Evaluation of the prevalence of musculoskeletal conditions in consecutive patients with skin psoriasis: a descriptive cross-sectional study.

The association between psoriatic arthritis (PsA) and psoriasis is well known, but some have suggested that other musculoskeletal (MSK) conditions might also be more common in patients with skin psoriasis compared with the general population. The aim of our study was to describe the prevalence of a large panel of MSK conditions, in consecutive patients with psoriasis according to skin phenotype. This was a cross-sectional study. We consecutively included 148 patients, consulting for their skin psoriasis, in the dermatology department of a tertiary hospital, Hospital Cochin in Paris, France. After the scheduled consultation with a dermatologist, a rheumatologist conducted a dedicated face-to-face interview to collected data, included demographics, comorbidities, information about the psoriasis, the MSK conditions and their treatments. Of the 148 patients, 122 (82%) had at least one MSK condition. The most common condition was mechanical back pain, present in 98 (66%) patients. Nineteen (13%) patients had spondyloarthritis (SpA), of which 95% had PsA. For all MSK conditions, the dominant psoriasis phenotype was psoriasis vulgaris. The prevalence of the other phenotypes of psoriasis differed by disease. In SpA patients, the three predominant psoriasis phenotypes were: psoriasis vulgaris (82%), scalp involvement (76%) and inverse psoriasis (65%). For all MSK diseases, the prevalence was higher than expected in the general population. Our data suggest that skin psoriasis is associated with different MSK diseases, and not only PsA.

Effectiveness and Safety of Anti-interleukin-17 Therapies in Elderly Patients with Psoriasis.

Anti-interleukin-17 agents have recently been developed for the treatment of psoriasis. This study evaluated the tolerance and effectiveness of anti-interleukin-17 agents for psoriasis in elderly patients in daily practice. A multicentre, retrospective study was performed, involving psoriatic patients aged ≥65 years who had received an anti-interleukin-17 agent, including secukinumab, ixekizumab or brodalumab. A total of 114 patients were included: 72 received secukinumab, 35 ixekizumab, and 7 brodalumab. Treatment was stopped in 32 patients (28.9%), because of relapses in 14 patients (41.2%), primary failures in 11 patients (32.4%), or adverse events in 7 patients (20.6%). The 3 most frequently reported adverse events were injection site reactions (n = 4), oral candidiasis (n = 3), and influenza-like illness (n = 3). Regarding effectiveness, 80 patients (70%) reached a Physician Global Assessment score of 0/1, 6 months after treatment initiation. In conclusion, anti-interleukin-17 therapy appears to be an effective and safe therapeutic option for psoriasis treatment in patients aged ≥ 65 years.

[Clinical evaluation of a psoriatic patient]. / Évaluation clinique d'un patient atteint de psoriasis.

Clinical evaluation of a psoriatic patient. Psoriasis is a frequent and burdening inflammatory dermatosis. It affects the quality of life of patients in a deep and sustained way, even if the disease is not very extensive. As we now have an array of very effective treatments, it is important to be able to evaluate the objective and subjective severity of the dermatosis, in order to choose the optimal therapeutic goal for each patient. Of course, an associated psoriasis arthritis must be sought because it will influence the choice of treatment. There is a growing body of evidence suggesting a link between psoriasis and a number of comorbidities such as metabolic syndrome, diabetes, increased cardiovascular risk, depression, etc. In order for the patient to be fully taken care of, these risks must be detected and prevented.

Évaluation clinique d'un patient atteint de psoriasis. Le psoriasis est une dermatose inflammatoire fréquente et affichante. Elle grève la qualité de vie des patients de façon durable et profonde, même si l'atteinte n'est pas très étendue. À l'heure où nous disposons de nombreux traitements très efficaces, il est important de savoir évaluer la sévérité objective et ressentie d'un psoriasis, pour décider au mieux de l'objectif thérapeutique à atteindre pour un patient donné. Bien entendu, la présence ou non d'une atteinte rhumatologique doit être recherchée car elle influence le choix du traitement. De plus en plus de travaux évoquent un lien entre le psoriasis et un certain nombre de comorbidités comme le syndrome métabolique, le diabète, un risque cardiovasculaire accru, la dépression… Afin que le patient soit pris en charge dans sa globalité ces facteurs de risque doivent être dépistés et prévenus.

Multiparameter grouping delineates heterogeneous populations of human IL-17 and/or IL-22 T-cell producers that share antigen specificities with other T-cell subsets.

The ontogenic relationship between pro-inflammatory populations of interleukin-17 (IL-17A)- and/or IL-22-producing T cells and other T-cell subsets is currently unclear in humans. To appreciate T helper cell-lineage commitment, we combined cytokine production profiles of in vitro expanded T-cell clones with T-cell receptor (TCR) clonotypic signatures. Moreover, ex vivo cytokine production profiles at the single-cell level were analyzed using an original approach based on the hierarchical cluster analysis of multiparametric flow cytometry data. These combined approaches enabled the delineation of distinct functional T-cell subsets, including Th1, Th2, Tr1, Th17 cells and a highly polyfunctional IL-22-producing T-cell population. Cluster analysis highlighted that the IL-22-producing T-cell population should be considered independently from the Th17 and Th1 subsets, although it was more closely related to the former. In parallel, we observed extensive TCRαß sharing across all five subsets defined. The strategy described here allows the objective definition of cellular subsets and an unbiased insight into their similarities. Together, our results underscore the ontogenic plasticity of CD4(+) T-cell progenitors, which can adopt a differentiation profile irrespective of antigen specificity.

[Prescribing immunosuppressive and immunomodulatory drugs in psoriasis]. / Prescrire les immunosuppresseurs et les immunomodulateurs dans le psoriasis.

Even though systemic immunomodulating or immunosuppressive therapies have shown efficacy in patients with psoriasis, their usage remains restricted to patients with severe, refractory forms of the disease. Indeed, the risk/benefit balance should be cautiously taken into account before prescribing such drugs. Nevertheless, risks inherent to their usage are limited by a careful knowledge of prescription rules and by a monitoring of side effects.