Normal levels and function of endothelial progenitor cells in patients with psoriatic arthritis

Endothelial progenitor cells (EPCs) are a population of bone marrow derived cells which have been attributed with the ability to migrate into areas of tissue ischemia and to posses reparative qualities. EPCs have been shown to be decreased in level and function in various inflammatory disorders. Psoriasis and psoriatic arthritis are associated with an increase in cardiovascular morbidity. The aim of the study was to investigate the number of EPCs among patients suffering from psoriasis and psoriatic arthritis. Patients suffering from active psoriasis and psoriatic arthritis were recruited as well as healthy controls. Disease activity was assessed with the DAS-28, BASDAI and PASI scores. Peripheral blood mononuclear cells were isolated and EPC numbers evaluated by FACS analysis using the CD34/133 and CD34/KDR. No significant difference was found between numbers of EPCs between healthy controls, patients with psoriasis and psoriatic arthritis. A significant correlation was found between levels of VGEF and the BASDAI score. The results of the current study do not support a significant role for EPCs in the pathogenesis of psoriasis and psoriatic arthritis.     

Corticosteroid prescribing in rheumatoid arthritis and psoriatic arthritis

Corticosteroid usage was assessed in rheumatoid arthritis (RA) and psoriatic arthritis (PA) patients in Italy. A multicentre, observational study was undertaken in 10 Italian rheumatological centres from 1990 to 1992 using a computerised clinical data bank. Nine hundred and seven RA patients and 180 PA patients were studied; 510 (56.2%) RA patients and 44 (24.4%) PA patients were using corticosteroids. The percentage of patients taking corticosteroids ranged from 20.5 to 85.4% for RA patients and from 0 to 55% for PA patients for the different centres. Methylprednisolone was the most prescribed corticosteroid, both in RA patients (63.2%) and in PA patients (65.9%). The average methylprednisolone daily dose was 5.7±3.6 mg in RA patients and 4.5±1.4 mg in PA patients. The data provide evidence that corticosteroids are taken in an unexpectedly high percentage of patients with RA and PA in Italy.     

高尿酸血症与内皮功能障碍

高尿酸血症是常见的与代谢综合征相关的疾病,其与内皮细胞功能障碍的发生密切相关.尿酸既可以通过增强细胞内氧化应激、上调内皮细胞内的Ras-丝裂原活化蛋白激酶信号转导通路、引起线粒体钙离子显著超负荷和活性氧簇产生增加、降低一氧化氮和内皮型一氧化氮合酶(eNOS)的产生等直接损害血管内皮细胞的功能,又能够通过其常伴随的低脂联素血症、高瘦素血症和与高尿酸血症互为相关的胰岛素抵抗等共同影响磷脂酰肌醇3激酶-蛋白激酶B-eNOS和AMP活化蛋白激酶-eNOS等信号通路,间接损害内皮功能.虽然目前对于无症状高尿酸血症是否应该给予临床干预尚存在争议,但许多证据支持高尿酸血症可损害内皮功能,应当适当时机给无症状高尿酸血症患者予以干预.     

Clinical features of psoriatic arthritis

Psoriatic arthritis (PsA) is associated with decreased quality of life. As delayed diagnosis may lead to progressive joint destruction and long-term disability, the key clinical features of PsA should be recognizable to a wide range of clinicians to facilitate early diagnosis. In addition to assessment and identification of skin and nail lesions, which occur in up to 85% of those with musculoskeletal manifestations, clinicians should be aware of both the peripheral and axial manifestations of musculoskeletal disease reviewed here. Peripheral joint diseases include polyarticular, oligoarticular, distal, and arthritis mutilans subtypes, and cognizance of these patterns of disease, as well as periarticular manifestations, including dactylitis and enthesitis, is useful for swift diagnosis of PsA. Axial psoriatic arthritis (axial PsA), also known as the spondylitis subtype, may be limited to the spine and sacroiliac joints, but may also affect peripheral structures. Meticulous history-taking and physical examination and familiarity with appropriate imaging studies are often necessary to distinguish axial-PsA from other differential diagnoses. Swift diagnosis and treatment are necessary to both control PsA disease and mitigate the risks of the many associate comorbidities that may accompany it.     

Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis

Our aim is to assess the prevalence and associated clinical features of anti-CCP (cyclic citrullinated peptide) antibodies for RF (rheumatoid factor)-positive and RF-negative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). In a prospective, cross-sectional, multi-centre study, we determined the titres of anti-CCP antibodies in 208 RA patients (129 RF-positive, 79 RF-negative), 56 PsA patients and 39 healthy controls (HC). Clinical parameters including disease activity (disease activity score 28-DAS28), physical disability (health assessment questionnaire-HAQ), functional capacity (functional class) and radiological erosions were investigated in patients with RA. In PsA patients, clinical and radiological features were determined. Anti-CCP2 antibodies were measured using a second-generation anti-CCP enzyme-linked immunosorbent assay (Euro-Diagnostica, Netherlands). One-hundred four of 129 RF-positive RA (81%), 16 of 79 RF-negative RA (20%), seven of 56 PsA patients (12.5%) and none of the HC had anti-CCP antibodies. RA patients with anti-CCP antibodies had significantly higher disease activity, greater loss of function and more frequent erosive disease than anti-CCP antibody-negative group. In subgroup analysis, anti-CCP antibodies in RF-negative patients were also associated with erosive disease. All PsA patients with anti-CCP antibodies had symmetric arthritis with higher number of swollen joints. The prevalence of anti-CCP antibodies in RF-positive RA patients was significantly higher than in RF-negative RA and PsA patients. Anti-CCP antibodies were also associated with erosive disease in RF-negative RA patients. Both anti-CCP and RF tests were negative in 30% of the patients. Anti-CCP positivity was a frequent finding in PsA and associated with symmetrical polyarthritis.     

Unmet needs in psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with a highly variable clinical presentation that does not have a validated molecular or imaging test, making accurate diagnosis a challenge. Consequences of diagnostic delay include irreversible joint damage and significant morbidity. Over the past few decades, there have been major advances in the understanding and treatment of PsA, leading to more targeted therapies. However, there is no current method to predict optimal treatment strategy to achieve minimal disease activity and prevent medication-related adverse events in the management of early disease. PsA is also associated with other comorbidities that include metabolic syndrome and psychosocial burden; two areas that are often unaddressed in the clinical setting and have associated sequelae. This chapter focuses on key domains of unmet needs, which include diagnostic challenges, delay in diagnosis, prognostication systems and stratified medicine approaches and precision medicine strategies for established and emerging therapies.     

Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis

The cardiovascular burden in inflammatory rheumatic diseases is well recognized. Recently, this burden has been highlighted in ankylosing spondylitis (also known as radiographic axial spondyloarthritis) and psoriatic arthritis. We review the cardiovascular morbidity and mortality in these diseases, as well as the prevalence and incidence of traditional cardiovascular risk factors. We examine the contribution of anti-inflammatory therapy with nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and TNF inhibitors on the cardiovascular risk profile. Finally, we examine the available recommendations for the management of cardiovascular comorbidity, as they apply to the spondyloarthritis population.     

银屑病性关节炎患者动脉粥样硬化的机制和危险因素

流行病学研究显示,银屑病以及银屑病关节炎(PsA)患者动脉粥样硬化(AS)的危险因素(如肥胖、糖尿病、高脂血症)增加,并且主要心血管不良事件(MACE)的发病率升高。PsA与心血管疾病、代谢综合征等疾病存在着一些共同的涉及慢性炎症的通路以及细胞因子,可能是此类患者合并心血管疾病、代谢综合征的基础。本文综述了PsA患者合并AS的危险因素,为PsA患者罹患AS的监测及预防提供指导。     

Joint and nail involvement in Turkish patients with psoriatic arthritis

Psoriatic arthritis is an autoimmune, chronic, systemic inflammatory disorder characterized by the association of arthritis with psoriasis. In this paper, we explore the characteristics of joint and nail involvement in Turkish patients with psoriatic arthritis. Forty patients with psoriasis (M/F, 18/22) and 49 (M/F, 25/24) subjects with psoriatic arthritis were included in the study. Clinical characteristics of the patients were recorded. The distribution of the subjects with arthritis: (according to the clinical and radiological findings): polyarticular, 65%; oligoarticular, 23%; isolated axial involvement, 7.7%; arthritis mutilans, 3.8%; sacroiliitis, 19%. Nail involvement was significantly higher among patients with arthritis; i.e., 91 versus 32%; (P < 0.05). There were no correlation between the skin involvement pattern and the arthritis type (P > 0.05). Nevertheless, no relation was observed between the psoriasis duration and arthritis (P > 0.05). Nail involvement is a frequent feature of the psoriatic arthritis which may be a useful finding for differential diagnosis of psoriatic arthritis from other inflammatory arthropathies.     

A method to score radiographic change in psoriatic arthritis

INTRODUCTION: Radiographic features of psoriatic arthritis (PsA) are very characteristic and differ from those observed in rheumatoid arthritis, especially in two aspects: 1) the distribution of affected joints (i.e. DIP joints), 2) the presence of destructive changes and bone proliferation at the same time. A scoring method for PsA, therefore, has to account for these characteristics of PsA. OBJECTIVE: To develop, describe and validate a method for scoring radiographic changes in patients with PsA. DESCRIPTION OF THE METHOD: Forty joints of the hands and feet are scored for destruction and proliferation. In the destruction score (DS) grading on a 0-5 scale is based on the amount of joint surface destruction: 0 = normal, 1 = one or more erosions with an interruption of the cortical plate of > 1 mm with destruction of the total joint surface up to 10%, 2 = 11-25%, 3 = 26-50%, 4 = 51-75%, 5 = > 75% joint surface destruction. The proliferation score (PS) sums up any kind of bony proliferation typical for PsA; graded 0-4: 0 = normal, 1 = bony proliferation of 1-2 mm or bone growth < 25% of the original size (diameter), 2 = bony proliferation 2-3 mm or bone growth 25-50%, 3 = bony proliferation > 3 mm or bone growth > 50%, 4 = bony ankylosis. The DS (0-200) and the PS (0-160) can be summed up to the total score (0-360). VALIDATION OF THE METHOD: To validate the method x-rays of 20 patients with active PsA taken 3 years apart were read twice in pairs, knowing the chronological order but not knowing demographic, clinical or laboratory data of the patients. The data were analyzed with a hierarchical analysis of variance model. RESULTS: There was good agreement between the first and the second reading of the same rater and between the two raters regarding the destruction score. The agreement regarding the proliferation score was lower but still acceptable. The reliability of the method to describe change over time--relation of progression (intra-patient variance) to the measurement error (inter-rater variance)--was 3.9 for the DS, 2.8 for the PS and 4.1 for the total score. The minimal detectable change when the readings of two raters were compared (inter-rater MDC) was 5.8, 5.0 and 4.6%, respectively of the maximum possible score for the destruction, the proliferation and the total score. These data compare very well with the results of standard scoring methods in rheumatoid arthritis. CONCLUSION: We propose a method for scoring radiographic change in psoriatic arthritis which reliably quantifies the progression of the disease seen on radiographs.     

Pathogenesis of psoriatic arthritis

Psoriatic arthritis (PsA) is a heterogenous systemic inflammatory disorder which affects peripheral joints (PsA) and skin (psoriasis (Ps)), but also causes inflammation at entheseal sites, digits (dactylitis) and the axial skeleton. Over the past decade, there have been considerable advances both in our understanding of the pathogenesis of PsA and in the treatment of its diverse manifestations. This article reviews our current knowledge of the pathogenesis of PsA, and how genetic pre-disposition coupled with mechanical stress may influence the development of the pathognomonic features of PsA including enthesitis and osteoproliferation, with concomitant osteoporosis and erosive disease. We consider factors that influence the development of PsA in patients with Ps, and how improving our knowledge of the phenotypes of PsA may ultimately facilitate our goal of precision medicine, a key unmet need as defined by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.     

Effects of rituximab treatment on endothelial dysfunction, carotid atherosclerosis, and lipid profile in rheumatoid arthritis

Increased cardiovascular mortality has been associated with rheumatoid arthritis (RA). There have been reports indicating that tumor necrosis factor blockers may exert favorable but transient effects on lipid profile, flow-mediated vasodilation (FMD) of the brachial artery, and common carotid intima–media thickness (ccIMT) in RA. In this study, we assessed the effects of rituximab on FMD, ccIMT, and lipid profile. Five female RA patients received two infusions of 1000 mg rituximab i.v. High-resolution B-mode ultrasound was used to assess brachial FMD and ccIMT. We also determined plasma total cholesterol (TC), HDL-C, LDL-C, and triglyceride (Tg) levels. Assessments were performed at baseline, as well as at weeks 2, 6, and 16 after the first infusion. Rituximab (RTX) treatment resulted in a rapid and sustained improvement in FMD. The mean improvement was 30%, 22%, and 81% at weeks 2, 6, and 16, respectively. RTX had little effect on atherosclerosis within this short period of time; however, we observed 10%, 9%, and 2% decreases in ccIMT at weeks 2, 6, and 16, respectively. RTX therapy resulted in 3–11% decrease in TC, as well as 14–35% increase in HDL-C levels. Two infusions of RTX exerted early and sustained favorable effects on endothelial dysfunction, as well as plasma TC and HDL-C levels. RTX may also decrease ccIMT; however, longer follow-up is needed to assess the prolonged effects of RTX on vascular function and lipid profile in RA patients.     

Clinical and laboratory characteristics of psoriatic arthritis in a cohort of Egyptian patients

Aim of the workTo detect the clinical and laboratory characteristics of psoriatic arthritis (PsA) in sample of Egyptian population.Patients and methods100 PsA patients were subjected to full medical history, full clinical, musculoskeletal and dermatological examination, routine laboratory investigations and assessment of disease severity.ResultsAmong 100 PsA patients, 79 females and 21 males. The mean age was 44.4 ± 12.9 years. 21% of patients had hypertension, 11% had diabetes and 4% hepatitis C-virus. 14% had family history of other rheumatologic disease. 66% of patients experienced psoriasis onset with mean latency; 11.6 ± 8.2 years, 20% had dual onset of both diseases and 10% experienced PsA first with mean latency 3.6 ± 3.5 years. 86% of the patients had enthesitis, 41% had dactylitis, 39% had axial affection and 18% of patients had uveitis. 90% of patients had current psoriasis and 89% of them had current nail lesion. The most common drug was methotrexate. 38% of patients had axial spondyloarthritis, 33% had symmetric polyarthritis, 26% had asymmetric oligoarthritis, and 3% had predominant distal inter-phalangeal (DIP) involvement. The mean value for serum hemoglobin was 12.1 ± 8.21.6 g/dl, platelets; 278.4 ± 90.3 x10³/mm³, the white blood cells 7.2 ± 2.2 x10³/mm³, C-reactive protein was 10.9 ± 10.1 mg/dl and erythrocyte sedimentation rate was 49.3 ± 27.5 mm/1st hr. 92% of patients were negative for rheumatoid factor.ConclusionAmong the cohort of Egyptian patients, most had axial spondyloarthritis, followed by symmetric polyarthritis and asymmetric oligoarthritis. The least frequent was predominant DIP involvement. The onset of psoriasis precedes arthritis and methotrexate was the most common therapy.     

Purpura and serum mixed cryoglobulinemia in psoriatic arthritis

We here firstly describe the case of a psoriatic arthritis associated with cutaneous purpura and lower limbs weakness. The presence of type III mixed cryoglobulinemia in serum was the only possible detected cause. Discrepancies with the hepatitis C virus-related mixed cryoglobulinemia picture are discussed.     

Gender specific differences in patients with psoriatic arthritis

Objectives: To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA).

Methods: Consecutively recruited patients were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms.

Results: Women (n?=?115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n?=?72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis [AS]) were quite similar between men and women.

Conclusions: Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.     

Spondylitis is the most common pattern of psoriatic arthritis in Korea

We assessed the prevalence and clinical features of psoriatic arthritis (PsA) in Korean patients with psoriasis. The prevalence of PsA in patients with psoriasis was 9%. Patients with PsA were older and had a longer duration of skin disease than those with psoriasis alone (median age, 40 vs 35 years, P = 0.03, and 15.3 vs 11.7 years, P = 0.04, respectively). Spondylitis was the most common pattern of PsA (50%). Nail change, dactylitis, and enthesopathy were observed in 36%, 15.4%, and 15.6% of patients with PsA, respectively. Increased erythrocyte sedimentation rate (ESR), antinuclear antibody, and radiological sacroiliitis were more frequent in patients with PsA than in those with uncomplicated psoriasis (25.8% vs 10.3%, P = 0.04; 37.9% vs 16.7%, P = 0.02; and 37.8% vs 1.1%, P < 0.01, respectively). The onset ages of psoriasis and arthritis in the spondylitis group were significantly lower than those in the non-spondylitis group (median age, 21.5 vs 31 years, P = 0.03, and 28.5 vs 43.5 years, P = 0.01, respectively). HLA-B27 was prevalent in 8% of patients with PsA. Received: 11 May 1999 / Accepted: 20 October 1999     

Clinical and radiographic involvement of cervical spine in patients with psoriatic arthritis

ObjectivesTo evaluate clinical and radiographic patterns of cervical spine affection in patients with psoriatic arthritis (PsA).MethodsThis cross sectional study included 30 PsA patients, who were examined clinically and had radiographics of the cervical spine, sacroiliac joints and both hands and feet.ResultsCervical spine disease was evident clinically in 46.7% and radiographically in 20% of PsA patients, with no significant correlation between radiological and laboratory abnormalities. Also, there was no significant correlation between peripheral arthritis and cervical spine affection.ConclusionCervical spine disease is not an uncommon clinical and radiographic finding in patients with PsA.     

Classification and categorisation of psoriatic arthritis

For over 30 years, investigators have used the simple but non-validated classification criteria suggested by Moll and Wright. Several authors have suggested modifications to these but most remain unvalidated or require human leukocyte antigen analysis. Now, a worldwide initiative has developed new criteria which include both clinical and radiological features. These will require further study before they are fully adopted but their improved performance should result in less variation between study cohorts. The recurring question of disease heterogeneity continues to occupy researchers in this field. Despite recent pleas to abandon the original five sub-groups, a case can be made for retaining at least the two sub-groups of peripheral and axial disease and, possibly, splitting the peripheral disease into oligo- and poly-arthritis.     

Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis: a clinical and sonographic study

The aim of our study was to evaluate the effects of intra-articular methotrexate (MTX) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Twenty-three consecutive patients, 10 with RA and 13 with PsA, with prevalent or unique arthritic involvement of one knee, were treated with intra-articular injections of MTX 10 mg every 7 days for 8 weeks. Before the beginning of the treatment and after 9 and 17 weeks, the patients underwent a clinical evaluation measuring maximal knee flexion angle, visual analog scale (VAS) and erythrocyte sedimentation rate (ESR). On the same days, an ultrasonographic examination of the involved knee was performed by two independent experienced operators. Synovial thickness in the suprapatellar bursa and the presence of joint effusion and Bakers cyst were assessed. An increase of the mean value of maximal knee flexion angle and a reduction of the mean values of ESR and VAS between T0, T9 and T17 were demonstrated. Ultrasonographic evaluation showed significant reduction of synovial thickness and joint effusion. No differences were detected for the presence of Bakers cyst. We may conclude that repeated intra-articular injections of MTX resulted in a decrease of local as well as systemic inflammatory signs. As far as we know, this is the first study that explores the effects of intra-articular MTX in RA and PsA both clinically and by ultrasonography.