Factores de riesgo cardiovascular en pacientes con artritis psoriásica / Cardiovascular Risk Factors in Patients with Psoriatic Arthritis

Introducción: La presencia de factores de riesgo cardiovascular agrava el pronóstico de los pacientes con artritis psoriásica. Objetivo: Determinar los factores de riesgo cardiovascular en pacientes con diagnóstico de artritis psoriásica. Métodos: Se realizó un estudio descriptivo de corte transversal, en el Servicio de Reumatología del Hospital Hermanos Ameijeiras, en el período de enero de 2021 a abril de 2022. Se recogieron variables demográficas, clínicas y hemoquímicas relacionadas con la enfermedad, así como el score de riesgo de Framingham y la evaluación de aterosclerosis carotídea subclínica. Resultados: Se incluyeron 89 pacientes con edad media de 56,3 ± 11,8 años, 69,7 por ciento del sexo femenino 48,3 por ciento con evolución mayor de 10 años y 77,5 por ciento con afectación periférica. La actividad de la enfermedad por el índice ASDAS fue alta (55,1 por ciento) igual que por BASDAI (68,5 por ciento). Los factores de riesgo cardiovascular más frecuentes fueron: dislipidemia (61,8 por ciento), obesidad (59,6 por ciento) hipertensión arterial (50,6 por ciento). La obesidad, la diabetes y la hipertensión arterial fueron mayores en pacientes con elevada actividad de la enfermedad. La aterosclerosis carotídea fue mayor en pacientes con tabaquismo, diabetes y dislipidemia. El 39,3 por ciento presentó grosor íntima media aumentado, y el 27,0 por ciento con presencia de placa carotídea. En pacientes con aterosclerosis carotídea el 25,7 por ciento fue considerado como riesgo bajo por Framingham. Conclusiones: Los factores de riesgo cardiovascular se presentaron con una frecuencia elevada, asociado a la aterosclerosis subclínica, a la actividad inflamatoria y a una subestimación de riesgo por la escala de Framingham(AU)

Introduction: The presence of cardiovascular risk factors aggravates the prognosis of patients with psoriatic arthritis. Objective: To determine cardiovascular risk factors in patients diagnosed with psoriatic arthritis. Methods: A descriptive cross-sectional study was carried out at the Rheumatology Service of Hermanos Ameijeiras Hospital from January 2021 to April 2022. Demographic, clinical, and hemochemical variables related to the disease were collected, as well as Framingham risk score and he evaluation of subclinical carotid atherosclerosis. Results: Eighty nine patients with mean age of 56.3 ± 11.8 years were included, 69.7percent female, 48.3percent with evolution older than 10 years and 77.5percent with peripheral involvement. Disease activity by ASDAS index was high (55.1percent), the same as by BASDAI (68.5percent). The most frequent cardiovascular risk factors were dyslipidemia (61.8percent), obesity (59.6percent) and arterial hypertension (50.6percent). Obesity, diabetes and arterial hypertension were higher in patients with high disease activity. Carotid atherosclerosis was higher in patients with smoking habits, diabetes, and dyslipidemia. 39.3percent showed increased intima media thickness and 27.0% had carotid plaque. In patients with carotid atherosclerosis, 25.7percent were considered low risk by Framingham. Conclusions: Cardiovascular risk factors occurred with high frequency, associated with subclinical atherosclerosis, inflammatory activity and underestimation of risk by the Framingham scale(AU)

Prevalence of psoriatic arthritis in Chinese population with psoriasis: A multicenter study conducted by experienced rheumatologists / 中华医学杂志(英文版)

BACKGROUND@#Reports on the prevalence of psoriatic arthritis (PsA) among Chinese patients with psoriasis are very limited. This study, conducted by rheumatologists, estimated the prevalence of PsA in a large number of Chinese patients with psoriasis.@*METHODS@#Consecutive patients with a confirmed diagnosis of psoriasis attending nine dermatology clinics in five hospitals were recruited. All psoriasis patients were asked to complete a questionnaire comprising 16 questions to identify possible cases of PsA. All patients with one or more positive answers to the questionnaire were evaluated by two experienced rheumatologists.@*RESULTS@#A total of 2434 psoriasis patients, including 1561 males and 873 females, were enrolled. Both the questionnaire and rheumatologists' examinations were completed in the dermatology clinics. The results identified 252 patients with PsA, comprising 168 males and 84 females. The overall prevalence of PsA among psoriasis patients was 10.4% (95% confidence interval [95% CI], 9.1%-11.7%). By sex, the prevalence was 10.8% (95% CI, 9.2%-12.5%) for males and 9.6% (95% CI, 7.7%-11.9%) for females and there was no significant sex difference in the prevalence of PsA (P = 0.38). Of the 252 PsA patients, 125 (49.6%, 95% CI, 41.3%-59.1%) were newly diagnosed by rheumatologists. Consequently, the prevalence of undiagnosed PsA among psoriasis patients was 5.2% (95% CI, 4.4%-6.2%).@*CONCLUSION@#The prevalence of PsA in the Chinese population with psoriasis is about 10.4%, which is almost double that of previous reports in the Chinese population, but lower than that in Caucasians.

Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR) / 中华医学杂志(英文版)

BACKGROUND@#The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.@*METHODS@#Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.@*RESULTS@#In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use.@*CONCLUSIONS@#Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.

Role of Interleukin-36 in inflammatory joint diseases / 浙江大学学报·医学版

Interleukin (IL)-36 is a family of cytokines that belongs to the larger IL-1 superfamily. IL-36 agonist/antagonist binds to the interleukin-36 receptor involving in physiological inflammation regulation and pathogenesis of many inflammatory diseases. In inflammatory joint diseases, the expression of IL-36 changes, and some studies have initially explored the role of IL-36 in these diseases. In psoriatic arthritis, IL-36 signal mediates plasma cell and fibroblast-like synoviocyte crosstalk presenting IL-36 agonist/antagonist imbalance. In rheumatoid arthritis, IL-36 agonists induce fibroblast-like synoviocyte to produce pro-inflammatory factors, while IL-36 antagonist deficiency leads to lesion progression. In osteoarthritis, IL-36 agonists induce chondrocytes to produce catabolic enzymes and pro-inflammatory factors. This article reviews the expression and function of IL-36 in different inflammatory joint diseases to provide a reference for revealing their pathogenic mechanisms and discovering therapeutic targets.

Impacto de la presencia de depresión y ansiedad en pacientes con artritis psoriásica / Impact of depression and anxiety in patients with psoriatic arthritis

Introducción: un tercio de los pacientes con artritis psoriásica (APs) sufre ansiedad y/o depresión, lo que podría impactar negativamente en la actividad de la enfermedad. Los objetivos de este estudio fueron: evaluar la prevalencia de depresión y ansiedad en pacientes con APs, estudiar su asociación con diferentes factores sociodemográficos y clínicos, y determinar el efecto sobre los diferentes componentes de los índices compuestos de la actividad de la APs. Materiales y métodos: se incluyeron pacientes con APs que cumplían criterios de la Classification criteria of psoriatic arthritis (CASPAR). La depresión se definió según el Patient Health Questionnaire-9 (PHQ-9) y la ansiedad según el cuestionario General Anxiety Disorder-7 (GAD-7). Se realizó regresión logística múltiple para identificar variables asociadas a ansiedad y depresión. Resultados: se incluyeron 100 pacientes con APs, de los cuales el 26% y el 59% presentaron depresión mayor y ansiedad respectivamente. Los pacientes con depresión mayor tuvieron mayor actividad de la enfermedad, dolor, fatiga, ansiedad, y menor educación formal y peor calidad de vida. Aquellos con ansiedad manifestaron mayor actividad de la enfermedad, dolor y fatiga, y peor calidad de vida y capacidad funcional. La alta actividad de la enfermedad y la menor educación formal se asociaron independientemente con depresión mayor. Conclusiones: la presencia de depresión mayor y ansiedad se asoció con mayor actividad de la enfermedad en pacientes con APs.

Introduction: nearly one-third of psoriatic arthritis (PsA) patients suffer from anxiety and/or depression. The objectives of this study were to estimate the prevalence of depression and anxiety in patients with PsA, establish the relationship with different socio-demographic and clinical factors, and determine the effect of depression and anxiety on various components of disease activity scores. Materials and methods: patients with PsA who met the Classification criteria of psoriatic arthritis (CASPAR) criteria were included. Depression was defined according to the Patient Health Questionnaire-9 (PHQ-9) and anxiety according to the General Anxiety Disorder-7 (GAD-7) questionnaire. Multiple logistic regression was performed to identify variables associated with anxiety and depression. Results: 100 patients were included. The prevalence of major depression and anxiety was 26% and 59%, respectively. Patients with major depression had higher disease activity, pain, fatigue and anxiety, less formal education and worse quality of life. In comparison those patients with anxiety showed higher disease activity, pain and fatigue and worse quality of life and functional capacity. High disease activity and low formal education were independently associated with the existence of major depression. Conclusions: patients with PsA who suffer from major depression and anxiety show higher disease activity levels.

Biological therapy in psoriatic arthritis patients with and without previous biologic experience / Terapia biológica em pacientes com artrite psoriásica com e sem experiência prévia no uso de medicamentos biológicos

Objective: this study evaluated the biological therapy effects on disease activity, functionality, quality of life, drug survival, and safety of patients with psoriatic arthritis naïve and experienced in biological therapy. Methods: a one-year prospective observational study was performed. The outcomes assessed were drug survival, disease activity, functionality, quality of life, and safety. Multiple linear regression was used to assess predictive factors for clinical re-sponse. Results: a total of 205 patients were included, 155 of whom were biologic naïve and 50 biologic experienced. Drug survival rate was greater for naïve patients than experienced patients at 6 months, but not at 12 months. Drug survival rates were 71.5% for naïve patients and 70.0% for experienced patients at 12 months. All clinical parameters improved for both biologic naïve and experienced patients. At 12 months, 63% of naïve patients and 52% of expe-rienced patients had an improvement in their quality of life. Besides, 48% of naïve patients and 42% of experienced patients had an improvement in functionality. The axial disease improved in 67% of naïve individuals and 56% of experienced patients. Good control of peripheral disease was achieved by 49% of naïve patients and 44% of experi-enced patients. Female sex, use of etanercept or infliximab, and lower functionality or quality of life at baseline were the main predictors of poor clinical response. Conclusion: Patients' health improved after starting biological therapy. In general, biologic experienced patients had more adverse reactions and lesser effectiveness (AU)

Objetivo: avaliar os efeitos da terapia biológica sobre a atividade da doença, funcionalidade, qualidade de vida, per-sistência no tratamento e segurança em pacientes com artrite psoriásica sem experiência e com experiência prévia em terapia biológica. Métodos: um estudo observacional prospectivo de um ano foi realizado. Os desfechos avaliados foram a persistência no tratamento, atividade da doença, funcionalidade, qualidade de vida e segurança. Um modelo de regressão linear múltipla foi utilizado para avaliar os fatores preditores de resposta clínica. Resultados: foram incluídos 205 pacientes, dos quais 155 não tinham e 50 tinham experiência prévia com medicamentos biológicos. As taxas de persistência no tratamento foram maiores para pacientes sem experiência prévia em comparação aos experientes em seis meses de acompanhamento, mas não em 12 meses. As taxas de persistência no tratamento foram 71,5% em pa-cientes sem experiência prévia e 70% em pacientes com experiência prévia em 12 meses. Todos os desfechos clínicos avaliados melhoraram em ambos os grupos de pacientes. Aos 12 meses, 63% dos pacientes sem experiência prévia e 52% dos pacientes com experiência prévia apresentaram melhora na qualidade de vida. Além disso, 48% dos pacientes sem experiência prévia e 42% dos pacientes com experiência prévia apresentaram melhora na funcionalidade. A do-ença axial melhorou em 67% dos pacientes sem experiência prévia e em 56% dos pacientes com experiência prévia. Um bom controle da doença articular periférica foi observado em 49% dos pacientes sem experiência prévia e em 44% dos pacientes com experiência prévia. Os principais fatores preditores de pior resposta clínica foram sexo feminino, uso de etanercepte ou infliximabe, bem como pior funcionalidade e qualidade de vida no início do estudo. Conclusão:a saúde dos pacientes melhorou após o início do tratamento com os medicamentos biológicos. Em geral, pacientes com experiência prévia com medicamentos biológicos apresentaram mais reações adversas e menor efetividade (AU)

Comorbilidades en pacientes con artropatía psoriásica / omorbidities in patients with psoriatic arthropathy

Introducción: En los últimos años, diversas investigaciones han demostrado que la presencia de comorbilidad agrava el pronóstico de los pacientes con artritis psoriásica. Objetivo: Determinar las comorbilidades en pacientes con diagnóstico de artritis psoriásica. Métodos: Se realizó un estudio descriptivo de corte transversal, en el servicio de Reumatología del Hospital Clínico Quirúrgico Hermanos Ameijeiras, que incluyó 111 pacientes con artritis psoriásica durante el periodo comprendido entre enero de 2016 a febrero de 2018. Resultados: El grupo de edad más representado fue el de 50 a 60 años, predominó el sexo femenino (63,1 por ciento) y el color de piel blanca (77,5 por ciento). El 50,5 por ciento presentó un tiempo de evolución de la artritis psoriásica mayor de 10 años. El 94,5 por ciento expresó el patrón articular periférico y la forma clínica articular más frecuente fue la oligoarticular (56,7 por ciento). Las comorbilidades identificadas con mayor frecuencia fueron la obesidad (80,18 por ciento), dislipidemia (68,46 por ciento), hipertensión arterial (HTA) (54,95 por ciento) y el hígado graso no alcohólico (53,15 por ciento). El 73,0 por ciento presentó tres o más comorbilidades. El sexo y el tiempo de evolución de la enfermedad y la actividad inflamatoria no mostraron una relación significativa. La actividad inflamatoria de la enfermedad se demostró en el 83,8 por ciento. Conclusiones: Se evidenció la presencia de comorbilidades asociadas en pacientes con APs, presentándose con mayor frecuencia, la obesidad, dislipidemia, HTA e hígado graso no alcohólico. Un porcentaje elevado de pacientes presentaron más de tres comorbilidades y no se demostró asociación significativa entre el número de comorbilidades y variables de la enfermedad(AU)

Introduction: In recent years, various investigations have shown that the presence of comorbidity worsens the prognosis of patients with psoriatic arthritis. Objective: To determine the comorbidities in patients diagnosed with psoriatic arthritis. Methods: A descriptive cross-sectional study was conducted in the Rheumatology service of the Hermanos Ameijeiras Clinical-Surgical Hospital, which included 111 patients with psoriatic arthritis from January 2016 to February 2018. Results: The age group most represented was that of 50 to 60 years, female sex (63.1`percent) and white skin color (77.5percent) patients predominated. 50.5percent had a psoriatic arthritis evolution time greater than 10 years. 94.5percent expressed the peripheral joint pattern and the most frequent joint clinical form was oligoarticular (56.7percent). The most frequently identified comorbidities were obesity (80.18percent), dyslipidemia (68.46percent), arterial hypertension (HBP) (54.95percent) and non-alcoholic fatty liver (53.15percent). 73.0percent had three or more comorbidities. The sex and the time of evolution of the disease and the inflammatory activity did not show significant relationship. The inflammatory activity of the disease was demonstrated in 83.8percent. Conclusions: The presence of associated comorbidities was evidenced in patients with PsA, with obesity, dyslipidemia, hypertension, and non-alcoholic fatty liver occurring more frequently. A high percentage of patients had more than three comorbidities and no significant association was demonstrated between the number of comorbidities and disease variables(AU)

Systemic amyloidosis manifestation in a patient with psoriatic arthritis

Abstract Systemic amyloidosis secondary to psoriatic arthritis is rare, and published data are based mainly on case reports and are associated with increased mortality. This is the report of a patient with long-term psoriatic arthritis and chronic sialadenitis, who showed an inadequate response to therapy. The diagnosis of secondary amyloidosis was attained through biopsies of genital skin lesions. Although very rare, it is important that dermatologists and general practitioners consider the possibility of amyloidosis in patients with chronic inflammatory diseases, since an early intervention can be implemented, and thus, the prognosis of this condition can be improved.

Prevalence of psoriatic arthritis among patients with plaque psoriasis: a Brazilian retrospective study

ABSTRACT BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.

Hiperuricemia em psoriase e artrite psoriática / Hyperuricemia in psoriasis and psoriatic arthritis

Introdução: A psoríase é uma doença inflamatória crônica, imunomediada, de base genética, com grande polimorfismo de expressão clínica. É caracterizada pelo envolvimento de pele, unhas e, eventualmente, articulações. De ocorrência mundial, possui prevalência entre 2 a 3% na população geral. Entre 20-30% dos pacientes com psoríase desenvolvem a artrite psoriática (AP) a qual pode preceder, estar associada ou suceder o aparecimento da psoríase. A hiperuricemia é uma condição frequentemente associada a pacientes psoriásicos. Objetivos: Estudar a prevalência de hiperuricemia em pacientes com psoríase e sua possível associação com o fenótipo da doença, atividade articular e cutânea. Metodologia: Trata-se de um estudo transversal e analítico realizado através da avaliação de ácido úrico de 58 pacientes diagnosticados com psoríase (com e sem AP) acompanhados pelos ambulatórios de dermatologia e reumatologia do Hospital Universitário Evangélico Mackenzie de Curitiba, PR. Resultados: Cerca de 58 indivíduos foram analisados; dentre eles 24 mulheres e 34 homens, com mediana da idade é de 57 anos. Dos pacientes acometidos pela psoriase, a hiperuricemia esteve presente em 13,7%, sendo mais prevalente no sexo masculino (p=0.01)., nos com artrite psoriásica (p=0.04) e naqueles com envolvimento ungueal (p=0.006) e mais rara naqueles com a forma vulgar da psoríase (p<0.0001). Nenhum paciente apresentou artrite gotosa. A atividade da doença de pele e da doença articular não interferiram nos níveis de ácido úrico (p=ns). Conclusão: Pacientes com artrite psoriásica têm maior incidência de hiperuricemia do que aqueles com psoríase só de pele. Hiperuricemia é mais comum nos pacientes masculinos, com envolvimento ungueal e menos comum naqueles com psoríase vulgar

Introduction: Psoriasis is a chronic, immunomodulated, genetic-based inflammatory disease with great polymorphism of clinical expression. It is characterized by the involvement of skin, nails and eventually joints. It has a worldwide occurrence, with prevalence between 2 and 3% in the general population. Between 20-30% of patients with psoriasis develop psoriatic arthritis (PA), which may precede, be associated with, or succeed psoriasis. Hyperuricemia is a condition often associated with psoriatic patients. Objectives: To study the prevalence of hyperuricemia in patients with psoriasis and its possible association with the phenotype of the disease, joint and skin activity. Methodology: This is a cross-sectional and analytical study conducted through the evaluation of uric acid in patients diagnosed with psoriasis (with and without PA) followed by dermatology and rheumatology outpatient clinics of the Mackenzie Evangelical University Hospital of Curitiba, PR. Results: About 58 individuals were analyzed; among them 24 women and 34 men, with a median age of 57 years. Of the patients affected by psoriasis, hyperuricemia was present in 13.7%, being more prevalent in males (p=0.01), in those with psoriatic arthritis (p=0.04) and in those with nail involvement (p=0.006) and less common in those with the vulgar form of psoriasis (p<0.0001). No patient had gouty arthritis. Skin disease and joint disease activities did not interfere with uric acid levels (p=ns). Conclusion: Patients with psoriatic arthritis have a higher incidence of hyperuricemia than those with skin-only psoriasis. Hyperuricemia is more common in male patients, with nail involvement and less common in those with psoriasis vulgaris

Análise do perfil clínico e epidemiológico de pacientes com artrite psoriásica em ambulatório de reumatologia na Região Amazônica / Clinical and epidemiological profile analysis of patients with psoriatic arthritis in a rheumatology clinic in the Amazon Region

Objetivo: Conhecer o perfil clínico e epidemiológico de pacien- tes portadores de artrite psoriásica de uma região brasileira. Método: Pesquisa observacional, transversal, epidemiológica e documental, baseada na coleta de dados obtidos a partir da análise de 53 prontuários de pacientes cadastrados do Ambu- latório de Reumatologia da Universidade do Estado do Pará, na Região Amazônica. Resultados: Houve predominância do padrão do tipo poliartrite simétrica, sem distinção entre os sexos, com a presença de manifestações extra-articulares, pso- ríase em placas, em uso de metotrexato em doses médias. Con- clusão: Apesar da etiopatogenia da doença ser dependente de fatores genéticos, ambientais e imunológicos e da população amazônica ser muito particular, de uma miscigenação entre eu- ropeus, ameríndios e negros, o perfil clínico e epidemiológicos dos pacientes do Ambulatório de Reumatologia da Universidade do Estado do Pará é semelhante ao das literaturas nacional e internacional.

Objective: To know the clinical and epidemiologic profile of pso- riatic arthritis patients of a Brazilian region. Method: This is an observational, cross-sectional, epidemiological, and documental study, based on the data obtained from the analysis of the medi- cal records of 53 patients registered on the Rheumatology Cli- nic of the Universidade do Estado do Pará, in the Amazon area. Results: There was a predominance of the symmetrical polyar- ticular pattern, with no sexual distinction, extra articular invol- vement, plaque psoriasis, and treatment withn methotrexate, in medium doses. Conclusion: Despite the etiopathogenesis being dependent on genetic, environmental, and immunological fac- tors, and the population of the Amazon being a mix of Europeans, Amerindians, and black people, the clinical and epidemiological profile of the patients of the Rheumatology clinic of the Univer- sidade do Estado do Pará is similar to the ones described on the national and international literature.

Psoriatic Arthritis Quality of Life Questionnaire: translation, cultural adaptation and validation into Brazilian Portuguese language

Abstract Introduction: Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that can cause joint destruction and impair quality of life. The Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) was the first disease-specific tool for determining the impact of the disease on the quality of life of people with PsA. Objectives: The primary objective was to develop and validate a Brazilian Portuguese version of the PsAQoL. Methods: The UK PsAQoL was translated into Brazilian Portuguese using two translation panels. This translation then checked for face validity and construct validity with new samples of patients. Finally, a test-retest validation study was conducted with 52 patients with PsA. The survey included the Nottingham Health Profile (NHP) as a comparator instrument. Results: Internal consistency and reproducibility were both excellent for the new adaptation (0.91 and 0.90 respectively Scores on the PsAQoL were found to correlate as expected with the comparator measure and the instrument was able to detect differences in score related to perceived severity of PsA, general health status and presence of a flare. Conclusions: The Brazilian PsAQoL was found easy to understand and complete and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine PsA practice and clinical trials.

Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis

Abstract Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.(AU)

Risk factors associated with osteoporosis and fracture in psoriatic arthritis / 中华医学杂志(英文版)

BACKGROUND@#Although there are few studies mentioned there may be some relationship between psoriatic arthritis (PsA) and osteoporosis, clinical data in real world still need to be clarified in China. The aim of this study was to assess the areal and volumetric bone mineral density (BMD), frequency of fracture, and risk factors in patients with PsA.@*METHODS@#A total of one hundred PsA patients who visited Peking University First Hospital and one hundred age- and sex-matched healthy controls with DXA data were enrolled in the study. Patients with clinical fractures confirmed by X-ray during follow-up were also recorded. Clinical characteristics of the patients were recorded and compared between the abnormal BMD group and the normal BMD group, as well as between the fracture and non-fracture groups. Risk factors for fracture and low BMD were analyzed.@*RESULTS@#Mean BMD at the total hip and femoral neck was significantly lower in PsA patients than that in healthy controls (0.809 ± 0.193 vs. 0.901 ± 0.152 g/cm2, P  = 0.041; 0.780 ± 0.146 vs. 0.865 ± 0.166 g/cm2, P  = 0.037, respectively). Moreover, lumbar spine BMD was negatively correlated with psoriasis duration, swollen joint count and DAS28-CRP (r = -0.503, -0.580, -0.438; P < 0.05). Total hip BMD and femoral neck BMD were negatively correlated with HAQ (r = -0.521, -0.335; P < 0.05). Fractures occurred in 29 patients during the follow-up period. Logistic regression analysis showed that older age (OR 1.132 [95%CI: 1.026-1.248), P < 0.05], higher HAQ score (OR 1.493, 95%CI: 1.214-1.836, P < 0.01), higher disease activity index for psoriatic arthritis (OR 1.033, 95% CI: 1.002-1.679, P < 0.05) and hip joint involvement (OR 6.401, 95% CI: 4.012-44.180, P < 0.05) were risk factors for fracture in the multivariate model.@*CONCLUSIONS@#Increased risks of osteoporosis and fracture were found in PsA patients compared to healthy controls. Besides age, high disease activity and hip joint involvement were risk factors for decreased BMD and fracture.

Multicentric reticulohistiocytosis: A case report / 北京大学学报(医学版)

A 65-year-old woman developed erythema, papules and nodules over the body. Some nodules of her auricles and hands like string beads. Besides, she suffered from symmetrical swelling and pain of multiple joints, morning stiffness with deformity of joints; She had elevated erythrocyte sedimentation rate and C reactive protein levels; Her rheumatoid factor and antinuclear antibody were positive; Joints destruction was found with X-ray imaging; Skin pathology showed Dermal infiltrate of abundant histiocytes, part of them with a ground-glass appearance; A CD68 immunohistochemical stain was positive and the cells were negative for S100, CD1a. These findings were diagnostic evidences of multicentric reticulohistiocytosis (MRH). The patient received high-dose of glucocorticoids combinated with immunosuppressive agents, and achieved a satisfactory effect. MRH was a rare multisystem disease characterized by papulonodular mucocutaneous and destructive arthritis, and its pathogeny was not yet completely understood. The typical lesions of MRH were hard papules or nodules that usually occured on the hands, face and arms. Classic coral bead appearance from periungual cutaneous nodules that were characteristic of MRH. MRH was an inflammatory joint disease, affecting almost all the appendicular joints and characterized by joint multiple, symmetrical, destructive, progressive disability. Joints destruction of the distal interphalangeal joints was a unique feature of MRH. In addition to skin and joints, it could also involve other systems. There were no diagnostic laboratory markers for MRH. Laboratory examinations had often been found to be non-specific. Imageological examination mainly showed bone and joint destruction. Skin biopsy was the best test to diagnose MRH, the typical histopathological findings included an infiltrate with histiocytes and multinucleated giant cells with a ground-glass appearing in eosinophilic cytoplasm, and the immunohistochemical stain was positive for CD68. The diagnosis was typically made based on the clinical presentation, supportive radiographic findings and skin biopsy. MRH was easily possible to mistake for other more common autoimmune conditions, such as rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and dermatomyositis, but the distinctive clinical, radiographic, and histologic features could aid in differentiating these diseases. MRH could mimic other rheumatic diseases, besides, it could also coexist with cancer or other autoimmune disorders. There was no standardized treatment for MRH. However, Nonsteroidal anti-inflammatory drugs, glucocorticoid, Immunosuppressant, biologic medications, and bisphosphonates had been used with varying degrees of curative effect. Treatment with glucocorticoid combined with immunosuppressants were effective for rash and arthritis, early use of them should be strongly considered, and refractory cases could be treated with biological agents. By reporting a MRH case and reviewing literature, this paper aims to help the clinicians improve the understanding of this rare disease, and suggests that when one diagnosis cannot explain the whole picture of the disease, and further evidence should be sought to confirm the diagnosis.

Benefit of ultrasound in the phenotype recognition of psoriatic arthritis / 北京大学学报(医学版)

OBJECTIVE@#To explore the difference in phenotype recognition of PsA patients in two clinical scenarios, physical examination with and without ultrasound assessment.@*METHODS@#PsA patients who visited the rheumatology and clinical immunology department of Peking University First Hospital between January 2010 and October 2020, with complete data of clinical and ultrasound assessment were enrolled. The phenotypes were first identified based on physical examination only, and then combined with enthesitis and dactylitis shown on power doppler and gray-scale ultrasound. The phenotype groupings without and with ultrasound assessment were presented with Wayne diagram. The distributions of different clinical phenotypes were compared by using χ2 test or Fisher's exact test. The differences of clinical phenotypes with and without ultrasound assessment were compared by using Wilcoxon signed rank test.@*RESULTS@#A total of 227 patients with PsA were enrolled with one or more clinical domains. Physical examination revealed that psoriasis was in 209 (92.1%, 209/227) patients, nail involvement in 98 (43.2%, 98/227) patients, peripheral arthritis in 219 (96.5%, 219/227) patients, axial involvement in 25 (11.0%, 25/227) patients, dactylitis in 80 (35.2%, 80/227) patients, and enthesitis in 18 (7.9%, 18/227) patients. Besides 18 patients with clinical enthesitis, ultrasound scan revealed acute enthesitis in 80 patients, with hypoechogenicity (55 cases), tendon thickening (62 cases), and presence of Doppler signals (48 cases). Similarly, dactylitis on ultrasound was found in 18 patients besides those patients with clinical dactylitis. Compared with the phenotypes recognized based on physical examination only, the additional ultrasound assessment revealed that the most common phenotypes, peripheral arthritis was significantly less frequently recognized (49.8% vs. 27.8%, P < 0.001), however on the other hand, the proportion of the patients with peripheral arthritis and enthesitis was significantly increased (4.4% vs. 18.1%, P < 0.001). The phenotype of peripheral arthritis combined with enthesitis, and dactylitis was also dramatically increased (1.8% vs. 17.6%, P < 0.001).@*CONCLUSION@#Ultrasound is a useful tool to identify enthesitis and dactylitis. With the aid of ultrasound assessment, rheumatologists can better identify the lesions of PsA, accurately identify the phenotypes, and further guide the subsequent treatment.

Ambulatório conjunto de dermatologia e reumatologia para tratamento de psoríase e artrite psoriásica: experiência de um hospital terciário do sul do Brasil / Combined dermatology and rheumatology outpatient clinic for the management of psoriasis and psoriatic arthritis: a Southern Brazilian experience

Introdução: Diversas diretrizes enfatizam as vantagens do manejo multidisciplinar no cuidado ao paciente com psoríase (PSO) e artrite psoriásica (PSA). O diagnóstico precoce de PSA se relaciona com melhores desfechos em 5 anos. No entanto, o diagnóstico precoce de PSA ainda é um desafio. Métodos: Estudo transversal retrospectivo de pacientes com diagnóstico prévio ou suspeito de PSO e/ou PSA atendidos em ambulatório conjunto de dermatologia e reumatologia do sul do Brasil de janeiro de 2013 a janeiro de 2017. Resultados: Entre os 55 pacientes previamente diagnosticados com PSO, 30,9% (n = 17) foram diagnosticados com PSA. Alterações do tratamento foram feitas em 58,5% (n = 48) dos pacientes, principalmente devido ao mau controle da pele e das articulações. Os imunobiológicos foram a classe de medicamentos mais comumente iniciada, correspondendo a 35,4% (n = 17) das modificações terapêuticas. O metotrexato foi o segundo medicamento mais comumente iniciado (18,8%, n = 9) ou com modificação da dose ou via de administração (20,8%, n = 10), totalizando 39,6% (n = 19) de modificações terapêuticas. Houve um aumento na proporção de pacientes em uso de tratamento sistêmico (79,3%, n = 65). Conclusão: Este estudo reforça a importância da abordagem multidisciplinar no diagnóstico precoce da PSA e demonstra que a abordagem conjunta entre dermatologia e reumatologia é possível de ser realizada no Brasil, com resultados semelhantes aos reportados na literatura internacional. (AU)

Introduction: Several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA is associated with better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: We conducted a retrospective cross-sectional study of patients with previous or suspected diagnosis of PSO and/or PSA treated at a combined dermatology and rheumatology outpatient clinic in southern Brazil from January 2013 to January 2017. Results: Of 55 patients previously diagnosed with PSO, 30.9% (n = 17) were diagnosed with PSA. Changes in treatment were made in 58.5% (n = 48) of patients, mainly due to poor control of cutaneous and articular symptoms. Immunobiological agents were the most commonly prescribed class of drugs, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most commonly prescribed drug (18.8%; n = 9) and the second drug to undergo most changes in dose or route of administration (20.8%; n = 10), accounting for 39.6% (n = 19) of changes in medical therapy. There was an increase in the number of patients undergoing systemic therapies (79.3%; n = 65). Conclusions: This study reinforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a collaborative approach between dermatology and rheumatology is feasible in Brazil, with outcomes similar to those reported in the international literature. (AU)

Efficacy and safety of secukinumab in patients with psoriatic arthritis: A meta-analysis of different dosing regimens

The appropriate dosing regimens of secukinumab for psoriatic arthritis (PsA) are not well defined. We performed a meta-analysis to evaluate the efficacy and safety of different dosing regimens of secukinumab in the treatment of PsA. A systematic search was conducted using major electronic databases to identify relevant randomized controlled trials (RCTs) comparing secukinumab 300 mg versus secukinumab 150 mg in patients with PsA. Meta-analysis was performed using Review Manager software (version 5.3). Six studies with a total of 1141 patients were included. At week 24, secukinumab 300 mg was associated with a higher American College of Rheumatology 20% response (ACR 20), ACR 50, PASI 75 response rate, and dactylitis resolution rate than secukinumab 150 mg, especially in the anti-TNF-IR subgroup. At week 52, secukinumab 300 mg was associated with a higher psoriasis area and severity index (PASI) 75 and PASI 90 response rate than secukinumab 150 mg. There was no significant difference between secukinumab 300 mg and secukinumab 150 mg in the risk of any adverse events (AEs) and serious AEs at either week 24 or week 52. Secukinumab 300 mg was significantly more effective than 150 mg, especially for patients with PsA who have failed TNF therapy, and it was well tolerated.

Immunogenicity to biological drugs in psoriasis and psoriatic arthritis

Monoclonal antibodies or fusion proteins, defined as biological drugs, have modified the natural history of numerous immune-mediated disorders, allowing the development of therapies aimed at blocking the pathophysiological pathways of the disease, providing greater efficacy and safety than conventional treatment strategies. Virtually all therapeutic proteins elicit an immune response, producing anti-drug antibodies (ADAs) against hypervariable regions of immunoglobulins. Immunogenicity against biological drugs can alter their pharmacokinetic and pharmacodynamic properties, thereby reducing the efficacy of these drugs. In more severe cases, ADAs can neutralize the therapeutic effects of the drug or cause serious adverse effects, mainly hypersensitivity reactions. The prevalence of ADAs varies widely depending on the type of test used, occurrence of false-negative results, and non-specific binding to the drug, making it difficult to accurately assess their clinical impact. Concomitant use of immunosuppressors efficiently reduces the immunogenicity in a dose-dependent manner, either by decreasing the frequency of detectable ADAs or by delaying their appearance, thereby enhancing the effectiveness of biological therapies. Among the new therapeutic strategies for the management of psoriasis, biological agents have gained increasing importance in recent years as they interrupt key inflammation pathways involved in the physiopathology of the disease. Reports regarding ADA in new biologics are still scarce, but the most recent evidence tends to show little impact on the clinical response to the drug, even with prolonged treatment. It is therefore essential to standardize laboratory tests to determine the presence and titles of ADAs to establish their administration and management guidelines that allow the determination of the real clinical impact of these drugs.