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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
Research
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)

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.

Causes

Hyperuricemia is an independent risk factor for psoriatic arthritis (PsA) in psoriatic patients. Hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects and it appears to be an independent risk factor for PsA. PubMed, J Dermatol, 07/10/2017.

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). (Also see Rheumatoid Arthritis and Stress)

Complications

Association of Psoriasis With Inflammatory Bowel Disease: A Systematic Review and Meta–analysis. These findings suggest that psoriasis is significantly associated with IBD and gastroenterology consultation may be indicated when patients with psoriasis present with bowel symptoms. PubMed, JAMA Dermatol, 10/24/2018. (Also see Inflammatory Bowel Disease)

Increased Prevalence of Metabolic Syndrome (MetS) and Adipocytokine Levels in a Psoriatic Arthritis(PsA) Cohort. Clinicians caring for PsA patients ought to be aware of the increased risk of MetS in PsA patients, confirmed in different regions worldwide. PubMed, J Clin Rheumatol, 2018 Sep;24(6):302-307.

Risk of type 2 diabetes (T2D) and cardiovascular disease in an incident cohort of people with psoriatic arthritis (PsA): A population–based cohort study. The development of T2D in an incident population of PsA is significantly higher than in psoriasis alone, whereas the increased risk of cardiovascular disease in PsA and psoriasis is similar. Rheumatology, 09/06/2018. (Also see Symptoms and Complications of Diabetes)

Comorbidity in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). High rates of comorbidity were found and the prevalence of depression, cardiovascular risk factors and other comorbidities were higher in PsA than RA participants. PubMed, Intern Med J, 07/26/2018. (Also see Rheumatoid Arthritis in Overlap)

Psoriasis and arthritis sufferers have a higher risk of heart attacks and strokes, study finds. People with inflammatory arthritis and psoriasis should be closely monitored and given extra support to help prevent heart attack and strokes. Mail Online, 04/23/2018.

Subclinical impairment of myocardial and endothelial functionality in very early psoriatic (PsA) and rheumatoid arthritis patients: Association with vitamin D and inflammation. Disease activity was the main predictor of myocardial strain impairment and myocardial function was altered and associated with carotid intima-media thickness. Atherosclerosis, 03/06/2018. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Prevalence and type II diabetes–associated factors in psoriatic arthritis. Results suggested that diabetes was notably related to late–onset psoriasis and hypertension and the risk of diabetes ought to be evaluated carefully in subjects whose psoriasis begins after 40 years. PubMed, Clin Rheumatol, 02/22/2018. (Also see Symptoms and Complications of Diabetes)

Metabolic syndrome (MetS) in psoriatic arthritis (PsA): the interplay with cutaneous involvement. Evidences from literature and a recent cross–sectional study. In our study, the occurrence of MetS and mean levels of serum uric acid were higher in PsA patients with clinical evident psoriasis compared to sine psoriasis PsA. PubMed, Clin Rheumatol, 01/08/2018.

Infections and the risk of psoriatic arthritis (PsA) among psoriasis patients: a systematic review. While the studies summarized did not all provide evidence supporting an association between infections and PsA certain trends emerged. PubMed, Rheumatol Int, 11/09/2017.

Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis (PsA): a population–based cohort study. In a primary care–based incidence cohort of patients with PsA, there were substantial risks of developing uveitis and/or Crohn's disease, but not ulcerative colitis, when compared with the general population and psoriasis controls. PubMed, Ann Rheum Dis, 11/01/2017. (Also see Inflammatory Bowel Disease)

Risk of incident liver disease in patients with psoriasis (PsO), psoriatic arthritis (PsA) and rheumatoid arthritis (RA): a population–based study. More so than RA, PsO and PsA are associated with liver disease, particularly non-alcoholic fatty liver disease and cirrhosis, and this was true even among patients without systemic therapy exposure. PubMed, J Invest Dermatol, 10/27/2017. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Cardiometabolic Disorders in Psoriatic Disease (PsD). These findings highlight the importance of controlling disease activity as potential target that could lead to reduced cardiovascular risk in patients with PsD. PubMed, Curr Rheumatol Rep, 2017 Aug 26;19(10):63. (Also see Cardiac (Heart) Involvement)

Psoriasis, Depression, and Suicidality. Age and severity of disease are significant with a clear association of increased depression and suicidality found in patients who are younger or have more severe disease. PubMed, Skin Therapy Lett, 2017 May;22(3):1-4. (Also see Depression and Suicide Prevention)

The problem in differentiation between psoriatic–related polyenthesitis and fibromyalgia (FMS). The unmet needs in the differentiation between FM and enthesitis in psoriatic disease patients are highlighted and critically evaluated in this article. PubMed, Rheumatology (Oxford), 04/05/2017. (Also see Fibromyalgia)

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.

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. (Also see Lichen Sclerosus, Morphea, Systemic Sclerosis, and Multiple Autoimmune Syndrome)

Diagnosis

Potential Role of Cytochrome c and Tryptase in Psoriasis and Psoriatic Arthritis Pathogenesis: Focus on Resistance to Apoptosis and Oxidative Stress. The cytochrome c release into the extracellular space and tryptase may have a role in skin and joint inflammation. PubMed, Front Immunol, 2018 Oct 30;9:2363. (Also see Oxidative Stress)

The pathogenesis of psoriatic arthritis. Improving our understanding of psoriatic arthritis pathogenesis could help to establish validated biomarkers for diagnosis. PubMed, Lancet, 2018 Jun 2;391(10136):2273-2284.

Novel serum biomarkers differentiate psoriatic arthritis (PsA) from psoriasis without psoriatic arthritis (PsC). There is a high prevalence of undiagnosed PsA in psoriasis patients and identifying soluble biomarkers for PsA will help in screening PsC patients for appropriate rheumatology referral. PubMed, Arthritis Care Res (Hoboken), 06/06/2017.

Enhanced liver fibrosis test (ELF) in psoriasis (PSO), psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients: a cross–sectional comparison with procollagen–3 N–terminal peptide (P3NP). ELF may be superior to P3NP alone but further research should be done to validated ELF test susceptible for developing liver fibrosis for PSO, PSA and RA. PubMed, Br J Dermatol, 12/07/2016.

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.

Research for Psoriasis

Progress in genetic research on psoriatic arthritis. These studies have laid a foundation for risk prediction, diagnosis and drug development for psoriatic arthritis. PubMed, Zhonghua Yi Xue Yi Chuan Xue Za Zhi, 2017 Aug 10;34(4):606-610.

Treatments for Psoriasis

Naturally derived Heme-Oxygenase 1 inducers attenuate inflammatory responses in human dendritic cells and T cells: relevance for psoriasis treatment. This study supports reports highlighting the therapeutic potential of curcumin in psoriasis by providing insight into its immunological effects. PubMed, Sci Rep, 2018 Jul 6;8(1):10287.

Drug Utilization Patterns and Adherence in Patients on Systemic Medications for the Treatment of Psoriasis: A Retrospective Comparative Cohort Study. We report greater adherence in new users of biologics when compared to methotrexate. PubMed, J Am Acad Dermatol, 07/04/2018. (Also see Biologic Agents)

Low Doses of Etanercept (ETN) Can Be Effective to Maintain Remission in Psoriatic Arthritis (PsA) Patients. The main reasons that hinder the dosing interval increase in ETN in PsA patients are peripheral polyarthritis pattern and exacerbation of cutaneous manifestations. PubMed, J Clin Rheumatol, 2018 Apr;24(3):127-131. (Also see Biologic Agents)

Precision medicine using different biological DMARDs based on characteristic phenotypes of peripheral T helper cells in psoriatic arthritis. Strategic treatment in which different bDMARDs were selected according to phenotypic differences in helper T cells showed significantly higher efficacy. PubMed, Rheumatology (Oxford), 04/02/2018. (Also see Biologic Agents)

Use of biological drugs in patients with psoriasis (PsO) and psoriatic arthritis (PsA) in Italy: Results from the PSONG survey. Adalimumab could be the best therapeutic option over other anti–TNF agents for the treatment of PsO and PsA patients. PubMed, Dermatol Ther, 12/07/2017. (Also see Biologic Agents)

Residual disease activity and treatment adjustments in psoriatic arthritis (PsA) in current clinical practice. Remaining disease activity is present in almost two thirds of patients with PsA when scored by the treating rheumatologist, but triggers treatment adjustment in only a minority. PubMed, Arthritis Res Ther, 2017 Oct 10;19(1):226.

Management of psoriatic arthritis in 2016: a comparison of EULAR and GRAPPA recommendations. In this Perspectives article, we address the similarities and differences between these two sets of recommendations and the implications for patient management. PubMed, Nat Rev Rheumatol, 2016 Dec;12(12):743-750.

Melanoma and non-melanoma skin cancer in psoriatic patients treated with high-dose phototherapy. A thorough risk-benefit evaluation should always be done before UV treatment and patients should be carefully monitored for skin cancer during and after treatment discontinuation. PubMed, J Dermatolog Treat, 2016 Oct;27(5):443-7. (Also see Cancer)

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.

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