Monocyte-to-High-Density Lipoprotein Ratio Is Associated with Systemic Inflammation, Insulin Resistance, and Coronary Subclinical Atherosclerosis in Psoriasis: Results from 2 Observational Cohorts.

Systemic inflammation or insulin resistance drive atherosclerosis. However, they are difficult to capture for assessing cardiovascular risk in clinical settings. The monocyte-to-high-density lipoprotein ratio (MHR) is an accessible biomarker that integrates inflammatory and metabolic information and has been associated with poorer cardiovascular outcomes. Our aim was to evaluate the association of MHR with the presence of subclinical atherosclerosis in patients with psoriasis. The study involved a European and an American cohort including 405 patients with the disease. Subclinical atherosclerosis was assessed by coronary computed tomography angiography. First, MHR correlated with insulin resistance through homeostatic model assessment for insulin resistance, with high-sensitivity CRP and with 18F-fluorodeoxyglucose uptake in spleen, liver, and bone marrow by positron emission tomography/computed tomography. MHR was associated with both the presence of coronary plaques >50% of the artery lumen and noncalcified coronary burden, beyond traditional cardiovascular risk factors (P < .05). In a noncalcified coronary burden prediction model accounting for cardiovascular risk factors, statins, and biologic treatment, MHR added value (area under the curve base model = 0.72 vs area under the curve base model plus MHR = 0.76, P = .04) within the American cohort. These results suggests that MHR may detect patients with psoriasis who have subclinical burden of cardiovascular disease and warrant more aggressive measures to reduce lifetime adverse cardiovascular outcomes.

Association of the Complement System with Subclinical Atherosclerosis in Psoriasis: Findings from an Observational Cohort Study.

Psoriasis is a chronic and inflammatory disease that affects the skin and joints and is associated with multiple comorbidities and cardiovascular risk factors. Consequently, patients with psoriasis have an increased risk of cardiovascular diseases such as atherosclerosis, a chronic pathology that shares common inflammatory and immune-response mechanisms with psoriasis, including vascular inflammation and complement activation. To better understand the relationship between atherosclerosis and psoriasis, a proteomics study followed by a bioinformatics analysis was carried out, with a subsequent validation step using ELISA and western blotting. When the plasma from patients with psoriasis alone was compared with that from patients with psoriasis and atherosclerosis, 31 proteins of interest related to the complement system and oxygen transport were identified. After the validation phase, 11 proteins appeared to define the presence of subclinical atherosclerosis in patients with psoriasis, indicating the importance of complement cascades in the development of atherosclerotic plaques in individuals with psoriasis. These results are a step forward in understanding the pathological pathways implicated in the cardiovascular risk associated with this population, which may represent an interesting starting point for developing predictive tools that improve the follow-up of these patients and design more effective therapies.

Predictive factors for anti-MDA5 antibody in patients with dermatomyositis: a retrospective multicenter study.

BACKGROUND AND OBJECTIVES: Melanoma differentiation-associated gene 5 antibody (anti-MDA5) in dermatomyositis (DM) is associated with rapidly progressive interstitial lung disease and poor prognosis. Early diagnosis is key to improving the prognosis of these patients. The aim was to confirm cutaneous characteristics in patients with anti-MDA5 dermatomyositis and to explore new diagnostic markers for the presence of anti-MDA5 (anti-MDA5+ ). PATIENTS AND METHODS: A multicenter cross-sectional retrospective cohort study of 124 patients diagnosed with DM, of which 37 were anti-MDA5+ . Demographic data, laboratory data, and clinical manifestations were collected. RESULTS: Anti-MDA5+ DM is characterized by a distinct mucocutaneous phenotype that includes oral lesions, alopecia, mechanic's hands, palmar and dorsal papules, palmar erythema, vasculopathy, and skin ulceration. We found vasculopathy and digit tip involvement very frequently in anti-MDA5+ patients (p <0.001), being a diagnostic marker of anti-MDA5+ (OR, 12.355; 95% CI 2.850-79.263; p  =  0.012 and OR, 7.447; 95% CI 2.103-46.718; p  =  0.004, respectively). The presence of ulcers deserves special mention, especially in anti-MDA5+ patients, because in our cohort, up to 97% of the anti-MDA5+ patients had ulcers. CONCLUSIONS: In patients with suspected DM with digit tip involvement or vasculopathy, the presence of anti-MDA5 antibodies must be ruled out, as it may be a clinical predictor.

Úlceras plantares verdes / Green foot ulcers

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Nagelbefall kann bei Patienten mit Psoriasis auf eine Enthesiopathie hinweisen.

HINTERGRUND: Obwohl subklinische Enthesiopathie ein gut etabliertes diagnostisches Merkmal der Psoriasisarthritis (PsA) ist, wird sie häufig übersehen, da viele Patienten asymptomatisch sind. Gäbe es klinische Hinweise auf das Vorliegen einer Enthesiopathie, würde dies den Klinikern die Möglichkeit eröffnen, eine PsA frühzeitig zu diagnostizieren. MATERIAL UND METHODEN: Es wurde eine monozentrische prospektive Studie mit insgesamt 90 Psoriasis-Patienten durchgeführt, um mittels Ultraschall das Vorliegen von Enthesenanomalien zu untersuchen und eine Korrelation mit dem Befall der Nägel festzustellen. ERGEBNISSE: Enthesenanomalien wurden bei 23 Patienten (25,5 %) gefunden, von denen 19 (82,6 %) Nagelbefall aufwiesen. Bei 4 Patienten waren die Nägel nicht betroffen. Enthesiopathie lag bei 31,1 % (19/61) der Patienten mit Onychopathie vor, von den Patienten ohne Nagelbefall litten nur 13,8 % (4/29) an Enthesiopathie (p = 0,07). Zwischen dem Target-NAPSI-Score und dem Vorliegen einer Enthesiopathie bestand eine signifikante Korrelation. Eine signifikante Korrelation bestand darüber hinaus auch zwischen dem Vorliegen einer Enthesiopathie und der Anzahl der betroffenen Nägel (p = 0,035). SCHLUSSFOLGERUNGEN: Klinische Belege für eine Onychopathie können der Schlüssel für die frühe Diagnose einer Enthesiopathie bei Psoriasis-Patienten sein.

Nail involvement can predict enthesopathy in patients with psoriasis.

BACKGROUND: Although subclinical enthesopathy is a well-established diagnostic criterion for psoriatic arthritis (PsA), it is frequently overlooked, as many patients are asymptomatic. The possibility of finding a clinical clue predicting enthesopathy would help clinicians establish an early diagnosis of PsA. MATERIAL AND METHODS: A prospective single-center study of a total of 90 patients with psoriasis was conducted to assess the presence of entheseal abnormalities as detected by ultrasound, and to determine any correlation with nail involvement. RESULTS: Entheseal abnormalities were found in 23 patients (25.5 %), 19 (82.6 %) of whom showed nail involvement, whereas four (17.4 %) individuals did not. Enthesopathy was present in 31.1 % (19/61) of patients with onychopathy compared to 13.8 % (4/29) of those without nail involvement (p  =  0.07). There was a significant correlation between target NAPSI score and evidence of enthesopathy. In addition, the number of nails affected also showed a significant correlation with the presence of enthesopathy (p  = 0.035). CONCLUSIONS: Clinical evidence of onychopathy may be the clue to an early diagnosis of enthesopathy in psoriasis patients.

Sarcoidosis morfeiforme como manifestación atípica de sarcoidosis. Revisión de la bibliografía y diagnóstico diferencial / Morpheiform sarcoidosis as atypical manifestation of sarcoidosis. Review of the literature and differential diagnosis

La sarcoidosis se considera una enfermedad multisistémica, idiopática que se caracteriza por la formación de granulomas en los órganos afectados. Las manifestaciones clínicas son muy diversas y tradicionalmente se han clasificado como específicas (con presencia de granulomas típicos en la biopsia) y no específicas (sin granulomas). Dentro del primer grupo, la variante de sarcoidosis morfeiforme se considera excepcional y puede suponer un auténtico reto diagnóstico para el clínico. Hacemos una revisión de todos los casos descritos hasta la fecha y planteamos los posibles diagnósticos diferenciales. Resaltamos la importancia de conocer las formas atípicas de sarcoidosis y la capacidad para simular cuadros morfeiformes o esclerodermiformes en los pacientes que la padecen (AU)

Sarcoidosis is an idiopathic multisystem granulomatous disease that commonly involves the skin in 25% of affected patients. Because lesions assume a vast array of morphologies, a classification dividing them into specific (with presence of typical granulomas in the biopsy) or nonspecific (not containing granulomas) has been proposed. In the first group the variant morpheaform is considered exceptional. We review the cases reported in the literature and describe the possible differential diagnosis. We highlight the importance of recognizing the very atypical presentation of sarcoidosis and its ability to mimic morpheaform or sclerosis diseases in our patients (AU)

Dermatosis ampollosa a distancia en pacientes tratados con heparina / Bullous dermatosis at distant sites in patients treated with heparin

Desde que en el año 2006 Perrinaud describiera por primera vez 3 pacientes con ampollas hemorrágicas en relación con el uso de heparinas, han sido numerosos los casos publicados hasta la fecha, pasando en pocos años a constituir un proceso patológico claramente definido. Hacemos una revisión de todos los casos reportados, repasamos las claves diagnósticas y aquellas características que las diferencian de otras manifestaciones cutáneas provocadas por heparinas, cuyo pronóstico es más grave y su identificación resulta crucial (AU)

Since Perrinaud in 2006 first described three patients with hemorrhagic bullae in relation to the use of heparins, numerous cases have been published. Currently, this entity has been established as a clearly defined pathology. We review all reported cases, diagnostic features and features that differentiate it from other skin manifestations caused by heparin having a worse prognosis and requiring a precise identification (AU)

[Morpheiform sarcoidosis as atypical manifestation of sarcoidosis. Review of the literature and differential diagnosis]. / Sarcoidosis morfeiforme como manifestación atípica de sarcoidosis. Revisión de la bibliografía y diagnóstico diferencial.

Sarcoidosis is an idiopathic multisystem granulomatous disease that commonly involves the skin in 25% of affected patients. Because lesions assume a vast array of morphologies, a classification dividing them into specific (with presence of typical granulomas in the biopsy) or nonspecific (not containing granulomas) has been proposed. In the first group the variant morpheaform is considered exceptional. We review the cases reported in the literature and describe the possible differential diagnosis. We highlight the importance of recognizing the very atypical presentation of sarcoidosis and its ability to mimic morpheaform or sclerosis diseases in our patients.

[Bullous dermatosis at distant sites in patients treated with heparin]. / Dermatosis ampollosa a distancia en pacientes tratados con heparina.

Since Perrinaud in 2006 first described three patients with hemorrhagic bullae in relation to the use of heparins, numerous cases have been published. Currently, this entity has been established as a clearly defined pathology. We review all reported cases, diagnostic features and features that differentiate it from other skin manifestations caused by heparin having a worse prognosis and requiring a precise identification.

Placas eritematoedematosas y dolorosas: un inusual efecto secundario por pemetrexed / Painful generalized erythematous patches: A very rare cutaneous adverse effect of pemetrexed

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Síndrome de Dowling-Degos / Dowling-Degos syndrome

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Cuadro ampolloso distal de inicio brusco y hemorragias en astilla / Sudden onset of distal bullae and splinter hemorraghes

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