A case of psoriatic arthritis without the appearance of psoriatic skin or nail lesions for 21 years

In some patients with psoriatic arthritis, arthritis may precede psoriatic skin lesions. In fact, psoriatic skin lesions may not develop for more than 10 years after the onset of arthritis. Making diagnostic and therapeutic decisions in such patients is therefore challenging. We describe a case with classic features of psoriatic arthritis without psoriatic skin or nail lesions for 21 years. We suggest that recognition of psoriatic arthritis sine psoriasis is important for selecting appropriate therapy to prevent joint damage.     

Psychometric validation of a patient-reported outcome questionnaire (Qualipsosex) assessing the impact of psoriasis and psoriatic arthritis on patient perception of sexuality

Psoriasis (Pso) and psoriatic arthritis (PsA) frequently have a negative impact on patients’ sexual health. We have developed a specific questionnaire assessing the impact of Pso and PsA on patient perception of sexuality: the QualipsoSex Questionnaire (QSQ). The aim of the present study was to further validate this questionnaire by checking its psychometric properties including validity, reliability, and responsiveness.A cross sectional observational study with a longitudinal component for responsiveness and test–retest reliability was performed in 12 centers in France including 7 dermatologists and 5 rheumatologists. Psychometric properties were examined according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) check-list.At baseline, 114 patients had Pso and 35 patients had PsA including 17 peripheral arthritis, 4 axial disease, 13 patients with both axial disease and peripheral arthritis and one patient with an undifferentiated phenotype. The mean Pso Area and Severity Index score was 12.5. Genital organs were involved in 44.7% of Pso cases. Internal consistency, construct validity, and reliability were good with Cronbach''s α coefficient, measure of sampling adequacy and intraclass correlation coefficient respectively at 0.87, 0.84, and 0.93. The QSQ also demonstrated acceptable sensitivity to change.The QSQ has demonstrated good psychometric properties fulfilling the validation process relative to the recommendations of the COSMIN check list. The QSQ is simple to score and may hopefully be valuable in clinical practice and in clinical trials.     

Pattern of psoriatic arthritis in an Asian population (Malaysia)

Objective: To profile the pattern of psoriatic arthritis (PsA) and its relationship to disease duration. Methods: Forty‐six consecutive patients with PsA were entered into a cross‐sectional study. Demographic data, disease duration and disability were recorded. Joint involvement was documented at 6 months from onset and at presentation. X‐rays of the sacroiliac (SI) joints, thoracolumbar spine, and hands were taken. HLA B27 typing was done. Results: The male : female ratio was 2.3 : 1, mean age at onset of arthritis was 35.8 years and mean duration of PsA was 4.2 years. Oligoarticular involvement predominated (63%) at onset. Progression from oligoarthritis to polyarthritis occurred largely in the second year; 65.2% reported asymmetrical disease at onset while 50% had asymmetrical disease when disease duration was > 1 year. The frequency of involvement at onset was as follows: sausage toes, metatarsophalangeals (MTPs) and interphalangeals (IPs) in 50% (each), proximal interphelangeals (PIPs) in 47.8%, sausage fingers 34.7% and knees 30%. With mean duration of 4.2 years it was: sausage toe 71.1%, IP 69.5%, PIP and MTP 63%, knees 60.8%, distal interphalangeals (DIPs) 54.3%, sausage finger 52.1%, wrist 47.8%, followed by neck and back pain. Disability related to lower limb functions predominated and occurred early. Forty‐one percent had radiological sacroiliatis/spondylitis and 46% had erosive arthritis in the hands; 10.2% were HLA B27 positive. Conclusion: PsA was progressive, starting predominantly as an asymmetrical oligoarthritis and becoming largely polyarticular within 2 years from onset. Lower limb disability was evident early and erosive changes in hand X‐rays were seen in more than half the patients after 1 year.     

Validation of the Toronto Psoriatic Arthritis Screen II (ToPAS II) questionnaire in a Brazilian population

Clinical Rheumatology - The Toronto Psoriatic Arthritis Screen II (ToPAS II) was developed as a tool to screen patients with probable psoriatic arthritis. We aimed to evaluate the validation of the...     

Sustained clinical response and high infliximab survival in psoriatic arthritis patients: a 3-year long-term study

OBJECTIVE: To investigate the efficacy, toxicity, and survival of infliximab in patients with psoriatic arthritis (PsA). METHODS: Thirty-two patients with PsA, refractory to at least 2 disease-modifying antirheumatic drugs, were included in this prospective, open-label, uncontrolled study. All had active disease, defined as having a tender or swollen joint count > or =6, Psoriasis Area and Severity Index (PASI) scores > or =10, and erythrocyte sedimentation rate > or =28 mm Hg/h, or C-reactive protein > or =10 mg/L. The primary endpoints were the percentage of patients who achieved the Psoriatic Arthritis Response criteria (PsARC) and the improvement of PASI. Patients were treated with infliximab (5 mg/kg) at weeks 0, 2, 6, and every 8 weeks thereafter for a period of 3 years. Data concerning infliximab efficacy, tolerability, concomitant therapy, adverse events, and drug discontinuation were recorded. The clinical response according to the American College of Rheumatology (ACR) criteria as well as the disease activity for 28 joint indices score (DAS-28) were also recorded. RESULTS: After the third year of treatment, PsARC was achieved by 23/32 of patients, PASI 70 by 24/32, and PASI 90 by 23/32. A significant improvement of ACR and DAS-28 was noted. Clinical improvement was associated with a reduction of acute phase reactants. Eight patients withdrew from the study primarily for acute allergic reactions. After the first year, infliximab survival was 84%, while after the second year, it was 75%, which was maintained throughout the third year of treatment. CONCLUSION: Infliximab was effective, safe, and well tolerated in patients with PsA. The clinical response was maintained for a period of 3 years with high infliximab survival.     

Toronto Psoriatic Arthritis Screening (ToPAS) questionnaire: a report from the GRAPPA 2009 annual meeting

The Toronto Psoriatic Arthritis Screening questionnaire (ToPAS) was developed as a tool to screen for psoriatic arthritis (PsA) in patients with psoriasis as well as in the general population. Thus, it differs from PsA-specific screening tools and may be used to screen for PsA in epidemiologic and family investigations. In a presentation at the 2009 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) in Stockholm, Sweden, the authors described the development, testing, and validation of the ToPAS tool. Results of a comparison of the ToPAS questionnaire with the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire were also presented. Modification and further validation of the ToPAS are under way.     

不同亚型银屑病关节炎的临床特征和实验室指标

目的分析不同亚型银屑病关节炎(PsA)临床特征、实验室指标的差异,以提高对该疾病的认识,为临床诊疗提供借鉴。方法对中国人民解放军264医院2005年1月至2011年12月住院诊治的PsA患者进行分型,并对不同亚型PsA患者首发症状、受累关节、类风湿因子(RF)、抗环瓜氨酸多肽抗体(抗CCP抗体)、人类白细胞抗原-B27(HLA-B27)进行比较分析。结果 82例PsA患者,皮疹先发于关节炎者60例(73%),皮疹和关节炎症状1个月内同时出现者9例(11%),关节炎先发于皮疹者13例(16%)。PsA临床分型:远端指(趾)间关节炎型10例(12.2%)、残毁型关节炎型6例(7.3%)、对称性多关节炎型19例(23.2%)、非对称性寡关节炎型20例(24.4%)、脊柱关节炎型27例(32.9%)。红细胞沉降率、C反应蛋白在PsA各亚型之间比较,差异无统计学意义(均P>0.05)。对称性多关节炎型RF或抗CCP抗体的阳性率为68%,远高于脊柱关节炎型(P<0.05)。脊柱关节炎型HLA-B27阳性率为37%,远高于远端指(趾)关节炎型、对称性多关节炎型、非对称性寡关节炎型(均P<0.05)。结论 PsA多以皮疹为首发,仍有部分患者以关节炎首发。临床分型以脊柱关节炎型多见。RF阳性或抗CCP抗体阳性PsA患者易出现对称性多关节受累,HLA-B27阳性PsA患者易出现中轴关节受累。     

The effects of IL-17/IL-17R inhibitors on atherosclerosis in psoriasis and psoriatic arthritis: A protocol for systematic review and meta analysis

Background:Psoriasis (PSO) is a systemic inflammatory disorder that presents with erythematous scaling of the skin and is associated with autoimmune dysfunction. Atherosclerosis is one of the major comorbidities of PSO. PSO-associated inflammatory factor IL-17 could lead to vascular endothelial cell injury and atherosclerosis. While some research results show that IL-17 helps stabilize plaque formation. Efficacy and safety on PSO and psoriatic arthritis (PSA) of existing IL-17/IL-17R biologics (secukinumab, ixekizumab, brodalumab, and bimekizumab) have been clinically validated, but whether they can improve atherosclerotic outcomes in psoriatic patients remains controversial.Methods:Seven electronic search engines will be searched from inception to December 1, 2020, including PubMed, Embase, Scopus, PsycINFO, Global Health, Web of Science and the Cochrane Library. Clinical trial registries, potential grey literature, relevant conference abstracts, and reference lists of identified studies will also be searched. Literature selection, data extraction, and quality assessment will be done by 2 independent authors. Based on the heterogeneity test, the fixed effect or random effect model will be used for data synthesis. Changes in lung function will be evaluated as the primary outcome. Assessment of symptoms, quality of life, medication use, exacerbations and adverse events will be assessed as secondary outcomes. RevMan V. 5.3.5 (The Nordic Cochrane Centre, Copenhagen, Denmark) will be used for meta-analysis.Results:This study will provide a synthesis of current evidence of IL-17/IL-17R inhibitors on atherosclerosis in PSO and PSA.Conclusion:The conclusion of our study will provide updated evidence to judge whether IL-17/IL-17R inhibitors is an effective solution to atherosclerosis as comorbidity of PSO and PSA.PROSPERP registration number:CRD42020209897