MTX对关节病型银屑病患者血清TNF-α影响的研究

目的：研究肿瘤坏死因子α（TNF-α）在关节病型银屑病发病中的作用及MTX对其调节作用，探讨MTX治疗关节病型银屑病的机制。方法：应用双抗体夹心酶联免疫吸附法（ELISA），检测15例关节病型银屑病患者经MTX治疗前后外周血清中TNF-α的水平。结果：MTX治疗前血清中。的水平显著高于治疗后及正常人对照组（P〈0．001）。结论：TNF—α在关节病型银屑病致病中可能起重要作用。MTX治疗关节病型银屑病的机制可能是通过抑制TNF-α的分泌而达到治疗作用。     

来氟米特联合羟氯喹治疗关节病型银屑病疗效及对血清IL-8、TNF-α的影响

目的观察来氟米特联合羟氯喹治疗关节病型银屑病(psoriaticarthritis,Ps A)患者的临床效果及其对外周血白细胞介素(Interleukin,IL)-8、肿瘤坏死因子(Tumor necrosis factor,TNF)-α的影响。方法 25例Ps A患者给予来氟米特联合羟氯喹口服治疗16周,对比分析治疗前后的银屑病皮损面积和严重程度指数(psoriasis area and severity index,PASI)、关节疾病活动度(disease activity score-28,DAS28)及医生和患者对疾病活动性的VAS评分等指标,同时采用双抗体夹心酶联免疫吸附法(ELISA)分别检测Ps A患者治疗前、后和20例健康对照组血清IL-8、TNF-α的水平。结果 Ps A患者治疗后PASI、DAS28、医生和患者的VAS评分均较治疗前明显下降(P0.05),治疗前血清IL-8、TNF-α水平均显著高于健康对照组(P0.05),而治疗后IL-8、TNF-α水平均较治疗前明显下降(P0.01),且与对照组相比差异无显著性(P0.1)。结论来氟米特联合羟氯喹治疗Ps A患者具有较好的疗效和安全性,可降低血清IL-8、TNF-α的水平。     

生物制剂治疗中重度斑块状银屑病及关节病型银屑病的进展

银屑病是一种免疫介导的慢性复发性炎症性疾病,针对其发病机制中细胞因子及受体的生物制剂近年成为银屑病重要的治疗手段。随着司库奇尤单抗（secukinumab）和乌司奴单抗（ustekinumab）等生物制剂在我国陆续上市,生物制剂在银屑病治疗中的应用将越来越普遍。本文综述不同生物制剂治疗中重度斑块状银屑病及关节病型银屑病...     

关节病型银屑病1例

患者男,36岁,农民.因双掌鳞屑伴皲裂,进行性加重16年,手指活动受限2年于2001年11月8日来我院.     

兄弟两人同患关节病型银屑病报告

<正> 关节病型银屑病(以下简称PA)是银屑病的一种特殊类型。同发生在亲兄弟者,国内尚未见有报道。现将我们所见案例介绍如下。例1男,19岁。因头皮生“癣”伴关节     

关节病型银屑病1例

患者，男，39岁，工人。因全身红斑、鳞屑4年，加重伴膝、腕、指(趾)关节红肿疼痛5个月，于2003年8月27日收入院。患者于4年前无明显诱因先于双下肢出现散在分布的指甲盖大小的红斑及轻度鳞屑，同时伴有轻微瘙痒。1年后皮损逐渐增多，并扩展到头皮和躯干、双上肢部位，部分皮损扩大融合     

肿瘤坏死因子α与银屑病

银屑病是一种慢性炎症性皮肤病,其发病机理至今尚未完全明确。肿瘤坏死因子-α(tumor necrosis factoralpha,TNF-α)是一种前炎症性细胞因子,研究发现其与银屑病的发病和治疗有密切联系。本文就近年来相关研究作一综述。     

关节病型银屑病30例临床分析

目的:总结关节病型银屑病的临床特点.方法:对30例关节病型银屑病患者的临床资料进行回顾性分析.结果:本组病例的平均发病年龄为31.4岁,男:女为1:1.以皮损为首发者26例(86.6%);皮损和关节症状同时出现者2例(6.7%);以关节炎为首发者2例(6.7%).皮损类型为寻常型27例(90%).关节炎分类为对称性多关节炎型12例(40%);其次为远端指(趾)关节炎型7例(23.3%);非对称性关节炎型6例(20%);最后为残毁性关节炎型3例(10%);脊柱关节病变型2例(6.7%).经X线检查的26例患者中,23例阳性(88.5%).常见的改变有关节间隙变窄、骨质疏松、骨质吸收等.结论:各型银屑病皮损都可伴发关节炎病变.对称性多关节炎和远端指(趾)关节炎、非对称性少数关节炎是本病的主要特点.     

关节病型银屑病37例临床分析

目的:探讨关节病型银屑病的临床特点。方法:对37例关节病型银屑病患者的临床资料进行回顾性分析。结果:本组病例平均发病年龄32.2岁,男:女为2.4:1。非对称性少数关节炎型最为常见,占45.9%(17例);其次为对称性多数关节炎型,占21.6%(8例),远端指(趾)关节炎型,占16.2%(6例),脊椎关节病型,占10.8%(4例)及残毁性关节炎型,占5.4%(2例)。各型银屑病皮损均可发生关节炎病变。膝关节最为常见(56.8%),其次为指(趾)关节(54.1%)及踝关节(35.1%)。在21例伴有甲病的患者中,19例患有远端指(趾)关节炎,占90.5%。3例患者尿蛋白检查阳性。X线检查常见的改变有关节间隙变窄,骨质疏松和骨质吸收等,亦可见关节骨性融合、骨刺形成和关节残毁性损害等不常见的改变。结论:非对称性多发性关节炎和远端指(趾)易受累是本病的特点,甲病变是远端指(趾)关节炎型的特征。一部分病人可伴有肾脏损害。非甾体类抗炎药、小剂量糖皮质激素、雷公藤多甙、氨苯砜、甲氨蝶呤等和中药的合理联合应用可取得一定疗效。     

关节病型银屑病26例分析

关节病型银屑病(PA),又称银屑病性关节炎,根据流行病学、临床、放射学和血清学确认它为一种独特的关节病[1]。为探讨其临床特点、治疗反应与预后的关系,现将我院近年来收治的26例PA患者和部分随访病例的临床资料作一回顾性分析,现报道如下。一、一般资料26例均为首次住院患者。其中男19例,女7例,男女之比为2.7:1。发病年龄15～63岁,平均37.1岁,30～50岁发病者17例,占65%。均未提及有银屑病及关节病的家族史。二、临床表现1.发病方式:皮损先发者21例,从皮损至关节症状出现的间隔时间不定,<1年者3例,>10年者7例,最长达21年。皮损和关节症状…     

Etanercept for the treatment of psoriasis and psoriatic arthritis

Etanercept is a fully human soluble recombinant p75 TNF receptor that blocks the binding of TNF to cell surface receptors, thereby neutralizing its biologic activity. Data supporting the FDA's approval of etanercept for controlling signs and symptoms and for inhibiting XRAY progression of psoriatic arthritis will be presented. Data supporting the FDA filing of etanercept for the treatment of moderate to severe psoriasis will also be presented. Long term safety data of etanercept in the over 231,000 adults and children with rheumatoid arthritis who have been treated worldwide will be briefly summarized.     

Treatment of recalcitrant psoriatic arthritis with anti-tumor necrosis factor-α antibody

Currently available treatments for psoriatic arthritis are either not completely effective or toxic in some patients. As tumour necrosis factor (TNF)-alpha is involved in both the joint and skin involvement in psoriatic arthritis, blockade of TNF-alpha seems a reliable way to treat patients with this disease. We report two patients with progressive recalcitrant psoriatic arthritis treated with low-dose methotrexate (7.5 mg, once per week) in combination with intravenous chimeric monoclonal anti-TNF-alpha antibody (infliximab, 3 mg/kg body weight). Both showed a dramatic and rapid response in the reduction of pain, followed by improvement of laboratory and clinical signs of joint inflammation. Skin disease also responds after a short delay. The observation shows that infliximab is effective and well tolerated in patients with recalcitrant progressive psoriatic arthritis. Different kinetics of symptom release during treatment suggest a variable role for TNF-alpha in disease pathways of pain, joint inflammation and skin involvement.     

Long-term study of infliximab in Japanese patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma

The efficacy and safety of infliximab in patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis (excluding localized type) and psoriatic erythroderma were assessed in clinical practice. Without washout of the existing treatment of psoriasis, treatment was switched to infliximab, which was given at a dose of 5 mg/kg at weeks 0, 2 and 6 and then every 8 weeks up to week 46. The primary end-points were 75% improvement in Psoriasis Area and Severity Index score (PASI 75 response rate) for plaque psoriasis, 20% improvement in American College of Rheumatology criteria (ACR 20 response rate) for psoriatic arthritis, and global improvement in pustular psoriasis and psoriatic erythroderma. The PASI 75 response rate in plaque psoriasis was 72.2% at week 10 and 53.6% at week 50. The ACR 20 response rate in psoriatic arthritis was 66.7% at week 14 and 80.0% at week 46. The response defined as global improvement in pustular psoriasis was between 66.7% and 100.0% during the 2–50-week period. The response defined as global improvement in psoriatic erythroderma was between 75.0% and 100.0% during the week-2–50 period. There were 14 discontinued patients. The most frequently reported reason for discontinuation was the development of adverse events. However, there were no serious respiratory diseases, infections or infusion reactions. In patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma, infliximab was well tolerated, regardless of prior treatment, and also showed superior efficacy over a period of approximately 1 year.     

Psoriatic arthritis: a review

Psoriatic arthritis (PsA) is an immunologically triggered, chronic inflammatory arthropathy, which can have a lasting influence on the quality of life of affected individuals. An early diagnosis is essential in order to institute adequate therapy. Both dermatologists and rheumatologists should be involved in the diagnosis and management of the disorder. Mild forms can be managed with NSAID and systemic corticosteroids. In acute forms with a confirmed diagnosis and oligo‐ to polyarticular involvement, disease‐modifying therapy with DMARD (Disease‐Modifying Antirheumatic Drugs) is indicated. New studies of PsA show that tumor necrosis factor (TNF) plays a central role in mediating inflammation. For this reason, TNF‐α antagonists have become more and more important as a second‐line therapy for PsA.     

Adalimumab markedly improves enthesitis in patients with psoriatic arthritis: Evaluation with a magnetic resonance imaging scoring system

Psoriatic arthritis (PsA), a seronegative arthropathy, may often result in progressive joint damage without treatment, leading to disability and impaired quality of life. Early therapeutic intervention of PsA is therefore crucial before the development of irreversible joint damage. Because psoriatic skin lesions generally precede the onset of PsA, dermatologists occupy an important position in treating patients with early PsA. This study aimed to evaluate the efficacy of adalimumab in treating joint disease in patients with PsA, using the PsA magnetic resonance imaging scoring system (PsAMRIS). Five adult Japanese male patients with active PsA were treated with adalimumab. Magnetic resonance imaging was obtained at baseline and 8–32 weeks with 2–3 time points following adalimumab treatment and assessed using PsAMRIS. Adalimumab treatment markedly improved clinical symptoms and disease activities of joint disease, which was confirmed by the reduction of PsAMRIS scores in all patients. Bone marrow edema and periarticular inflammation, reflecting the presence of enthesitis, were dramatically improved at week 8, while improvement of synovitis and flexor tenosynovitis was observed later, at week 24 or 32. However, bone erosion was not improved by adalimumab treatment during the follow‐up period. These results indicate that adalimumab treatment is associated with dramatic improvement of enthesitis in patients with PsA, whereas bone erosion may be resistant to such treatment. PsAMRIS appears to be useful for the evaluation of treatment efficacy in PsA.     

Successful treatment of psoriatic arthritis and comorbid annular atrophic lichen planus with etanercept

Psoriasis vulgaris and lichen planus are distinct T-cell-driven inflammatory skin diseases. Both present in a variety of clinical subtypes. Mucosal or nail involvement may be present. Here, we report the rare concomitant clinical presentation of psoriatic arthritis and annular atrophic lichen planus on the trunk of a 52-year-old male patient. Treatment with sulfasalazine failed to control inflammatory activity; methotrexate and leflunomide were ceased due to side-effects. After confirmation of both diagnoses, we initiated a tumor necrosis factor (TNF)-α-directed therapy with the fusion protein etanercept resulting in significant improvement of both conditions. This case report aims to highlight the rare colocalization of psoriasis and lichen planus, the rare entity of annular atrophic lichen planus, and to discuss a possible beneficial impact of certain TNF-α inhibitors on subtypes of lichen planus.     

Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients

Psoriatic arthritis (PsA) is a spondyloarthritic condition mainly seen in patients with psoriasis. Psoriatic patients with plaques on the scalp, gluteal fold or nail lesions are known to develop PsA more frequently, but other markers for PsA have not yet been identified. To determine which psoriatic patients are at greatest risk of developing PsA, psoriasis vulgaris (PsV) patients who visited the Department of Dermatology, Fukuoka University Hospital in 2015 were enrolled. Patients with and without PsA were statistically compared with respect to age, sex, age at onset, body mass index (BMI), smoking and drinking habits, familial history of psoriasis and comorbidities. Of 331 patients (237 men, 94 women), 55 had PsA (17%; 39 men, 16 women). PsA patients had significantly higher frequencies of nail lesions (PsA vs PsV‐only, 62% vs 29%; P < 0.0001) and hyperuricemia (PsA vs PsV‐only, 22% vs 9%; P = 0.01). These were confirmed as independent risk factors for PsA by logistic regression analysis, with odds ratios of 5.05 for nail lesions (P < 0.0001) and 4.18 for hyperuricemia (P < 0.01). There was no difference in age at onset, sex, BMI and incidence of diabetes mellitus, hypertension or dyslipidemia. Hyperuricemia is also known to be more frequent in psoriatic subjects than the normal population. Uric acid crystals are a strong stimulator of innate immunity. Considering that none of our cohort had gouty arthritis, hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects. Hyperuricemia appears to be an independent risk factor for PsA.     

关节病性银屑病29例临床分析

目的：探讨关节病性银屑病的临床特点及治疗。方法：对29例关节病性银屑病患者的临床资料进行回顾性分析。结果：本组病例平均发病年龄31．4岁,男18例、女11例,男：女为1．64：1。以皮损为首发者20例（69．0％）,关节炎首发者6例（20．7％）,皮损和关节炎同时发生者3例（10．3％）;皮损类型为寻常型27例（93．1％）,脓疱型1例（3．4％）,红皮病型1例（3．4％）;关节炎分类为非对称性少关节炎型10例（34．5％）,远端指（趾）间关节炎型7例（24．1％）,脊柱关节病型6例（20．7％）,对称性多关节炎型4例（13．8％）,残毁性关节炎型2例（6．9％）;25例患者接受关节X线检查,其中20例有阳性改变,表现为关节间隙变窄、骨质疏松、骨质吸收和骨刺形成。结论：本病男性多发,各型银屑病皮损都可并发关节炎病变。非对称性少关节炎和远端指（趾）关节易受累是本病的特点。甲氨蝶呤、来氟米特、阿维A、雷公藤多苷、沙利度胺、环孢素、吗替麦考酚酯、非甾体类抗炎药、小剂量糖皮质激素等合理联合用药可取得较好疗效。     

Pediatric psoriasis and psoriatic arthritis

Psoriasis and psoriatic arthritis (PsA) are not uncommon among the pediatric population. Recognizing and treating these chronic disorders in children present unique challenges for the dermatologist. Paucity of clinical trials and a dearth of available treatment modalities, many of which carry significant risk or adverse effects, can make treating pediatric psoriasis and PsA a daunting task. This review attempts to define and consolidate the current state of knowledge with regards to this disease spectrum. The need for further clinical trials to investigate treatment options in the pediatric population is also discussed.