Subclinical cardiovascular disease and it's improvement after long-term TNF-α inhibitor therapy in severe psoriatic patients.

BACKGROUND: There are conflicting data on the occurrence of subclinical myocardial dysfunction in psoriatic patients and on the impact of long-term tumour necrosis factor-alpha (TNF-α) inhibitor therapy on cardiac function. OBJECTIVE: In this study, we explored whether there are any signs of subclinical cardiovascular disease (echocardiographic abnormalities) in severe psoriatic patients without clinically overt heart disease. As a second objective, the influence of long-term treatment with TNF-α inhibitors on the ventricular functions of psoriatic patients was also investigated. METHODS: Clinical and echocardiographic data from 44 psoriatic patients and 45 age- and sex-matched controls were processed. As a first step, the echocardiographic parameters of psoriatic patients obtained before anti-TNF-α treatment were compared with controls. As a second step, to detect the effect of long-term anti-TNF-α treatment on echocardiographic parameters, data of patients before and after therapy were analysed. RESULTS: The right ventricular Tei index was higher (P < 0.001), whereas the tricuspid annular plane systolic excursion (TAPSE) and right ventricular free wall peak systolic velocity were lower (P < 0.001 and P < 0.0001, respectively) in the psoriatic patients than in the controls. Following treatment with TNF-α inhibitors, TAPSE and right ventricular free wall peak systolic velocity significantly improved (P < 0.0001 for both parameters). The Tei index of both ventricles improved during biological therapy; however, this change did not reach statistical significance. CONCLUSION: Patients with severe psoriasis exhibit signs of subclinical cardiovascular disease compared to control, and prolonged anti-TNF-α therapy has a potentially beneficial effect on these signs.

Moderate to severe psoriasis patients' subjective future expectations regarding health-related quality of life and longevity.

BACKGROUND: Unrealistic expectations regarding treatments and clinical outcomes may lead to disappointment about therapy and sub-optimal compliance; nonetheless, these expectations have not been studied in psoriasis patients yet. OBJECTIVE: To evaluate psoriasis patients' subjective future expectations regarding health-related quality of life (HRQOL) and life expectancy, and to explore clinical features associated with under- or overestimating behaviour. METHODS: A cross-sectional questionnaire survey of consecutive adult patients with moderate to severe psoriasis was conducted. HRQOL expectations were recorded by applying the EQ-5D descriptive system for 6 months ahead and for future ages of 60, 70, 80 and 90 respectively. RESULTS: In total, 167 patients (71% males) were included in the analysis with mean age of 50.4 ± 12.4 years and mean EQ-5D score of 0.71 ± 0.30. Overall 65% had chronic plaque psoriasis, 35% nail psoriasis, 35% scalp involvement, 29% psoriatic arthritis, 9% inverse psoriasis and 5% palmoplantar psoriasis respectively (combinations occurred). Participants expected 0.1 ± 0.23 mean improvement in EQ-5D within 6 months (P < 0.001) that achieves the minimum clinically important difference. Overall 37% expected improvement and 13% decline; however, 49% expected no changes in any of the five dimensions of EQ-5D within 6 months. Female gender, inverse or palmoplantar involvement and more severe psoriasis were likely associated with higher expectations. Patients at the initiation of their first biological at the time of the survey expected 0.18 ± 0.24 increase that seems to be realistic compared to the EQ-5D utility gain achieved in randomized controlled trials. Males expected by 2.7 ± 11.1 more, while females expected by 5.2 ± 9.3 less life years compared to the average statistical gender- and age-matched life expectancy (P < 0.05). Patients who expected to be alive at ages of 60, 70, 80 and 90 scored their future EQ-5D at ages of 60 to 90: 0.59 ± 0.46, 0.48 ± 0.41, 0.42 ± 0.41 and 0.22 ± 0.47 respectively. CONCLUSION: Our findings highlight the importance of exploring expectations that might help to increase patients' compliance.

Prevalencia de osteoporosis en la población española por ultrasonografía de calcáneo en función del criterio diagnóstico utilizado. Datos del estudio GIUMO / Calcaneous ultasonography es measurement of osteoporosis prevalence in the general population in relation to the diagnostic criterion utilized. Data of the study GIUMO

Fundamento. En los últimos años se han desarrollado un gran número de técnicas para estimar la densidad mineral ósea y con ello poder realizar el diagnóstico de osteoporosis. Sin embargo, invariablemente se aplican los criterios diagnósticos que fueron establecidos por la OMS para su utilización con la densitometría radiológica dual (DEXA), lo cual podría no ser correcto en el caso de los ultrasonidos. Método. Se estudió a una población escogida aleatoriamente de 2.589 personas de ambos sexos, 1.138 varones y 1.451 mujeres de entre 10 y 99 años de edad procedente de 11 provincias españolas. Se efectuó una medición de los parámetros que estima el ultrasonógrafo de calcáneo Sahara®, Hologic®: velocidad del sonido, (SOS), coeficiente de atenuación de banda ancha (BUA), índice de consistencia (QUI) y densidad mineral ósea estimada (est. DMO). Se calculó la prevalencia de osteopenia y osteoporosis aplicando los criterios de la OMS (osteopenia: Tscore 1 y osteoporosis Tscore 2,5) y la prevalencia de osteoporosis efectuando el corte en un Tscore de -1,8.Resultados. Empleando los criterios de la OMS, existe osteoporosis (Tscore 2,5) en el 1,5 por ciento de los varones y el 5,9 por ciento de las mujeres de entre 51 y 70 años y en el 2,6 por ciento de los varones y el 22,1 por ciento de las mujeres de más de 70 años. Si efectuamos el corte en un Tscore de -1,8, la prevalencia asciende al 8,2 por ciento de los varones y 21,9 por ciento de las mujeres de entre 51 y 70 años y al 8,4 por ciento de los varones y 40,9 por ciento de las mujeres de más de 70 años. Conclusión. La prevalencia de osteoporosis en la población española de ambos sexos difiere notablemente aplicando el punto de corte en un Tscore de -2,5 como indica la OMS o en -1,8 sugerido por otros autores. Es necesario la realización de un consenso para establecer cuál es el punto de corte apropiado para el diagnóstico de osteoporosis por ultrasonografía cuantitativa de calcáneo (AU)