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Neue Studien
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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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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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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Psoriasis body surface area (BSA) of 10% or more has been a major criterion for determining systemic therapy eligibility. However, patients with BSA < 10% and even ≤ 3% may have high disease burden and difficulties accessing biologics. To assess psoriasis burden among patients with BSA ≤ 10%, this study characterized patient-reported outcomes (PROs) across BSA categories among systemic treatment-naïve patients initiating biologic therapy.Methods
Patients from the CorEvitas Psoriasis Registry initiating biologics between April 2015 and September 2023 were categorized according to low (< 3%), medium (3-10%), or high (> 10%) BSA involvement. Measures assessed at initiation of biologic therapy included health-related quality of life, itch, pain, fatigue, psoriatic arthritis, psoriasis disease characteristics, and medical history. Overlap between BSA groups for each outcome was calculated via non-parametric Mann-Whitney statistic transformation (range 0.0-1.0; 0.5 indicates complete similarity [i.e., for a comparison between low and high BSA groups, overlap of 0.5 means there is 50% probability that a randomly selected patient with low BSA would have the same or greater PRO burden as one with high BSA]; 0 or 1 indicates complete dissimilarity) to determine whether each measure differed in randomly selected patients with low or medium versus high BSA.Results
Of 1640 patients who initiated biologics, 7.0% had low BSA, 46.9% had medium BSA, and 46.2% had high BSA involvement. PRO overlap statistics ranged from 0.52 to 0.59 and from 0.60 to 0.70 for randomly selected patients with high versus medium and low BSA, respectively, indicating patients with high and medium BSA are likely to have similar levels of disease burden, and patients with high BSA are slightly more likely to have higher disease burden than those with low BSA. Near complete overlap (range 0.44-0.58) was observed for psoriasis disease characteristics and medical history in the low versus high and medium BSA groups.Conclusion
Observed overlap in PROs across BSA categories shows that patients with low BSA can experience similarly poor quality of life and high symptom burden to those with higher BSA. These findings support the appropriateness of considering biologic therapies for patients with low BSA and indicators of high disease burden.Trial registration
ClinicalTrials.gov: NCT02707341.Weiterlesen
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Psoriasis is a chronic immune-mediated disease with significant systemic implications. Tildrakizumab, an IL-23p19 inhibitor, has demonstrated efficacy in moderate-to-severe plaque psoriasis. Higher doses may be beneficial for patients with elevated body weight or greater disease burden. This study evaluates the effectiveness of tildrakizumab 200 mg in a real-world setting, analyzing outcomes based on weight, Psoriasis Area Severity Index (PASI), body mass index (BMI), and prior biologic exposure.Methods
A multicenter retrospective study was conducted across 10 Italian hospitals. Adult patients (≥ 18 years) with moderate-to-severe plaque psoriasis treated with tildrakizumab 200 mg for ≥ 36 weeks were included. Patients were stratified by weight (≥ 90 kg vs. < 90 kg), BMI (≥ 30 vs. < 30), PASI (≥ 15 vs. < 15), and biologic history (naïve vs. biologic (bio)-experienced). PASI100 response rates at 36 weeks were assessed. Statistical analyses included Fisher's exact test (p < 0.05 significant).Results
Among 137 patients, PASI100 response rates were 67.1% for patients < 90 kg vs. 49.2% for ≥ 90 kg (p = 0.04), 61.5% for PASI < 15 vs. 50% for PASI ≥ 15 (p = 0.03), and 60.8% for bio-naïve vs. 57.1% for bio-experienced (p = 0.08). BMI ≥ 30 was associated with lower PASI100 (44.2%) compared to BMI < 30 (61.4%) (p = 0.05). Despite subgroup differences, all patients exhibited clinical improvement.Conclusion
Tildrakizumab 200 mg effectively treated moderate-to-severe psoriasis across diverse patient subgroups. While higher weight and PASI were associated with slightly lower PASI100 rates, significant improvements were observed, supporting its role in difficult-to-treat patients.Weiterlesen
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Flexible biologic therapy dosing regimens in psoriasis management are common, but data from routine care in Germany are scarce. This study evaluated treatment adjustments for biologic therapies commonly prescribed in Germany.Patients and methods
Charts for up to 100 consecutive patients treated at 29 centers were reviewed. Data were extracted for adults (aged 18-65 years) with moderate-to-severe plaque psoriasis treated with adalimumab, guselkumab, ixekizumab, secukinumab, or ustekinumab for ≥ 36 weeks. The primary endpoint was time to first treatment adjustment. Secondary endpoints included frequency of and reasons for treatment adjustments. Time to treatment adjustment was analyzed using Kaplan-Meier methods.Results
Among 982 patients, 297 treatment adjustments in 240 (24.4%) patients were identified. The mean (median; interquartile range) time to first treatment adjustment (n = 223) was 8.4 (4.0; 2.0-12.0) months (secukinumab: 14.1 [10.0; 4.0-21.0], adalimumab: 11.0 [7.0; 3.0-14.5], ustekinumab: 11.0 [6.0; 2.0-16.0], ixekizumab: 5.8 [3.0; 2.0-8.5], guselkumab: 5.1 [3.0; 2.0-7.0]). The most frequent adjustment type was starting concomitant treatment(s) (10.4% of patients); insufficient skin effectiveness was the most frequent reason for adjustment.Conclusions
Biological treatment adjustments are frequent in moderate-to-severe psoriasis; flexible dosing regimens would support optimal management.Weiterlesen
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