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To describe the psoriatic phenotype associated with psoriatic arthritis (PsA).Methods
Based on the previously published 4-item Psoriatic Arthritis Uncluttered Screening Evaluation (PURE-4) validation study, this work aims to describe the sociodemographic and clinical characteristics, as well as the PURE-4 questionnaire outcomes, of patients with psoriasis (PsO) who completed the study. It compares those diagnosed with PsA during the study to those with PsO only. The variables compared were age, sex, time since diagnosis of PsO, PsO location, PsO treatment, Psoriasis Area and Severity Index (PASI), and Dermatology Life Quality Index (DLQI).Results
The study included 253 patients with PsO, from whom 46 developed PsA (28 [60.9%] male; mean age 48.9 [11.1] years) during the study. At baseline, patients who developed PsA had more involvement of PsO in the neck (13% vs 3.4%, P < 0.01), knees (71.4% vs 50%, P = 0.02), hands (40% vs 17.7%, P < 0.01), and feet (22.9% vs 9.8%, P = 0.03) as well as high-impact areas. PASI (8.7 [SD 5.6] vs 6.8 [SD 5.0], P = 0.03) and DLQI (9.9 [SD 6.9] vs 7.6 [SD 6.7], P = 0.09) values were higher among patients with PsA. Peripheral joint pain with swelling (item 4) was the most prevalent item of PURE-4 among patients with PsA, ranging from 67.6% (vs 47.1%; P = 0.03) in Assessment I to 91.7% (vs 45.4%; P < 0.01) in Assessment II.Conclusion
Greater PsO involvement in neck, knees, hands, and feet as well as in high-impact areas of patients who developed PsA provides additional information on the arthritogenic phenotype of PsO in our study population compared to locations generally linked to arthritis risk, such as the nails or scalp.Weiterlesen
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Psoriasis is a chronic, systemic inflammatory disease with significant physical and psychosocial burden. Advances in understanding the pathogenesis of psoriasis, particularly the role of interleukin (IL)23/Th17 axis, have led to the development of selective drugs targeting these cytokines. Among these, IL23 inhibitors (guselkumab, risankizumab, and tildrakizumab), represent the most recent class of biologic drugs approved for the management of moderate-to-severe plaque psoriasis. Since their approval, real-life data on the use of anti-IL23 have confirmed their high efficacy, durability, and favorable safety profile.Areas covered
This narrative review summarizes real-world data on the effectiveness, also in difficult-to-treat areas, safety, and drug survival of IL23 inhibitors in psoriasis.Expert opinion
Real-world evidence consistently confirms the strong efficacy, favorable safety profile, and long-term treatment durability of IL23 inhibitors across various patient subgroups, including those with comorbidities, prior biologic failures, and the involvement of difficult-to-treat areas. IL23 inhibitors have become key components of the therapeutic arsenal in psoriasis, and their performance in real-world settings continues to support their widespread adoption in clinical practice.Weiterlesen
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Psoriasis is frequently associated with metabolic syndrome and an increased cardiovascular risk. Tildrakizumab, an IL-23 inhibitor, may affect metabolic parameters in addition to improving skin severity.Aim of the study
To evaluate the impact of increasing tildrakizumab dosage on lipid and glucose levels in psoriasis patients with metabolic syndrome who showed a partial response to the standard 100 mg dose.Materials and methods
Twenty-five patients with psoriasis and metabolic syndrome were enrolled in a 52-week prospective study. After 16 weeks of treatment with 100 mg tildrakizumab, patients with an absolute PASI >2 were switched to 200 mg. Total cholesterol, LDL, and glucose were measured at baseline, week 16, week 40, alongside PASI and DLQI.Results
At baseline, mean total cholesterol, LDL, and glucose were 190.7, 120.1, and 99.4 mg/dL, respectively. The 100 mg dose did not result in significant metabolic changes at week 16. However, switching to 200 mg tildrakizumab led to significant reductions at week 40 in total cholesterol (178.3 mg/dL), LDL (110.1 mg/dL), and glucose (87.2 mg/dL) (all p < 0.05). Significant improvements in PASI (1.2) and DLQI (0.2) were also observed (p < 0.05).Conclusions
Increasing the tildrakizumab dose to 200 mg in partial responders with metabolic syndrome significantly improved both skin severity and metabolic profiles, lowering cholesterol, LDL, and glucose. These findings suggest a possible dose-dependent effect of tildrakizumab on metabolic parameters through enhanced IL-23 inhibition.Weiterlesen
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Although IL-17 inhibitors like Secukinumab and Ixekizumab have shown significant efficacy in psoriasis, the impact of early intervention with biologics to modify the disease course and achieve long-term remission remains unclear.Objectives
To examine the potential of early intervention with IL-17 inhibitors for disease modification in psoriasis.Methods
We conducted a multicenter retrospective cohort study on moderate-to-severe plaque psoriasis patients who received at least 4 weeks of treatment with Secukinumab or Ixekizumab between April 2019 and April 2023, taking the relapse rate one year after cessation of treatment as the primary endpoint.Results
Among 400 patients who discontinued treatment after achieving PASI90, the median relapse time was 3.29 months(approximately 14 weeks). Of 141 patients who discontinued treatment after achieving PASI90 for over a year, 24 (88.89%) in the ultra-short disease duration(USDD, psoriasis duration ≤ 1 year) group and 33 (82.5%) in the short disease duration(SDD, psoriasis duration ≤ 2 year) group achieved one year of drug-free remission.Limitations
The potential impact of early intervention on comorbidity development was not addressed in this study.Conclusion
Early intervention with IL-17 inhibitors leads to faster responses and may promote disease modification in psoriasis.Weiterlesen
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Residual confounding effects and disease severity are attributed to controversial results in studies of psoriatic disease (PsD) and mortality. We aimed to evaluate the risk of mortality in patients with incident PsD, compared to matched controls from the population.Methods
We used the nationwide, population-based insurance claim datasets in Taiwan from 2010 to 2018. Incident cases of PsD were identified by International Classification of Diseases (ICD) codes. A nonexposed cohort was established through propensity score matching (PSM). Deaths were identified via the National Mortality Database. We evaluated the risk of all-cause mortality in PsD compared to the PSM nonexposed individuals using Cox regression. The mortality risk was evaluated in patients with more severe disease stratified by systemic therapy use and having psoriatic arthritis (PsA).Results
There were 108,642 patients with incident PsD (40.2% women) and an equal number of PSM non-PsD individuals. Compared to the age- and sex-matched controls, there was a higher risk of mortality among patients with PsD (adjusted hazard ratio [aHR] 1.73, 95% CI 1.68-1.77, P < 0.001). After PSM, we found an attenuated but persistent higher risk of mortality in PsD compared to controls (aHR 1.20, 95% CI 1.16-1.24). There was a trend of higher mortality in patients exposed to biologic therapies, but not for PsA.Conclusion
There was an increased risk of all-cause mortality in individuals with PsD compared to individuals without PsD before and after both PSM and adjustment for comorbidities. The risk of mortality was higher in patients with psoriasis but not in patients with PsA as compared to controls.Weiterlesen
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To describe the psoriatic phenotype associated with psoriatic arthritis (PsA) METHODS: Based on the previously published PURE 4 validation study, this work aims to describe the sociodemographic and clinical characteristics, as well as the PURE-4 questionnaire outcomes, of psoriasis patients who completed the study. It compares those diagnosed with PsA during the study to those with only psoriasis . The variables compared were age, gender, time since diagnosis of psoriasis, psoriasis location, psoriasis treatment, Psoriasis Area and Severity Index (PASI), and Dermatology Life Quality Index (DLQI).Results
The study included 253 psoriasis patients, from whom 46 developed PsA (28 [60.9%] male; mean age 48.9 [11.1]) during the study. At baseline, patients who developed PsA had more involvement of psoriasis in the neck (13.0% vs. 3.4%, p<0.01), knees (71.4% vs. 50.0%, p=0.02), hands (40.0% vs. 17.7%, p<0.01), and feet (22.9% vs. 9.8%, p=0.03) as well as high impact areas. PASI (8.7 [5.6] vs. 6.8 [5.0], p=0.03) and DLQI (9.9 [6.9] vs. 7.6 [6.7], p=0.09) values were higher among patients with PsA. Peripheral joint pain with swelling (item 4) was the most prevalent item of PURE-4 among patients with PsA, ranging from 67.6% in Assessment I to 91.7% in Assessment II (91.7% vs. 45.4%, p<0.01).Conclusion
Greater psoriasis involvement in neck, knees, hands, and feet as well as high impact areas of patients who developed PsA suggests additional information on arthritogenic phenotype of psoriasis in our study population compared to locations generally linked to arthritis risk (nail or scalp).Weiterlesen
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Only limited data is available on the benefit of brodalumab 210 mg, an IL-17 receptor A antagonist, on patient-reported outcomes (PROs) in different psoriasis severity groups under real-world-evidence (RWE) conditions.Methods
LIBERO, a prospective, multicenter, 12- and 52-weeks (W) non-interventional study on brodalumab in adult patients with plaque-type psoriasis assessed its short- and long-term impact on PROs in mild, moderate and severe psoriasis defined by Psoriasis Area Severity Index (PASI).Results
200 (31.3%) patients with severe (PASI ≥ 20), 263 (41.2%) with moderate (PASI = 10-19) and 168 (26.3%) with mild (PASI < 10) psoriasis were analyzed. In all severity groups a rapid and sustained reduction of mean(m) PASI was observed as of W2. 76.7, 84.9 and 82.0% of patients assessed their psoriasis as being clear/almost clear in mild, moderate and severe subgroups and mean Dermatological Life Quality Index improved from 11.2, 14.3 and 17.1 to 3.2, 2.9 and 3.8. 73.7% of patients rated brodalumab as being quite/very beneficial (Patient Benefit Index, PBI) and were quite/very satisfied with the treatment (TSQM-9). Regaining disease control and reducing physical impairment achieved highest PBI-scores.Conclusion
LIBERO confirms the benefit of brodalumab on PROs including rapid and complete clearance of skin lesions, quality of life and individual patient benefits - irrespective of their disease severity.Weiterlesen
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Psoriasis is a chronic inflammatory disease associated with abnormalities in the immune system. Microsomal prostaglandin E synthase-1 (mPGES-1), a terminal enzyme for prostaglandin (PG) E2 biosynthesis, is highly expressed in the skin of psoriasis patients. However, the detailed role of mPGES-1 in psoriasis remains unclear. In the present study, we aimed to investigate the role of mPGES-1 in psoriasis-like skin inflammation induced by imiquimod (IMQ), a well-established model of psoriasis.Methods
Psoriasis was induced in mPGES-1-deficient (mPGES-1-/-) and wild-type (WT) mice by administering IMQ for 6 days. Psoriasis was evaluated based on the scores of the macroscopic symptoms, including skin scaling, thickness, and redness, and on the histological features. The skin expression of mPGES-1 was determined by real-time polymerase chain reaction and Western blotting. The impact of mPGES-1 deficiency on T-cell immunity was determined by flow cytometry and γδ T-cell depletion in vivo with anti-T-cell receptor (TCR) γδ antibody.Results
The inflamed skin of mPGES-1-/- mice showed severe symptoms after the administration of IMQ. Histological analysis further showed significant exacerbation of psoriasis in mPGES-1-/- mice. In WT mice, the mPGES-1 expression was highly induced at both mRNA and protein levels in the skin, and PGE2 increased significantly after IMQ administration, while the PGE2 production was largely abolished in mPGES-1-/- mice. These data indicate that mPGES-1 is the main enzyme responsible for PGE2 production in the skin. Furthermore, the lack of mPGES-1 increased the numbers of IL-17A-producing γδ T cells in the skin with IMQ-induced psoriasis, and γδ T-cell depletion resulted in a reduction of the facilitated psoriasis symptoms under the condition of mPGES-1 deficiency.Conclusions
Our study results demonstrate that mPGES-1 is the main enzyme responsible for skin PGE2 production, and that mPGES-1 deficiency facilitates the development of psoriasis by affecting the development of T-cell-mediated immunity. Therefore, mPGES-1 might impact both skin inflammation and T-cell-mediated immunity associated with psoriasis.Weiterlesen
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The Association of Psoriasis and Bacterial Infections in Pediatric Patients: A Retrospective Review.
Guttate psoriasis onset and plaque psoriasis flares are associated with streptococcal pharyngitis. Literature regarding the relationship between anogenital bacterial dermatitis and psoriasis in pediatric patients is limited. We aimed to evaluate the clinical characteristics, microbiology, and treatment course of patients with psoriasis/psoriasiform dermatitis and concomitant pharyngeal and/or anogenital bacterial infections.Methods
A multicenter retrospective review of patients ≤ 18 years of age with psoriasis/psoriasiform dermatitis and bacterial infection, defined by positive culture results, was performed. Demographic characteristics, clinical features, microbiology, treatment recommendations, and outcomes were evaluated. Comparisons were made between pharyngeal and anogenital culture groups.Results
A total of 166 unique patients with psoriasis/psoriasiform dermatitis and suspected pharyngeal and/or anogenital infection were evaluated between 2011 and 2021. Staphylococcus sp. and Streptococcus sp. were isolated in anogenital cultures. Inverse psoriasis was associated with a positive anogenital culture (p = 0.0356). Guttate psoriasis was more common in patients with a positive pharyngeal culture (p < 0.0001). Treatment of a positive bacterial culture did not correlate with the treatment response of psoriasis/psoriasiform dermatitis.Conclusions
Investigations for anogenital and pharyngeal infections should be considered in pediatric patients presenting with new-onset or worsening psoriasis. A high clinical suspicion should be maintained for anogenital infection in patients with inverse psoriasis, specifically.Weiterlesen
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Patients' quality of life is greatly impacted by psoriasis, a prevalent chronic inflammatory skin condition that is frequently linked to a number of systemic disorders. Recent research shows that obesity is a major risk factor for psoriasis. Since Relative Fat Mass (RFM), an innovative way to measure obesity, offers a more precise estimate of body fat percentage, this study aims to investigate the connection between RFM and psoriasis and its potential as a disease predictor.Methods
The analysis included 6,006 people the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2006, 151 of whom had psoriasis. Weighted multivariable logistic regression, restricted cubic splines (RCS), subgroup analysis, and interaction tests were employed to assess the link between RFM and psoriasis. ROC curves were used to compare RFM with conventional measures of obesity (WWI, BRI). Furthermore, LASSO regression and multivariable regression based on AIC were used to create a psoriasis risk prediction model that included RFM and additional clinical factors.Results
RFM and psoriasis risk were revealed to be significantly positively correlated. The chance of developing psoriasis increased by 7% for every unit rise in RFM (95% CI: 1.03 to 1.12). RFM showed better predictive ability than conventional markers including BMI, WWI, and BRI (AUC = 0.573). The RFM-psoriasis relationship and diabetes status significantly interacted, with the association being weaker in diabetic individuals, according to subgroup analysis and interaction tests. Promising results were obtained from the created psoriasis risk prediction model that included RFM, age, total dietary sugar, education level, history of heart disease, and hypertension.Conclusion
This research demonstrates that RFM outperforms traditional anthropometric methods in predicting risk. It also presents the initial evidence establishing a positive link between RFM and the likelihood of developing psoriasis.The psoriasis risk prediction model underscores RFM's effectiveness as a valuable approach in both clinical and public health domains, aiming to alleviate the impact of psoriasis-related issues by offering a practical instrument for early risk assessment and personalized clinical strategies.Weiterlesen
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Investigating gender-specific differences in rheumatology is crucial for improving personalized treatment. The present study aimed to explore gender differences in psychological characteristics and features associated with impaired physical and mental quality of life in male and female patients affected by axial spondyloarthritis or psoriatic arthritis.Methods
The present study is cross-sectional. Quality of life was evaluated using a Medical Outcome Study 36-item Short Form health survey (SF-36), and physical and mental component scores were presented. Data about disease activity, anxiety and depression, fatigue, perceived stress, and coping strategies were collected. The patients were stratified by gender, and clinical and psychological data were compared.Results
A total of 119 patients with axial spondyloarthritis [age 49.0 (SD 11.7); 45.4% F] and 198 patients with psoriatic arthritis [age 56.9 (SD 11.6); 62.6% F] were included. Female patients with axial spondyloarthritis and psoriatic arthritis had worse scores on fatigue, pain, perceived stress, physical quality of life, dysfunctional coping strategies, mental quality of life (only in axial spondyloarthritis), and anxiety (only in psoriatic arthritis) than men. In multivariable analysis, physical quality of life is mainly explained by fatigue and pain, and mental quality of life by fatigue, anxiety and stress in women with axial spondyloarthritis and psoriatic arthritis. Fatigue, pain and anxiety were significant variables across the models with male patients.Conclusions
The study indicates that female patients with axial spondyloarthritis and psoriatic arthritis experience worse scores in psychological variables compared to men. Additionally, women's quality of life is significantly lower when compared to men's one, primarily due to factors such as fatigue, stress, pain, and anxiety. To enhance patient well-being, therapeutic strategies should be tailored to address the unique clinical and psychological needs that arise from gender differences.Weiterlesen
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The impact of traditional systemic drugs to treat psoriasis (ciclosporin, methotrexate, and acitretin) in a subsequent response to biologics, has not been adequately addressed in the literature. In clinical practice it is increasingly necessary to initiate, due to concomitant comorbidities, biologics in patients with psoriasis or psoriatic arthritis (PsA) who have not undergone prior treatment with systemics, i.e. full-naive.Objectives and methods
This study analyzed the possible impact of non-biological systemic therapies on the effectiveness and drug survival of first-line biologic drug up to 12 months in bio-naive psoriatic and PsA patients consecutively enrolled from January 2017 to March 2021.Results
95 patients with severe psoriasis (13.5%) were full-naive. Being full-naive and having or not having undergone methotrexate or cyclosporine therapy did not impact response to subsequent years of biologic therapy. Only acitretin promotes faster response to subsequent biologic drugs with 59.6% and 74.2% of patients achieving Psoriasis Area Severity Index (PASI) 90 at 16 and 28 Week, respectively, vs. 50.5% and 65% (p = 0.034 and 0.026). In multivariate analysis, the advantage given by acitretin was lost.Conclusion
Previous systemic therapy in bio-naive patients does not appear to result in a differential response to biologics during the first year of treatment.Weiterlesen
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To investigate the prevalence of psoriasis in SLE using a Swedish regional cohort and a nationwide cohort from the National Patient Register (NPR). Furthermore, we compared clinical features between patients with and without comorbid psoriasis.Methods
In total, 351 patients diagnosed with SLE based on the 1982 American College of Rheumatology and/or the 2012 Systemic Lupus International Collaborating Clinics criteria from Linköping University Hospital were evaluated. We obtained patient-reported and relevant clinical data extracted in 2024. Individuals with coexisting psoriasis were identified via the International Classification of Diseases code L40 and subsequent confirmation through chart review in the regional cohort. In the NPR, 7490 subjects with SLE living in Sweden in 2022 were identified, as well as therapies obtained from the Prescribed Drug Register.Results
We identified 12 subjects with SLE and coexisting psoriasis (3.4%) in the regional cohort and 367 patients (4.9%) in the nationwide cohort. Men were proportionally more common in the group with comorbid psoriasis in both cohorts. Patients with psoriasis reported more pain on a visual analogue scale (median 45.5/100 mm, IQR 23.3-58.3) compared with those without coexisting psoriasis (median 27.0/100 mm, IQR 7.0-50.5, p<0.04). We observed no differences in damage accrual or clinical phenotypes between the two groups. Subjects with psoriasis were more frequently prescribed methotrexate in the nationwide cohort.Conclusion
The prevalence of coexisting psoriasis in patients with SLE in Sweden was estimated to be 3.4-4.9%. Individuals with comorbid psoriasis reported more pain and were more likely to be prescribed methotrexate than those without psoriasis.Weiterlesen
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Psoriasis, a chronic inflammatory skin condition, poses significant management challenges due to its persistent nature, recurrences, and side effects associated with conventional therapies. Ayurveda correlates psoriasis with Ekakushtha (a type of skin disorder), primarily involving Vata-Kapha dosha imbalance.Objective
To evaluate the efficacy of Ayurvedic therapies, including Shodhana (Vamana, Raktamokshana) and Shamana (pacification medications), in managing scalp psoriasis.Methodology
A 35-year-old male with chronic scalp psoriasis underwent Panchakarma, including Vamana (therapeutic emesis). Post-Shodhana, conservative management included 777 oil, Psora soap, Panchatikta Ghrita Guggulu, and Sut Shekhar Ras, along with Leech therapy (Raktamokshana) weekly for one month. Lifestyle and dietary modifications were also advised.Results
The patient experienced significant relief from itching, scaling, erythema, and lesion thickness. Follow-up revealed improved scalp texture, reduced scaling, and absence of flare-ups. No adverse effects were reported.Conclusion
Ayurvedic interventions combining detoxification (Shodhana) and pacification (Shamana) therapies demonstrated a safe and effective approach for managing scalp psoriasis, addressing systemic pathology while minimizing side effects. Further clinical trials are warranted to validate these findings.Keywords
Ayurvedic treatment, therapeutic emesis, Vaman, Panchatikta Ghrita, Leech Therapy, Psora soap, scalp psoriasis, case report.Weiterlesen
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