A short history of biological therapy for psoriatic arthritis.

Psoriatic arthritis (PsA) is an inflammatory disease characterised by the clinical domains of arthritis, enthesitis, dactylitis, spondylitis, and psoriasis, often causing significant functional disability, loss of quality of life, and premature mortality. Prior to the introduction of targeted biologic medications, such as TNF inhibitors, the capacity to control disease activity was limited, with only modest effects noted in most patients with traditional oral medications such as methotrexate and sulfasalazine. The introduction of TNF inhibitors substantially changed the outlook of PsA patients, yielding significant response in all relevant clinical domains and demonstrating the capacity to inhibit progressive structural damage of joints. However, not all patients responded to these agents and many patients displayed initial response which waned over time, partly due to immunogenicity (development of antibodies which blocked full therapeutic effect of the biologic protein), or because of poor tolerability and/or adverse events. Thus, it has been important to develop new medicines which target other key cytokines and immunologic pathways, including ustekinumab which inhibits both IL12 and IL23 and thus is felt to work in both the TH1 and TH7 pathways of inflammation, has been approved for the treatment of PsA as well as psoriasis. IL17 inhibitors, including secukinumab and ixekizumab have demonstrated significant effectiveness in psoriasis and PsA; abatacept, which modulates T cell activity via inhibition the second signal of T cell activation is under study. This article provides an historical overview of this revolution; details of specific biological therapies will be provided in adjacent articles in this supplement.

Psoriatic arthritis: Mary Stults Sherman, a forgotten figure in its history.

Mary Sherman was an American orthopedic surgeon who in 1952 published one of the earliest descriptions of psoriatic arthritis in the English literature. In a time when the general consensus by American rheumatologists was that there was no sufficient evidence to consider psoriatic arthritis as a distinct entity, Mary Sherman argued otherwise. Her work provided clinical, pathological, and therapeutic evidence in support of its distinctiveness as a unique disorder separate from rheumatoid arthritis.

Psoriasis and psoriatic arthropathy, historical aspects: part I.

Psoriasis was probably described no later than the first century AD, and the term was coined in the second century. However, a clear association between descriptions recognizable as psoriasis and articular symptoms began in the 19th century. This review was from the English-language, German, and French literature. The development of the differentiation of psoriatic arthritis from clinically similar symptoms, including relevant serologic and radiologic findings and therapeutics with a focus up to the 1960s and the recognition of the efficacy of methotrexate, is reported.

The illnesses of Carlo di Ferdinando I de' Medici: a second opinion.

OBJECTIVES: To offer a second opinion on the recently published retrospective diagnosis of Cardinal Carlo de' Medici (1596-1666), a prominent member of the grand ducal family then ruling Tuscany. METHODS: Retrospective diagnosis of historical figures is difficult and at times controversial, even with modern technology. It is based on contemporaneous medical descriptions and historical reviews, inherited iconography, and rarely - as in the case of the Medici of Florence - skeletal assessment, completed with radiological, histological and even immunological studies. Modern clinical work is often complemented with a second opinion obtained from specialists in the relevant fields. It is this type of second opinion that our collaborative Australian and Italian team, comprised of an orthopaedic/spinal surgeon, a rheumatologist and two medical historians, now offers. RESULTS: The authors concur with the first opinion's diagnosis of Klippel-Feil syndrome in Carlo de' Medici, but disagree with the diagnoses of tuberculosis (Pott's disease) and rheumatoid arthritis. We find evidence, instead, for a psoriatic-DISH arthropathy with involvement of Klippel-Feil syndrome. CONCLUSIONS: A psoriatic-DISH arthropathy, previously described by the present authors as the 'Medici syndrome', was commonly found in the males of the primary branch of the family. The diagnosis of this condition in Cardinal Carlo de' Medici represents its first identification in a male of the secondary (grand ducal) branch of the family.

Historia de la Artritis Psoriática. Primera parte. Desde Alibert hasta V. Wright / History of Psoriatic Arthritis. First part. From Alibert to V. Wright

Presentamos, en esta primera parte de la historia de la artritis psoriática, los eventos que llevaron al conocimiento de esta enfermedad, de cómo se separó de las otras y cómo se generaron los primeros criterios clasificatorios de esta patología.Palabras clave: historia, espondioartropatía, psoriasis, artritis psoriática.

In this first part of the history of psoriatic arthritis, we present the most important events that led to the knowledge of this disease, how it was separated from other inflammatory arthropathies, as well as how the first classificatory criteria in this disease were developed.Key words: history, spondyloarthropathy, psoriasis, psoriatic arthritis.

Autoimmune joint diseases in Late Medieval skeletal sample from Croatia.

Analysis of 25 skeletons from Late Medieval cemetery Uzdolje-Grablje near Knin, Croatia, revealed three cases of systematic pathological changes to joints. Observed pathological lesions were examined macroscopically and radiologically and compared to the available paleopathological standards in order to formulate a differential diagnosis. In all three cases observed changes were most consistent with autoimmune joint diseases including ankylosing spondylitis, juvenile idiopathic arthritis and psoriatic arthritis. Based on published clinical studies, we suggest that the high prevalence of autoimmune diseases in our skeletal sample stems from the genetic basis of the autoimmunity, and that three individuals describe here are possibly closely related.

Psoriatic arthritis from Wright's era until today.

This article reviews advances related to psoriatic arthritis (PsA). While the period since Wright's seminal papers is emphasized, his achievements are reviewed in light of knowledge of PsA in his day, as well as knowledge gained since the seminal work of Wright and Moll. Since other presentations focus on pathogenesis and treatment, this article emphasizes the clinical features and prognosis, as well as development of outcome measures.

"The Leeds Idea": an historical account of the spondarthritis concept.

In the 1960s, Professor Verna Wright became increasingly interested in possible relationships between certain seronegative "variants of rheumatoid arthritis", as they were then generally known. At the Rheumatism Research Unit, a department within the division of medicine at Leeds University, he gathered around him a succession of research workers, whom he inspired to study aspects of these relationships. The focus was on family studies, as it was thought that genetic factors could be important. The striking association previously noted between sacroiliitis or full-blown ankylosing spondylitis and several of these disorders to be studied - e.g., psoriatic arthritis, ulcerative colitis, and the arthritis associated with Crohn's disease - was to be central for each of these studies. As a provisional collective name for these possibly related conditions, the term "Spondarthritides" was chosen. These were the days before HLA B27, and so the research tools were simply clinical, radiological (for sacroiliitis) and serological (for rheumatoid factor). The research programme confirmed not only links between the primary disorders with ankylosing spondylitis, but also links between the disorders themselves. Over subsequent years, the spondarthritis concept (dubbed by some "The Leeds Idea") has gained further strength from HLA studies internationally. And membership of the group of conditions fulfilling spondarthritis criteria has grown substantially. It is hoped that this now consolidated framework of spondylitis-related entities will pave the way for further research, with exciting prospects of gene-based prevention and/or cure through the increasing sophistication of molecular biology.

The classification of psoriatic arthritis: what will happen in the future?

Some patients with psoriasis have articular involvement that falls within the spectrum of seronegative spondyloarthropathies. This form of arthritis has been classified by Moll and Wright into five clinical subsets. Recently this classification has been contested. We review the historical evolution of the concept of psoriatic arthritis and discuss its clinical spectrum.

Psoriatic arthritis in a fifth-century Judean Desert monastery.

Psoriatic arthritis is a greatly underreported seronegative erosive arthropathy, due to the ambiguous lesions it leaves on bone in all but the most severe cases. For a confident diagnosis of psoriatic arthritis to be made, sacroiliac and intervertebral joint fusion must be present together with erosive lesions of the peripheral skeleton including most especially the terminal interphalangeal joints. In modern times it is only a small percentage of cases who experience such debilitating disease, which may explain who so few cases of psoriatic arthritis can confidently be identified from past populations. This report describes this pathological condition as observed in the comingled skeletal remains of nine males and one female from the tomb of Paulus in the Byzantine Monastery of Martyrius, in the Judean Desert. Visual study was complemented using radiographic techniques along with scanning electron microscopy. Two adult males show characteristic lesions of psoriatic arthritis, demonstrating the form known as arthritis mutilans. A third individual shows less widespread erosive lesions which may signify a pauciarticular example of psoriatic arthritis, as is true of most cases in modern times, or the remains may represent Reiter's disease. During the Byzantine period the earlier practise of expelling those with disfiguring diseases (biblical leprosy) evolved into a philanthropic, caring philosophy where the sick were housed and fed out of charity, often within monasteries. The presence of these cases of psoriatic arthritis within such a Judean Desert monastery confirms earlier suggestions that psoriasis was one of the diseases included by those in the ancient eastern Mediterranean under the umbrella term of biblical leprosy.

Psoriatic arthritis. Historical background and epidemiology.

Psoriatic arthritis was first described in the early part of the nineteenth century. Over the past 50 years, concepts of the disease have evolved as a result of clinical, epidemiological, radiological and immunogenetic study. Epidemiological and clinical investigations suggest that the disease is a unique arthropathy rather than the coincident occurrence of two common diseases. There are no validated criteria for classification; this is partly because of the heterogeneous clinical features associated with the disease, and the relapsing and remitting nature of both psoriasis and arthritis. Clinical subgroups have been proposed and have proved useful in study of the disease; however, there are inconsistencies and overlaps in the published data. The population prevalence of psoriatic arthritis is in the range of 2-10 per 10,000 although this is probably an underestimate as those with sacroiliac involvement only are not included. There are currently no incidence figures from population samples. The disease is slightly more common in females than males, although there is variation in the sex ratio by disease subgroup. There is evidence that hormonal and environmental factors play a role in the occurrence of disease.