Economic burden of psoriatic patients in Japan: Analysis from a single outpatient clinic

Topical and systemic agents have dramatically improved the treatment efficacy of psoriasis. Few reports, however, exist describing the economic burden in Japanese psoriatic patients. The aim of the study was to evaluate the total costs as well as cost versus efficacy of topical and systemic treatments of psoriatic patients under the Japanese health insurance system. The retrospective study was performed from the database of our clinic, which is located in Hokkaido Prefecture. Cost and effectiveness of psoriatic patients were evaluated during the 12‐month period from April 2015 to March 2016. Data were collected and calculated for the total cost per year, treatment efficacy and cost versus efficacy. The mean total cost of topical corticosteroid treatment was ¥18 184/year and was lowest among the treatments. The systemic treatment with biologics was most expensive and the costs were over ¥400 000/year. Among the topical treatments, calcipotriol/betamethasone dipropionate was most expensive (¥34 693/year). However, cost versus efficacy was not significantly different from that of topical corticosteroid treatments. The cost of secukinumab was highest among all the treatments (¥631 600/year). However, treatment day per cost was lowest of all the psoriasis treatments. Biologics showed the highest cost than topical or systemic treatments. However, they showed most marked efficacy in terms of improving the psoriatic skin lesions.     

寻常型银屑病患者血清IL-22水平与治疗转归的关系

目的：探究寻常型银屑病患者血清IL-22水平与治疗转归的关系。方法选取寻常型银屑病患者240例,设为观察组,选取健康人240例,设为对照组。用酶联免疫吸附法（ELISA）检测对照组患者,以及观察组治疗前与治疗后2周、4周及6周血清中的IL-22水平;评估观察组患者的疾病严重程度指数（PASI）。应用Pearson直线相关分析对观察组治疗期间IL-22水平与PASI评分进行相关性分析。结果观察组在治疗前血清中IL-22水平显著高于对照组（P＜0.05）,观察组治疗后血清中IL-22水平显著低于治疗前（P＜0.05）。应用Pearson直线相关分析显示血清IL-22水平与PASI评分呈正相关关系（r=0.832,P=0.001）。结论寻常型银屑病患者体内血清IL-22水平与疾病进展程度和预后转归相关性。     

寻常型银屑病（湿热证）的血清蛋白组学表达研究

【目的】应用同位素相对标记与绝对定量技术（iTRAQ技术）对寻常型银屑病（湿热证）患者的血清蛋白进行定量分析,探求其与正常人的差异性表达蛋白质,从蛋白组学角度揭示湿热证的部分内涵。【方法】取寻常型银屑病（湿热证）患者（15例）及正常人（10例）血清,予纯化、去丰度等处理后,十二烷基硫酸钠－聚丙烯酰胺凝胶（SDS-PAGE）电泳分离,经iTRAQ特异性标记酶解后的肽段,采用串联质谱分析鉴定其差异蛋白。【结果】共鉴定出787个蛋白质组,具有生物信息学分析（gene ontology , GO）功能注释的蛋白质共有718个;与正常人比较发现了651个显著性差异蛋白（P<0.05）,其中有强显著性差异的蛋白418个（P<0.01）。【结论】寻常型银屑病（湿热证）患者血清中存在与正常人有差异性表达蛋白,但哪种蛋白在辨别寻常型银屑病“湿热证”中处于关键地位,以及湿热症状与蛋白之间的关系等,还有待进一步研究。     

Role of endothelial cell specific molecule-1 (endocan) and cardiac imaging in early detection of cardiac involvement in psoriatic patients with or without arthritis

Aim of the workMeasuring serum endocan level to determine its potential role in detecting subclinical cardiovascular involvement in psoriatic patients with or without arthritis.Patients and methodsThis work included 14 psoriatic arthritis (PsA) patients, 14 psoriasis only (PsO) patients, and 14 age and sex matched controls. The psoriasis area severity index was evaluated. Serum endocan level was measured, subclinical atherosclerosis was assessed using brachial artery flow-mediated vasodilation (FMD), and echocardiography: standard and tissue Doppler imaging (TDI) was performed.ResultsThe mean age of PsA patients was 38.3 ± 9.9 years and for PsO was 37.9 ± 8 years. They were 3 males and 11 females in both groups with a comparable psoriasis duration (11 ± 4.9 vs 8 ± 6.3 years; p = 0.17). PsA patients had significantly increased endocan level (618 ± 227.8 ng/L) compared to those with PsO or controls (359 ± 185.7 and 130.6 ± 38.2 ng/L respectively; p < 0.001). 4 (28.6%) PsA patients, 1 (7.1%) PsO patient and none of the controls had FMD abnormality. TDI revealed early diastolic mitral annular motion velocity (E') abnormality in 5 (35.7%) PsA patients. In PsA patients, endocan level was significantly elevated in patients with FMD or E' abnormality compared to those without (p = 0.01 and p = 0.001, respectively). Serum endocan significantly negatively correlated with FMD and E' in psoriatic patients. Serum endocan significantly detected FMD and E' abnormalities in psoriatic patients (p = 0.002 and p = 0.001, respectively).ConclusionSubclinical cardiovascular involvement was evident among psoriatic patients, particularly those with arthritis. Serum endocan is a promising endothelial biomarker for detecting subclinical atherosclerosis and preclinical cardiac dysfunction in psoriatic patients.     

窄谱中波紫外线治疗寻常型银屑病的疗效观察

目的：探讨窄谱中波紫外线（NB-UVB）治疗寻常型银屑病的疗效。方法选取2014年1月—2014年6月成都市龙泉驿区第一人民医院收治的寻常型银屑病患者60例,按随机数字表法将患者分为对照组与观察组,各30例。对照组患者予以常规治疗,观察组患者在对照组基础上予以 NB-UVB 治疗。观察两组患者临床疗效及不良反应（皮肤干燥、皮肤瘙痒、红斑、色素沉着）发生情况。结果观察组患者总有效率高于对照组,差异有统计学意义（P ＜0.05）;观察组患者不良反应发生率低于对照组（ P ＜0.05）。结论 NB-UVB 治疗寻常型银屑病的疗效显著,且不良反应少。     

Aspects of the spectrum, prevalence and disease susceptibility determinants of Reiter's syndrome and related disorders associated with HIV infection

Summary Arthrocutaneous disorders including Reiter's syndrome, psoriasiform rashes, and other forms of chronic arthritis and enthesopathy, such as psoriatic arthritis, occur with an increased prevalence in the setting of HIV infection. Herein we describe the spectrum and prevalence of musculoskeletal and allied skin disorders as they occur in the setting of HIV infection. The role of genetic susceptibility in the development of these disorders is addressed. Based on the frequency of infectious agents capable of triggering reactive arthritis and the presence of HLA-B27 in 71% of these individuals, it is suggested that the disorder strongly resembles Reiter's syndrome as it occurs in the not HIV-infected group. Preliminary evidence indicates an enhanced penetrance for susceptibility among HLA-B27 individuals. In contrast, among HIV-infected patients with psoriasiform lesions there was no statistically significant association (P<0.05) between the presence of psoriasiform rash and the HLA alleles Cw6, B7, B17, Bw16, or Bw57 when compared with HIV-infected controls. These findings suggest that among HIV-infected individuals the development of Reiter's syndrome involves an immune recognition event primarily dependent upon HLA-B27 molecules in which an unknown antigen in the context of HLA-B27 is presented to CD8 lineage suppressor/cytotoxic cells. In contrast, the pathogenesis of psoriasiform lesions in HIV patients, despite their similarity to certain lesions in Reiter's syndrome, proceeds by distinct pathways that do not involve events influenced by specific polymorphic class I molecules.     

来氟米特与甲氨蝶呤治疗银屑病关节炎关节病变的临床研究

目的 评价来氟米特、甲氨蝶呤及甲氨蝶呤与来氟米特联用治疗银屑病关节炎(PsA)关节病变的疗效与安全性.方法 2个中心的开放性临床对照研究.选确诊的PsA患者,接受甲氨蝶呤(甲氨蝶呤组)、来氟米特(来氟米特组)、甲氨蝶呤+来氟米特(联合治疗组)中的任意一种治疗方案,治疗24周.以PsA疗效标准(PsARC)为主要疗效指标,修改的美国风湿病学会疗效标准提高20%(ACR20)为次要疗效指标,对关节病变进行评估,并分析具体评价指标[包括压痛关节数、肿胀关节数、疼痛视觉模拟评分、患者总体评价(PGA)、医生总体评价、健康评估问卷(HAQ)]的变化.结果 治疗24周时甲氨蝶呤组、来氟米特组、联合治疗组达到PsARC的比例分别为75.0%、68.8%、83.3%,达到ACR20的比例分别为66.7%、50.0%、83.3%.24周后3组患者压痛关节数、肿胀关节数、疼痛视觉模拟评分、PGA、医生总体评价、HAQ均显著低于基线水平(P<0.05).联合治疗组在疼痛视觉模拟评分、HAQ、ESR的改善程度显著高于来氟米特组,甲氨蝶呤组在疼痛视觉模拟评分、PGA、HAQ、ESR的改善程度亦显著高于来氟米特组.甲氨蝶呤、来氟米特、联合治疗组不良反应发生率分别为38.5%、38.9%、35.0%,无严重不良事件发生.结论 甲氨蝶呤与来氟米特联合治疗与单用药物治疗对PsA的关节病变均具有良好的疗效和安全性.     

来氟米特与甲氨蝶呤治疗银屑病关节炎关节病变的临床研究

目的 评价来氟米特、甲氨蝶呤及甲氨蝶呤与来氟米特联用治疗银屑病关节炎(PsA)关节病变的疗效与安全性.方法 2个中心的开放性临床对照研究.选确诊的PsA患者,接受甲氨蝶呤(甲氨蝶呤组)、来氟米特(来氟米特组)、甲氨蝶呤+来氟米特(联合治疗组)中的任意一种治疗方案,治疗24周.以PsA疗效标准(PsARC)为主要疗效指标,修改的美国风湿病学会疗效标准提高20%(ACR20)为次要疗效指标,对关节病变进行评估,并分析具体评价指标[包括压痛关节数、肿胀关节数、疼痛视觉模拟评分、患者总体评价(PGA)、医生总体评价、健康评估问卷(HAQ)]的变化.结果 治疗24周时甲氨蝶呤组、来氟米特组、联合治疗组达到PsARC的比例分别为75.0%、68.8%、83.3%,达到ACR20的比例分别为66.7%、50.0%、83.3%.24周后3组患者压痛关节数、肿胀关节数、疼痛视觉模拟评分、PGA、医生总体评价、HAQ均显著低于基线水平(P<0.05).联合治疗组在疼痛视觉模拟评分、HAQ、ESR的改善程度显著高于来氟米特组,甲氨蝶呤组在疼痛视觉模拟评分、PGA、HAQ、ESR的改善程度亦显著高于来氟米特组.甲氨蝶呤、来氟米特、联合治疗组不良反应发生率分别为38.5%、38.9%、35.0%,无严重不良事件发生.结论 甲氨蝶呤与来氟米特联合治疗与单用药物治疗对PsA的关节病变均具有良好的疗效和安全性.     

Genetic variants within ANRIL (antisense non coding RNA in the INK4 locus) are associated with risk of psoriasis

BackgroundPsoriasis is a systemic inflammatory disease which mostly affects skin. Evidences support the role of autoimmune responses in this disorder. The long non-coding RNA (lncRNA) antisense non coding RNA in the INK4 locus (ANRIL) has been shown to participate in modulation of immune response and in the pathogenesis of immune-related disorders.MethodsWe genotyped four single nucleotide polymorphisms (SNPs) with this lncRNA (rs1333045, rs1333048, rs4977574 and rs10757278) in 286 patients with psoriasis and 300 age-/sex-matched controls to identify the role of ANRIL as a risk locus for psoriasis.ResultsThe C allele of rs1333048 SNP was significantly more prevalent among cases compared with controls (OR (95% CI) = 1.56 (1.23–1.97), adjusted P value = 8.31E−4). The A allele of the rs4977574 had a protective effect against psoriasis (OR (95% CI) = 0.63 (0.49–0.81), adjusted P value = 0.001). The G allele of the rs10757278 conferred risk of psoriasis in the assessed population (OR (95% CI) = 1.9 (1.51–2.4), adjusted P value = 2.18 E−7). The C A G A haplotype (rs1333045, rs1333048, rs4977574 and rs10757278, respectively) was reported to be a protective haplotype against psoriasis (OR (95% CI) = 0.5 (0.35–0.71), adjusted P value = 0.001). The C A G G and T C G G haplotypes conferred risk of psoriasis in the assessed population (OR (95% CI) = 2.37 (1.59–3.54), adjusted P value = 2.4E−4; OR (95% CI) = 5.42 (2.88–10.22), adjusted P value = 1.1E−7, respectively).ConclusionConsequently, ANRIL can be regarded as a risk locus of psoriasis in the assessed population. Future studies are needed to verify whether this contribution is exerted through modulation of immune responses.