Prevalence of psoriatic arthritis in psoriasis patients according to newer classification criteria

The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to Classification of Psoriatic Arthritis (CASPAR) criteria, Assessment of Spondyloarthritis International Society (ASAS) peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % had nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was of 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs 10 years, p?=?0.02), and a higher frequency of nail involvement (88.2 vs 49.4 %, p?=?0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs 1.2 %, p?=?0.0006 and 80 vs 16.7 %, p?=?0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding a proper classification.     

Prevalence of psoriatic arthritis in psoriasis patients according to newer classification criteria

The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to CASPAR criteria, ASAS peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs. 10 years, p?=?0.02), and a higher frequency of nail involvement (88.2 vs. 49.4 %, p?=?0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs. 1.2 %, p?=?0.0006 and 80 vs. 16.7 %, p?=?0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding a proper classification.     

HLA antigens may influence the age of onset of psoriasis and psoriatic arthritis

OBJECTIVE: To analyze whether HLA antigens may influence the age of onset of both psoriasis and psoriatic arthritis (PsA). METHODS: One hundred thirty-five patients with PsA (77 men, 58 women, mean age 47 +/- 12 yrs) were analyzed. All were studied with a standard protocol and consecutively recruited to evaluate the relative contribution of HLA-Cw and HLA-B27 alleles to PsA susceptibility. Fifty patients with psoriasis alone were also recruited to analyze the role of HLA-Cw genes on disease susceptibility. HLA-Cw antigens were investigated by DNA based methods (PCR-SSOP), while HLA-B27 antigen was studied using serological methods, and their frequencies were compared to 177 healthy controls. RESULTS: In PsA Cw6+ patients, the mean age at psoriasis onset was 23 +/- 12 years compared to 32 +/- 12 years in Cw6- patients (p = 0.012). Age of arthritis onset was 35 +/- 13 years in Cw6+ patients versus 38 +/- 12 years in Cw6- patients (p = NS). In patients with psoriasis alone, the age at onset was 18 +/- 10 years in Cw6+ versus 30 +/- 11 years in Cw6- patients (p < 0.01). Cw6 correlated well with a positive family history of psoriasis among first-degree relatives (64% of patients with family history were Cw6+, whereas only 30% of those without family history had this allele (p < 0.05). The onset age of psoriasis in HLA-B27+ patients was 24 +/- 8 years vs 32 +/- 14 years in B27- patients (p = 0.026), whereas onset age of arthritis was 30 +/- 10 years in B27+ compared to an age of onset of 40 +/- 12 in B27- patients (p = 0.0056). CONCLUSION: Our results confirm the known association between Cw6, early onset psoriasis and positive family history (type I psoriasis). The association between HLA-B27 and earlier onset ages for both psoriasis and arthritis in PsA had not previously been emphasized. The HLA antigens may determine not only disease susceptibility, but also the age of disease onset in psoriasis and PsA.     

Association between environmental factors and onset of psoriatic arthritis in patients with psoriasis

Objective

To investigate the association between potential environmental exposures and the development of psoriatic arthritis (PsA) in patients with psoriasis.

Methods

In this case–control study, the cases were patients with recent‐onset PsA. The controls were psoriasis patients without arthritis. The occurrence of the following environmental exposures was recorded through a standardized questionnaire: smoking, alcohol consumption, infections, injuries, physically demanding occupational tasks, stressful life events, vaccinations, and female hormonal exposures. The association between each exposure to environmental events and disease status was assessed through logistic regression after adjustment for age, sex, education level, and duration and severity of psoriasis.

Results

There were 159 subjects in each group. The following exposures remained significantly associated with PsA following multivariate logistic regression: lifting cumulative loads of at least 100 pounds/hour (odds ratio [OR] 2.8, 95% confidence interval [95% CI] 1.51–5.05), infections that required antibiotics (OR 1.7, 95% CI 1.00–2.77), smoking (OR 0.6, 95% CI 0.36–0.89), and injuries (OR 2.1, 95% CI 1.11–4.01). The results were not appreciably changed with the inclusion of each of these factors in a single regression model; however, the level of significance for injuries had become borderline. No association was found between PsA and alcohol consumption, vaccination, stressful life events, and female hormonal exposures.

Conclusion

Lifting heavy loads and infections that required antibiotics were associated with the occurrence of arthritis among patients with psoriasis. There was an inverse association between smoking and PsA. Further studies are necessary to determine whether these and other environmental factors are moderated by predisposing genetic factors.     

Rhythm profile in patients with psoriatic arthritis

OBJECTIVE: To analyze the rhythmic profile in patients with psoriatic arthritis (PA). DESIGN: In order to evaluate the rhythmic profile of patients with PA, we have carried out ambulatory 24 hour ECG recordings in 22 patients presented consecutively to the Holter ECG laboratory. SETTING: Patients followed in a specialised rheumatology consultation, in Santa Maria Hospital. PATIENTS: We have studied 22 patients (pts), 10 male and 12 female, aged 49.8 +/- 8.4 years, presenting PA diagnosed in average 12.9 years before. A group of 36 individuals, 25 male and 11 female, aged 37 +/- 8 years and without disease, were used as control. RESULTS: All patients were in sinus rhythm with a mean heart rate of 71 +/- 6 (min - 51.5 +/- 7.0 and max - 130.3 +/- 15.0). In 8 (36.6%) there were sinus bradycardia less than 50/min and sinus tachycardia (greater than 120/min) in 15 patients (68.1%). Two patients (9%) presented supraventricular tachycardia and one had AV block. There were premature atrial systoles in 14 pts (63.6%), and ventricular arrhythmias in 9 (40.9%). In control group, there were sinus bradycardia in 16.6%, sinus tachycardia in 33.3%, premature atrial systoles in 33.3% and ventricular arrhythmias in 25% of them; in 11% there were conduction disturbances. CONCLUSIONS: a) Premature atrial systoles were the rhythm disturbance more prevalent. b) Patients with PA presented a significant higher incidence of sinus bradycardia and sinus tachycardia. c) Cardiac conduction disturbances were not frequent. d) Our results may suggest the presence of a subtle autonomic dysfunction in patients with psoriatic arthritis.     

Metabolic disorders in patients with psoriasis and psoriatic arthritis

Psoriasis is one of the common complex disorders in Western world, affecting 2% to 3% of the population. Recent studies indicate that psoriasis is associated with an increased risk of comorbidity and mortality compared to the general population. It appears that patients with psoriasis have a higher prevalence of metabolic disorders such as diabetes, hypertension, obesity, and hyperlipidemia, as well as a higher frequency of cigarette smoking. These concomitant diseases can complicate the treatment of psoriasis. Even though the etiology of these associations is elusive, physicians should be aware of them and take active steps to reduce the risk profiles of patients with psoriasis and psoriatic arthritis, in order to lessen mortality and comorbidity.     

Clinical features of psoriatic arthritis in Korean patients with psoriasis: a cross-sectional observational study of 196 patients with psoriasis using psoriatic arthritis screening questionnaires

The prevalence and clinical features of psoriatic arthritis (PsA) in psoriasis patients vary widely in different countries, and studies on Korean population are rarely reported. The aim of this study was to investigate the clinical features of PsA in a Korean population of patients with psoriasis by using psoriatic arthritis screening questionnaires. A cross-sectional observational study was conducted, and consecutive psoriatic patients were evaluated for PsA by using two kinds of psoriatic arthritis screening questionnaires: Psoriatic Arthritis Screening and Evaluation tool (PASE) and Psoriasis Epidemiology Screening Tool (PEST). Psoriatic patients with higher score in screening questionnaires were referred to rheumatologist for confirmative diagnosis of PsA. Among 196 psoriasis patients screened by PASE and PEST, total prevalence of PsA was 11.2 % (n = 22/196) with 59.1 % of the cases being newly diagnosed. Compared with patients without PsA, patients with PsA had more extensive psoriasis, higher frequency of pustular and inverse type of psoriasis, and lower frequency of plaque type of psoriasis. Spondylitis was the most common manifestation pattern, followed by polyarthritis, oligoarthritis, predominant distal interphalangeal arthritis, and arthritis mutilans. Our findings are consistent with a low prevalence of PsA among patients with psoriasis in Asia. We also confirm a spondylitis as the most common pattern of PsA in Korea. PsA screening questionnaires can be a simple and useful tool to screen PsA in patients with psoriasis.     

The prognosis of hypertension according to age at onset

Data from a program for hypertension screening and follow-up were used to study the relationship between age at onset of hypertension and the risk of cardiovascular complications. The risk for hypertensive subjects, compared with normotensive subjects of similar age, declined significantly as age of onset increased from 40 to 69 years. This pattern was not explained by differences in initial severity of hypertension, control of hypertension, obesity, smoking, or alcohol consumption. A sex-specific analysis showed that the pattern was confined to male subjects, but it is argued that it might be seen in female subjects if data for women of more advanced age were available. Further lines of investigation of this interesting phenomenon are proposed.     

Onset of psoriatic arthritis in patients treated with efalizumab for moderate to severe psoriasis

OBJECTIVE: To investigate the nature of polyarthritis in patients with moderate to severe psoriasis undergoing treatment with efalizumab, a humanized anti-CD11a monoclonal antibody. METHODS: In a multicenter study, we retrospectively analyzed patients who developed arthritis during treatment with efalizumab. The relationship between joint manifestations and psoriatic disease was addressed by using different classification criteria for psoriatic arthritis (PsA). The course of arthritis and its response to treatment were also investigated. RESULTS: Sixteen patients developed de novo inflammatory rheumatic disease, with a mean delay of 15 weeks following the start of treatment, and with exclusive asymmetric peripheral monarthritis or oligoarthritis (8 patients), inflammatory spinal disease (1 patient), or both (7 patients), associated in some cases with enthesitis and dactylitis. All patients fulfilled at least 2 different sets of classification criteria for PsA. In most of them, an improvement in skin lesions was observed at the onset of PsA, as measured using the Psoriasis Area and Severity Index (mean score 24.88 before efalizumab versus 18.78 at the time of arthritis). Efalizumab treatment was stopped in 11 patients and was followed by the elimination of rheumatologic symptoms in 1 patient, while 8 patients required treatment with nonsteroidal antiinflammatory drugs with or without methotrexate, with 2 later being switched to tumor necrosis factor alpha inhibitors. Reintroduction of efalizumab (2 patients) was followed by a relapse of PsA. CONCLUSION: This study questions the role of efalizumab in the induction of PsA. It also emphasizes the discrepancy between the courses of psoriatic skin and joint manifestations under treatment. Prospective case-control studies are needed to accurately investigate the impact of efalizumab on PsA.     

Hypertension is associated with increased age at the onset of psoriasis and a higher body mass index in psoriatic disease

Clinical Rheumatology - High blood pressure (HBP) is a common comorbidity in psoriatic disease. Some studies indicate a higher prevalence of HBP among arthritis patients, in relation to psoriasis...     

Genetics of psoriasis and psoriatic arthritis

Psoriasis and psoriatic arthritis are linked diseases characterised by (distinct ?) immune-mediated pathogenetic mechanisms and by a genetic background interacting with environmental factors. Some candidate susceptibility genes have been studied extensively; they include HLA genes, genes within the HLA region and genes outside the HLA region; among them corneodesmosin and other genes of PSORS1 region, MICA and TNF-a polymorphisms. The main findings in the literature are discussed.     

Immunopathology of psoriasis and psoriatic arthritis

Psoriatic arthritis (PsA) is characterised by several unique clinical features that differentiate it from rheumatoid arthritis (RA). Attempts to identify immunopathological mechanisms, some shared with psoriasis, that underlie these differences from RA have been most challenging. Recent research studies, however, highlight novel findings in PsA at the molecular, cellular, and tissue levels that form the basis for a new understanding of this relatively common form of inflammatory arthritis. In particular, the availability of new, biological antitumour necrosis factor alpha therapies have allowed further insight into the immunopathology of psoriasis and PsA. This brief review focuses on immunohistological studies in psoriatic skin, PsA synovium, and bone to demonstrate how these data advance our knowledge of disease pathogenesis.     

Epidemiology of psoriasis and psoriatic arthritis

Psoriasis is widely diffused in the World, with the exception of a few populations, such as the natives from Alaska and Australia, where it is unknown. Its average prevalence is about 3-4%. This is probably an underestimate, for it is mostly based on self-reports. In fact, on the one hand minimal psoriasis, e.g. nail disease, could remain undiagnosed; on the other, precise classification criteria for psoriatic arthritis (PsA) are lacking and the skin disease is often of elusive nature. The frequency of PsA may be higher than commonly believed, as suggested by recent studies reporting a prevalence of up to 0.42%. There are no major differences in the frequency of psoriasis between sexes, nor specific time trends. Indirect data suggest that PsA may be more frequent in the old than in the new World, a point that could be clarified only by standardized international studies. In practice, both psoriasis and PsA are relatively common conditions, with major impact on the patients'quality of life, and requiring appropriate intervention strategies. An important advance should be the adoption of univocal definitions of psoriasis and PsA, including guidelines for patterns of skin and joint involvement.     

Cardiovascular risk profile of patients with psoriatic arthritis compared to controls--the role of inflammation

Objective. To examine the distribution of traditional and novelrisk factors of cardiovascular disease (CVD) in patients withPsA compared with healthy controls. Methods. We compared risk factors for CVD between 102 consecutivePsA patients and 82 controls, adjusting for BMI. We also assessedthe role of inflammation on the CVD risk factor by using a BMIand high-sensitivity CRP (hsCRP)-adjusted model. Results. The BMI of PsA patients were significantly higher thanhealthy controls. After adjusting for the BMI, PsA patientsstill have a higher prevalence of diabetes mellitus (DM) [oddsratio (OR) 9.27, 95% CI 2.09, 41.09) and hypertension (OR 3.37,95% CI 1.68, 6.72), but a lower prevalence of low high densitylipoprotein (HDL) cholesterol (OR 0.16, 95% CI 0.07, 0.41).PsA patients have significantly increased systolic and diastolicblood pressures, insulin resistance and inflammatory markers(hsCRP and white cell count) compared to controls. PsA patientshave higher HDL cholesterol and apolipoprotein (Apo) A1 levels;and lower total cholesterol (TC) and low density lipoproteincholesterol levels; and a lower TC/HDL ratio. However, the ApoB level (P < 0.05), and the Apo B/Apo A1 ratio (P = 0.07)were higher in PsA patients. Further adjustment for hsCRP levelrendered the differences in the prevalence of hypertension andDM; the TC, and sugar levels; and white cell count non-significantbetween the two groups; while the differences in other parametersremained significant. Conclusion. These data support the hypothesis that PsA may beassociated with obesity, hypertension, dyslipidaemia and insulinresistance because of the shared inflammatory pathway. KEY WORDS: PsA, Obesity, Hypertension, Dyslipidaemia, Insulin resistance, Inflammatory markers Submitted 25 October 2007; revised version accepted 5 February 2008.