AbstractJournal of PeriodontologyPosted online on April 23, 2012.(doi:10.1902/jop.2012.120009)

Periodontal Condition of Patients with Auto-Immune Diseases and the Effect of Anti-Tnf-A TherapyYaniv Mayer,* Rina Elimelech,* Alexandra Balbir-Gurman,†,‡Yolanda Braun-Moscovici,†,‡ Eli E. Machtei, *,‡

*Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.

†B. Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.

‡Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.

Corresponding author's address: Dr. Yaniv Mayer, Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel, Tel: +972-54-6565905; email: y_mayer@rambam.health.gov.il

Background: The aim of this study was to evaluate the effect of auto-immune diseases (AI) as well as anti TNF-α therapy on the clinical and immunological parameters of the periodontium.

Methods: 36 AI patients [12 Rheumatoid arthritis (RA), 12 Psoriatic arthritis (PA) & 12 Systemic sclerosis (SSc)], were recruited together with 12 healthy (H) and 10 RA patients receiving anti TNF-α therapy (RA+). Periodontal indices including plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing (BOP) were measured and gingival crevicular fluid (GCF) was collected from five deepest pockets using papers strips. The TNF-α level was analyzed using Enzyme-Linked Immunosorbent Assay (ELISA). ANOVA test was used for statistical comparison between groups while Pearson's linear correlation coefficient test was used to examine the association between TNF-α and periodontal status indices.

Results: The three AI sub-groups were very similar in clinical and immunological parameters. GI was greater in the AI patients compared to the H and RA+ groups (1.91±0.54, 1.21±0.67, 1.45±0.30 respectively, p=0.0005). AI patients exhibited significantly more BOP than H and RA+ (46.45±17.08%, 30.08±16.86% and 21.13±9.51%; respectively, p=0.0002). PD in H and RA+ groups were lower than in the AI (3.47±0.33mm, 3.22±0.41mm, 3.91±0.49mm; p=0.0001). Number of sited with PD above 4 mm was higher in AI patients compared to H and RA+ (42.44±17.5 versus 24.33±15.62 versus 33.3±6.6, p=0.0002). GCF's TNF-α were higher amongst the AI patients (1.67±0.58 ng/site) compared to 1.07±0.33 ng/site for the H and 0.97±0.52

ng/site for the RA+ (p=0.0002). A significant positive correlation was found between PD and TNF-α levels in the GCF (r=0.4672, p=0.0002), BOP (r=0.7491, p=0.0001) and GI (r=0.5420, p=0.0001).

Conclusion: Patients with AI diseases have higher periodontal indices & GCF TNF-α than healthy controls. Anti-TNF-α treatment appears to reverse this phenomenon.

KEYWORDS: Tumor Necrosis Factor-alpha, Rheumatoid Arthritis, Scleroderma, Chronic periodontitis, Gingival Cervicular Fluid

Clin Exp Rheumatol. 2012 Apr 17. [Epub ahead of print]

Effect of age at disease onset in the clinical profile of spondyloarthritis: a study of 1424 Brazilian patients.Skare TL, Leite N, Bortoluzzo AB, Gonçalves CR, Da Silva JA, Ximenes AC, Bértolo MB, Ribeiro SL, Keiserman M, Menin R, Carneiro S, Aze vedo VF , Vieira WP, Albuquerque ED, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HM, Costa IP, Duarte AP, Gavi MB, Kohem CL, Lima SA, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FA, Santiago MB, Sauma MD, Sampaio-Barros PD.

Source

Hospital Evangélico de Curitiba, Curitiba, Brazil. tskare@onda.com.br.

Abstract

OBJECTIVES:

To analyse demographic and clinical variables in patients with disease onset before and after 40, 45 and 50 years in a large series of Brazilian SpA patients.

METHODS:

A common protocol of investigation was prospectively applied to 1424 SpA patients in 29 centres distributed through the main geographical regions in Brazil. The mean age at disease onset was 28.56±12.34 years, with 259 patients (18.2%) referring disease onset after 40 years, 151 (10.6%) after 45 years and 81 (5.8%) after 50 years. Clinical and demographic variables and disease indices (BASDAI, BASFI, BASRI, MASES, ASQoL) were investigated. Ankylosing spondylitis was the most frequent disease (66.3%), followed by psoriatic arthritis (18%), undifferentiated SpA (6.7%), reactive arthritis (5.5%), and enteropathic arthritis (3.5%).

RESULTS:

Comparing the groups according to age of disease onset, those patients with later onset presented statistical association with female gender, peripheral arthritis, dactylitis, nail involvement and psoriasis, as well as negative statistical association with inflammatory low back pain, alternating buttock pain, radiographic sacroiliitis, hip involvement, positive familial history, HLA-B27 and uveitis. BASDAI, BASFI and quality of life, as well as physicians and patient's global assessment, were similar in all the groups. Radiographic indices showed worse results in the younger age groups.

CONCLUSIONS:

There are two different clinical patterns in SpA defined by age at disease onset: one with predominance of axial symptoms in the group with disease onset ≤40 years and another favouring the peripheral manifestations in those with later disease onset.

PMID:

22510473

[PubMed - as supplied by publisher]

Clin Exp Rheumatol. 2012 Mar 27. [Epub ahead of print]

Patients with psoriatic arthritis may show differences in their clinical and genetic profiles depending on their age at psoriasis onset.Queiro R, Alperi M, Alonso-Castro S, Ballina J, Huergo-Zapico L, Fernández-Guizán A, Acebes-Huerta A, Martínez-Borra J, Sarasqueta C, López-Larrea C, González S.

Source

Rheumatology Service, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain. ruquei@mixmail.com.

Abstract

OBJECTIVES:

The age of psoriasis onset has an important impact on the clinical expression and heritability of psoriasis. Psoriasis characteristics according to the age at disease onset

have been extensively studied. However, the impact of the age of psoriasis onset on psoriatic arthritis (PsA) features has not been analysed in depth. The aim of the present paper is to analyse whether the age of psoriasis onset may have an impact on the clinical and genetic characteristics in a cohort of PsA patients.

METHODS:

The study included 110 PsA patients classified in accordance with the CASPAR criteria. Patients were divided into early (onset age <30 years) and late (onset age >30 years) onset psoriasis, and clinical features were studied in accordance to this stratification. Distribution of several genes within the MHC region were analysed in accordance with the prior stratification, and their frequencies compared to that of 110 healthy matched blood donors.

RESULTS:

Compared to patients with late-onset disease, PsA patients with early-onset psoriasis showed more frequently: a longer psoriasis-arthritis latency period (9.9±6 years vs. 3.8±4 years, p=0.0001), a positive family history of disease (60.3% vs. 20.5%, OR 6.1, 95% CI: 2.5-15.0, p=0.0001), severe psoriasis (PASI 8.2±4 vs. 3.6±2.2, p=0.0001), clinical enthesitis (37.7% vs. 22.4%, OR 2.09, 95% CI: 0.9-4.9, p=0.08), and oligoarthritis (47.5% vs. 28.6%, OR 2.26, 95% CI: 1.02-5.02, p=0.04). MICA-A9 was associated with susceptibility in both early-onset (60.7% vs. 30%, p=0.0002) and late-onset patients (59.2% vs. 30%, p=0.0008). However, HLA-Cw*0602 was significantly increased in patients with early-onset psoriasis (73.8% vs. 17%, p<0.0001), whereas the allele 384 of the microsatellite C1_4_4, located 34 kb telomeric to HLA-C locus, was increased only in late-onset cases (49% vs. 21%, p=0.001).

CONCLUSIONS:

Clinical and genetic features of PsA may differ depending on the age at psoriasis onset. This type of stratification should be considered in future genetic and epidemiological studies of PsA.

PMID:

22510299

[PubMed - as supplied by publisher]

Int J Immunopathol Pharmacol. 2012 Jan-Mar;25(1):297-300.

Occurrence of salivary gland tumours in two patients treated with biological agents.Carlesimo M, Mari E, La Pietra M, Orsini D, Pranteda G, Pranteda G, Grimaldi M, Arcese A.

Abstract

We report two cases of salivary gland tumors arising in two psoriatic patients treated with an anti- TNF-alpha agent. A clear causal relationship could not be established, but the exceptional onset of a bilateral Warthin&#x0027;s tumor in one of these patients should be emphasized.

PMID:

22507345

[PubMed - indexed for MEDLINE]

Rheumatol Int. 2012 Mar 27. [Epub ahead of print]

Presentation of psoriatic arthritis in the literature: a twenty-year bibliometric evaluation.Jamshidi AR, Gharibdoost F, Nadji A, Nikou M, Habibi G, Mardani A, Ghaemi M.

Source

Department of Rheumatology, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Psoriatic arthritis is an inflammatory arthritis disabling patients with psoriasis. Bibliometric studies are tools for evaluating scientific productions in different countries, universities as well as publications related to a special topic. We aimed to perform a scientometric study to evaluate articles published under "Psoriatic arthritis" topic and also attempted to compare publications of different authors, countries, universities, and journals related to this topic. Study was performed on all articles published between 1989 and 2009. The ISI web of science was our main source. Two key words, "Psoriatic arthritis" and "Psoriatic arthropathy," were used to conduct search. Original articles were subject of further evaluation. A whole number of 3,727 article was result of our

search. From this number, 1,961 (52.6 %) were original articles. Whole original articles were cited 38,613 times with average citations per item of 19.69. Gladman DD was the most popular author in this field. Articles were mostly in English (91.3 %). USA was the leading country in producing article under this topic with 463 (23.6 %) publications. University of Toronto was the first rank institution while publishing 125 (6.4 %) articles. More than half of articles were published under "Rheumatology" subject. "Journal of Rheumatology," "Annals of the Rheumatic Diseases," and "Arthritis and Rheumatism" were three journals with highest number of articles on this topic. There has been growing interest in psoriatic arthritis subject during these two decades. Between countries, institutions and journals; USA, university of Toronto, "Journal of Rheumatology," "Annals of The Rheumatic Diseases," and "Arthritis and Rheumatism" have special contributions to body of literature published under this topic, respectively.

PMID:

22451035

[PubMed - as supplied by publisher]

Mo Med. 2012 Jan-Feb;109(1):69-74.

Spondyloarthropathies: new directions in etiopathogenesis, diagnosis and treatment.Wilson G, Folzenlogen DD.

Source

University of Missouri School of Medicine, Division of Immunology and Rheumatology, USA. Wilsongj@health.missouri.edu

Abstract

The spondyloarthropathies (SpA) are a group of inflammatory rheumatic diseases affecting the spine, peripheral joints and nonarticular structures. Often referred to as "seronegative" due to the absence of rheumatoid factor, SpA include ankylosing spondylitis (AS), reactive arthritis (ReA), enteropathic (IBD) associated arthritis, psoriatic arthritis (PsA), as well as undifferentiated, and juvenile SpA. A broad and overlapping spectrum of disease presentations creates difficulties in determining an initial diagnosis. In the last 10 years treatment options have expanded.

PMID:

22428451

[PubMed - indexed for MEDLINE]

Clin Rev Allergy Immunol. 2012 Mar 18. [Epub ahead of print]

Cytokine-Based Therapy in Psoriasis.Mitra A, Fallen RS, Lima HC.

Source

Department of Dermatology, VA Medical Centre, Sacramento, University of California, Davis, Sacramento, CA, USA.

Abstract

Psoriasis and psoriatic arthritis are chronic inflammatory diseases of unknown etiology, affecting 2-3% of the world population. Initially, psoriasis was thought to be a hyper-proliferation disorder of keratinocytes only, but as time passed, the role of immune system became more evident and now both diseases are considered autoimmune disorders. In last few years, the discovery of interleukin (IL)-23/Th17 axis in pathophysiology of psoriatic diseases shifts the cytokine paradigm from Th1 to Th17 cytokines, focused mainly on IL-17 and IL-22. Therapeutic experiences strongly support the use of cytokine antagonists as an important modality in the treatment of psoriatic arthritis and plaque psoriasis. Studies examining these therapeutic agents which target different steps of the psoriatic inflammatory cascade have also shown significant efficacy. The relatively new IL-23/Th17 axis in psoriatic diseases got more importance with the success of ustekinumab, a new monoclonal antibody against IL-12 and IL-23. In IL-17 and IL-22 knock-out and transgenic mouse models, it has been found that recombinant IL-23 fails to produce epidermal hyperplasia which resembles psoriasis. Also, some success in animal models of psoriasis was found with anti IL-17A and anti IL-22. More studies are needed to validate the efficacy and safety of these cytokine antagonists in psoriatic diseases. Using a historical perspective and a chess game as an analogy, the main objective of this review is to summarize the central role of some of these cytokines in psoriasis pathophysiology and to develop a strategic approach to new therapeutic weapons within the armamentarium of psoriasis treatment.

PMID:

22426927

[PubMed - as supplied by publisher]

Semin Arthritis Rheum. 2012 Mar 15. [Epub ahead of print]

Differences in the Patient's and the Physician's Perspective of Disease in Psoriatic Arthritis.Dandorfer SW, Rech J, Manger B, Schett G, Englbrecht M.

Source

Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.

Abstract

OBJECTIVE:

To define the relative impact of disease components of psoriatic arthritis (PsA) on the global burden of disease and to compare physician's and patients' ratings of disease activity.

METHODS:

PsA patients fulfilling the Classification Criteria for Psoriatic Arthritis (N = 55) were asked for an evaluation of the absolute and relative impact of general and specific rheumatic symptoms (ie, arthritis, enthesitis, spinal disease, dactylitis), general and specific psoriatic symptoms (skin disease, nail disease), and other common symptoms (eg, fatigue). Results were related to the respective physician's evaluations of disease-related symptoms based on visual analog scale (VAS) ratings and comparative measures of disease activity (ie, swollen and tender joint counts, MASES, PASI, NAPSI).

RESULTS:

One-half of the global burden of disease in PsA patients was attributed to rheumatic symptoms with peripheral arthritis as the leading component, whereas the other one-half was equally distributed to psoriatic and additional common symptoms such as fatigue. In general, corresponding patient and physician ratings of global, rheumatic, and psoriatic disease activity showed good correlations when using VAS but at the same time revealed significantly lower ratings of the corresponding physician on VAS and transformed comparative measures (all P ≤ 0.02).

CONCLUSIONS:

Although we found good correlations of various disease activity measures, physicians usually evaluated the disease activity of PsA lower than patients. These results highlight

the necessity of incorporating patient reported outcome measures into the assessment of disease activity in PsA, which can easily be visualized with the help of a spiderweb graph.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:

22424812

[PubMed - as supplied by publisher]

Reumatol Clin. 2012 Mar;8 Suppl 1:S15-9. Epub 2012 Mar 14.

[New therapeutic targets in psoriatic arthritis].[Article in Spanish]

Montilla Morales C, Gómez-Castro S, Sánchez M, López R, Hidalgo C, Del Pino-Montes J.

Source

Servicio de Reumatología, Hospital Clínico Universitario Salamanca, Salamanca, España. montillamorales.carlos@gmail.com

Abstract

Registries estimate that one third of patients with psoriatic arthritis (PsA) are "resistant" to of TNF-alpha blockers. Therefore, the search for new approaches to treatment of this disease may be justified. Currently the treatment options that have proven effective are associated with inhibition of the T cell costimulatory pathway (abatacept and alefacept) and blocking the P40 fraction of IL-12 and IL-23 (ustekinumab). A novel pathway inhibition, which deserves special attention is offered by apremilast. This molecule inhibits phosphodiesterase IV, responsible for hydrolyzing cyclic adenosine monophosphate to adenosine monophosphate, which causes an increase in cAMP. This metabolite is associated with decreased TNF-alpha. It has a modest efficacy (ACR 20 response of 43%), and subsequent studies have shown an improvement in visual analog scale and the SF36 compared to placebo. Currently there are five clinical trials in phase III to assess its effectiveness in parameters of inflammation and radiographic progression. The spectrum of possibilities before treatment failure with anti-TNF alpha, is augmented by the appearance of several reports that show efficacy with the individual use of CD20 inhibitors and IL-1. In patients with rheumatoid arthritis (RA) the effectiveness of molecules that inhibit signal transduction of cytokines (Anti-JAK) has been proven, so it is possible that in the future they may be used in patients with PsA.

Copyright © 2011 Elsevier España, S.L. All rights reserved.

PMID:

22421457

[PubMed - in process]

Clin Rev Allergy Immunol. 2012 Feb 24. [Epub ahead of print]

Role of IL-17 in Psoriasis and Psoriatic Arthritis.Raychaudhuri SP.

Source

VA Sacramento Medical Centre,, 10535, Hospital Way, Mather, CA, 95655, USA, sraychaudhuri@ucdavis.edu.

Abstract

The role of T cell subpopulations in human disease is in a transition phase due to continuous discovery of new subsets of T cell, one of which is Th17, characterized by the production of signature cytokine IL-17. In the last couple of years, many articles are coming out on the role of Th17 and its signature cytokine IL-17 in different autoimmune diseases like rheumatoid arthritis, psoriasis, psoriatic arthritis (PsA), SLE and multiple sclerosis. Psoriasis and PsA are immune-mediated diseases, affecting the skin and joints, respectively. Initially, it was thought that psoriasis and PsA were Th1-mediated diseases; however, studies in knockout animal models (IL-17 knockout mice) as well as human experimental data indicate that Th17 and its signature cytokine IL-17 have a critical role in the pathogenesis of psoriatic disease. Th17 cells have been identified from the dermal extracts of psoriatic lesions. Subsequently, our research group has substantiated this observation that Th17 cells are enriched in the papillary dermis of psoriatic plaques and in freshly isolated effector T lymphocytes from the synovial fluid of PsA patients, and we have reported that the majority of these CD4 + IL-17+ T cells are of memory phenotype (CD4RO(+)CD45RA(-)CD11a(+)). Recent reports also suggest that the synovial tissue in psoriatic arthritis is enriched with IL-17R, and its most well recognized receptor IL-17RA is functionally active in psoriatic arthritis. In this review article, we have discussed the role of IL-17 in psoriatic disease and have narrated about the novel IL17/IL-17R antibodies currently in preparation for its therapeutic uses in autoimmune diseases.

PMID:

22362575

[PubMed - as supplied by publisher]

Clin Rev Allergy Immunol. 2012 Feb 23. [Epub ahead of print]

A Cutting Edge Overview: Psoriatic Disease.Raychaudhuri SP.

Source

Department of Medicine, VA Sacramento Medical Centre, 10535 Hospital Way, Mather, CA, 95655, USA, sraychaudhuri@ucdavis.edu.

Abstract

Psoriasis is a lifelong skin disease, affecting about 2% of the global population. Generalized involvement of the body (erythroderma), extensive pustular lesions, and an associated arthritis known as psoriatic arthritis (PsA) are severe complications of psoriasis. Genetic, immunologic, and environmental factors contribute to its pathogenesis. A complete understanding of the pathogenesis of psoriasis and psoriatic arthritis is lacking. Cytokines, chemokines, adhesion molecules, growth factors like NGF, neuropeptides, and T cell receptors all act in an integrated way to evolve into unique inflammatory and proliferative processes typical of psoriasis and PsA. Management of psoriasis requires exemplary skin care along with careful monitoring of arrays of comorbidities which includes arthritis and coronary artery disease. In many ways, psoriasis can be considered a model autoimmune disease. This statement itself is ironic considering that it was not recognized as immune mediated until relatively recently. Fortunately, the immunobiology has made enormous strides and there are now excellent therapeutic options for patients. In this thematic review, we have attempted to provide summaries of not only basic science and clinical research, but also an overview of future research directions.

PMID:

22359072

[PubMed - as supplied by publisher]

Reumatol Clin. 2012 Mar;8 Suppl 1:S10-4. Epub 2012 Feb 7.

[Biopathology of the synovial membrane in psoriatic arthritis].[Article in Spanish]

Cañete JD.

Source

Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España. jcanete@clinic.ub.es

Abstract

The study of the pathobiology of the synovium in psoriatic arthritis has identified morphological, cellular and molecular differences from rheumatoid arthritis. Here we review some processes that are more characteristic or have greater intensity in psoriatic arthritis, such as vascular patterns, angiogenesis and the role of the innate immune cells. We highlight in detail the finding that interleukin (IL) 17, whose role in the pathophysiology appears relevant, is produced mainly by mast cells and neutrophils in different target tissues of psoriatic arthritis, as well as the synovium, skin and axial joints. On the other hand, we try to understand the complexity of the study of the pathophysiology of psoriatic synovitis, which presents multiple interactions between cells and molecules that can vary depending on the phenotype and the stage of the disease in each patient and requires a complex methodological approach.

Copyright © 2011 Elsevier España, S.L. All rights reserved.

PMID:

22317849

[PubMed - in process]

Clin Exp Rheumatol. 2012 Mar-Apr;30(2):282-9. Epub 2012 Apr 13.

Efficacy and safety of DMARDs in psoriatic arthritis: a systematic review.Pereda CA, Nishishinya MB, Martinez Lopez JA, Carmona L.

Source

Department of Rheumatology, Clínica Mediterráneo, Almería, Spain. cpereda@ser.es.

Abstract

OBJECTIVES:

Disease-modifying antirheumatic drugs (DMARDs) are frequently prescribed as a first step therapy in active psoriatic arthritis (PsA). However, evidence is sparse and scattered. The objective of this study is to evaluate the efficacy and safety of DMARDs in PsA.

METHODS:

We performed a systematic review based on electronic searches through Medline, Cochrane Central and Embase (from July 1980-2010) for randomised control trials (RCTs) in PsA. Outcome measures were those included in the core-set from Outcome Measures in Rheumatology Clinical Trials (OMERACT) and adverse effects.

RESULTS:

A preliminary search identified 3781 potentially relevant RCTs, while only 11 fulfilled inclusion criteria. Ten studies had a parallel design and, one was a cross-over trial. Quality reached a Jadad score over 3 in 6/11 (54.6%). We observed evidence of a moderate improvement of pain and reduction of ESR with DMARDs. The global risk of withdrawals due to adverse events was 2.41 [95% confidence interval (CI) 1.53, 3.82]. The risk of GI adverse effects (nausea, vomiting, abdominal pain, diarrhoea and/or oral ulcers) was 2.02 [95% CI 1.34, 3.03] and of headache was 2.34[95% CI 1.05, 5.19]. There were no significant differences in the rate of increase of flu-like symptoms, rash, or liver enzymes.

CONCLUSIONS:

The evidence of DMARD efficacy in PsA is certainly limited, basically due to the small number of studies, dissimilar outcomes being evaluated, high withdrawal rates, and absence of new published studies. With regard to adverse effects, only GI events and headaches were significant compared to placebo.

PMID:

22339882

[PubMed - in process]

Immunopharmacol Immunotoxicol. 2012 Feb 2. [Epub ahead of print]

Safety of anti-TNFα agents in the treatment of psoriasis and psoriatic arthritis.Girolomoni G, Altomare G, Ayala F, Berardesca E, Calzavara-Pinton P, Chimenti S, Peserico A, Puglisi Guerra A, Vena GA.

Source

Department of Dermatology, University of Verona , Italy.

Abstract

Context: The efficacy and favorable safety profile of anti-tumor necrosis factor (TNF) agents in the treatment of psoriasis and psoriatic arthritis (PsA) are supported by several randomized controlled studies and meta-analyses. However, some concerns on the long-term safety of these drugs still exist, as these studies generally included small patient numbers and were performed in selected patient populations. Objective: This review presents and discusses current evidence on the safety of anti-TNFα agents in patients with psoriasis and PsA, with a focus on European registry studies and case reports of particular importance. Methods: Key studies on the safety of anti-TNFα agents in the treatment of adult patients with psoriasis or PsA were identified by a MEDLINE search (last updated 10 November 2011) based on several interrelated queries, with a focus on European registries. Other studies and case reports were included if deemed relevant. Studies concerning other conditions, such as rheumatoid arthritis (RA), were included as appropriate when data in psoriatic disease were unavailable or insufficient. Results: Available data on the safety of anti-TNFα agents such as etanercept in psoriasis and PsA appear reassuring, even if some concerns still exist. Most notably, data suggest a higher incidence of infection and lymphoma amongst patients treated with the anti-TNFα monoclonal antibodies infliximab and adalimumab compared with etanercept. Conclusion: The overall safety profile of monoclonal antibodies in patients with psoriasis, PsA and RA seems less favorable than that of etanercept, particularly in terms of risk of infection and hepatotoxicity.

PMID:

22296031

[PubMed - as supplied by publisher]

Clin Rev Allergy Immunol. 2012 Feb 1. [Epub ahead of print]

Psoriatic Arthritis: a Critical Review.Dhir V, Aggarwal A.

Source

Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Abstract

Psoriatic arthritis is a chronic inflammatory arthritis that affects about 5-25% of patients with psoriasis. The prevalence varies from 20-420 per 100,000 population across the world except in Japan where it is 1 per 100,000. Psoriatic arthritis affects both genders equally and in more than half it follows long-standing psoriasis. Psoriatic arthritis has been grouped into five subtypes: distal interphalangeal (DIP) predominant, symmetrical polyarthritis, asymmetrical oligoarthritis and monoarthritis, predominant spondylitis, and arthritis mutilans. Oligoarthritis occurs in nearly 60% during early disease but later polyarticular disease predominates mainly due to evolution of oligoarthritis to polyarthritis. In 50-60% polyarthritis is symmetrical. Dactylitis and enthesopathy are other major features seen in nearly one third of patients. The diagnosis of psoriatic arthritis is easy in the presence of typical skin lesions, however it can also be made in absence of skin lesions using Classification of Psoriatic Arthritis criteria. Though 30-40% of patients develop joint deformities at a follow-up of 5-10 years but most retain good functional status. Clinical damage has a strong relationship with number of swollen joints, erythrocyte sedimentation rate, and duration of arthritis. Radiological damage occurs early and erosions are present in nearly 50% at 10 years of disease. Spinal disease also has good outcome with maintained spinal mobility in majority of the patients. Screening of patients with psoriasis using questionnaire can help in early diagnosis. Nail dystrophy, scalp lesions, and intergluteal/perianal psoriasis are associated with higher chance of development of psoriatic arthritis. Early diagnosis will lead to early treatment and better outcome especially with advent of new drugs.

PMID:

22294201

[PubMed - as supplied by publisher]

Reumatol Clin. 2012 Mar;8 Suppl 1:S1-6. Epub 2012 Jan 28.

[Update in the pathogenesis of psoriatic arthritis].[Article in Spanish]

González S, Queiro R, Ballina J.

Source

Departamento de Biología Funcional, IUOPA, Universidad de Oviedo, Oviedo, España. segundog@uniovi.es

Abstract

Psoriasis and psoriatic arthritis are autoimmune diseases that share common pathogenic mechanisms. The cause and the pathogenesis of these diseases are unknown; however, there is increasing evidence which suggest that cytotoxic CD8T cells, Th1 and Th17 may be involved in the pathogenesis of these diseases. Cytokines produced as the result of Th1 and Th17 responses, such as TNF-α and IL-17, play a key role in the chronic inflammatory response observed in the joints of psoriatic arthritis patients. It is conceivable that unraveling of the pathogenesis of this disease may lead to the development of new therapeutic approaches and may improve the prognosis of patients.

Copyright © 2011 Elsevier España, S.L. All rights reserved.

PMID:

22285206

[PubMed - in process]

Inflamm Allergy Drug Targets. 2012 Apr;11(2):159-68.

The IL23/Th17 pathway as a therapeutic target in chronic inflammatory diseases.Toussirot E.

Source

Clinical Investigation Center CIC-Biotherapy 506, St. Jacques Hospital, Batiment St. Joseph, Besancon, France. etoussirot@chu-besancon.fr

Abstract

IL-23 is a pro-inflammatory cytokine belonging to the IL-12 cytokine family. IL-23 is essential for the differentiation of Th17 lymphocytes, a subtype of T lymphocyte implicated in chronic inflammatory/autoimmune mediated diseases. IL-23 and Th17 correspond to a new axis that drives immune activation and chronic inflammation through the differentiation and activation of Th17 cells. Animal models of chronic inflammatory diseases such as chronic joint diseases, inflammatory bowel diseases and demyelinating diseases strongly suggest the involvement of this cytokine pathway. Thus, IL-23/Th17 is considered as a relevant therapeutic target in autoimmune driven

diseases, and biological agents blocking IL-23 or IL-17 are currently being developed. Ustekinumab is a monoclonal antibody targeting the common p40 subunit of IL-12 and IL-23. This treatment has demonstrated its efficacy over placebo in randomized placebo controlled trials and is currently licensed for the treatment of psoriasis. It has also demonstrated its efficacy in psoriatic arthritis. Results for Crohn's disease were less evident, while ustekinumab was ineffective in multiple sclerosis. Secukinumab is an IL-17A monoclonal antibody that is under development and preliminary results have suggested its efficacy in inflammatory mediated diseases such as psoriasis and ankylosing spondylitis. Several other IL-23 or IL-17 neutralizing agents are being evaluated in clinical trials. The biological properties of the IL-23/Th17/IL-17 axis and the clinical applications of the drugs that aim to block its functions are reviewed here. Targeting the IL-23/Th17 axis seems to be a relevant and realistic therapeutic approach and these new agents pave the way for additive and alternative treatments to currently available biologics in chronic inflammatory diseases.

PMID:

22280236

[PubMed - in process]

Open Rheumatol J. 2011;5:133-7. Epub 2011 Dec 30.

Synovial tissue response to treatment in psoriatic arthritis.Codullo V, McInnes IB.

Source

University of Glasgow, UK.

Abstract

Following its validation and wide application in rheumatoid arthritis (RA), synovial tissue analysis has recently been applied to studies on Psoriatic Arthritis (PsA). Such studies aim to thereby clarify its distinctive features and the nature of specific responses upon administration of disease modifying anti-rheumatic drug (DMARD) or biologic agents. In consequence, insights to disease pathogenesis, drugs' mechanisms of action (MOA) and biomarkers of response have emerged. Data from pilot and open-label studies, and recently from randomized controlled trials, have helped in refining the therapeutic approaches to PsA patients, by improving understanding of MOA and in provision of biomarkers of response. The availability of less invasive and reproducible analysis techniques to obtain and evaluate synovial biopsies will further enhance the utility of this approach in due course.

PMID:

22279513

[PubMed - in process]

PMCID:

PMC3263446

Clin Rev Allergy Immunol. 2012 Jan 25. [Epub ahead of print]

The Genetics of Psoriasis and Psoriatic Arthritis.Chandran V.

Source

Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada, vchandra@uhnresearch.ca.

Abstract

Genetic epidemiological studies have demonstrated a significant genetic basis to both psoriasis and psoriatic arthritis (PsA). Although candidate gene association studies had identified genes for disease susceptibility, recent genome-wide association studies have demonstrated robust associations both within and outside the major histocompatibility region on chromosome 6p. The susceptibility genes identified include HLA-C, IL13, IL4, TNFAIP3, IL23A, IL23R, IL28RA, REL, IFIH1, ERAP, TRAF3IP2, NFKBIA, TYK2, ZNF313, NOS2, FBXL19 and NFKBIA in subjects of European ethnicity and HLA-C, IL12B, LCE3D, ERAP1, TNIP1, PTTG1, CSMD1, GJB2, SERPINB8 and ZNF816A in subjects of Chinese ethnicity. These associations provide us with a model for the pathogenesis of psoriasis involving skin barrier function, innate and adaptive immunity. Gene-gene and gene-environmental interaction effects have also been demonstrated. However, loci identified to date do not fully account for the high heritability of psoriasis and PsA, and therefore many genetic as well as environmental factors and interaction effects remain to be determined. This article reviews the current status of genetic studies in psoriasis and PsA.

PMID:

22274791

[PubMed - as supplied by publisher]

Best Pract Res Clin Rheumatol. 2011 Dec;25(6):825-42. doi: 10.1016/j.berh.2011.11.006.

Spondyloarthritides.Baraliakos X, Braun J.

Source

Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany. baraliakos@me.com

Abstract

The most important clinical features of the spondyloarthritides (SpA) are not only inflammatory back pain (IBP) but also peripheral (enthesitis) and extra-articular symptoms. For clinical purposes, two forms related to the predominant clinical manifestation - axial and peripheral SpA - and five subgroups- ankylosing spondylitis (AS), SpA associated with psoriasis and inflammatory bowel disease (IBD), reactive arthritis and undifferentiated SpA - are differentiated. Axial SpA including AS is the most frequent subtype of SpA, followed by psoriatic arthritis and undifferentiated SpA, while reactive arthritis and IBD-related SpA are less frequent. The prevalence of SpA has been shown to be similar to rheumatoid arthritis. The outcome of the disease is influenced by the degree of disease activity over time, which is mainly related not only to inflammation but also on the structural damage (new bone formation) that occurs over time. Treatment options for patients with SpA have been limited for decades. Non-steroidal anti-inflammatory agents are currently considered first choice, since they have shown good amelioration of symptoms in SpA patients especially when suffering by the typical symptom of IBP. Furthermore, there is a clear role for regular physiotherapy in AS to prevent loss of spinal mobility. For patients who have insufficiently responded to conventional therapies, four anti-tumour necrosis factor (TNF) agents are available and are approved for the treatment of patients with active AS: infliximab, etanercept, adalimumab and golimumab. As far as it stands now, TNF blockers seem to have no influence on new bone formation in AS.

Copyright © 2011 Elsevier Ltd. All rights reserved.

PMID:

22265264

[PubMed - in process]

Clin Exp Rheumatol. 2012 Jan-Feb;30(1):23-30. Epub 2012 Mar 6.

Complement system in psoriatic arthritis: a useful marker in response prediction and monitoring of anti-TNF treatment.Chimenti MS, Perricone C, Graceffa D, Di Muzio G, Ballanti E, Guarino MD, Conigliaro P, Greco E, Kroegler B, Perricone R.

Source

Allergology, Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.

Abstract

OBJECTIVES:

Treatment with anti-TNF agents is well established in psoriatic arthritis (PsA). Anti-TNF agents are capable of modulating complement activity in vitro but there are no data on the in vivo effect. Anti-TNF have high costs and potential risks, thus, there is an urgent need for accurate predictors of response. We aimed at studying the usefulness of erythrocyte-sedimentation-rate (ESR), C-reactive protein (CRP), and complement for response prediction and monitoring of anti-TNF treatment in PsA patients.

METHODS:

Fifty-five patients were included consecutively before starting etanercept or adalimumab. ESR, CRP, plasma complement C3, C4, and C3 and B cleavage fragments were evaluated at baseline and after 22 weeks of anti-TNF treatment. Disease activity was measured with DAS28 and response to therapy with EULAR criteria. Complement was evaluated at baseline in 30 healthy subjects as well.

RESULTS:

At baseline, C3 and C4 levels were significantly higher than in controls (C3 126.9±22 vs. 110±25 mg/dl, p=0.000002; C4 31.2±9.2 vs. 22.7±8.3 mg/dl, p=0.0003). After anti-TNF therapy, C3 and C4 levels were significantly reduced to normalization (p=0.0009 and 0.0005, respectively) and ESR, CRP and DAS28 showed a significant reduction (p=0.002, 0.004 and 0.0001, respectively). Split products of C3 and B were not observed at baseline and after 22 weeks. Higher baseline C3 levels were associated with EULAR non-response (p=0.011).

CONCLUSIONS:

PsA patients with moderate to severe disease show elevated C3 and C4 levels, reverted by anti-TNF treatment. High C3 may be considered a hallmark of inflammation and C3 revealed the highest predictive value for response to anti-TNF.

PMID:

22260811

[PubMed - in process]

Reumatol Clin. 2012 Mar;8 Suppl 1:S7-9. Epub 2012 Jan 17.

[Prognostic factors in psoriatic arthritis].[Article in Spanish]

Fernández Sueiro JL, Lema Gontad JM.

Source

INIBIC, Servicio de Reumatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España. L.sueiro@canalejo.org

Abstract

Peripheral psoriatic arthritis is an inflammatory and progressive disease; its burden, either at the structural level or the function and quality of life, is similar to other chronic poliarthritidies. In spite of treatment with synthetic or biologic DMARDs, remission is only achieved in about 30% of the patients. From a clinical point of view, persistent joint activity (tender and swollen joints) is a factor leading to joint damage progression. These data indicate the need for a tight follow up and treatment of the patients.

Copyright © 2011 Elsevier España, S.L. All rights reserved.

PMID:

22257679

[PubMed - in process]

Arthritis Care Res (Hoboken). 2012 May;64(5):758-65. doi: 10.1002/acr.21602.

Longitudinal study of the bidirectional association between pain and depressive symptoms in patients with psoriatic arthritis.Husted JA, Tom BD, Farewell VT, Gladman DD.

Source

University of Waterloo, Waterloo, Ontario, Canada.

Abstract

OBJECTIVE:

To test the bidirectional hypothesis that depressive symptoms influence changes in pain over time, and pain influences changes in depressive symptoms.

METHODS:

A total of 394 patients attending the University of Toronto Psoriatic Arthritis clinic were followed over a mean period of 7.5 years with annual assessments, including number of swollen joints (SJC), Health Assessment Questionnaire (HAQ), and the Medical Outcomes Survey Short Form 36 (SF-36). Linear mixed-effects models were used to examine the cross- and lagged associations between the changes in HAQ pain and in the SF-36 mental component summary (MCS) score, adjusting for SJC and other covariates.

RESULTS:

The strongest predictors of changes in pain, SJC, and depressive symptoms between visits were scores of the corresponding variables at the previous visit, with standardized regression coefficients exceeding 0.75 in absolute value. There was, however, evidence of a small, but consequential, bidirectional relationship (i.e., standardized regression coefficients <0.3) between depressive symptoms and pain. Both previous MCS scores and change in MCS scores were associated with change in pain between visits; conversely, previous pain scores and change in pain scores were associated with change in depressive symptoms between visits.

CONCLUSION:

Even though cross-variable associations between pain and depressive symptoms exist, changes in pain and depressive symptoms appear to be strongly driven by their measurements at the previous visit. To optimize patient outcomes, a clinical approach that assesses and treats clinically significant depressive symptoms, as well as pain, is required.

Copyright © 2012 by the American College of Rheumatology.

PMID:

22231988

[PubMed - indexed for MEDLINE]

J Am Acad Orthop Surg. 2012 Jan;20(1):28-37.

Psoriatic arthritis.Day MS, Nam D, Goodman S, Su EP, Figgie M.

Source

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.

Abstract

Psoriatic arthritis is a chronic inflammatory arthropathy that affects approximately 6% to 48% of patients with psoriasis. Arthritis is not correlated with the extent of skin disease. Classic radiographic findings of the involved joint include erosion, ankylosis, and fluffy periostitis. Site-specific characteristic deformities such as pencil-in-cup deformity of the phalanges also may be present. The disease typically follows a moderate course, but up to 47% of cases develop into destructive arthritis in which the inflammatory process leads to bony erosion and loss of joint architecture. The mainstay of treatment is biologic therapy (eg, tumor necrosis factor-α inhibitors) in conjunction with disease-modifying antirheumatic drugs. Patients with end-stage joint destruction may require surgery to alleviate pain and restore function. Orthopaedic surgeons should be cognizant of the risk factors (eg, increased risk of cardiovascular disease) and potential complications (eg, poor wound healing and increased risk of infection) associated with psoriatic arthritis.

PMID:

22207516

[PubMed - indexed for MEDLINE]

Arthritis Rheum. 2012 May;64(5):1420-9. doi: 10.1002/art.33507.

Enrichment of circulating interleukin-17-secreting interleukin-23 receptor-positive γ/δ T cells in patients with active ankylosing spondylitis.Kenna TJ, Davidson SI, Duan R, Bradbury LA, McFarlane J, Smith M, Weedon H, Street S, Thomas R, Thomas GP, Brown MA.

Source

University of Queensland, Brisbane, Queensland, Australia.

Abstract

OBJECTIVE:

Ankylosing spondylitis (AS) is a common inflammatory arthritis affecting primarily the axial skeleton. IL23R is genetically associated with AS. This study was undertaken to investigate and characterize the role of interleukin-23 (IL-23) signaling in AS pathogenesis.

METHODS:

The study population consisted of patients with active AS (n = 17), patients with psoriatic arthritis (n = 8), patients with rheumatoid arthritis, (n = 9), and healthy subjects (n = 20). IL-23 receptor (IL-23R) expression in T cells was determined in each subject group, and expression levels were compared.

RESULTS:

The proportion of IL-23R-expressing T cells in the periphery was 2-fold higher in AS patients than in healthy controls, specifically driven by a 3-fold increase in IL-23R-positive γ/δ T cells in AS patients. The proportions of CD4+ and CD8+ cells that were positive for IL-17 were unchanged. This increased IL-23R expression on γ/δ T cells was also associated with enhanced IL-17 secretion, with no observable IL-17 production from IL-23R-negative γ/δ T cells in AS patients. Furthermore, γ/δ T cells from AS patients were heavily skewed toward IL-17 production in response to stimulation with IL-23 and/or anti-CD3/CD28.

CONCLUSION:

Recently, mouse models have shown IL-17-secreting γ/δ T cells to be pathogenic in infection and autoimmunity. Our data provide the first description of a potentially pathogenic role of these cells in a human autoimmune disease. Since IL-23 is a maturation and growth factor for IL-17-producing cells, increased IL-23R expression may regulate the function of this putative pathogenic γ/δ T cell population.

Copyright © 2012 by the American College of Rheumatology.

PMID:

22144400

[PubMed - in process]

Nat Rev Rheumatol. 2011 Nov 8;7(12):718-32. doi: 10.1038/nrrheum.2011.169.

Genetics of susceptibility and treatment response in psoriatic arthritis.O'Rielly DD, Rahman P.

Source

Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, Newfoundland A1B 3V6, Canada.

Abstract

Psoriatic arthritis (PsA), an inflammatory arthritis associated with psoriasis, has a wide spectrum of disease severity. The clinical heterogeneity in PsA probably reflects substantial genetic heterogeneity. In recent years, many genes that contribute to the pathogenesis of psoriasis and PsA have been identified, especially in Western cohorts. Emerging evidence from functional studies of candidate genes identified by genome-wide association studies is suggestive of an integrated, multi-tiered pathogenic model, comprising distinct signaling networks that affect skin barrier function, innate immune responses (involving NFκB and interferon signaling), and adaptive immune responses (involving CD8(+) T cells and type 17 T-helper-cell signaling). Although several genes--and variants thereof--within these pathways have been associated with susceptibility to psoriasis and PsA, replication in large multiethnic cohorts, fine mapping and resequencing efforts, together with functional studies of the variants, are warranted to better understand their role in disease susceptibility. With respect to pharmacogenetics, several candidate gene polymorphisms have been shown to influence responses to both traditional and biologic therapies in psoriasis and PsA, but confirmation in large prospective cohorts is required before the information can be used in the clinical setting.

PMID:

22064628

[PubMed - in process]

Br J Dermatol. 2012 Mar;166(3):474-82. doi: 10.1111/j.1365-2133.2011.10712.x.

Genetic susceptibility to psoriasis and psoriatic arthritis: implications for therapy.Hébert HL, Ali FR, Bowes J, Griffiths CE, Barton A, Warren RB.

Source

Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, Stopford Building, Manchester, M13 9PT, UK.

Abstract

The era of genome-wide association studies has revolutionized the search for genetic susceptibility loci in complex genetic conditions such as psoriasis. There are currently 16 loci with confirmed evidence for association with psoriasis susceptibility but there is the potential for more to be discovered as the genetic heritability of the disease has not yet been fully explained. Many of the associated loci overlap with those for psoriatic arthritis. In contrast to psoriasis susceptibility, few studies have been performed to identify predictors of drug response in psoriasis. As large-scale collaborations and registries for psoriasis and psoriatic arthritis are established, it is likely that a genome-wide approach may be used as a more effective method of searching for genetic predictors of treatment response. However, candidate gene studies will still have a role; for example, it is likely that some disease susceptibility genes will also be markers of treatment response, based on evidence from other diseases. This review summarizes recent advances in investigating the role genetics plays in psoriasis susceptibility and contrasts these to advances made in psoriatic arthritis. Further, it describes the genetics of treatment response in the two diseases and indicates how susceptibility loci could be used to identify drug response in the future.

© 2011 The Authors. BJD © 2011 British Association of Dermatologists.

PMID:

22050552

[PubMed - indexed for MEDLINE]

Clin Chim Acta. 2012 Jan 18;413(1-2):303-7. Epub 2011 Oct 20.

A comparative study of serum and synovial fluid lipoprotein levels in patients with various arthritides.Oliviero F, Lo Nigro A, Bernardi D, Giunco S, Baldo G, Scanu A, Sfriso P, Ramonda R, Plebani M, Punzi L.

Source

Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. francesca.oliviero@unipd.it

Abstract

The aim of this study was to investigate apolipoprotein (apo) A-I, apo B, lipoprotein (Lp) (a), HDL-cholesterol (C), LDL-C, triglycerides (TG) and total cholesterol (TC) values in the serum and synovial fluid (SF) of untreated rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA) patients.

METHODS:

Paired SF and serum samples were collected simultaneously from 14 patients with RA, 14 with PsA, and 16 with OA and tested for apo A-I, apo B, HDL-C, LDL-C, Lp(a), TC and TG. Serum C reactive protein (CRP) and amyloid A (SAA) levels were also determined.

RESULTS:

The inflammatory arthritis patients had higher SF lipid levels with the exception of HDL. Reflecting increased synovial permeability, the lipid SF/serum ratio was always higher in RA and PsA with respect to OA patients. The positive correlation between serum and SF apo A-I, apo B, HDL-C, TG, and Lp(a) levels confirmed that there is lipoprotein diffusion into the SF. RA and PsA patients had lower concentrations of all serum lipids except for Lp(a) with respect to OA patients. The levels in the RA patients were similar to those in healthy matched controls, while the PsA patients had significantly lower apo A-I and HDL levels and higher apo B and LDL values.

CONCLUSIONS:

Lipid diffusion into the joint cavity, which largely depends on the degree of inflammation, may contribute to modulating local inflammatory processes.

Copyright © 2011 Elsevier B.V. All rights reserved.

PMID:

22037510

[PubMed - indexed for MEDLINE]

Psoriatic arthritis.Rajendran CP, Ledge SG, Rani KP, Madhavan R.

Source

Department of Rheumatology, Madras Medical College and Government General Hospital, Chennai, Tamil Nadu, India.

Abstract

AIM OF THE STUDY:

To evaluate the clinical pattern of psoriatic arthritis in patients attending a tertiary referral centre in South India.

METHODOLOGY:

Case records of one hundred and sixteen patients with psoriatic arthritis (PsA) who had attended our Rheumatology Department were analysed using demographic, clinical, laboratory and radiographic variables and the data were compared with other studies.

RESULTS:

Among 116 patients, 78 were males and 38 were females (ratio 2:1). Peak incidence (69%) was in the fourth and fifth decades. One patient had juvenile psoriatic arthritis (onset <16 years of age). Symmetric polyarthritis (48.3%) was the commonest subtype. Arthritis followed the skin lesions in 50.8% of patients, preceded in 12.1% and occurred simultaneously in 37.1%. Knee (66.4%) was the commonest joint involved. Extra-articular features like sausage digits (19%), enthesitis (7.8%) and eye manifestations (1.7%) like conjunctivitis and uveitis were observed. Psoriasis vulgaris (81%) was the commonest psoriatic lesion. Scalp (57.8%) was the most common hidden site. All the three patients with DIP arthritis alone had nail lesions. ESR and C-reactive protein were elevated in 51.7% and 43.9% of patients respectively. Rheumatoid factor was positive in 3.4 % and antinuclear antibody (ANA) was present in 5.4% (3/56) of patients. HIV infection was detected in 2.3% (1/44) of patients. Radiographic features like sacroiliitis (11.2%), calcaneal spur (7.8%), erosions (5.2%) and syndesmophytes (5.2%) were observed. One patient had 'pencil-in-cup deformity'.

CONCLUSION:

Psoriatic arthritis is more common in males. Symmetric polyarthritis is the commonest subtype. Arthritis commonly follows the skin lesions. Psoriasis vulgaris is the most common skin lesion and scalp is the commonest hidden site. ESR and CRP can be normal in psoriatic arthritis.

PMID:

15260390

[PubMed - indexed for MEDLINE]