the ROC curve was 0.768, 95% confidence interval (0.624-0.913). CONCLUSION The new PsA activity index corresponds to the existing ones and takes into consideration the clinical heterogeneity and comorbidity of the disease.
Collapse
Affiliation(s)
| | | | | | - E E Gubar
- Nasonova Research Institute of Rheumatology
| | | | | | - E L Nasonov
- Nasonova Research Institute of Rheumatology
- Sechenov First Moscow State Medical University (Sechenov University)
| |
Collapse
|
8
|
Li SS, Du N, He SH, Liang X, Li TF. Exploring the Association Between History of Psoriasis (PSO) and Disease Activity in Patients with Psoriatic Arthritis (PsA). Rheumatol Ther 2022; 9:1079-1090. [PMID: 35579829 PMCID: PMC9314511 DOI: 10.1007/s40744-022-00455-8] [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: 03/13/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Psoriatic arthritis (PsA) is a common inflammatory disease affecting the peripheral and axial skeleton. History of psoriasis (PSO), either personal or family history, is an important factor in the diagnosis of PsA. We investigated the association between history of PSO and clinical characteristics of PsA. Methods PsA patients were consecutive recruited from 2019 to 2020. These patients were subjected to clinical, biochemical, and radiographic examinations, and disease activity was evaluated. Continuous and categorical variables analyses were presented. Results All registered patients (296 cases) met the classification criteria of PsA. They were divided into three groups based on the history of psoriasis (PSO), as: (1) 145 patients with PSO themselves (pPsA); (2) 96 patients with family history of PSO (fPsA); (3) 55 patients with family history and coexisting PSO themselves (fPsA/PSO). Compared to fPsA/PSO, the levels of CRP, ESR, uric acid, DAPSA, BASDAI, ASDAS, and BASFI were lower in fPsA, but similar to pPsA. The severity of sacroiliitis tended to be more severe in fPsA/PSO than fPsA (OR2 vs. 3 0.508; 95% CI 0.272 to 0.949, p < 0.05). No significant differences were found in HLA-B-27 and common inflammatory articular and extra-articular manifestations among the three groups. Furthermore, there were no differences in LEI, TJC, SJC, and DAS28CRP. Interestingly, a correlation was found between the ages of individuals with PSO and the onset of arthritis, and the earliest arthritis onset occurred in fPsA/PSO patients (p < 0.001). Conclusions Our study demonstrates that currently existing cutaneous lesions in patients themselves are correlated with disease activity and severity of axial joint damage, whereas family history does not have an evident impact on the disease activity of PsA.
Collapse
Affiliation(s)
- Shan-Shan Li
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Na Du
- Department of Medicine, Division of Rheumatology, Central Hospital of Kaifeng City, Kaifeng, China
| | - Shi-Hao He
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu Liang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tian-Fang Li
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
9
|
Lucasson F, Kiltz U, Kalyoncu U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Ryussen-Witrand A, Soubrier M, Aydin SZ, Eder L, Gaydukova I, Lubrano E, Richette P, Husni E, Coates LC, de Wit M, Smolen JS, Orbai AM, Gossec L. Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries. RMD Open 2022; 8:e002031. [PMID: 35523519 PMCID: PMC9083399 DOI: 10.1136/rmdopen-2021-002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments. METHODS A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription. RESULTS In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0% and 18.4% patients, vs 29.1% and 49.5% in the middle tertile and 16.8% and 41.3% in the high tertile, respectively (all p<0.001). bDMARDs use was similar in the tertiles (overall mean 61%). The overall rate of patients with DAPSA >14 and no bDMARDs was 18.5%, and was higher in lower GDP/capita countries (p=0.004). CONCLUSION PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.
Collapse
Affiliation(s)
- Florian Lucasson
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Uta Kiltz
- Herne and Ruhr-Universität, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ying Ying Leung
- Duke-NUS Medical School, Singapore General Hospital, Singapore
| | - Penélope Palominos
- Rheumatology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Juan D Cañete
- Servicio de Reumatología, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza Università di Roma, Roma, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Adeline Ryussen-Witrand
- Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
| | | | - Sibel Zehra Aydin
- The Ottawa Hospital Research Institute, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Inna Gaydukova
- North-western State Medical University, St.Petersburg, Russian Federation
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Pascal Richette
- Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France
- Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Maarten de Wit
- Patient Research Partner, EULAR, Zaltbommel, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
| | - Ana-Maria Orbai
- Division of Rheumatology, Psoriatic Arthritis Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| |
Collapse
|
10
|
Coates LC, de Wit M, Buchanan-Hughes A, Smulders M, Sheahan A, Ogdie AR. Residual Disease Associated with Suboptimal Treatment Response in Patients with Psoriatic Arthritis: A Systematic Review of Real-World Evidence. Rheumatol Ther 2022; 9:803-821. [PMID: 35412298 PMCID: PMC9127027 DOI: 10.1007/s40744-022-00443-y] [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: 12/08/2021] [Accepted: 03/14/2022] [Indexed: 01/18/2023] Open
Abstract
Objective This systematic literature review aimed to identify and summarise real-world observational studies reporting the type, prevalence and/or severity of residual symptoms and disease in adults with psoriatic arthritis (PsA) who have received treatment and been assessed against remission or low disease activity targets. Methods Patients had received treatment and been assessed with treat-to-target metrics, including minimal disease activity (MDA), Disease Activity Index in PsA (DAPSA) and others. MEDLINE, Embase® and the Cochrane Database of Systematic Reviews (CDSR) were searched using search terms for PsA, treatment targets and observational studies. Screening of search results was completed by two independent reviewers; studies were included if they reported relevant residual disease outcomes in adults with PsA who had received one or more pharmacological treatments for PsA in a real-world setting. Non-observational studies were excluded. Information from included studies was extracted into a prespecified grid by a single reviewer and checked by a second reviewer. Results Database searching yielded 2328 articles, of which 42 publications (27 unique studies) were included in this systematic literature review. Twenty-three studies reported outcomes for MDA-assessed patients, and 14 studies reported outcomes for DAPSA-assessed patients. Physician- and patient-reported residual disease was less frequent and/or severe in patients reaching targets, but often not absent, including when patients achieved very low disease activity (VLDA) or remission. For example, studies reported that 0–8% patients in remission according to DAPSA (or clinical DAPSA) had > 1 tender joint, 25–39% had Psoriasis Area and Severity Index (PASI) score > 1 and 0–10% had patient-reported pain > 15. Residual disease was usually less frequent and/or severe among patients achieving MDA-assessed targets versus DAPSA-assessed targets, especially for skin outcomes. Conclusion The findings demonstrate a need for further optimisation of care for patients with PsA.
Collapse
Affiliation(s)
- Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Maartje Smulders
- UCB Pharma, Anderlecht, Belgium
- Present Address: Astellas Pharma Europe B.V., Leiden, The Netherlands
| | | | - Alexis R. Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
11
|
Lucasson F, Richette P, Aouad K, Ryussen-Witrand A, Wendling D, Fautrel B, Gossec L. Prevalence and consequences of psoriasis in recent axial spondyloarthritis: an analysis of the DESIR cohort over 6 years. RMD Open 2022; 8:rmdopen-2021-001986. [PMID: 35091462 PMCID: PMC8804683 DOI: 10.1136/rmdopen-2021-001986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The consequences of psoriasis associated to axial spondyloarthritis (axSpA) are unclear. The objectives were to determine the prevalence and the consequences of psoriasis in recent axSpA over 6 years of follow-up. METHODS The multicentric prospective cohort DESIR (NCT01648907) of adult patients with recent inflammatory back pain suggestive of axSpA was analysed over 6 years. Psoriasis was recorded at each visit and cumulative prevalence and incidence were calculated. Patients with vs without psoriasis at any time point were compared. Outcomes included disease activity (Ankylosing Spondylitis Disease Activity Score-C reactive protein (ASDAS-CRP), joint and enthesitis count, CRP), patient-reported outcomes for function (Health Assessment Questionnaire for axSpA, HAQ-AS) and quality of life, and treatment use over 6 years. Outcomes were compared through univariable and multivariable analyses, as well as linear mixed effect models. RESULTS In 589 patients, mean age 40.5±8.7 years, 45.8% men and baseline mean symptom duration 1.5±0.9 years, the cumulative prevalence of psoriasis increased from 16.8% (99/589) at baseline to 26.8% (158/589) at 6 years, leading to an incidence of 2.1/100 patient-years. Over 6 years of follow-up, patients with psoriasis developed more synovitis (p=0.008), and received more methotrexate (cumulative use, 25.5% vs 11.8%, p<0.001) and biological disease-modifying drugs (55.7% vs 38.5%, p<0.001). There were no significant consequences of psoriasis on other outcomes, including disease activity (ASDAS-CRP), functional capacity (HAQ-AS) and quality of life. CONCLUSION Psoriasis is frequent in early axSpA. AxSpA patients with psoriasis had more swollen joints over time and received more biologics; they did not have worse outcomes related to axSpA in terms of activity and severity. TRIAL REGISTRATION NUMBER NCT01648907.
Collapse
Affiliation(s)
- Florian Lucasson
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Pascal Richette
- Rheumatology Department, APHP, Université de Paris, Hôpital Lariboisière, Paris, France.,INSERM UMR1132 Bioscar, Université de Paris, Paris, France
| | - Krystel Aouad
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Adeline Ryussen-Witrand
- Rheumatology Department, Centre d'Investigation Clinique de Toulouse CIC 1436, Inserm, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
| | - Daniel Wendling
- Department of Rheumatology, University Teaching Hospital, CHRU de Besançon, Besancon, France.,EA 4266 EPILAB, Université Bourgogne Franche-Comté, Besancon, France
| | - Bruno Fautrel
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Pitié Salpêtrière Hospital, Rheumatology Department, APHP.Sorbonne Université, Paris, France
| | - Laure Gossec
- INSERM UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Pitié Salpêtrière Hospital, Rheumatology Department, APHP.Sorbonne Université, Paris, France
| |
Collapse
|
12
|
Gottlieb AB, Wells AF, Merola JF. Telemedicine and psoriatic arthritis: best practices and considerations for dermatologists and rheumatologists. Clin Rheumatol 2022; 41:1271-1283. [PMID: 35083564 PMCID: PMC8791553 DOI: 10.1007/s10067-022-06077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
Telemedicine encompasses a variety of modalities that allow for the remote assessment and treatment of patients. The technologies, services, and tools available for telemedicine in the USA are increasingly becoming an integral part of the healthcare system to bridge the gaps in care that can arise from geographic and/or socioeconomic obstacles and provider shortages. Telemedicine can be applied to a spectrum of clinical areas, including rheumatic diseases. Psoriatic arthritis (PsA) is a chronic, inflammatory, multisystem disease with predominately skin and joint manifestations. PsA is often misdiagnosed and/or undiagnosed, which can lead to worse patient outcomes, including irreversible joint erosion and damage. The difficulties in diagnosing and managing PsA are confounded by the emergence and increased use of telemedicine because of the COVID-19 pandemic. Telemedicine presents the opportunity to increase access to healthcare by rheumatologists and dermatologists to improve training and education regarding PsA and to decrease time attributed to office visits associated with PsA. However, challenges in diagnosing PsA without a thorough in-person physical examination by a trained rheumatologist or dermatologist exist. We provide an overview of the ways telemedicine can be incorporated into clinical care and optimized for patients with PsA; characteristic clinical features of PsA, with a focus on skin and joint signs and symptoms; screening tools to be used in routine clinical care; assessments that can be used to evaluate quality of life, functional ability, and disease activity in PsA; and resources and recommendations for the development of future telemedicine use in rheumatology and dermatology.Key Points • Patients with psoriatic arthritis (PsA) are often misdiagnosed and/or undiagnosed. • Telemedicine can improve access to healthcare by rheumatologists and dermatologists. • Telemedicine can be incorporated into clinical care and optimized for managing PsA. |
Collapse
Affiliation(s)
- Alice B. Gottlieb
- Icahn School of Medicine at Mount Sinai, 10 Union Square East, New York, NY USA
| | - Alvin F. Wells
- Aurora Rheumatology and Immunotherapy Center, Franklin, WI USA
| | - Joseph F. Merola
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| |
Collapse
|
13
|
McBride SR, Fargnoli MC, Fougerousse AC, García Bustínduy M, Catton L, Senturk L, Ecoffet C, Koren J, Andreoli L, Coates LC, Titialii A. Impact of psoriatic disease on women aged 18 to 45: Results from a multinational survey across 11 European countries. Int J Womens Dermatol 2022; 7:697-707. [PMID: 35028368 PMCID: PMC8714576 DOI: 10.1016/j.ijwd.2021.08.011] [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: 05/14/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Plaque psoriasis (PSO) is a long-term inflammatory condition that can cause concomitant joint symptoms (psoriatic arthritis [PsA]) in up to 30% of patients. The impact of psoriatic disease on disease outcomes and quality of life is greater in women than men. Objective We evaluated the impact of psoriatic disease on women aged 18 to 45 years across Europe. Methods Women aged 18 to 45 years with moderate to severe PSO, PsA, or PSO + PsA (PSO with progression to PsA) and prior biologic experience were recruited from market research panels and patient association groups of the International Federation of Psoriasis Associations, European Federation of Psoriasis Patient Associations, and Arthritis Ireland and asked to complete a survey. Questions covered social and psychological wellbeing, employment, and family planning. Question types included 5- or 7-point agreement scales, where the highest/lowest two ratings were considered agreement/disagreement, respectively. The results are reported as proportions of those who selected the answer, divided by overall respondents for each question. Women were not required to answer all questions. Results Survey respondents (N = 573) had a diagnosis of PSO (n = 236), PsA (n = 173), or PSO + PsA (n = 164). Women self-reported similar mean scores for physical (57.0 of 100) and mental (59.0 of 100) health. A fifth (21%) had not achieved their desired career due to PSO/PsA; career dissatisfaction and increased sick leave were linked to poor mental health. Some women reported having a limited social life (33%), smaller families (34%), and being more likely to adopt children (27%) due to PSO/PsA. A quarter of women (27%) reported not understanding enough about PSO/PsA (nonmembers vs. members of patient association groups: 37% vs. 8%). Conclusion Our findings highlight the considerable burden of psoriatic disease on women of childbearing age. Increased provision of information tailored to women, training for health care professionals, and shared decision-making between patients and health care professionals may help better support women with psoriatic disease.
Collapse
Affiliation(s)
- Sandy R McBride
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maria C Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anne-Claire Fougerousse
- Department of Dermatology, GEM ResoPso, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Marta García Bustínduy
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, San Cristobal de La Laguna, Spain
| | | | | | | | | | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Alice Titialii
- International Federation of Psoriasis Associations, Stockholm, Sweden
| |
Collapse
|
14
|
Vela J, Cordtz RL, Kristensen S, Torp-Pedersen C, Petersen KK, Arendt-Nielsen L, Dreyer L. Is pain associated with premature mortality in patients with psoriatic arthritis? A nested case-control study using the DANBIO Register. Rheumatology (Oxford) 2021; 60:5216-5223. [PMID: 33668054 DOI: 10.1093/rheumatology/keab192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES It has been hypothesized that the presence of chronic pain causes excess mortality. Since chronic pain is prevalent among patients with PsA this potential association should be explored. We aimed to investigate whether higher cumulative pain intensity is associated with an excess mortality risk in patients with PsA. METHODS A nested case-control study using data from the nationwide DANBIO Register (Danish Database for Biological Therapies in Rheumatology) Register and Danish healthcare registers. Cases were patients who died and corresponding to the date of death, matched on sex, year of birth and calendar period at the time of death with up to five controls. Exposure of interest was mean pain intensity reported during the time followed in routine rheumatology practice. Pain intensity was measured using a visual analogue scale from 0 to 100 and conditional logistic regression was used to calculate odds of mortality per 5 unit increase in pain while adjusting for confounders. RESULTS The cohort consisted of 8019 patients. A total of 276 cases were identified and matched with 1187 controls. Higher mean pain intensity was associated with increased odds of mortality [odds ratio 1.06 (95% CI 1.02, 1.10)] in the crude model, but there was no association [odds ratio 0.99 (95% CI 0.95, 1.03)] when adjusting for additional confounders. Factors shown to increase the odds of mortality were recent glucocorticoid use, concomitant chronic obstructive pulmonary disease, diabetes mellitus, cancer and cardiovascular disease. CONCLUSION These results indicate that experienced pain in itself is not associated with premature mortality in patients with PsA. However, recent glucocorticoid use and concurrent comorbidities were.
Collapse
Affiliation(s)
- Jonathan Vela
- Department of Rheumatology.,Department of Clinical Medicine, Aalborg University, Aalborg
| | - Rene Lindholm Cordtz
- Department of Rheumatology.,Centre for Rheumatology and Spine diseases, Gentofte Hospital, Copenhagen
| | - Salome Kristensen
- Department of Rheumatology.,Department of Clinical Medicine, Aalborg University, Aalborg
| | | | - Kristian Kjær Petersen
- Centre for Sensory-Motor Interaction, Aalborg University, Aalborg.,Centre for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg
| | | | - Lene Dreyer
- Department of Rheumatology.,Department of Clinical Medicine, Aalborg University, Aalborg.,DANBIO Register, Denmark
| |
Collapse
|
15
|
Carvalho AL, Hedrich CM. The Molecular Pathophysiology of Psoriatic Arthritis-The Complex Interplay Between Genetic Predisposition, Epigenetics Factors, and the Microbiome. Front Mol Biosci 2021; 8:662047. [PMID: 33869291 PMCID: PMC8047476 DOI: 10.3389/fmolb.2021.662047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Psoriasis is a symmetric autoimmune/inflammatory disease that primarily affects the skin. In a significant proportion of cases, it is accompanied by arthritis that can affect any joint, the spine, and/or include enthesitis. Psoriasis and psoriatic arthritis are multifactor disorders characterized by aberrant immune responses in genetically susceptible individuals in the presence of additional (environmental) factors, including changes in microbiota and/or epigenetic marks. Epigenetic changes can be heritable or acquired (e.g., through changes in diet/microbiota or as a response to therapeutics) and, together with genetic factors, contribute to disease expression. In psoriasis, epigenetic alterations are mainly related to cell proliferation, cytokine signaling and microbial tolerance. Understanding the complex interplay between heritable and acquired pathomechanistic factors contributing to the development and maintenance of psoriasis is crucial for the identification and validation of diagnostic and predictive biomarkers, and the introduction of individualized effective and tolerable new treatments. This review summarizes the current understanding of immune activation, genetic, and environmental factors that contribute to the pathogenesis of psoriatic arthritis. Particular focus is on the interactions between these factors to propose a multifactorial disease model.
Collapse
Affiliation(s)
- Ana L Carvalho
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom
| |
Collapse
|
16
|
Mistegård J, Gudbjornsson B, Lindqvist U, Laasonen L, Ejstrup L, Ståhle M, Iversen L. Comorbidities in a Cohort of 66 Patients With Psoriatic Arthritis Mutilans-Results From the Nordic PAM Study. Front Med (Lausanne) 2021; 8:629741. [PMID: 33614686 PMCID: PMC7889950 DOI: 10.3389/fmed.2021.629741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis due to excessive bone erosion causing joint destruction and decreased functional capacity. The aim of this study was to investigate the prevalence of comorbidities among patients with PAM and the association between comorbidities and joint involvement. Methods: A total of 66 patients aged ≥18 years from the Nordic countries with past or present psoriasis along with at least one mutilated joint were included in the present study. Results: The median number of comorbid conditions per patient was 1 [interquartile range (IQR) 0-2] and 16.7% reported three or more comorbidities. The most frequent comorbidity was hypertension (36.4%). The median number of mutilated joints per patient was 3 (IQR 1-8.3; range 1-38). Conclusion: Two thirds of the patients with PAM reported comorbid conditions and the most frequent was hypertension which affected more than a third of the patients. However, this study was unable to detect any association between comorbidities and the severity of PAM.
Collapse
Affiliation(s)
| | - Bjorn Gudbjornsson
- Faculty of Medicine, Centre for Rheumatology Research, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Ulla Lindqvist
- Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Leena Laasonen
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Leif Ejstrup
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Mona Ståhle
- Dermatology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
17
|
Landewé RBM, van der Heijde D. Use of multidimensional composite scores in rheumatology: parsimony versus subtlety. Ann Rheum Dis 2020; 80:280-285. [PMID: 33144304 DOI: 10.1136/annrheumdis-2020-216999] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022]
Abstract
Rheumatic and musculoskeletal diseases (RMDs) form a diverse group of diseases. Proper disease assessment is pivotal, for instance to make treatment choices and for optimising outcome in general. RMDs are multidimensional diseases, entrenching many, sometimes very different aspects. Composite outcome measures ('composites') have become very popular to assess RMDs, because of their claim to catch all relevant dimensions of the disease into one convenient measure.In this article we discuss dimensionality of RMDs in the context of the most popular conceptual framework of RMDs, being an inflammatory process leading to some sort of damage over time. We will argue that multidimensionality not only refers to heterogeneity in disease manifestations, but also to heterogeneity in possible outcomes. Unlike most unidimensional measures, multidimensional composites may include several disease manifestations as well as several outcome dimensions into one index. We will discuss fundamental problems of multidimensional composites in light of modern strategies such as treat-to-target and personalised medicine.Finally, we will disentangle the use of multidimensional composites in clinical trials versus their use in clinical practice, and propose simple solutions in order to overcome problems of multidimensionality and to avoid harm to our patients due to overtreatment.
Collapse
Affiliation(s)
- Robert B M Landewé
- Amsterdam Rheumatology Center, Amsterdam University Medical Center, Amsterdam, The Netherlands .,Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Diakonhjemmet Hospital, Norway
| |
Collapse
|
18
|
Tillett W, Merola JF, Thaçi D, Holdsworth E, Booth N, Lobosco LS, Milligan G, Hufford MM, Birt JA, Boehncke WH. Disease Characteristics and the Burden of Joint and Skin Involvement Amongst People With Psoriatic Arthritis: A Population Survey. Rheumatol Ther 2020; 7:617-637. [PMID: 32700230 PMCID: PMC7410983 DOI: 10.1007/s40744-020-00221-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic, systemic, inflammatory disease where disease burden and quality of life (QoL) are affected by both joint and skin manifestations. METHODS Patient and physician reported data were collected about 3200 patients in a cross-sectional survey of patients from nine countries. Patient-reported outcomes (PROs) included perceptions of symptom importance, EuroQol questionnaire (EQ-5D), Psoriatic Arthritis Impact of Disease (PsAID12), and Work Productivity and Activity Impairment (WPAI) Index. Outcomes were compared in patients with 'joint-only' and 'joint and skin' disease symptoms. RESULTS Of the 3200 patients, 2703 had complete information for 'joint-only' or 'joint and skin' involvement and were included in the analysis. Patients had a mean age of 49.2 years, 45.2% were female, and 64.5% had 'joint and skin' involvement. Patients with 'joint and skin' involvement had higher mean tender and swollen joint counts (5.2 and 4.8) than patients who were 'joint-only' (2.0 and 1.5). Significantly more patients with active 'joint and skin' symptoms experienced a flare (currently or within the last 12 months) compared with 'joint-only' patients (34.9 vs. 23.2%, p < 0.001). When asked to prioritize the burden of symptoms, 61.6% of patients prioritized joints, 38.4% prioritized skin. Anxiety/depression was experienced by 41.4% of patients, 62.4% of whom indicated that both joint and skin symptoms were the cause. Patients with 'joint and skin' involvement reported significantly worse QoL, work productivity and activity impairment than 'joint-only' patients (EQ-5D index 0.79 vs. 0.85, p < 0.001; EQ-5D VAS 71.98 vs. 77.68, p < 0.001; PsAID12 2.91 vs. 1.66, p < 0.001; WPAI overall work impairment 25.61 vs. 16.32, p < 0.001). CONCLUSIONS PsA patients who experience 'joint and skin' symptoms had significantly worse clinical outcomes, health-related QoL, and work productivity compared with patients with 'joint-only' symptoms.
Collapse
Affiliation(s)
- William Tillett
- Royal National Hospital for Rheumatic Diseases, Bath, UK
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | | | | | | | | | | | - Julie A Birt
- Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - Wolf-Henning Boehncke
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
19
|
López-Medina C, Ortega-Castro R, Castro-Villegas MC, Font-Ugalde P, Puche-Larrubia MÁ, Gómez-García I, Arias-de la Rosa I, Barbarroja N, Schiotis R, Collantes-Estévez E. Axial and peripheral spondyloarthritis: does psoriasis influence the clinical expression and disease burden? Data from REGISPONSER registry. Rheumatology (Oxford) 2020; 60:1125-1136. [DOI: 10.1093/rheumatology/keaa398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/06/2020] [Indexed: 02/04/2023] Open
Abstract
Abstract
Objective
To evaluate whether the presence of psoriasis influences the clinical expression, disease activity and disease burden in both axial and peripheral phenotypes of spondyloarthritis (SpA).
Methods
Patients from the Spanish REGISPONSER registry classified as having SpA according to the ESSG criteria were included. Patients were classified as psoriatic or non-psoriatic depending on the presence of cutaneous or nail psoriasis; thereafter, they were classified as having either axial [presence of radiographic sacroiliitis OR inflammatory back pain (IBP)] or peripheral phenotype (absence of radiographic sacroiliitis AND absence of IBP AND presence of peripheral involvement). Pair-wise univariate and multivariate analyses among the four groups (psoriatic/non-psoriatic axial phenotypes and psoriatic/non-psoriatic peripheral phenotypes) were performed with adjustment for treatment intake.
Results
A total of 2296 patients were included in the analysis. Among patients with axial phenotype, psoriasis was independently associated (P < 0.05) with HLA-B27+ [odds ratio (OR) 0.27], uveitis (OR 0.46), synovitis (ever) (OR 2.59), dactylitis (OR 2.78) and the use of conventional synthetic DMARDs (csDMARDs) (OR 1.47) in comparison with non-psoriatic patients. Among patients with peripheral phenotype and adjusting for csDMARD intake, psoriasis was independently associated with higher age at disease onset (OR 1.05), HLA-B27+ (OR 0.14) and heel enthesitis (OR 0.22). Higher scores for patient-reported outcomes and greater use of treatment at the time of the study visit were observed in psoriatic patients with either axial or peripheral phenotype.
Conclusion
These findings suggest that, among all patients with SpA, psoriasis is associated with differences in clinical expression of SpA, a greater disease burden and increased use of drugs.
Collapse
Affiliation(s)
- Clementina López-Medina
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
- Rheumatology Department, Cochin Hospital from Paris/INSERM U 1153, Clinical Epidemiology and Biostatistics, Paris, France
| | - Rafaela Ortega-Castro
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - M Carmen Castro-Villegas
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Pilar Font-Ugalde
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - M Ángeles Puche-Larrubia
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Ignacio Gómez-García
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Iván Arias-de la Rosa
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | | | - Ruxandra Schiotis
- Rheumatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, SCBI, Cluj-Napoca, Romania
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain
| |
Collapse
|