Position statement for the management of comorbidities in psoriasis.

BACKGROUND: The association between psoriasis and some diseases has become relevant in recent years. Providing appropriate management of psoriasis from an early stage requires prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat psoriasis potentially related to the onset of comorbidities. OBJECTIVE: To provide the dermatologist with an accurate and friendly tool for systematizing the diagnosis of psoriasis-associated comorbidities, which generally escapes the scope of the dermatology setting, and to facilitate decision-making about the referral and treatment of patients with comorbidities. METHODS: These position statement recommendations were developed by a working group composed of ten experts (four dermatologists, one cardiologist, one rheumatologist, one gastroenterologist, one nephrologist, one endocrinologist and one psychiatrist) and two health services researchers. The expert group selected the psoriasis comorbidities considered according to their relevance in the dermatology setting. The recommendations on diagnostic criteria are based on the current clinical practice guidelines for each of the comorbidities. The information regarding the repercussion of psoriasis medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug. RESULTS: Recommendations were developed to detect and refer the following psoriasis comorbidities: psoriatic arthritis, cardiovascular risk factors (diabetes, dyslipidaemia, obesity, hypertension and metabolic syndrome), non-alcoholic fatty liver disease, inflammatory bowel disease, kidney disease and psychological disorders (anxiety and depression). In addition, alcohol consumption and tobacco consumption were included. The tables and figures are precise, easy-to-use tools to systematize the diagnosis of comorbidities in patients with psoriasis and facilitate the decision-making process regarding referral and treatment of patients with an associated disease. CONCLUSION: The application of these position statement recommendations will facilitate the dermatologist practice, and benefit psoriasis patients' health and quality of life.

Clinical, Diagnostic, and Therapeutic Implications in Psoriasis Associated With Cardiovascular Disease. / Implicaciones clínicas, diagnósticas y terapéuticas de la psoriasis y enfermedad cardiovascular.

In recent years the concept of psoriasis as a systemic disease has gained acceptance due to its association with numerous comorbid conditions, particularly atherosclerosis and cardiovascular disease. Several studies have shown that patients with psoriasis, especially younger patients and those with more severe forms of psoriasis or with psoriatic arthritis, have a higher prevalence of risk factors and metabolic syndrome, as well as an increased risk of major cardiovascular events such as myocardial infarction, cerebrovascular disease, and peripheral arterial disease. Furthermore, it remains unclear which of the current treatments might be more effective in reducing cardiovascular risk in these patients. It is therefore important for dermatologists to be aware of this increased risk, to be able to detect modifiable risk factors early and, when appropriate, refer patients to other specialists for the prevention of major cardiovascular events.

[Guidelines for quality management of dialysis solutions]. / Guías de gestión de calidad del líquido de diálisis (LD).

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

[PSA and PSAD study in patients with renal dysfunction]. / Estudio de PSA y PSAD en pacientes con disfunción renal.

This study analyzes the changes in serum and urinary PSA values in 28 subjects; 13 with creatinine clearance under 75 ml/mn and 15 with creatinine clearance over 75 ml/mn. Both groups were compared for prostate size, measured by transrectal ultrasound, prostate weight, serum PSA (SPSA), 24h urine PSA (PSAO), PSA clearance (PSACl), serum creatinine (SCr), creatinine clearance (CrCl), PSA density (PSAD), PSA/creatinine ratio (PSA/Cr) and PSACl/CrCl ratio. Mean values of SPSA and PSAO were 4.5 +/- 0.8 and 222 +/- 29.7 ng/ml respectively, values for SCr, CrCl and PSACl averaging 1.62 +/- 0.2 mgr/dl, 71.6 +/- 6.5 ml/mn and 150.5 +/) 32.9 ml/mn. Median prostate size was 32.6 +/- 3.9 cc, with weights of 40.3 +/- 4.9 g and mean PSA density (PSAD) 0.13 +/- 0.02. The results of the homogeneity study showed that there are no significant differences between both groups with regard to the variables considered in the study. SPSA values were higher in patients with CrCl < 75; 3.4 vs 5.7, but not significantly. There are no significant differences between PSAO and PSACl values for both groups, even though PSAO levels were higher in patients with CrCl < 75 ml/min (p = 0.1). PSAD values for patients with CrCl > 75 ml/mn were lower than those for patients with CrCl < 75 ml/mn; 0.09 vs 0.17 (p = 0.08). In the entire sample, PSAD levels showed correlation with SPSA and PSA/Cr values; R = 0.63 (P = 0.0003) and r = 0.5 (p = 0.009) respectively. Also, they were significantly but inversely correlated with PSACl levels; r = - 0.5 (p = 0.006) and PSACl/CrCl; r = - 0.048 (p = 0.01). No correlation was seen between PSAD values and the following parameters; PSAO (p = 0.7), SCr (p = 0.5) and CrCl (p = 0.27). When the group of patients with CrCl < 75 ml/mn is considered, PSAD values are correlated exclusively with PSACl values; r = - 0.69 (p = 0.008) and PSACl/CrCl; r = 0.68 (p = 0.009). Our data appear to indicate that there is a certain relationship between PSAD and the renal function although the physiopathological mechanism responsible for that is unknown. Nevertheless, considering the sample size, more comprehensive studies will be necessary to obtain more convincing results.

Serum concentrations of carboxyterminal cross-linked telopeptide of type I collagen (ICTP), serum tartrate resistant acid phosphatase, and serum levels of intact parathyroid hormone in parathyroid hyperfunction.

We have studied the levels of a new biochemical marker of bone resorption, carboxyterminal cross-linked telopeptide of type I collagen (ICTP), in 26 healthy control subjects, 15 patients with primary hyperparathyroidism (PHPT) and 17 patients with secondary hyperparathyroidism (secondary HPT). Levels of ICTP in PHPT and secondary HPT have been correlated with those of serum tartrate resistant acid phosphatase (TRAP), another biochemical marker of bone turnover, and with serum levels of intact parathyroid hormone (iPTH). The ICTP levels of the control group were 2.07 +/- 0.58 micrograms l-1, n = 26, range 1.3-3.2. They were independent of sex and age in the studied age range (30-62 years). The ICTP levels of PHPT patients were 3.5 +/- 3.5 micrograms l-1, mean +/- SD, range 0.5-12.2 micrograms l-1, significantly higher than those of control subjects (p < 0.05). We found a significant linear correlation between values of ICTP and iPTH levels (p < 0.01), between values of ICTP and serum activity of TRAP (p < 0.01) and between iPTH and TRAP levels (p < 0.01) in patients with PHPT. The ICTP levels in patients with secondary HPT were higher than those of patients with PHPT, 46 +/- 37 micrograms l-1, range 12-167 micrograms l-1 (p < 0.001) due to the impaired renal clearance of this peptide. We did not find a significant linear correlation between values of ICTP and iPTH levels in the serum of patients with secondary HPT, although we found a significant correlation between levels of ICTP and levels of TRAP, both biochemical markers of bone turnover.(ABSTRACT TRUNCATED AT 250 WORDS)

[Calciphylaxis in chronic renal failure]. / Calcifilaxis en la insuficiencia renal crónica.

Three cases of calciphylaxis in patients with terminal renal insufficiency are discussed. The existence of metastatic calcifications, mainly vascular, in patients with chronic renal insufficiency is frequent. However calciphylaxis is a process which is rarely found in these patients. This entity is characterized by the obliteration of small vessels with ischemia and necrosis. The exceptionality of the disease, its difficult treatment and poor evolution make calciphylaxis a bad prognostic complication which should be considered in the differential diagnosis of cutaneous lesions in patients with chronic renal insufficiency.