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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.

Causes

Negative regulation of dendritic cell (DC) activation in psoriasis mediated via CD100-Plexin-B2. Our results uncovered a negative regulatory mechanism for DCs activation in psoriasis, which was mediated via CD100-Plexin-B2 in a cell type- and receptor- specific manner. PubMed, J Pathol, 01/14/2020. (Also see Dendritic Cells)

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.

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

Depression and suicidality in psoriasis and clinical studies of brodalumab: a narrative review. Clinicians are urged to evaluate patients with psoriasis for psychiatric risk factors regardless of their therapy. PubMed, Cutis, 2019 Dec;104(6):361-365. (Also see Depression and Suicide Prevention)

Association Between Psoriasis with Arthritis (PsA) and Hearing Impairment (HI) in US Adults: Data from the National Health and Nutrition Examination Survey. PsA is independently associated with a significantly increased risk of HI, which partially mediates an association with worsened psychiatric outcomes. PubMed, J Rheumatol, 2019 Jun;46(6):587-594.

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)

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

Unbalanced Sphingolipid Metabolism and Its Implications for the Pathogenesis of Psoriasis. The significance of SLs as structural and signalling molecules and their actions in inflammation are discussed. PubMed, Molecules, 2020 Mar 3;25(5).

The role of epigenetics and immunological imbalance in the etiopathogenesis of psoriasis (Ps) and psoriatic arthritis (PsA). Besides well-known genetic susceptibility loci, epigenetic DNA modifications, which are associated with Ps development, have been characterized recently. PubMed, Ther Adv Musculoskelet Dis, 2019 Nov 6;11:1759720X19886505.

Evidence for a role of autoinflammation in early-phase psoriasis. IL-1β overexpression in combination with low expression of cytokines that are predominant in late-phase plaque psoriasis may support the role of autoinflammation in early-phase disease. PubMed, Clin Exp Immunol, 09/11/2019.

Musculoskeletal ultrasound can improve referrals from dermatology to rheumatology for patients with psoriasis. Due to the high frequency of non-specific pain in psoriasis, it is not possible for every psoriasis patient with joint pain to be assessed by a rheumatologist. PubMed, Br J Dermatol, 09/10/2019.

Differential synovial tissue (ST) biomarkers among psoriatic arthritis and rheumatoid factor/anti–citrulline antibody–negative rheumatoid arthritis. Histological analysis of ST may help to solve the clinical overlap between the two diseases and provides prognostic data about the therapy success. PubMed, Arthritis Res Ther, 2019 May 9;21(1):116. (Also see Diagnosis of Rheumatoid Arthritis)

Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease. The purpose of this review is to describe the new pathogenetic mechanisms and the different clinical pictures of Systemic Psoriatic Disease. PubMed, Autoimmun Rev, 04/05/2019.

Genetic variation at the glycosaminoglycan metabolism pathway contributes to the risk of psoriatic arthritis (PsA) but not psoriasis. These findings provide insights into the biological mechanisms that are specific for PsA and could contribute to develop more effective therapies. PubMed, Ann Rheum Dis, 2019 Mar;78(3).

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.

C5a and C5aR are elevated in joints of rheumatoid and psoriatic arthritis patients, and C5aR blockade attenuates leukocyte migration to synovial fluid. The data support that the C5a-C5aR axis may be driving the infiltration of inflammatory cells into the synovial fluid and synovium in both rheumatoid and psoriatic arthritis, and suggest that C5a or C5aR may be a promising treatment target in both diseases. PubMed, PLoS One, 2017 Dec 8;12(12):e0189017. (Also see Diagnosis of Rheumatoid Arthritis)

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.

Mortality and Prognosis

Remission in psoriatic arthritis: Definition and predictors. The use of biologic agents increased not only the chance of remission, but also the chance of sustained remission for at least 12 months. Seminars in Arthritis and Rheumatism, 02/03/2020. (Also see Biologic Agents)

Identification of Novel Autoantibodies Associated with Psoriatic Arthritis. Our findings suggest that these autoantibodies may be useful biomarkers and indicative of therapeutic targets of psoriasis and psoriatic arthritis. PubMed, Arthritis Rheumatol, 01/07/2019.

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

Interleukin-36 family dysregulation drives joint inflammation and therapy response in psoriatic arthritis. Exogenous replacement of IL-36 antagonists may be a novel promising therapeutic target for PsA patients. PubMed, Rheumatology (Oxford), 09/03/2019.

Effect of disease-modifying anti-rheumatic drugs (DMARDs) on bone structure and strength in psoriatic arthritis (PsA) patients. Despite longer disease duration, bDMARD-treated PsA patients benefit from higher bone mass and better bone strength than PsA patients receiving methotrexate or no DMARDs. PubMed, Arthritis Res Ther, 2019 Jul 3;21(1):162. (Also see Disease-Modifying Anti_Rheumatic Drugs)

Case Report: Efficacy and Metabolic Effect on Serum Lipids of Apremilast in Psoriatic Arthritis (PsA). Our observations suggest that apremilast is effective in controlling mild skin and joint involvement and suggest a potentially advantageous metabolic effect in patients with PsA. PubMed, J Clin Med.

The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis. Continuation of biologics therapy was associated with a low level of disease activity and a low probability of flare during pregnancy. PubMed, J Rheumatol, 2018 Dec;45(12):1651-1655. (Also see Biologic Agents)

Improved patient–reported outcomes (PROs) in patients with psoriatic arthritis (PsA) treated with abatacept: results from a phase 3 trial. Abatacept treatment improved PROs in patients with PsA versus placebo, with better results in elevated baseline C-reactive protein and tumour necrosis factor inhibitor– na├»ve subpopulations. BMC Journals, Arthritis Research & Therapy, 12/06/2018. (Also see Biologic Agents)

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.

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