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Psoriasis and Psoriatic Arthritis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Cause
Complications
Diagnosis
Mortality and Prognosis
Treatments

Overview

Psoriasis KaleidoscopePsoriasis is an autoimmune skin disease that causes scaly red patches of skin. Sometimes people with psoriasis develop joint pain, which is called psoriatic arthritis.

If you develop a scaly red rash that doesn't go away in a reasonable period of time with the usual over-the-counter products, see your doctor as it may be psoriasis or another skin condition. (Also see Autoimmune Diseases and Skin Diseases)

Psoriasis Health Center. WebMD.

What is Psoriatic Arthritis? Not everyone with psoriasis develops psoriatic arthritis, but everyone with psoriatic arthritis has psoriasis. Most people develop the skin signs of psoriasis first and are later diagnosed with psoriatic arthritis. Joint pain in people with psoriatic arthritis can range from mild to severe. Mayo Clinic.

Support for Psoriasis. The National Psoriasis Foundation is a patient-driven, nonprofit organization that is the voice for the millions of Americans affected by psoriasis and psoriatic arthritis. NPF.

Prevalence of Psoriatic Arthritis in Primary Care Patients with Psoriasis. Among psoriasis patients in primary care the prevalence of PsA is conservatively estimated to be 3.2% increasing to 4.6% if enthesitis is taken into account. PubMed, Arthritis Rheumatol, 12/04/2015.

Psoriasis linked to worse quality of life for family members, too. Both psoriasis patients and the people who live with them say psoriasis negatively impacts their quality of life, and both groups tend to report more depression and anxiety than people not affected by the condition. Reuters Health, 06/06/2014. (Also see Depression)

Causes

Increased circulating anti–α6–integrin autoantibodies in psoriasis (Ps) and psoriatic arthritis (PsA) but not in rheumatoid arthritis (RA). This study shows the presence of anti–α6–integrin antibodies in Ps and PsA but not in RA, which could indicate ongoing abnormal processes in the skin. PubMed, J Dermatol, 10/28/2016. (Also see Causes of Rheumatoid Arthritis)

Immune responses to stress in rheumatoid arthritis (RA) and psoriasis. Patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation. PubMed, Rheumatology (Oxford), 2014 May 20. (Also see Rheumatoid Arthritis and Stress)

IL-17A: A Unique Pathway in Immune-Mediated Diseases: Psoriasis, Psoriatic Arthritis (PsA) and Rheumatoid Arthritis (RA). IL-17A is either important in a subset of patients or plays a relatively minor role in inflammatory joint disease. PubMed, Immunology. 2013 Jul 2. (Also see Causes of Rheumatoid Arthritis)

Pathogenetic overview of psoriatic disease. The traditional model of pathogenesis in PsA has identified it as an autoimmune disease; however, an alternative model classifies it as having autoinflammatory features. PubMed, J Rheumatol Suppl, 2012 Jul;89:7-10.

Complications

Psoriatic arthritis (PsA) is associated with bone loss of the metacarpals. The BoneXpert (BX) MCI score showed periarticular demineralisation and severity–dependent bone loss in patients with PsA. PubMed, Arthritis Res Ther, 2016 Oct 25;18(1):248.

Prevalence of cardiovascular–related (CVD) comorbidity in ankylosing spondylitis (AS), psoriatic arthritis (PsA) and psoriasis (Ps) in primary care: a matched retrospective cohort study. Our findings provide UK comparisons of CVD–related comorbidities in patients with AS, PsA and Ps alone, which further supports the argument for more evidence in the need for screening and intervention around CVD comorbidities in inflammatory conditions. PubMed, Clin Rheumatol, 08/02/2016. (Also see Ankylosing Spondylitis)

Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. The proposed mechanisms for shared pathogenesis between psoriatic diseases and cardiovascular diseases are inflammation, insulin resistance, dyslipidemia, angiogenesis, oxidative stress, and endothelial dysfunction. PubMed, Rheumatol Int, 05/29/2016.

Association Between Psoriasis and Asthma: A Population-Based Retrospective Cohort Analysis. Our study results indicate that patients with psoriasis are associated with increased risk of asthma development. PubMed, Br J Dermatol, 11/10/2014.

Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis. Useful and practical guidance for the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis. PubMed, J Eur Acad Dermatol Venereol, 2013 Dec 24.

Psoriasis Raises Risk of Other Ailments. Patients with psoriasis had an increased risk of multiple comorbid conditions affecting most major organ systems, including the lungs, liver, kidneys, and cardiovascular system. MedPage Today, 08/08/2013.

Cardiovascular (CV) morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. There may be a small, but significant increased risk of cardiovascular events, but not of CV mortality in psoriasis and PsA patients. Journal of the European Academy of Dermatology and Venereology, 11 July 2013.

Psoriasis and concomitant fibrosing disorders: Lichen sclerosus, morphea, and systemic sclerosis. In this population, a predisposition toward autoimmunity is seen as 38.5% of patients had a personal history of a third concomitant autoimmune disease, in addition to psoriasis and fibrosing disorder, whereas 42.3% reported a history of a first-degree relative with an autoimmune disease. Journal of the American Academy of Dermatology Volume 67, Issue 5 , Pages 1079-1083, November 2012. (Also see Lichen Sclerosus, Morphea, Systemic Sclerosis, and Multiple Autoimmune Syndrome)

Diagnosis

The development of psoriatic arthritis (PsA) in patients with psoriasis is preceded by a period of non–specific musculoskeletal symptoms: A prospective cohort study. A preclinical phase exists in patients with PsA prior to the diagnosis of the disease and is characterized by non–-specific musculoskeletal symptoms including joint pain, fatigue and stiffness. PubMed, Arthritis Rheumatol, 10/28/2016.

Psoriatic arthritis (PsA) and psoriasis: differential diagnosis. The aim of this review is to focus on PsA and psoriasis differential diagnosis. Springer Link, 05/07/2016.

Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic (US) study of the synovio–entheseal complex of the small joints of the hands. The US involvement of synovio–entheseal complex and US extrasynovial features may be helpful in the differential diagnosis between early rheumatoid and early psoriatic arthritis. PubMed, Clin Exp Rheumatol, 03/03/2016. (Also see Diagnosis of Rheumatoid Arthritis)

Clinical Risk Factors for the Development of Psoriatic Arthritis Among Patients with Psoriasis: A Review of Available Evidence. This review examines the basic epidemiologic principles of identifying risk factors and reviews the evidence to date about risk factors for PsA among patients with psoriasis. PubMed, Curr Rheumatol Rep, 2015 Oct;17(10):64.

Biomarkers for rheumatoid and psoriatic arthritis. Biomarkers are required to enable earlier diagnosis and predict prognosis in both rheumatoid arthritis and psoriatic arthritis. PubMed, Clin Immunol, 04/28/2015. (Also see Diagnosis of Rheumatoid Arthritis)

Mortality and Prognosis

Smoking and delay to diagnosis are associated with poorer functional outcome in psoriatic arthritis (PsA). Smoking, delay to diagnosis, older age at diagnosis, female sex and a history of anti-tumor necrosis factor (TNF) treatment are associated with worse physical function in established PsA. Ann Rheum Dis, 2013 Jan 3.

Treatments for Psoriasis

The effectiveness of a real life dose reduction strategy for TNF inhibitors in ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In a real–world setting, 60% of individuals with severe AS and PsA who achieve low disease activity can successfully reduce the dose of TNF inhibitor therapy by a third for a mean of 1 year. PubMed, Rheumatology (Oxford), 06/28/2016. (Also see Ankylosing Spondylitis)

Treatment patterns and costs for anti–TNFα biologic therapy in patients with psoriatic arthritis. While the majority of patients received only one line of anti–TNFα therapy, a subset of patients switched to multiple lines of therapy during the 3–year follow-up period. BMC Musculoskeletal Disorders, 06/14/2016. (Also see DMARD's)

New therapies for psoriasis and psoriatic arthritis. Secukinumab, an interleukin–17A antibody, has been approved for treatment of psoriasis and PsA in the United States. PubMed, Curr Opin Rheumatol, 2016 May;28(3):204-10.

Group for research and assessment of psoriasis and psoriatic arthritis (PsA): Treatment recommendations for psoriatic arthritis 2015. Overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities are presented and further updates are anticipated as the therapeutic landscape in PsA evolves. Wiley Online Library, 01/11/2016.

The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis (PsA) in Patients with Psoriasis. Collaboration of dermatologists with rheumatologists in managing psoriasis patients is likely to yield more optimal control of symptoms and improve long-term outcomes. PubMed, Drugs, 2014 Feb 25.

FDA approves Celgene drug for psoriatic arthritis. The drug, known chemically as apremilast, will be sold under the brand name Otezla. Reuters, 03/21/2014.

Hemostatic and Fibrinolytic Changes Are Related to Inflammatory Conditions in Patients with Psoriatic Arthritis (PsA) — Effect of Different Treatments. Tumor necrosis factor (TNF)-a inhibitors brought about a significant improvement of hemostatic and fibrinolytic balance in subjects with PsA. Maximal changes were found in patients achieving minimal disease activity (MDA.) PubMed, J Rheumatol, 2014 Feb 15.

The new era for the treatment of Psoriasis (PsO) and Psoriatic Arthritis (PsA). The role of IL-17 and IL-23 in the pathogenesis of PsO and PsA and their role as therapeutic targets for PsO and PsA treatment. PubMed, Autoimmun Rev, 09/07/2013.

Prior Psoriasis Treatments No Obstacle to IL-17a Blocker. Front-loaded treatment with a novel psoriasis drug achieved 75% disease response in more than half of patients, irrespective of prior exposure or response to biologic therapy, results of a randomized trial showed. Med Page Today. 03/07/2013.

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