Tuberculosis screening guidelines should be updated and quantiferon test should be a prerequisite prior to the initiation of treatment of psoriasis with biological agents.

OBJECTIVE: With the current study, we aimed at evaluating the quantiferon test results of psoriasis patients treated with biological agents. PATIENTS AND METHODS: Between April 2019 and June 2021, medical records of patients with psoriasis who were evaluated for latent tuberculosis infection before the initiation of biological agent treatment were reviewed retrospectively. RESULTS: This study included 132 patients, 50 (37.9%) female and 82 (62.1%) male. The mean disease duration was 16.42±10.99 years (range: 1-49 years). None of the patients had a previous history of tuberculosis. Quantiferon test was negative in 109 (82.6%) patients and positive in 23 (17.4%) patients. Patients with positive quantiferon test results were older than those who had negative quantiferon test results; the mean ages were 50.21±10.79 and 42.98±11.81 years, respectively (p=0.006). CONCLUSIONS: Within this study, 17.4% of patients with psoriasis had positive quantiferon test results. We suggest that quantiferon test should be performed in all patients with psoriasis especially in the elderly for latent tuberculosis screening before the initiation of biological agent treatment. Moreover, we suggest that psoriasis treatment guidelines with biological agents should include detailed information on the necessity of chest radiograph, choosing tuberculin skin test or interferon gamma release assays such as quantiferon and T-spot test. In addition, controversies on the requirement of screening for latent tuberculosis and prophylactic tuberculosis treatment before the initiation of novel biological agents such as IL-17 and IL-23 inhibitors should be clarified. An international consensus on the duration of latent tuberculosis treatment and the interval between tuberculosis prophylaxis and the initiation of biological agents should be achieved.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients.

BACKGROUND: Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. AIM: To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. METHODS: We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. RESULTS: In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). CONCLUSION: Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients.

BACKGROUND: Treatment options remain unsatisfactory for patients with palmoplantar psoriasis (PP) and palmoplantar pustular psoriasis (PPP). Aim To evaluate the therapeutic responses of PP and PPP patients that were treated in our psoriasis polyclinic between 2003 and 2007. METHODS: This retrospective study comprised PP (n = 62) and PPP (n = 52) patients. Treatments were individualized according to patient compliance and associating systemic diseases. The effect of systemic treatments was grouped as follows: 'no improvement': patients unresponsive for the present treatment; 'partial improvement': < 50% decrease in severity or affected area; 'moderate improvement': 50-75% decrease in severity or affected area, and 'marked improvement': > 75% decrease of the disease compared to baseline. RESULTS: In the PP group, 17 of 62 patients showed marked improvement to topical agents, while the remaining patients required systemic agents including oral retinoids (n = 24), local psoralen plus ultraviolet A (PUVA; n = 12), methotrexate (n = 9) and cyclosporine (n = 2). Marked improvement was achieved in 53%, 45%, 47% and 100%, respectively. In these patients, two (n = 10), three (n = 5), or four (n = 5) systemic agents were used alternately. In the PPP group, 18 of 52 patients achieved marked improvement by topical agents. Patients that required systemic agents were treated with colchicum (n = 19), local PUVA (n = 8), methotrexate (n = 4), oral retinoids (n = 3) and cyclosporine (n = 2). These treatments achieved a marked improvement in 60%, 33%, 57%, 83%, and 50% of the patients, respectively. In the course of the disease, 18 patients required two and 3 patients required three systemic agents alternately. CONCLUSIONS: Although the success rates appeared to be high, the high number of patients who required multiple systemic agents emphasized the fact that localized forms of psoriasis were resistant to therapy.

Changes in serum carbonyl and malondialdehyde levels following colchicine and vitamin E treatment in Behcet's disease.

Behcet's disease (BD) is an inflammatory disorder of an unknown cause, but growing evidence indicates that the oxidative stress is increased in BD, owing to the overproduction of reactive oxygen species (ROS) and decreased efficiency of antioxidant defenses. ROS affect proteins and lipids and cause their oxidation, therefore, contributing to the formation of oxidation products: carbonyl, a marker of protein oxidation, and malondialdehyde (MDA), a marker of lipid peroxidation. The investigation was undertaken to evaluate protein oxidation (carbonyl group) levels and lipid peroxidation (MDA) levels, and the role of colchicine and vitamin E therapy on protein carbonyl group and MDA levels in serum samples of patients with BD. In this study, subjects were classified as control group, colchicine therapy group alone and colchicine and vitamin E therapy group. Protein carbonyl and MDA levels at the beginning of the study were significantly (p < 0.05) higher in both therapy groups compared with those of the control group. We found that the protein carbonyl and MDA levels at the end of the study showed no significant (p > 0.05) differences between the therapy groups and control group. These results provide some evidence for a potential effect of colchicine and vitamin E therapies on increased protein oxidation and lipid peroxidation in BD.

The effects of calcipotriol and methylprednisolone aseponate on bcl-2, p53 and ki-67 expression in psoriasis.

OBJECTIVE: The decrease of physiological apoptosis in the psoriatic lesions is thought to be involved in the pathogenesis of psoriasis, and induction of apoptosis was shown to contribute to the regression of psoriatic hyperplasia. In the present study, we compared the effects of calcipotriol and methylprednisolone aseponate (MPA) treatments on bcl-2, p53 and ki-67 expressions in psoriatic patients in order to define a relationship between regulation of apoptosis and healing process in psoriasis. METHODS: Thirty psoriatic patients with stable and moderate chronic plaque psoriasis applied either calcipotriol or MPA ointment for 6 weeks twice daily. Evaluation of bcl-2, p53 and ki-67 positivity was performed at baseline and was repeated at sixth week for each therapy. RESULTS: The mean percentage of positive keratinocytes was 8.63 +/- 7.15% for p53, 20.66 +/- 14.45% for ki-67, and 3.74 +/- 2.83% for bcl-2 in psoriatic skin at baseline. Normal skin values were 3.27 +/- 3.21% for p53, 4.93 +/- 4.77% for ki-67, and 1.80 +/- 0.41% for bcl-2. The psoriatic skin showed higher ki-67 (P < 0.05) and bcl-2 (P < 0.05) expression rates when compared to normal skin. The p53 positivity observed in psoriatic skin and normal skin was not significantly different (P > 0.05). Following calcipotriol and MPA treatments, there was a significant reduction in p53 and ki-67 positivity accompanied by an increase in bcl-2 positivity (P < 0.05 each). No significant differences were found at sixth week between calcipotriol and MPA groups with respect to p53, ki-67 and bcl-2 positivity (P > 0.05). The post-treatment psoriatic skin showed lower expression of p53, higher expressions of ki-67 and bcl-2 when compared to normal skin (P < 0.05 each). CONCLUSION: The results of this study provide evidence that both calcipotriol and MPA decrease the p53 and ki-67 expression and increase bcl-2 expression. However, it should further be elucidated if these changes were the common behaviour of psoriatic keratinocytes to any antipsoriatic medication.

Natural killer cell activity, serum immunoglobulins, complement proteins, and zinc levels in patients with psoriasis vulgaris.

The role of the immune system in patients with psoriasis vulgaris (PV) was investigated. The genetic and immunological basis for psoriasis is still unknown. Because of the reports of immunological defects in this disease, we investigated serum levels of immunoglobulins IgG, IgM, IgA, complement proteins C3, C4, serum zinc (Zn) levels and natural killer (NK) cell activities. Skin lesions of the psoriatic patients involved in the study comprised less than 10 % of the total body and the disease was in a stationary period. Zn levels were measured by atomic absorption spectrophotometry. NK cell activity was measured by 51Cr (Na2 51CrO4). IgG, IgA, IgM, C3 and C4 assays were done by liquid-phase immunoprecipitation assay with nephelometric endpoint detection. IgG, IgA, C3 and C4 levels were significanty higher in patients with PV than in healty controls (p < 0.05). However, NK cell activity, serum Zn and IgM levels did not show significant differences between these two groups. There are changed immunological responses, which may play an important role in the pathogenesis of the disease. Many controversial results have been related to immunological parameters in psoriatic patients. Therefore, more detailed studies in this field need to be done to determine the relationship between psoriasis and the immune system.

Natural cellular cytotoxicity in Behçet's disease.

This study evaluated the cytotoxic activity of natural killer cells in the active and inactive stages of Behçet's disease (BD) and attempted to develop a new explanation for its immunopathogenesis. Blood samples were taken from 16 BD patients and compared with 11 healthy individuals. The lymphocyte fraction was separated and diluted in RPMI-1640. Candida as a target cell (T) was mixed with lymphocytes (E) (effector cells) in ratios of T:E 1/5 and T:E 1/25. After the numbers of colonies were counted with controls, the anticandidal index (natural cytotoxicity) was calculated. Natural cytotoxicity relatively decreased in the active stage and increased in the inactive stage of BD. Although the difference between the mean value of natural cytotoxicity in the active stage and in the inactive stage was significant, the difference between the averages of active stage and the control group was insignificant. However, the difference between inactive stage and the control group was remarkable. The increase of the natural cytotoxic activity in the inactive period of the disease may play a role together with other immune mechanisms in the aetiopathogenesis of BD.

Arachidonic acid metabolites and colchicine in Behçet's disease (BD).

Vasculitis is accepted to be the basis of Behçet's disease (BD) which is a multisystem disease, and the arachidonic acid(AA) metabolites acting as balancing mediators in the organism are accepted to be responsible for the vasculitis. In this study, we examined the prostaglandin E2 (PGE2) and leukotriene C4 (LTC4) levels of the patients with BD before and after colchicine therapy. We found a statistical decrease in the PGE2 and LTC4 levels after colchicine therapy compared to the previous levels, concluding that colchicine inhibits the inflammation and the polymorphonuclear leukocyte (PML) chemotaxis by inhibiting the cyclooxygenase and lipoxygenase pathways.