Association of 25-hydroxyvitamin D with metabolic syndrome in patients with psoriasis: a case-control study.

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

Life-threatening vasculo-Behçet following discontinuation of infliximab after three years of complete remission.

Behçet's disease (BD) is a chronic, complex multisystem vasculitis of unknown cause characterised for its ability to involve blood vessels of all sizes on both the arterial and venous sides of the circulation. It has been suggested that TNF-alpha plays a main role in the pathogenesis of BD. This hypothesis is supported by the efficacy of TNF-blocking antibodies in these patients, which have been shown to be very powerful in the induction of remission and as maintenance treatment on different BD manifestations, including severe vascular involvement. However, little is known about when and how to stop IFX after long-standing complete remission of these patients to avoid relapses. We describe a case of BD without previous vascular involvement that developed myocardial infarction and severe venous thromboses only four months after discontinuation of infliximab (IFX) after more than three years of complete remission. The patient did not respond to corticosteroids and intravenous cyclophosphamide and only recovered completely after reintroducing IFX.

Association of 25-hydroxyvitamin D serum levels and metabolic parameters in psoriatic patients with and without arthritis.

BACKGROUND: Psoriasis has been related to a higher prevalence of cardiovascular risk factors. Vitamin-D deficiency has been associated with metabolic syndrome, cardiovascular disease, and psoriasis. However, there has been no comparative study on the effects of vitamin-D status between patients with and without psoriatic arthritis. OBJECTIVE: The objective was to assess the relationship of 25-hydroxyvitamin D [25-(OH)D] levels with lipid and glucose metabolism parameters in psoriatic patients with and without arthritis. METHODS: We studied 122 patients with psoriasis (61 without arthritis and 61 with arthritis) from the psoriasis unit (dermatology department) and rheumatology department of our hospital, analyzing lipid and glucose metabolism variables and serum 25-(OH)D concentrations. Measurements were conducted within a 2-month period to minimize seasonal bias in 25-(OH)D levels. RESULTS: In the psoriatic patients without arthritis, serum 25-(OH)D levels were inversely correlated with fasting glucose (r = -0.285; P = .026), total cholesterol (r = -0.440; P = .000), low-density lipoprotein (r = -0.415; P = .001), total cholesterol/high-density lipoprotein (r = -0.303; P = .01), and triglyceride (r = -0.280; P = .029) values. This association remained statistically significant for glucose, total cholesterol, and low-density lipoprotein after controlling for confounding factors in multivariate analysis. No association was found between serum 25-(OH)D levels and any metabolic parameter in the patients with psoriatic arthritis. LIMITATIONS: This is a cross-sectional study that supports the hypothesis of an association between vitamin D and metabolic parameters but does not establish a causal relationship. CONCLUSIONS: Serum 25-(OH)D was inversely related to lipid and glucose metabolism parameters in psoriatic patients without arthritis, whereas no such association was observed in psoriatic patients with arthritis. Interventional studies are warranted to assess the effects of vitamin-D supplements on the metabolic profile of psoriatic patients without arthritis.

Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study.

BACKGROUND: Some autoimmune conditions have been associated with reduced vitamin D levels, including systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, and multiple sclerosis. OBJECTIVE: The main objective of this study was to analyze the 25-hydroxyvitamin D (OHD) status of patients with psoriasis in comparison with control subjects without this disease. METHODS: This case-control study included 86 patients (43 with psoriasis and 43 age- and sex-matched control subjects) from the outpatient clinic of our hospital dermatology department in Granada, Spain. All patients and control subjects were studied during one 4-week period to avoid seasonal variations in vitamin D levels. RESULTS: Serum 25-OHD levels were significantly lower in psoriatic patients than in control subjects even after adjusting for confounding factors in a multivariate analysis (odds ratio 2.89, 95% confidence interval 1.02-7.64, P < .03 for vitamin D insufficiency). Low 25-OHD levels were negatively associated with C-reactive protein (inflammatory activation marker) and body mass index in multiple linear regression analysis. Psoriatic patients with body mass index greater than or equal to 27 kg/m(2) had a higher risk of 25-OHD insufficiency (sensitivity of 82.3% and specificity of 51.7%). LIMITATIONS: Further studies with larger numbers of patients are required to analyze the pathogenic mechanisms underlying the relationship between 25-OHD deficiency and psoriasis. CONCLUSIONS: The 25-OHD values are significantly lower in psoriatic patients than in control subjects. Low 25-OHD levels are negatively associated with C-reactive protein, an inflammatory activation marker, and with obesity. Psoriatic patients with a body mass index of 27 or more are likely to have vitamin D insufficiency.

Atheroma plaque, metabolic syndrome and inflammation in patients with psoriasis.

BACKGROUND: Chronic inflammation plays an important role in the development of cardiovascular risk factors. Although the prevalence of comorbidities and cardiovascular events has been described in patients with psoriasis, few studies have examined subclinical atherosclerosis in psoriasis patients. OBJECTIVE: Our objective was to investigate the prevalence of atheroma plaques in patients with severe psoriasis compared with control subjects and to analyze the association with metabolic syndrome, homocysteine levels and inflammatory parameters. PATIENTS AND METHODS: This case-control study included 133 patients, 72 with psoriasis and 61 controls consecutively admitted to the outpatient clinic in Dermatology Departments (Granada, Spain.) RESULTS: Carotid atheroma plaques were observed in 34.7% of the psoriatic patients versus 8.2% of the controls (p=0.001) and metabolic syndrome was diagnosed in 40.3% of the psoriatic patients versus 13.1% of the controls (p<0.001). Significantly higher mean values of insulin, aldosterone, homocysteine and acute phase parameters (fibrinogen, D-dimer, C reactive protein and erythrocyte sedimentation rate) were found in psoriatic patients. Binary logistic regression showed a strong association between psoriasis and atheroma plaque and metabolic syndrome after controlling for confounding variables. LIMITATIONS: The absence of longitudinal quantification of metabolic syndrome parameters and intima-media thickness in psoriatic patients. CONCLUSION: The chronic inflammation and hyperhomocysteinemia found in psoriatic patients may explain the association with atheroma plaque and metabolic syndrome. Cardiovascular screening by metabolic syndrome criteria assessment and carotid ultrasound in psoriasis may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.

Cutaneous plaque in a diabetic patient - a case study.

CASE STUDY: A man, 31 years of age, with type 1 diabetes, presents with a slightly pruritic plaque located on the lateral aspect of his left elbow.

Multiple finger nodules and an erythematous rash - a case study.

CASE STUDY: A previously well male, 18 years of age, from a rural community, presented with three painful, itchy nodules on the fingers of his left hand, which had been present for 1 week. He had been prescribed amoxicillin clavulanate but presented again when there was no improvement after 4 days of taking antibiotics. Examination revealed three erythematous and umbilicated nodules without any halo, but with a central depression with exudate (Figure 1a). No specific treatment was instituted at this visit. One week later the patient re-presented with new erythematous lesions on the palms and dorsum of his hands. The original three lesions had improved and were drier than previously (Figure 1b, c). The new lesions disappeared after 2 weeks and the original lesions after 4 weeks, without any other treatment.

Interdigital erosions - tinea pedis?

Interdigital erosions are frequently due to tinea pedis. However, other infectious conditions, such as candidiasis, erythrasma or bacterial infections, can generate lesions that cannot be differentiated at the clinical level. Microbiological tests are therefore necessary. This clinical case shows a man with interdigital lesions of 10 months of evolution that are not responding to antifungal treatment.

Right ventricular dysfunction in acute pulmonary embolism: NT-proBNP vs. troponin T. / Disfunción del ventrículo derecho en la embolia pulmonar aguda: NT-proBNP frente a troponina T.

BACKGROUND AND OBJECTIVE: Dysfunction of the right ventricle (RV) is a parameter of severity in acute pulmonary embolism (PE). Echocardiographic assessment is not always possible in accident and emergency, hence the need to predict the presence of RV dysfunction using easily measurable parameters. To analyse the value of NT-proBNP and troponin T as markers of RV dysfunction in patients with acute PE. Secondarily, to assess the relationship between RV failure and clinical parameters related to PE. MATERIAL AND METHOD: Analytical, observational, cross-sectional and retrospective study comparing the values NT-proBNP, troponin T and presenting symptoms of PE among patients with and without RV dysfunction. RESULTS: One hundred seventy-two patients (52 with RV failure,120 without) were included. All symptoms occurred with similar frequency between the 2groups except dyspnea and syncope (more common in the group with RV failure). Both NT-proBNP and troponin T had significantly higher values in the group of patients with RV dysfunction. However, in the multivariate analysis, NT-proBNP had a higher explanatory value for RV failure than troponin T. CONCLUSION: NT-proBNP is a diagnostic parameter of RV dysfunction with higher sensitivity in the context of acute PE.

Bullous pemphigoid in infant post vaccination: Myth or reality?

Bullous pemphigoid is rare in children and even rarer in infants. By presenting two cases of bullous pemphigoid related by their temporal proximity with a previous episode of vaccination, it will be carefully discussed if a relationship is or is not possible. Our final conclusion is that the association is mostly a myth rather than a reality and bullous pemphigoid is not a contraindication to continue with the normal vaccination schedule of infants. It is important to know about this clinical entity in order to perform adequate treatment that avoids any worsening or future relapse of this disease.

Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients.

BACKGROUND: Psoriasis has been associated with vitamin D insufficiency and cardiovascular risk factors. Reports show that serum 25-hydroxyvitamin D (25-OHD) levels are inversely associated with chronic inflammatory systemic diseases, cardiovascular risk factors and cardiovascular outcomes. OBJECTIVE: To analyze the association between 25-hydroxyvitamin D serum levels and subclinical carotid atherosclerosis (maximal intima-media thickness (MIMT)) in psoriasis patients and controls. MIMT was compared and associated factors were analyzed. PATIENTS AND METHOD: This was a case-control study with 44 psoriatic patients without arthritis from a Dermatology outpatient clinic in Granada (Spain) and 44 controls. Confounding factors related to 25-OHD serum levels and cardiovascular risk factors were also analyzed. RESULTS: 25-OHD levels were significantly lower in the psoriatic than in the control group (29.20 vs. 38.00 ng/mL p<0.0001) and a significant negative correlation was found between serum 25-OHD levels and the MIMT (rs=-0.678, p<0.0001) in psoriatic patients. No correlation was found in healthy controls. This association remained after adjusting for confounders. Serum 25-OHD levels were significantly lower (p=0.003) in psoriatic patients with carotid atheromatous plaque (22.38±10.23 ng/mL) than in those without (31.74±8.62 ng/mL). Patients with a longer history of psoriasis presented significantly higher MIMT than controls (638.70±76.21 vs 594.67±80.20 µm; p=0.026 for ≥6 yrs with psoriasis). CONCLUSIONS: In psoriasis patients, lower serum 25-OHD levels were associated with higher MIMT after adjusting for selected confounding factors. The MIMT risk increases with a longer history of psoriasis, regardless of the patient's age.

Effects of aminobisphosphonates and thiazides in patients with osteopenia/osteoporosis, hypercalciuria, and recurring renal calcium lithiasis.

OBJECTIVE: To analyze the effects of aminobisphosphonates and thiazides on renal lithogenic activity and bone mineral density in patients with recurring renal calcium lithiasis. MATERIALS AND METHODS: A prospective cohort study with 3 years of clinical follow-up data was performed. The study included 2 groups of patients with recurring calcium lithiasis, hypercalciuria, and bone mineral density loss. Group 1 included 35 patients who underwent treatment with 70 mg/wk alendronate. Group 2 included 35 patients who underwent treatment with 50 mg/d hydrochlothiazide and 70 mg/wk alendronate. Biochemical analysis was performed at baseline, 6 months, and 2 years, bone densitometry at baseline and 2 years, and clinical follow-up during the 3 years of treatment. The biochemical variables from the blood and urine samples, recurrent lithiasis, and bone mineral density were analyzed. RESULTS: Age, sex, baseline biochemical markers, and bone density showed no differences between the 2 treatment groups at the onset of treatment. After 2 years of treatment, group 1 showed a significant decrease in bone turnover markers and calciuria and significant improvement in bone mineral density. After 2 years of treatment, group 2 showed a decrease in calciuria and bone markers. At 2 years, the decrease in calciuria and the improvement in bone mineral density were greater in group 2 than in group 1, and the difference was statistically significant. CONCLUSION: Aminobisphosphonates improve bone mineral density and slow lithogenic activity; however, administration of aminobisphosphonates in association with thiazides produced the same clinical effects and also reduced calciuria and improved bone mineral density.

Association of severe calcium lithogenic activity and bone remodeling markers.

OBJECTIVE: To establish cutoff points for markers of bone remodeling that allow for screening of patients at risk for serious lithogenic activity. MATERIALS AND METHODS: We conducted a cross-sectional study with 182 patients (aged between 25 and 60 years) divided into 3 groups: group 1, 56 patients without lithiasis; group 2, 67 patients with light calcium lithiasis; and group 3, 59 patients with severe calcium lithiasis. The criteria for inclusion in and exclusion from the study were established, and light and severe lithogenic activity were defined. Metabolic variables in blood and urine, along with bone densitometry, were studied for the groups. Statistical analysis of the results and preparation of receiver operating characteristic curves to establish optimal cutoff points were performed. RESULTS: The patients in group 3 showed the greatest bone mineral density loss and the highest values for markers of bone remodeling, together with increased 24-hour calciuria. Using the receiver operating characteristic curves developed and based on statistical significance (P = .0001), the following cutoff points for severe lithogenic activity, with a sensitivity between 75% and 85%, were established: ß-crosslaps >0.331 ng/mL; osteocalcin >13.2 ng/mL; ß-crosslaps/osteocalcin >0.024; 24-hour calciuria >306.6 mg; and fasting urine calcium/creatinine >0.105. CONCLUSION: Patients with calcium lithiasis and elevated values for osteocalcin, ß-crosslaps, ß-crosslaps/osteocalcin, 24-hour calciuria, and fasting urine calcium/creatinine may present a high risk of severe lithogenic activity.