Correlation of IL36RN and CARD14 mutations with clinical manifestations and laboratory findings in patients with generalised pustular psoriasis.

Background Generalized pustular psoriasis (GPP) is a chronic disease associated with genetic factors related to mutations of the interleukin 36 receptor antagonist gene (IL36RN) and the caspase recruitment domain 14 gene (CARD14). However, the relevance of these mutations to the clinical features and severity of GPP remains unclear. Aims Our objective was to correlate the presence of IL36RN and CARD14 mutations with the clinical and laboratory findings in patients with GPP. Methods This cross-sectional descriptive study was conducted in 64 subjects with GPP. Clinical manifestations were recorded and the severity was graded as mild, moderate, or severe. Routine laboratory tests were performed and blood samples were collected for Sanger sequencing. The clinical data of patients were compared among the different mutation groups. Results The two main variants of IL36RN were c.115+6T > C (p.Arg10ArgfsX1) and c.227C > T (p.Pro76Leu). The major CARD14 mutations were c.2458C > T (p.Arg820Trp), c.1641C > T (p.Arg547Ser), and c.1753G > A transitions. Provocative factors were uncommon in the group with both IL36RN and CARD14 mutations. Drugs (unspecified), especially herbals, were the most common triggers. A history of psoriasis was frequent in patients with only CARD14 mutations, but fever was uncommon. The c.1641C > T mutation was associated with leukocytosis > 15000/mm3 and the c.1753G > A mutation was associated with hypoalbuminemia <3.8g/dL. Both the c.115+6T > C and c.227C > T variants of IL36RN were associated with fever ≥38.5°C while the c.115+6T > C variant was also associated with geographic tongue. No gene mutations were associated with the total severity and severity grades. Limitations Four patients without the two major IL36RN mutations were excluded from the study. Conclusion The presence of IL36RN and CARD14 mutations were associated with a history of psoriasis, various provocative factors, fever, leukocytosis, hypoalbuminemia, and geographic tongue. Further studies to explore the role of these mutations in therapeutic efficacy and disease outcomes are necessary.

Effectiveness, Safety and Tolerance of Methotrexate in Vietnamese Psoriatic Arthritis Patients.

AIM: To access the effectiveness, safety and tolerance of methotrexate (MTX) in psoriatic arthritis (PsA) treatment. METHODS: We recruit 37 patients, admitted at HCMC Hospital of Dermato-Venereology from 1/2016 to 3/2017, with MTX dosage ranging from 10 mg to 15 mg per week. RESULTS: Skin lesion response after 12 weeks improved PASI 50: 40.5%, PASI 75: 24.3%. Disease activity score decreased after 12 weeks with ∆DAS28 = -1.43 + 0.79, 37.8% PsA achieved complete remission. Nausea and vomiting were 8.1%. These symptoms were mild and transient. We did not stop MTX usage. The rate of elevating SGPT 2-3 times as much as the upper limit of the normal range was 2.7%. CONCLUSION: We finally demonstrated that the rate of treatment response in Vietnam is the same as demonstrated by foreign authors in other countries.

Successful Psoriasis Treatment Using NB-UVB with Methotrexate: The Vietnamese Experience.

AIM: To compare the effectiveness of narrowband ultraviolet B (NBUVB) and oral methotrexate (MTX) to oral MTX alone in Vietnamese psoriasis patients, from May 2016 to May 2018. METHODS: We conducted a non-randomized trial on 70 patients with plaque-type psoriasis of moderate to severe. Thirty-five patients apply NBUVB once/day in 5 days/week for 4 weeks plus oral MTX 7.5 mg/week and 35 patients oral MTX 7.5 mg/week and both two groups treatment for 3 months. The extent of the lesion was assessed by the Psoriasis Area and Severity Index (PASI). RESULTS: The proportion of decreasing PASI was comparable (68.49% in NBUVB and MTX versus 57.62% in MTX alone); p < 0.05. Inside, good 28.58%, moderate 68.57% and poor 2.85% in NBUVB and MTX better than good 2.85%, moderate 71.4% and poor 25.72% in MTX alone; p < 0.05. The recurrence rate after 24 months of the NBUVB and MTX group (42.9%) was lower than the MTX alone group (71.4%); p < 0.05. CONCLUSION: NBUVB and oral MTX have affected treatment with chronic plaque psoriasis better than oral MTX alone.

The Relationship between HLA-B27, HLA-Cw06, HLA-DR7 and Psoriatic Arthritis in Vietnamese Patients: Disease Progression and Therapeutic Burden.

We conducted a prospective, cross-sectional study at Ho Chi Minh City Hospital of Dermato Venereology from January 2016 to March 2017 in 40 psoriatic arthritis (PsA) patients to evaluate the disease progression and therapeutic burden about the HLA patterns. Based upon our results, PsA with HLA-B27 (+) had a threat of severe arthritis. PsA with HLA-Cw06 (+) had a higher risk of earlier onset and shorter duration for plaque psoriasis to transform into PsA. HLA-DR7 (+) in PsA delayed the time for conversion from plaque psoriasis into PsA. These findings are quite similar to other studies in the literature.

Quality of Life in Psoriasis Vietnamese Patients Treated with Metformin in Combination with Methotrexate.

A cross-sectional study was performed on 48 psoriasis Vietnamese patients treated with metformin as an add-on for methotrexate and 48 psoriasis patients treated methotrexate alone. The mean PASI scores were 5.25 ± 5.72. Total QOL scores had a slight difference between patients treated metformin combined with methotrexate and methotrexate alone (62.32 ± 18.1 vs 60.91 ± 19.63). Combined therapy with metformin and methotrexate contributes to significantly improve the quality of life for patients with psoriasis.