Journal of Psoriasis and Psoriatic Arthritis最新文献

Background: There have been significant advances in psoriatic disease research in recent years, leading to better understanding of genes involved and increased treatment options. Purpose: To guide current research priorities for psoriatic disease, we held an interactive session on this topic consisting of a presentation and small group discussion with National Psoriasis Foundation (NPF) patient-volunteers, their family members, and NPF staff at the NPF 2025 IMPACT Volunteer Leadership Summit. Research design: We presented a list of 10 psoriatic research topics and asked attendees to rate the priority of each topic on a 9-point scale. The session also included breakout groups where attendees discussed research areas most important to them. Study Sample: National Psoriasis Foundation (NPF) patient-volunteers, their family members, and NPF staff at the NPF 2025 IMPACT Volunteer Leadership Summit. Data collection and/or Analysis: Attendees completed an online REDCap survey which was then analyzed by the study team. Results: "Improving treatment for psoriatic disease and achieving remission" was the research topic that received the highest overall rating. We also learned of research topics of high patient interest not included on our original list of 10 topics, including research exploring the relationship between psoriatic disease and hormones, infertility, and menopause. Increased research on pediatric psoriatic disease and research initiatives focused on increased patient and provider education were topics of importance to attendees as well. Conclusion: Overall, these findings may help guide future patient-centered research agendas in psoriatic disease.

Background: In order to apply current treatment recommendations for psoriatic arthritis (PsA), a complete assessment of psoriatic disease domains must be completed by the clinician. This includes a musculoskeletal examination (including tender and swollen joints, dactylitis, enthesitis, and axial disease) as well as skin and nail examination. Documentation in the clinician's note serves as a proxy for disease assessment.

Objective: To explore differences in documentation of psoriatic domains between PsA specialist and general rheumatologists at 2 academic centers.

Methods: We identified PsA patients seen by either general rheumatologists or by PsA combined clinic specialist providers at 2 established PPACMAN (Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network) sites. Records were assessed for the presence (and extent) of documentation for musculoskeletal and cutaneous PsA domains. We also examined accuracy of ICD coded diagnoses to understand the extent to which discrete data from the electronic medical record can be used to evaluate completeness of assessment.

Results: PsA combined clinic specialist providers documented disease domains significantly more consistently compared to generalists, including tender and swollen joint counts (P < 0.001), assessment of spondyloarthritis (P = 0.017), and presence/extent of skin involvement (P < 0.001). Additionally, PsA specialists more consistently coded for both psoriasis (PsO) and PsA.

Conclusions: In this multicenter, retrospective study, compared to generalists, PsA combined-clinic specialist providers more thoroughly documented both musculoskeletal and cutaneous psoriatic disease domains and ICD coding of PsO for patients, highlighting gaps in assessment and documentation. These findings underscore the need for improved training in psoriatic disease assessment and simplified modalities for documentation.

Biologic dosing frequency is a key concern among psoriasis (PsO) patients and physicians, yet dosing optimization remains a challenge. This study evaluates patient dosing preferences for IL-17 and IL-23 inhibitors, risankizumab (RZB) every 12 weeks, guselkumab (GUS) every 8 weeks, and ixekizumab (IXE) every 4 weeks, in managing PsO. This phone survey study evaluated 87 adults on RZB (n = 29), GUS (n = 35), or IXE (n = 23) from 2019 onward at two clinical sites. Patients were assessed for baseline PsO bothersome severity, current dosing frequency satisfaction, frequency of PsO flares, and preferred dosing frequency. Most patients were males (57.5%) with an average age of 54.1 years and an average treatment duration of 19.0 months. At baseline before treatment, 87% were 'very bothered' by their PsO. After treatment, 86% were either '3-somewhat' or '4-very satisfied' with their current dosing schedule, with no significant differences between each drug (P = 0.7). Across all biologics the majority of participants (62% with RZB, 57% with GUS, and 48% with IXE) preferred maintaining their current dosing frequency. No statistically significant differences were observed in dosing frequency preference between treatment groups, suggesting dosing schedule is not a primary concern for most patients. This aligns with previous research demonstrating effective disease control is the most important factor for patient satisfaction; however, tailoring dosing regimens to individual patient needs can also strengthen long-term adherence, as demonstrated in recent studies.

Background: Limited literature exists on the mortality burden of generalized pustular psoriasis (GPP) in the US.

Objective: To compare all-cause mortality among patients with GPP with matched populations of patients with plaque psoriasis (PsO) and the general population in the US.

Methods: An observational study was conducted using US claims data collected between January 1, 2016 and December 31, 2019. All-cause mortality was evaluated at 365 days post-index and at maximum follow-up in the following cohorts: GPP-only, Plaque-PsO-only, GPP + PsO, All-GPP, and general population. Propensity score matching was used to balance covariates between cohorts. The index date was the first medical claim for GPP (ICD-10 code L40.1) or PsO (L40.0), and a randomly selected date per year for individuals in the general population cohort.

Results: 1246 patients were included in GPP-only, 1384 in GPP + PsO, 2630 in All-GPP and 127,540 in plaque-PsO-only. 19,641,441 individuals were included in general population. The maximum follow-up ranged from 36.14 to 41.28 months (3.01-3.44 years). At 365-day follow-up, mortality risk was significantly higher in the All-GPP vs the general population (hazard ratio [HR] 4.93, 95% confidence interval [CI] 2.24-10.88) and plaque-PsO-only (HR 2.31, 95% CI 1.32-4.04) cohorts. At maximum follow-up, the mortality risk for the All-GPP cohort was four times higher than the general population (HR 3.98, 95% CI 2.92-5.43) and 1.5 times higher than the plaque-PsO-only (HR 1.49, 95% CI 1.20-1.85) cohorts.

Conclusion: Patients with GPP exhibited an elevated mortality risk in comparison to the matched plaque-PsO and general population cohorts.

Patients with psoriasis (PsO) and psoriatic arthritis (PsA) are at significantly increased risk for cardiovascular (CV) disease, attributed to chronic systemic inflammation and a high burden of cardiometabolic comorbidities. Despite this, CV risk factors in this population are frequently underdiagnosed and undertreated. This consensus document, developed by the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN), provides practical recommendations for dermatologists, rheumatologists, and primary care physicians to improve CV risk assessment and management in PsO and PsA. Key recommendations include conducting baseline CV risk assessments at diagnosis-particularly for patients with moderate-to-severe PsO, PsA, or those requiring biologic therapy-and routine screening for hypertension, diabetes, dyslipidemia, smoking, obesity, and metabolic syndrome. The use of biomarkers such as high-sensitivity C-reactive protein and lipoprotein(a) may help refine risk stratification. Patients at elevated risk should be referred to their primary care provider or a cardiologist for further evaluation and may require additional imaging, including coronary artery calcium scoring. Lifestyle counseling on diet, exercise, weight management, and smoking cessation is essential. Pharmacologic strategies, such as earlier initiation of statins and consideration of glucagon-like peptide-1 (GLP-1) receptor agonists, are encouraged when clinically appropriate. Systemic inflammation should be reduced using anti-inflammatory therapies, although outcome data remain mixed. Clinicians must carefully assess the risks and benefits of NSAIDs, corticosteroids, and Janus kinase (JAK) inhibitors. This document aims to bridge existing gaps in interdisciplinary care and facilitate earlier, more aggressive CV risk management in psoriatic disease, aligning with current cardiology and dermatology guidelines to reduce morbidity and mortality.

Importance: Dengue infection is an emerging global health concern. Understanding its impact on patients with a history of psoriasis is essential, particularly concerning its potential to trigger psoriasis flare-ups. Additionally, it is crucial to assess the influence of psoriasis treatments on the severity of dengue.

Objectives: This study aims to describe the effects of dengue infection on psoriasis exacerbations, in patients with pre-existing psoriasis and to assess whether prior psoriasis treatment influences dengue severity.

Design: A cross-sectional descriptive study.

Main outcomes and measures: Demographic, clinical, and treatment data were systematically collected.

Results: 25 dermatologists reported psoriasis flare-ups in 52 patients (67.3% male; median age 48 years, IQR 23-81). Among these patients, 63.5% (33 patients) experienced plaque psoriasis flare-ups, 19.2% (10 patients) developed guttate psoriasis, 11.5% (6 patients) progressed to erythroderma, 3.8% (2 patients) presented with plaque psoriasis and pustules, and one patient (1.9%) had an acute generalized pustular psoriasis flare-up. Overall, 63.5% of patients experienced moderate dengue, 30.8% had mild dengue, and 5.8% had severe dengue. Among the 19 patients receiving biologic treatments, 84.2% experienced moderate dengue, while 15.8% had mild dengue. Importantly, none of these patients required hospitalization for severe dengue. In the methotrexate-treated group, comprising seven patients, four experienced mild dengue and three had moderate dengue. Psoriasis flare-ups in this group included two severe cases, five moderate cases, one erythroderma, and six cases of plaque psoriasis.

Conclusions and relevance: Dengue infection appears to trigger psoriasis flare-ups in affected individuals. The most commonly observed type was plaque psoriasis. Our findings suggest systemic therapies for psoriasis may not exacerbate dengue severity and could be considered safe. Further prospective studies are necessary to elucidate the relationship between psoriasis severity and dengue outcomes.

Background: Psoriatic Arthritis (PsA), an immune mediated inflammatory arthritis, affects a quarter of patients with cutaneous psoriasis, usually after psoriasis onset. Early diagnosis of PsA is challenging. A biomarker-based diagnostic test may facilitate early diagnosis.

Objectives: We aimed to determine whether specific clinical features or genetic and protein markers, alone or in combination, can distinguish patients with PsA from those with psoriasis without PsA (PsC).

Methods: Patients with PsA and PsC were identified from a database of patients with psoriatic disease. Detailed demographic and clinical information were collected at time of assessment. Single-nucleotide polymorphisms (SNPs) of 19 "PsA weighted" genes were genotyped. Serum samples were used to assess 15 protein markers by ELISA. Association between clinical, genetic and protein markers and PsA were determined, and models were developed to discriminate PsA from PsC using machine learning algorithms.

Results: Demographic and clinical information had low predictive value in distinguishing PsA from PsC (AUC - 0.607, P < .01). SNP and protein panels also had low value in discriminating PsA from PsC (AUC - 0.691, P < .001 and AUC - 0.694, P < .001, respectively). Combining protein, SNPs and clinical features provided better discriminatory value (best performing model: Random Forest, AUC - 0.733, P < .001).

Conclusion: Combining previously identified clinical, genetic and protein markers have a fair ability to differentiate PsA from PsC. Further studies are required for identifying better diagnostic signatures.

Moderate to severe psoriasis is often treated with systemic medications, including traditional therapies (eg, methotrexate, cyclosporine) and biologics (eg, TNF inhibitors, IL-17 and IL-23 inhibitors). These immunomodulating treatments raise concerns about infection risks, particularly during the SARS-CoV-2 pandemic. However, literature on systemic therapy and COVID-19 outcomes in the United States is limited. This retrospective cohort study analyzed adults with psoriasis and a primary SARS-CoV-2 diagnosis from the 2020 Health care Cost and Utilization Project National Inpatient Sample database. Patients were stratified by systemic medication use, and propensity score matching adjusted for baseline comorbidities. Logistic regression and bivariate analyses assessed the association between systemic therapy and clinical outcomes, including medications and procedures for COVID-19 treatment, length of stay, and mortality. 721,870 patients were included after propensity score matching. Patients receiving systemic medications had higher odds of requiring supplemental oxygen (OR = 1.30; P < .001) but lower odds of mechanical ventilation (OR = .76; P < .001) and intubation (OR = .78; P < .001). They also experienced shorter hospital stays (IRR = .982; P < .001) and lower mortality (OR = .74; P < .001). Systemic treatments for psoriasis influence COVID-19 outcomes, reducing the need for severe respiratory interventions, shortening hospitalization duration, and lowering mortality. These findings highlight the safety of systemic therapies, even during periods of heightened infection risk like the SARS-CoV-2 pandemic. Future research should investigate the differential effects of biologics and traditional therapies.

IXE (Ixekizumab) is a monoclonal antibody targeting interleukin-17A (IL17A) which has demonstrated significant efficacy and safety in the management of psoriatic arthritis (PsA) in randomized controlled trials (RCTs). However, available data on long-term persistence of therapy are scarce.

Methods: This multi-center study aimed to evaluate the drug retention rate (DRR) of IXE in a real-world setting and to identify key factors influencing treatment persistence. 195 patients with PsA treated with IXE between 2018 and 2024 were included. The primary outcome was DRR, calculated at 360, 720, and 1080 days after treatment initiation. Clinical and demographic factors were analyzed as potential predictors of IXE treatment permanency.

Results: IXE retention rates were 66% at 360 days, 49% at 720 days, and 39% at 1080 days. Low baseline disease activity was a strong predictor of higher retention (HR 0.24, 95% CI: 0.09-0.62, p = 0.003), while younger age was significantly associated with improved persistence (HR 0.98, 95% CI: 0.96-1.00, p = 0.045). Conversely, patients with both axial and peripheral joint involvement were more likely to discontinue therapy (HR 1.78, 95% CI: 1.04-3.06, p = 0.036), as were those receiving IXE as a second- or third-line therapy (HR 1.17, 95% CI: 1.02-1.33, p = 0.021).

Conclusions: This multicenter real-world study confirms the long-term retention rate of IXE in PsA. The findings highlight key factors influencing treatment persistence and provide valuable insights to optimize patient management. Further real-world research is needed to better understand the therapeutic performance of IXE in different patient populations.

Background: Traditional oral small molecule disease-modifying antirheumatic drugs (OSMs) have historically been the cornerstone of psoriatic arthritis (PsA) management. However, biologics have gained prominence due to their superior efficacy in patients with an inadequate response to OSMs.

Objective: To analyze trends in the use of OSMs, biologics, and combination therapy for PsA management from 1993 to 2019.

Methods: We utilized the National Ambulatory Medical Care Survey to examine PsA treatment patterns. Medications were classified as OSMs, biologics, or combination therapy (both an OSM and a biologic). Weighted Rao-Scott χ² tests and one-way ANOVA assessed differences in treatment patterns over time and by patient demographics.

Results: Among an estimated 3.7 million visits for PsA (112 unweighted visits) where systemic therapy was prescribed, biologic use significantly increased (P = .006) over time, OSM use declined (P < .001), and combination therapy initially increased but later decreased (P < .001). There were no significant differences in treatment patterns by age, sex, race, ethnicity, or insurance status (all P > .2).

Conclusions: Biologics have increasingly replaced traditional OSMs as the primary treatment for PsA. The decline in combination therapy after 2013 likely reflects the improved efficacy of newer biologics, reducing the need for adjunctive OSM use. Limitations include the lack of disease severity data and the absence of visits for newer therapies, such as Janus kinase inhibitors.