Prevalence of psoriatic arthritis in Chinese population with psoriasis: A multicenter study conducted by experienced rheumatologists / 中华医学杂志(英文版)

BACKGROUND@#Reports on the prevalence of psoriatic arthritis (PsA) among Chinese patients with psoriasis are very limited. This study, conducted by rheumatologists, estimated the prevalence of PsA in a large number of Chinese patients with psoriasis.@*METHODS@#Consecutive patients with a confirmed diagnosis of psoriasis attending nine dermatology clinics in five hospitals were recruited. All psoriasis patients were asked to complete a questionnaire comprising 16 questions to identify possible cases of PsA. All patients with one or more positive answers to the questionnaire were evaluated by two experienced rheumatologists.@*RESULTS@#A total of 2434 psoriasis patients, including 1561 males and 873 females, were enrolled. Both the questionnaire and rheumatologists' examinations were completed in the dermatology clinics. The results identified 252 patients with PsA, comprising 168 males and 84 females. The overall prevalence of PsA among psoriasis patients was 10.4% (95% confidence interval [95% CI], 9.1%-11.7%). By sex, the prevalence was 10.8% (95% CI, 9.2%-12.5%) for males and 9.6% (95% CI, 7.7%-11.9%) for females and there was no significant sex difference in the prevalence of PsA (P = 0.38). Of the 252 PsA patients, 125 (49.6%, 95% CI, 41.3%-59.1%) were newly diagnosed by rheumatologists. Consequently, the prevalence of undiagnosed PsA among psoriasis patients was 5.2% (95% CI, 4.4%-6.2%).@*CONCLUSION@#The prevalence of PsA in the Chinese population with psoriasis is about 10.4%, which is almost double that of previous reports in the Chinese population, but lower than that in Caucasians.

Efficacy and safety of infliximab in the treatment of severe plaque psoriasis and its effect on the expression of programmed cell death-1 and programmed cell death ligand-1 / 中华皮肤科杂志

Objective:To investigate the efficacy and safety of infliximab in the treatment of severe plaque psoriasis and its effect on the expression of programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) in psoriatic lesions.Methods:A total of 17 patients with severe plaque psoriasis were enrolled from Shanghai Skin Disease Hospital from February 2019 to April 2019, and were treated with intravenous drips of infliximab at a dose of 5 mg/kg at weeks 0, 2, 6, 14, 22, 30, 38 and 46. Efficacy was evaluated by using the psoriasis area and severity index (PASI) score at weeks 2, 6, 10, 14, 22, 30, 38, 46 and 52, and adverse events were recorded during the trial. Real-time PCR was performed to determine the expression of PD-1 and PD-L1 in skin tissues of 8 volunteer controls, as well as in skin lesions of 14 patients with plaque psoriasis before treatment and 5 patients with plaque psoriasis after 10-week treatment, and immunofluorescence assay to measure the expression of PD-1 and PD-L1 in skin tissues of 5 volunteers and 5 patients with psoriasis. The independent sample t-test was used to compare the expression of PD-1 and PD-L1 in skin tissues between the patients with plaque psoriasis and controls, and paired t-test to compare the expression of PD-1 and PD-L1 in the skin lesions of patients before and after infliximab treatment. Results:After 2, 6, 10, 14, 22, 30, 38, 46 and 52 weeks of infliximab treatment, the proportion of patients with plaque psoriasis achieving PASI75 was 1/17, 6/16, 9/16, 10/16, 15/15, 14/15, 13/14, 11/13 and 10/11, respectively. Antinuclear antibody staining turned positive in 12 patients, which was the most common adverse reaction, and 1 patient experienced an infusion reaction, which was the most severe adverse reaction. Before the treatment, the expression of PD-1 and PD-L1 (1.111 ± 0.391, 0.902 ± 0.169, respectively) was significantly higher in the skin lesions of patients with psoriasis than in the skin tissues of controls (0.620 ± 0.225, t=3.116, P=0.007; 0.474 ± 0.360, t=3.208, P=0.006, respectively) ; after infliximab treatment, the expression of PD-1 and PD-L1 (0.570 ± 0.230, 0.150 ± 0.050, respectively) in the improved skin lesions was significantly lower than that in the corresponding lesions before the treatment (1.238 ± 0.414, t=3.107, P=0.036; 0.966 ± 0.184, t=8.423, P=0.001, respectively) . Conclusions:Infliximab is effective and safe for the treatment of plaque psoriasis, but monitoring is necessary during treatment. The expression of PD-1 and PD-L1 is aberrantly upregulated in plaque psoriasis lesions, and decreased after infliximab treatment, suggesting that PD-1/PD-L1 may be involved in inflammation regulation in psoriasis.

Psoriasis comorbidities / 中华皮肤科杂志

Psoriasis is an immune-mediated chronic inflammatory disease,whose occurrence is closely associated with genes,immunity,environment and other factors.Classic comorbidities associated with psoriasis mainly include cardiovascular diseases,obesity and inflammatory bowel diseases.Emerging data have shown some other diseases closely associated with psoriasis,including metabolic syndrome,chronic renal diseases,tumors,infections,and so on.This review summarizes psoriasis-associated comorbidities that have been reported in studies,and analyzes the possible co-pathogenesis of these diseases and psoriasis.

Relationship of psoriasis with microecology of the skin and intestine / 中华皮肤科杂志

Psoriasis is a chronic,non-infective inflammatory dermatosis characterized by erythemas covered with scales.Psoriasis is considered as a systemic disease,and several studies have confirmed that it is associated with many other diseases,such as cardiovascular diseases,obesity,diabetes mellitus type Ⅱ,dyslipidemia,nonalcoholic fatty liver disease,anxiety disorder,depression and inflammatory bowel disease.The occurrence and development of psoriasis is closely related to the immune response,and the immune dysfunction of T lymphocytes induced by the infiltration and activation of inflammatory cells has been confirmed as the key step in the pathogenesis of psoriasis.Various kinds of cytokines in the local microenvironment can promote the activation and proliferation of T lymphocytes,and regulate the differentiation of T lymphocytes into different subsets,which take an important part in the occurrence of psoriasis.In recent years,researchers have found that local microbes also play an important role in this process.Thus,this review summarizes the progress in the roles of human skin and gut microbiota in psoriasis.

Clinical features of 70 cases of psoriatic arthritis / 中华皮肤科杂志

Objective To investigate the prevalence of psoriatic arthritis (PsA) in patients with psoriasis and its clinical features.Methods A cross-sectional study was conducted among patients diagnosed with psoriasis from January 2014 to January 2015.Through a questionnaire survey,the diagnosis of PsA was confirmed according to the Classification Criteria for Psoriatic Arthritis (CASPAR) in patients with suspected PsA.Clinical data were collected from patients with newly and previously diagnosed PsA.Statistical analysis was carried out by t test for two-group comparisons,one-way analysis of variance (ANOVA) for multi-group comparisons,and chi-square test for comparisons of rates.All the statistical tests were two-sided.Results Totally,1 062 outpatients with psoriasis were enrolled into this study,and 125 were suspected to have PsA.According to the CASPAR,70 (6.59％) patients were finally diagnosed with PsA,with the ratio of male to female being 2.1 ∶ 1,and 45 of them (64.29％) were newly diagnosed.Psoriasis vulgaris lesions were observed in 50 (71.43％) patients with PsA,and were the most common type of skin lesions in patients with PsA.There were 5 clinical types of PsA in these patients,including asymmetrical oligoarthritis (23 cases,32.86％),symmetric polyarthritis (19 cases,27.14％),distal interphalangeal predominant arthritis (10 cases,14.29％),vertebral or sacroiliac arthropathy (7 cases,10.00％),and arthritis mutilans (11 cases,15.71％),with some overlap among these clinical types.As relatively distinctive manifestations of PsA,dactylitis and enthesitis were observed in 14 (20.00％) and 8 cases (11.43％) respectively.In addition,43 (61.43％) cases had nail involvements.Conclusion To master clinical features of PsA and to diagnose it early are of great significance for long-term prognosis of PsA patients.

Effect of Chinese Medicinal Herbs on Human Scalp Hair Growth in Vitro / 中华皮肤科杂志

Objective To study the effect of Chinese herbs on human scalp hair growth in vitro. Methods Organ culture of human scalp hair follicles was used to study the effects of extracts of Crataegus cuneata, Ligustrum lucidum, Polyporus umbelatus and Bletilla striata mixture and ginseng saponin on hair growth. Results Low doses of mixture extracts(1.28 ?g/mL and 6.4 ?g/mL) markedly enhanced the hair growth and lengthened the period of hair growth, while high doses of mixture extracts(4 mg/mL and 20 mg/mL) sharply inhibited hair growth and shortened the period of hair growth. High doses of ginseng saponin (40 ?g/mL and 200 ?g/mL) also had an inhibiting effect on hair growth. Conclusion This observation suggests that extracts of Crataegus cuneata, Ligustrum lucidum, Polyporus umbelatus and Bletilla striata mixture can promote hair growth in vitro.