Journal of Psoriasis and Psoriatic Arthritis最新文献

Background: Psoriasis is a systemic inflammatory disorder. It is associated with increased risk of developing other chronic health diseases such cardiovascular disorders. Fetuin A is a glycoprotein that is present in blood serum. It may prevent vascular calcification by forming calciprotien particles; which are formed from their attachment with phosphate and calcium complexes.

Aim: The aim of this study was to measure serum Fetuin A in Psoriatic patients and correlate its level with cardiac events and risks in these patients using CT calcium (Ca) scoring.

Patients and methods: 24 psoriatic patients (healthy without apparent cardiac risks to detect subclinical events if present) and 24 age and sex matched controls were tested for serum Fetuin A and underwent coronary calcium scoring by multidetector computed tomography (CT) scan. Psoriasis area and severity index (PASI) score for each patient was measured and was correlated with serum Fetuin A and CT calcium (Ca) scoring. Serum Fetuin A was compared between cases and controls and was correlated with coronary calcium score.

Results: There was highly statistically significant decrease in serum Fetuin A level in psoriatic group compared to control group (P-value < .001). There was highly statistically significant negative correlation between calcium score and the level of serum Fetuin A (P-value < .001). No statistically significant correlation was found between the serum level of Fetuin A and the psoriasis severity.

Conclusion: Serum Fetuin A is a simple, easy diagnostic tool to evaluate subclinical atherosclerosis in psoriatic patients.

Background: During the past decades, several unconventional strategies for controlling chronic inflammatory diseases, including psoriasis, have been developed. The use of probiotics has been gaining importance as an adjuvant therapy in the treatment of these pathologies.

Objectives: Evaluate the impact of the use of the Lactobacillus rhamnosus probiotic strain in patients diagnosed with common and palmoplantar psoriasis.

Methods: 35 patients were randomly divided into two groups: 18 using probiotics and 17 using placebo. They were evaluated on days 0 and 60, with photographic records of lesions, IL17 and IL23 quantification and calculations of Psoriasis Area Severity Index (PASI), Body Surface Area (BSA) and Dermatology Life Quality Index (DLQI) clinical evaluation scores.

Results: There was significative improvement in the clinical presentation and a reduction in the index of all clinical scores (PASI from 4.53 ± 4.457 to 3.57 ± 3.333, BSA from 5.44 ± 6.451 to 4.94 ± 5.961 and DLQI from 8.83 ± 8.631 to 7 ± 7.814, in the probiotic group.) However, there was no reduction in the quantification of IL23 and IL17. Adverse events related to the use of probiotics were minimal.

Conclusions: There was a Positive correlation between the use of probiotics and improvement of clinical aspects and clinical scores of disease severity, not associated with reduction in interleukins 17 and 23 blood levels.

Background: Palmoplantar pustulosis (PPP) is a rare skin disease characterized by episodes of neutrophilic pustules on the palms of the hands and soles of the feet. Current treatments for PPP have limited efficacy, and there is little real-world evidence characterizing the disease burden of PPP in patients.

Objective: To describe and compare the clinical characteristics and patient-reported outcomes (PROs) of patients with PPP with those of patients with plaque psoriasis.

Methods: This real-world study used data from patients with PPP or plaque psoriasis enrolled in the CorEvitas Psoriasis Registry. Disease characteristics, historical medical data, PROs, and quality-of-life measures were compared between patients with PPP and those with plaque psoriasis. These measures were also compared following patient stratification by body surface area involvement or Psoriasis Area and Severity Index. This study is purely descriptive; no hypothesis testing was performed.

Results: In this data set, patients with PPP (n = 64) reported higher mean overall pain, using the visual analog scale, relative to those with plaque psoriasis (n = 4894). Patients with PPP also reported a greater proportion of work hours missed or affected; greater impairment of work; and greater impairment of daily activity than patients with plaque psoriasis. Similar effects were observed irrespective of patient stratification.

Conclusion: Generally, PPP was associated with worse PROs and a greater impact on quality of life compared with plaque psoriasis. These findings highlight a need to develop effective therapies for PPP to improve disease management.

Background: Dermatologists would benefit from an easy to use psoriasis severity assessment tool in the clinic.

Objective: To develop psoriasis assessment tools to predict PASI and Dermatology Life Quality Index (DLQI) using simple measures typically collected in clinical practice.

Methods: Data included 33 605 dermatology visits among plaque psoriasis patients enrolled in the CorEvitas Psoriasis Registry (4/15/15-7/11/20). Performance (adjusted coefficient of determination [R² _adj], root mean square error [RMSE]) in predicting PASI and DLQI was assessed for 16 different linear regression models (specified a priori based on combinations of BSA, Investigator's Global Assessment [IGA], itch, skin pain, patient global assessment, age, sex, BMI, comorbidity index, prior biologic use), and 2 stepwise selection models and 1 elastic net model based on 56 available variables. For each prediction model, concordance (sensitivity, specificity) of predicted PASI75, PASI90 and DLQI 0/1 with observed values was evaluated.

Results: Mean (SD) age, BSA, and PASI were 51 (14) years, 6 (11), and 4 (6), respectively; 46% were women, and 87% were biologic experienced. A model predicting PASI using BSA plus IGA performed best among a priori specified models (R² _adj = .72, RMSE = 2.93) and only marginally worse than models including additional variables (R² _adj range .64-.74, RMSE range 2.82-3.36). Models including IGA had the best concordance between predicted and observed PASI75 (sensitivity range 83-85%, specificity range 88-91%) and PASI90 (sensitivity range 76-82%, specificity range 94-98%). DLQI prediction was limited.

Conclusion: An assessment tool for psoriasis including BSA and IGA may be an ideal option to predict PASI in a clinic setting.

Background: Among psoriasis patients, the presence of metabolic comorbidities associates with poorer response to biologics. How the presence of comorbidity impacts treatment patterns with biologics is not fully understood.

Methods: Adult patients in the CorEvitas Psoriasis Registry were included if they initiated biologic therapy between 5/2015-12/2019 and had a 6-month follow-up visit. The frequency of biologic discontinuations by 6-months were calculated by metabolic comorbidity status (current obesity and histories of hypertension [HTN], diabetes [DM], and hyperlipidemia [HLD]) for all patients and by drug class (tumor necrosis factor inhibitors [TNFi], interleukin-17i [IL-17i], and IL-23i or IL-12/23i).

Results: Among the 2924 participants, discontinuations were more frequent in those with obesity (17%, P < .01) or DM (20%, P < .001) compared to those without these (13% and 14%, respectively). Discontinuations were similar for those with and without histories of HTN or HLD. Frequencies of discontinuation for each biologic class were: TNFi (26%), IL-17i (16%), and IL-23i or IL-12/23i (9%). Among TNFi initiators, the proportions of discontinuations were greater in the presence of obesity (30%, P < .05), DM (34%, P < .05), or HTN (34%, P < .01) compared to those without (22%, 24%, and 22%, respectively). Of the IL-23i or IL-12/23i initiators, discontinuations were more frequent in those with obesity (11%, P < .01) or with DM (13%, P < .05) compared to those without (7% and 8%, respectively). Discontinuations did not statistically differ between comorbidity groups in IL-17i initiators.

Conclusion: Comorbid disease status, especially obesity and DM, should be assessed at biologic initiation as it may predict a less optimal clinical outcome.