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Abstracts From the 2020 IDEOM Meeting 2020 IDEOM会议摘要
Q3 Medicine Pub Date : 2021-09-06 DOI: 10.1177/24755303211043842
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引用次数: 0
Tildrakizumab Inadequate Responders Switching to an Alternative IL-23 Inhibitor: A Case Series Tildrakizumab反应不足者改用替代性IL-23抑制剂:一系列病例
Q3 Medicine Pub Date : 2021-08-05 DOI: 10.1177/24755303211037308
E. Song, A. Wong
Background: Biologic switching is not uncommon in the treatment of psoriasis and is most often due to inadequate response of adverse events. Staying within or switching out of the class is still based on expert opinion but there are published data on intra-class switching with TNF-alpha and IL-17 inhibitors. Less is known about the IL-23 inhibitors because of their limited time in the market. We would like to present our experience with inadequate responders to tildrakizumab, a selective IL23 inhibitor, who were switched to an alternative IL-23 inhibitor. Case Description: This is a case series of 6 patients at a single institution considered inadequate responders to tildrakizumab, which included primary failures, secondary failures, and intermediate responders, who were subsequently switched to another IL-23 inhibitor. Conclusion: All 6 patients who were inadequate responders to tildrakizumab showed significant improvement after switching to another IL-23 inhibitor, with 5/6 reaching IGA 0/1 after 16 weeks of treatment.
背景:生物转换在牛皮癣的治疗中并不罕见,最常见的是由于不良事件反应不足。留在类内或切换出类仍基于专家意见,但有关于tnf - α和IL-17抑制剂的类内切换的公开数据。由于IL-23抑制剂在市场上的时间有限,对它们的了解较少。我们希望展示我们对tildrakizumab(一种选择性IL-23抑制剂)反应不足的经验,这些患者被切换到另一种IL-23抑制剂。病例描述:这是一个单一机构的6例患者的病例系列,被认为对tildrakizumab反应不足,包括原发性失败,继发性失败和中间反应,随后切换到另一种IL-23抑制剂。结论:所有6例对tildrakizumab反应不足的患者在改用另一种IL-23抑制剂后均有显著改善,其中5/6在治疗16周后达到IGA 0/1。
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引用次数: 0
Remission of Recalcitrant Psoriasis on Combined Biologic Therapy With Infliximab and Ustekinumab 英夫利昔单抗和Ustekinumab联合生物治疗顽固性银屑病的疗效
Q3 Medicine Pub Date : 2021-07-01 DOI: 10.1177/24755303211029598
Kayla H. Taylor, S. Feldman
Introduction: Anti-TNF treatment is effective for inflammatory bowel disease (IBD), however it also has the potential to cause paradoxical psoriasis which can be challenging to manage. Discontinuation of anti-TNF agents may improve psoriatic lesions but may worsen IBD. Combining biologic therapies, though not yet commonly practiced, may be a useful approach to the treatment of both conditions. Case Presentation: We describe a case of paradoxical palmoplantar psoriasis in a 48-year-old woman with ulcerative colitis (UC). Her UC was well-managed on infliximab. Following trials of several other topical and systemic therapies for her psoriatic lesions, she ultimately received relief on combined ustekinumab and infliximab therapy without flare of her IBD. Discussion: While other publications report success using ustekinumab for paradoxical psoriasis following cessation of infliximab, this case report highlights successful treatment using a combination of ustekinumab and infliximab with no reported adverse effects at 3 months. Conclusion: Discontinuation of the anti-TNF agent and use of a single biologic that may treat both IBD and psoriasis is a treatment option. Additionally, combining biologic therapies, though not yet commonly practiced, may be a useful, albeit costly, approach to prevent potential flares of IBD that may accompany cessation of some biologics. Further studies may be beneficial to assess for long term adverse effects.
抗肿瘤坏死因子治疗是有效的炎症性肠病(IBD),但它也有可能引起矛盾的牛皮癣,这可能是具有挑战性的管理。停用抗肿瘤坏死因子可能改善银屑病病变,但可能加重IBD。结合生物疗法,虽然尚未普遍实践,可能是一个有用的方法来治疗这两种情况。病例介绍:我们描述了一个病例的矛盾掌足底牛皮癣在一个48岁的妇女溃疡性结肠炎(UC)。她的UC在英夫利昔单抗治疗下得到了很好的控制。在对她的银屑病病变进行了几种其他局部和全身治疗的试验后,她最终接受了ustekinumab和英夫利昔单抗联合治疗,没有IBD发作。讨论:虽然其他出版物报道了在停止英夫利昔单抗后使用乌斯特金单抗成功治疗矛盾型牛皮癣,但本病例报告强调了使用乌斯特金单抗和英夫利昔单抗联合治疗的成功治疗,在3个月时没有报告不良反应。结论:停用抗肿瘤坏死因子制剂并使用可同时治疗IBD和牛皮癣的单一生物制剂是一种治疗选择。此外,联合生物疗法虽然尚未普遍实施,但可能是一种有用的方法,尽管昂贵,可以预防可能伴随某些生物制剂停止的IBD潜在发作。进一步的研究可能有助于评估长期的不良影响。
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引用次数: 1
Authorial Conflicts of Interest and Sponsorship in Systematic Reviews and Meta-Analyses on Psoriasis 银屑病系统评价和荟萃分析中的作者利益冲突和赞助
Q3 Medicine Pub Date : 2021-06-10 DOI: 10.1177/24755303211020677
Michael Kee, M. Greenough, J. Anderson, Michael Weaver, M. Hartwell, M. Vassar
Background: Because industry influence – in the form of study sponsorship and authorial conflicts of interest (COI) – can bias the results and conclusions of systematic reviews, there is a need to understand their role in systematic reviews, particularly for common conditions like psoriasis. Objectives: This study identifies conflicts of interest and industry-author relationships in systematic reviews on psoriasis treatment. Methods: Consistent with our cross-sectional design, we searched MEDLINE and Embase for systematic reviews and meta-analyses focused on psoriasis treatment. We then performed a subgroup analysis to determine further industry ties within the systemic reviews funded by industry. Results: Our study consisted of 27 systematic reviews and meta-analyses by 146 researchers. We found that 22 (81.5%) of the included systematic reviews contained at least 1 conflicted author. Six authors (of 47; 4.1%) disclosed all COI within the systematic review, 23 (of 47; 15.7%) partially disclosed COI but were also found to have undisclosed COI, and 18 (of 47; 12.3%) did not disclose any COI. Thirteen (of 22; 59.1%) contained narratives that favored the treatment group and 19 (of 22; 86.4%) reported conclusions favoring the treatment group. Importantly, 3 systematic reviews were industry-sponsored. In terms of our subgroup analysis, we found several additional industry ties within the primary studies. Conclusion: Our study calls attention to conflicts of interest, industry sponsorship, and their influence on research outcomes in systematic reviews and meta-analyses. Further, we provide examples of how specific industry ties can influence systematic reviews and recommendations for reporting.
背景:由于行业影响——以研究赞助和作者利益冲突(COI)的形式——可能会对系统综述的结果和结论产生偏见,因此有必要了解它们在系统综述中的作用,特别是对银屑病等常见疾病的影响。目的:本研究确定银屑病治疗系统综述中的利益冲突和行业作者关系。方法:与我们的横断面设计一致,我们在MEDLINE和Embase上搜索了关于银屑病治疗的系统综述和荟萃分析。然后,我们进行了亚组分析,以确定由行业资助的系统审查中的进一步行业联系。结果:我们的研究由146名研究人员的27篇系统综述和荟萃分析组成。我们发现,在纳入的系统综述中,22篇(81.5%)包含至少1位矛盾的作者。6位作者(共47位;4.1%)在系统审查中披露了所有COI,23位作者(47位;15.7%)部分披露了COI,但也被发现有未披露的COI,18位作者(第47位;12.3%)没有披露任何COI。13个(22个;59.1%)包含有利于治疗组的叙述,19个(22个中;86.4%)报告了有利于治疗小组的结论。重要的是,行业赞助了3次系统审查。根据我们的亚组分析,我们在初步研究中发现了几个额外的行业联系。结论:我们的研究在系统综述和荟萃分析中呼吁关注利益冲突、行业赞助及其对研究结果的影响。此外,我们还提供了具体行业关系如何影响系统审查和报告建议的例子。
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引用次数: 1
Clinical Characteristics and HealthCare Resource Utilization in Patients With Generalized Pustular Psoriasis: Real-World Evidence From a Large Claims-Based Dataset 广泛性脓疱性银屑病患者的临床特征和医疗资源利用:来自大型索赔数据集的真实证据
Q3 Medicine Pub Date : 2021-06-10 DOI: 10.1177/24755303211021786
J. Crowley, A. Golembesky, N. Kotowsky, Ran Gao, R. Bohn, E. Garry, Julia A. Pisc, W. Valdecantos, S. Feldman, A. Menter
Background: Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease with significant unmet clinical need. Historically, GPP has not been well characterized; however, the advent of the International Classification of Diseases, 10th revision, has made it possible to more accurately characterize patients with GPP. Objective: To describe the characteristics and estimate the burden of disease in patients with GPP compared with those with plaque psoriasis. Methods: A retrospective study was conducted using a US administrative claims database, Optum® Clinformatics® Data Mart, between October 1, 2015, and March 31, 2019. Patients with at least 1 inpatient or 2 outpatient diagnosis codes for GPP (L40.1) or psoriasis vulgaris (L40.0) were included. The main outcome measures included the percentage of individuals with comorbidities, medication use, and healthcare resource utilization (HCRU), which were compared between patients with GPP and those with plaque psoriasis and a general population comparator control cohort. Results: Overall, 1,669 patients with GPP were identified at baseline; most patients were female (67.6%). Patients with GPP had more comorbidities than those with plaque psoriasis, specifically metabolic disorders: hyperlipidemia and type 2 diabetes. Medication use for patients with GPP differed from those with plaque psoriasis—patients with GPP required more frequent use of antihypertensives and antibiotics than those with plaque psoriasis. Patients with GPP also had higher HCRU than those with plaque psoriasis. Conclusion: Although this study has limitations, it shows that patients with GPP have a high burden of illness that differs from patients with plaque psoriasis.
背景:全身性脓疱性牛皮癣(GPP)是一种罕见的、严重的中性粒细胞性皮肤病,临床需求尚未得到满足。从历史上看,GPP没有很好地表征;然而,国际疾病分类第十次修订的出现,使得更准确地描述GPP患者成为可能。目的:描述GPP患者与斑块型银屑病患者的特征和疾病负担。方法:在2015年10月1日至2019年3月31日期间,使用美国行政索赔数据库Optum®Clinformatics®Data Mart进行回顾性研究。纳入至少有1次住院或2次门诊GPP (L40.1)或寻常型牛皮癣(L40.0)诊断代码的患者。主要结局指标包括患有合并症、药物使用和医疗资源利用率(HCRU)的个体百分比,这些指标在GPP患者和斑块型银屑病患者以及一般人群比较对照队列之间进行比较。结果:总体而言,在基线时确定了1,669例GPP患者;患者以女性居多(67.6%)。GPP患者比斑块型银屑病患者有更多的合并症,特别是代谢紊乱:高脂血症和2型糖尿病。GPP患者的药物使用与斑块型银屑病患者不同——GPP患者比斑块型银屑病患者需要更频繁地使用抗高血压药和抗生素。GPP患者的HCRU也高于斑块型银屑病患者。结论:虽然本研究存在局限性,但表明GPP患者与斑块型银屑病患者有较高的疾病负担。
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引用次数: 4
Healthcare Resource Utilization and Baseline Characteristics of Patients With Generalized Pustular Psoriasis: Real-World Results From a Large US Database of Multiple Commercial Medical Insurers 广泛性脓疱性银屑病患者的医疗资源利用和基线特征:来自多个商业医疗保险公司的大型美国数据库的真实世界结果
Q3 Medicine Pub Date : 2021-06-09 DOI: 10.1177/24755303211021779
J. Sobell, Ran Gao, A. Golembesky, N. Kotowsky, E. Garry, Erin Comerford, R. Bohn, W. Valdecantos, S. Feldman, C. Leonardi
Background: Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease with high unmet clinical need. The introduction of a GPP-specific International Classification of Diseases, 10th Revision (ICD-10), code has made it possible to generate a more accurate GPP patient profile. Objectives: To describe the characteristics and compare the patient profile and burden of disease of patients with GPP with patients with plaque psoriasis. Methods: A retrospective study was conducted using a US administrative claims database, the IBM® MarketScan® Research Database. The study took place between October 1, 2015, and September 30, 2018. Patients with at least 1 inpatient or 2 outpatient L40.1 (GPP) or L40.0 (psoriasis vulgaris) diagnostic codes were included for analysis. Outcome measures included descriptions of comorbidities, medication use, and healthcare resource utilization (HCRU) among GPP, plaque psoriasis, and general population (matched to those with GPP) cohorts. Results: Patients with GPP had more baseline comorbidities than those with plaque psoriasis and the matched cohort, including psoriatic arthritis (20.6% vs 6.4% and <0.1%) and hyperlipidemia (20.4% vs 16.3% and 11.8%). Patients with GPP also had greater medication use and higher HCRU than those with plaque psoriasis and the matched cohort. Conclusion: Patients with GPP generally experience more comorbidities, with higher HCRU, than patients with plaque psoriasis. Although the large dataset permitted identification of GPP patients with longitudinal follow-up, the lack of a validation algorithm for GPP is a limitation and a potential area for future research.
背景:广泛性脓疱性牛皮癣(GPP)是一种罕见的、严重的中性粒细胞性皮肤病,临床需求未得到满足。引入针对GPP的《国际疾病分类第十次修订版》(ICD-10)代码,使生成更准确的GPP患者概况成为可能。目的:描述GPP患者与斑块型银屑病患者的特征并比较其患者概况和疾病负担。方法:采用美国行政索赔数据库IBM®MarketScan®研究数据库进行回顾性研究。该研究于2015年10月1日至2018年9月30日期间进行。纳入至少1例住院或2例门诊L40.1 (GPP)或L40.0(寻常型牛皮癣)诊断代码的患者进行分析。结果测量包括GPP、斑块型银屑病和一般人群(与GPP患者相匹配)队列中合并症、药物使用和医疗资源利用(HCRU)的描述。结果:GPP患者的基线合并症比斑块型银屑病患者和匹配队列患者更多,包括银屑病关节炎(20.6% vs 6.4%和<0.1%)和高脂血症(20.4% vs 16.3%和11.8%)。GPP患者也比斑块型银屑病患者和匹配的队列有更多的药物使用和更高的HCRU。结论:GPP患者通常比斑块型银屑病患者有更多的合并症,HCRU更高。尽管大型数据集允许通过纵向随访识别GPP患者,但缺乏GPP验证算法是一个局限性,也是未来研究的潜在领域。
{"title":"Healthcare Resource Utilization and Baseline Characteristics of Patients With Generalized Pustular Psoriasis: Real-World Results From a Large US Database of Multiple Commercial Medical Insurers","authors":"J. Sobell, Ran Gao, A. Golembesky, N. Kotowsky, E. Garry, Erin Comerford, R. Bohn, W. Valdecantos, S. Feldman, C. Leonardi","doi":"10.1177/24755303211021779","DOIUrl":"https://doi.org/10.1177/24755303211021779","url":null,"abstract":"Background: Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease with high unmet clinical need. The introduction of a GPP-specific International Classification of Diseases, 10th Revision (ICD-10), code has made it possible to generate a more accurate GPP patient profile. Objectives: To describe the characteristics and compare the patient profile and burden of disease of patients with GPP with patients with plaque psoriasis. Methods: A retrospective study was conducted using a US administrative claims database, the IBM® MarketScan® Research Database. The study took place between October 1, 2015, and September 30, 2018. Patients with at least 1 inpatient or 2 outpatient L40.1 (GPP) or L40.0 (psoriasis vulgaris) diagnostic codes were included for analysis. Outcome measures included descriptions of comorbidities, medication use, and healthcare resource utilization (HCRU) among GPP, plaque psoriasis, and general population (matched to those with GPP) cohorts. Results: Patients with GPP had more baseline comorbidities than those with plaque psoriasis and the matched cohort, including psoriatic arthritis (20.6% vs 6.4% and <0.1%) and hyperlipidemia (20.4% vs 16.3% and 11.8%). Patients with GPP also had greater medication use and higher HCRU than those with plaque psoriasis and the matched cohort. Conclusion: Patients with GPP generally experience more comorbidities, with higher HCRU, than patients with plaque psoriasis. Although the large dataset permitted identification of GPP patients with longitudinal follow-up, the lack of a validation algorithm for GPP is a limitation and a potential area for future research.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":"6 1","pages":"143 - 150"},"PeriodicalIF":0.0,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/24755303211021779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45192040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Non-Medical Switching Impact on Patients and Providers – Psoriatic Disease Community Taking a Stand 非医疗转换对患者和提供者的影响——银屑病社区的立场
Q3 Medicine Pub Date : 2021-06-08 DOI: 10.1177/24755303211024205
A. Armstrong, M. Lebwohl, J. Merola, Samantha Koons, R. Fried, J. Hawkes, J. Koo, R. Langley, George Martin, S. Reddy, S. Schwartzman, E. Siegel, A. V. Van Voorhees, E. Wallace, J. Weinberg, L. Howard, S. Bell
Non-medical switching (NMS) occurs when a payer mandates that patients switch therapies, either within or across therapeutic classes, for non-medical reasons. This type of therapeutic substitution can increase the disease burden and present safety risks for patients. Often, the insurer or pharmacy benefit manager (PBM) institutes these policies due to financial incentives, which results in differential prioritization of medications on formularies. These incentives are typically not passed on to patients; rather, they are profits for the PBM or insurer. Of note, switching to a biosimilar is outside the scope of this letter. As NMS impacts therapies for psoriasis and psoriatic arthritis, the National Psoriasis Foundation (NPF) Medical Board strongly believes that individual treatment choices are best, and solely, determined by the prescribing healthcare provider (HCP) and their patient. Psoriasis is a chronic, systemic immune-mediated disease that requires long-term treatment. Because patients have heterogeneous presentations, therapies need to be individualized to maximize benefit and minimize risks. Each therapy has distinct characteristics including onset time, shortand long-term efficacy, effects on comorbidities, and safety profiles. In decision-making, HCPs consider patients’ presentation and medical history, as well as the MOA, efficacy, and safety of the medication before prescribing. This evidence-based approach results in adherence, greater satisfaction, and reduced burden of disease. Psoriasis in patients with an individualized regimen may remain well controlled for many years. These patients may also experience improvements in mental health and other comorbidities, or possible preventative benefit. NMS can disrupt well-controlled disease. Studies have shown that, in patients with inflammatory diseases, NMS was associated with significantly worse clinical outcomes, including increased flares, poor control, and increased health care resource utilization. In patients with psoriatic disease, NMS may negatively impact patient outcomes. For example, treatment disruptions can lead to exacerbations; the new therapy may not work as well or be tolerated as the prior treatment; or the prior treatment may become less effective when attempted later.
当付款人出于非医疗原因要求患者在治疗类别内或跨治疗类别切换治疗时,就会发生非医疗切换(NMS)。这种类型的治疗替代会增加患者的疾病负担并带来安全风险。通常,保险公司或药房福利经理(PBM)制定这些政策是出于经济激励,这会导致处方中药物的优先级不同。这些激励措施通常不会传递给患者;相反,它们是PBM或保险公司的利润。值得注意的是,改用生物仿制药不在这封信的范围之内。由于NMS影响银屑病和银屑病关节炎的治疗,国家银屑病基金会(NPF)医学委员会坚信,个人治疗选择是最好的,并且完全由处方医疗保健提供者(HCP)及其患者决定。银屑病是一种慢性、系统性免疫介导的疾病,需要长期治疗。由于患者有不同的表现,治疗需要个性化,以最大限度地提高疗效并将风险降至最低。每种疗法都有不同的特点,包括发病时间、短期和长期疗效、对合并症的影响和安全性。在决策中,HCP在开处方前考虑患者的表现和病史,以及药物的MOA、疗效和安全性。这种以证据为基础的方法有助于坚持、提高满意度和减轻疾病负担。个体化治疗的银屑病患者可能会在许多年内得到很好的控制。这些患者还可能经历心理健康和其他合并症的改善,或可能的预防益处。NMS可以破坏控制良好的疾病。研究表明,在炎症性疾病患者中,NMS与明显更差的临床结果相关,包括发作增加、控制不力和医疗资源利用率增加。在银屑病患者中,NMS可能会对患者的预后产生负面影响。例如,治疗中断可能导致病情恶化;新的治疗可能不如先前的治疗有效或耐受;或者当稍后尝试时,先前的治疗可能变得不那么有效。
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引用次数: 0
Proportions of Biologic Discontinuation Among Psoriasis Patients With Metabolic Comorbidities 代谢性共病银屑病患者的生物中止比例
Q3 Medicine Pub Date : 2021-05-01 DOI: 10.1016/J.JID.2021.02.301
C. Enos, V. Ramos, R. McLean, Tin-chi Lin, Nicole Foster, Blessing Dube, A. V. Van Voorhees
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引用次数: 0
Preliminary Validation of the Severity of Nail Psoriasis Score (SNAPS) for the Assessment of Nail Psoriasis in Patients With Psoriatic Arthritis 指甲银屑病严重程度评分(SNAPS)评估银屑病关节炎患者指甲银屑病的初步验证
Q3 Medicine Pub Date : 2021-04-22 DOI: 10.1177/24755303211011483
A. Antony, S. Saeed, Darren J. Hart, P. Nair, C. Cavill, E. Korendowych, N. McHugh, C. Lovell, W. Tillett
Background: Psoriatic nail dystrophy is infrequently assessed in routine care and observational cohorts due to the lack of a feasible validated outcome measure. Objective: To assess the measurement properties of the “Severity of NAil Psoriasis Score” (SNAPS) in PsA. Methods: Nail photography was performed on prospectively recruited patients at baseline and 6 months. The modified Nail Psoriasis Severity Index (mNAPSI) and Physician Nail Visual Acuity Scale (PhNVAS) were comparator instruments for construct validity. Reliability and feasibility were assessed using intra-class correlations (ICCs) and timed scoring. Responsiveness was assessed by correlating the changes in SNAPS, mNAPSI and PhNVAS. Retrospective data from the Bath PsA database was further utilized to assess responsiveness. Results: 21 patients participated in the prospective validation at baseline. Inter- and intra-rater reliability of SNAPS were 0.94 and 0.93-0.96 (p ≤ 0.005). Mean times required to score SNAPS and mNAPSI were 59 and 136 seconds. There were strong correlations between SNAPS and mNAPSI (r = 0.95, p < 0.001) and PhNVAS (r = 0.77, p < 0.001) at baseline. There was a significant reduction in the mNAPSI and SNAPS (p < 0.005) at 6 months and a strong correlation between the change in SNAPS and mNAPSI (rho = 0.838, p < 0.001). Historical data from 57 patients commenced on Etanercept were evaluated. Mean SNAPS reduced from 3.6 to 2.0 at 3 months and 1.2 at 6 months (p < 0.05). Change in SNAPS correlated with changes in Psoriasis Area Severity Index and Dermatology Quality of Life at 3 and 6 months (r≥0.510; p ≤ 0.003). Conclusion: SNAPS is a feasible, reliable and responsive outcome instrument for psoriatic nail dystrophy.
背景:银屑病指甲营养不良很少在常规护理和观察队列中进行评估,因为缺乏可行的有效结果测量。目的:评价银屑病PsA“银屑病严重程度评分”(SNAPS)的测量特性。方法:对前瞻性招募的患者在基线和6个月时进行甲摄影。改良的指甲银屑病严重程度指数(mNAPSI)和医师指甲视力量表(PhNVAS)是结构效度的比较工具。采用类内相关性(ICCs)和定时评分来评估可靠性和可行性。通过将SNAPS、mNAPSI和PhNVAS的变化相关联来评估反应性。进一步利用Bath PsA数据库中的回顾性数据来评估反应性。结果:21例患者在基线时参与了前瞻性验证。snap的组间信度和组内信度分别为0.94和0.93-0.96 (p≤0.005)。得分SNAPS和mNAPSI的平均时间为59秒和136秒。在基线时,SNAPS与mNAPSI (r = 0.95, p < 0.001)和PhNVAS (r = 0.77, p < 0.001)有很强的相关性。6个月时mNAPSI和SNAPS显著降低(p < 0.005), SNAPS和mNAPSI的变化之间有很强的相关性(rho = 0.838, p < 0.001)。对57例开始使用依那西普的患者的历史数据进行了评估。平均snap从3个月时的3.6降至2.0,6个月时的1.2 (p < 0.05)。snap的变化与3个月和6个月时牛皮癣面积严重指数和皮肤病生活质量的变化相关(r≥0.510;P≤0.003)。结论:SNAPS是治疗银屑病指甲营养不良的一种可行、可靠、反应灵敏的预后工具。
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引用次数: 0
Nail Changes in Psoriasis: Correlation Between Onychoscopy and NAPSI Scoring 银屑病患者的指甲变化:耳镜检查与NAPSI评分的相关性
Q3 Medicine Pub Date : 2021-04-21 DOI: 10.1177/24755303211011477
Anisha P. Bindagi, Bhavana Doshi, A. Pandit, Basavapudda Manjunathswamy
Background: Nail changes in psoriasis can present as a diagnostic challenge especially in the absence of cutaneous features. They occur in approximately 40% of psoriatics and in 5% as the sole presentation. Onychoscopy as a diagnostic tool aids in better visualization of nail matrix and bed abnormalities in psoriasis patients with nail involvement. Aim: To study onychoscopic features of nails in psoriasis and correlate it clinically using nail psoriasis severity index (NAPSI). Materials and Methods: A total of 60 patients of psoriasis with nail changes were recruited in this hospital based cross-sectional study over a period of one year. Cutaneous severity was assessed using psoriasis area severity index (PASI). NAPSI was used to determine the severity of nail involvement. Nails of the patients with psoriasis were examined clinically and onychoscopically. Statistical analysis was done using the software R i386.3.6.3. Results: Pitting was the most common nail change observed on clinical and onychoscopic examination, seen in 90% and 95% patients respectively. Leuconychia, red spots in lunula, onycholysis, and splinter hemorrhages were better visualized on onychoscopy. A statistically significant higher NAPSI (P < 0.05) was obtained on onychoscopy. There was a positive co- relation between the cutaneous severity of psoriasis and the extent of nail involvement. Conclusion: Onychoscopic examination coupled with NAPSI in nail psoriasis serves as a useful guide to assess the nail involvement and provides a better insight into the subtle nail changes in psoriatics which could have been missed clinically. Limitations: Small study population, lack of age and sex matched control group.
背景:银屑病的指甲变化是一种诊断挑战,特别是在没有皮肤特征的情况下。它们发生在大约40%的银屑病患者中,5%是唯一的表现。甲镜作为一种诊断工具,有助于更好地可视化甲基质和床异常的银屑病患者的指甲累及。目的:应用指甲银屑病严重程度指数(nail psoriasis severity index, NAPSI)探讨银屑病患者的甲镜特征与临床相关性。材料与方法:在本院进行为期一年的横断面研究,共招募60例银屑病伴甲变患者。使用银屑病区域严重程度指数(PASI)评估皮肤严重程度。NAPSI用于确定指甲受累的严重程度。对银屑病患者的指甲进行了临床及甲镜检查。采用ri386.3.6.3软件进行统计分析。结果:麻点是临床及甲镜检查中最常见的甲变,分别占90%和95%。白带、月牙红点、溶血、裂状出血在镜下表现较好。鼻内窥镜组NAPSI显著增高(P < 0.05)。银屑病的皮肤严重程度与指甲受累程度呈正相关。结论:甲型银屑病的甲镜检查联合NAPSI检查可有效指导甲的受累情况,并能更好地了解银屑病患者临床上可能忽略的细微指甲变化。局限性:研究人群小,缺乏年龄和性别匹配的对照组。
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引用次数: 1
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Journal of Psoriasis and Psoriatic Arthritis
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