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Neue Studien
Psoriatic arthritis (PsA) guidelines aim to provide consistent, evidence-based recommendations. Multiple regional guidelines exist, often based on similar evidence but with different methodologies and contexts. Our aim was to compare recent PsA treatment guidelines from the American College of Rheumatology, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, European Alliance of Associations for Rheumatology, and Pan American League of Associations for Rheumatology, identifying similarities, differences, and opportunities for global harmonization with regional adaptation.Methods
Narrative comparative review of guideline documents published between 2018 and 2024 by major rheumatology societies was performed. Data on methodology, panel composition, treatment domains, pharmacologic recommendations, and update strategies were extracted and synthesized.Results
Guidelines share core principles, including domain-based approaches, treat-to-target strategies, and the use of conventional synthetic disease-modifying antirheumatic drugs and biologics. Differences arise from methodological frameworks (eg, GRADE [Grading of Recommendations Assessment, Development, and Evaluation], domain-based, adolopment), stakeholder composition, and explicit consideration of regional drug access.Conclusion
A hybrid framework combining global core recommendations with modular regional adaptations may optimize resource use, improve guideline sustainability, and maintain local relevance. Living systematic reviews and artificial intelligence could support more timely updates.Weiterlesen
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Psoriasis is a chronic immune-mediated disease that significantly impacts patients clinically and psychologically. Physician-assessed severity measures, including Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Physician Global Assessment (PGA), often fail to capture patient-reported outcomes, particularly when clinical improvement and perceived quality-of-life gains are misaligned.Purpose
To clarify the association between clinical improvements and Dermatology Life Quality Index (DLQI) outcomes, identify predictors of substantial DLQI improvement (≥90% reduction), and explore reasons for suboptimal DLQI responses in patients achieving skin clearance.Methods
In this 12-week prospective study, 551 psoriasis patients were enrolled at Shanghai Skin Diseases Hospital. Data on demographics, clinical severity (PASI, BSA, and PGA), DLQI scores, and treatment modalities were collected. Logistic regression analyses were employed to assess the dose-response relationships between improvements in clinical parameters and DLQI reduction, and to identify factors of suboptimal DLQI improvement among patients achieving significant skin clearance.Results
Median DLQI improved significantly (8.0 to 3.0) at week 12, with 24.1% of patients achieving ≥90% DLQI reduction. Strong dose-response associations existed between clinical severity improvements (PASI, BSA, PGA) and DLQI gains. PASI75 responders were significantly more likely to achieve substantial DLQI improvement (OR = 2.48, 95% CI: 1.51-4.07). However, only 33.3% of PASI75 achievers reached ≥90% DLQI improvement. Early clinical response (as early as week 4) strongly predicted superior DLQI outcomes. Female sex, older age, lower baseline DLQI scores, and shorter disease duration were associated with achieving high skin clearance but suboptimal DLQI improvement.Conclusion
Early clinical response effectively predicts substantial DLQI improvement, whereas demographic and disease-related factors help identify patients at risk for suboptimal quality-of-life gains despite significant skin clearance. These insights support personalized therapeutic strategies aimed at improving patient satisfaction beyond skin clearance alone.Weiterlesen
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Objective:
To assess the severity of social appearance anxiety in patients with visible psoriasis vulgaris lesions compared to healthy controls, and to examine its associations with general anxiety, depression, perceived disease severity, and dermatology-related quality of life. Methods:
A cross-sectional case-control study was conducted involving 178 patients diagnosed with psoriasis vulgaris exhibiting visible skin lesions and 196 age- and sex-matched healthy controls. All participants completed the Social Appearance Anxiety Scale (SAAS) and the Hospital Anxiety and Depression Scale (HADS). Patients additionally completed the Dermatology Life Quality Index (DLQI) and a Visual Analog Scale (VAS) to evaluate subjective disease severity. Statistical analyses included group comparisons and Pearson correlations between psychological and clinical parameters. Results:
SAAS scores were significantly elevated in the patient group (mean = 60.32 ± 8.10) compared to controls (mean = 22.15 ± 9.05; p < 0.001), indicating a large effect size. In psoriasis patients, social appearance anxiety showed a moderate positive correlation with perceived disease severity (r = 0.293, p < 0.01), while correlations with DLQI and depression scores were not statistically significant. General anxiety levels (HADS-A) demonstrated a moderate correlation with SAAS (r = 0.484, p < 0.01). Conclusion:
Visible lesions in psoriasis vulgaris contribute substantially to social appearance anxiety, independent of general psychopathology. These findings underscore the psychological vulnerability of patients with visible psoriatic involvement and highlight the need for integrated psychosocial interventions as part of comprehensive dermatological care.Weiterlesen
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Psoriasis is a chronic inflammatory disease associated with multiple comorbidities, including metabolic syndrome and cardiovascular disease. Although specific dietary interventions, such as intermittent fasting and caloric restriction, have been shown to ameliorate inflammation and promote weight loss, the effect of these interventions independent of weight loss remains unclear. Time-restricted eating (TRE), a type of intermittent fasting, limits the daily eating window to a fixed number of hours. Recent studies suggest TRE may improve immune function in individuals with metabolic syndrome and cardiovascular risk factors. A crucial advantage of TRE over other investigated dietary restriction strategies is its reported high adherence rate, making it a more feasible intervention for long-term use. Therefore, exploring the effects of TRE on metabolic and immunological parameters in psoriasis is warranted.Objective
This study was designed to evaluate the effects of short-term, isocaloric TRE, independent of weight loss, on immune cell function and serum metabolite profiles of volunteers with mild-to-moderate psoriasis compared to healthy individuals.Methods
This case-control, prospective study was performed on 10 healthy male participants and 10 age-, BMI-, and sex-matched individuals with mild-to-moderate psoriasis. All individuals with psoriasis had stable disease and were being treated with topical therapies without any exposure to immunomodulatory biologics. This study was conducted at the National Institutes of Health Clinical Center. Immune profiles, glucose handling, energy expenditure, and participants' weights were assessed at baseline and after 3 days of TRE following a daily 6-hour eating window and 18-hour fast.Results
The trial commenced in June 2021 and was completed in February 2023. A total of 20 participants were enrolled-10 with mild-to-moderate psoriasis and 10 age-, BMI-, and sex-matched healthy individuals. As of the time of manuscript submission, data processing is ongoing. Multiomic datasets, including gene expression, surface and intracellular protein levels, and metabolite profiles, are being generated from peripheral blood mononuclear cells, CD4+-enriched T-cells, and serum samples. The integrated bioinformatics analyses will be reported once the data analysis is completed.Conclusions
This clinical protocol was designed to characterize the effects of short term (3-day) TRE on psoriasis, independent of weight loss, by comparing immune cell regulatory responses between healthy individuals and those with psoriasis. More specifically, we aim to map the molecular pathways activated by TRE and assess how they affect immune cell composition, activation, and metabolism. Additionally, components of the metabolic response to isocaloric TRE are being explored. Insights into how dietary interventions impact metabolism and the immune system will enhance our understanding of the pathogenesis of psoriasis and may reveal new therapeutic avenues for managing this inflammatory condition.Trial registration
ClinicalTrials.gov NCT04728165; https://clinicaltrials.gov/study/NCT04728165.Weiterlesen
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Psoriasis is a persistent inflammatory skin condition. Several studies have revealed that obesity significantly contributes to both the initiation and advancement of psoriasis. The metabolic score for visceral fat (METS-VF) represents an innovative measure designed to forecast visceral obesity, integrating factors such as insulin resistance metabolic score, waist-to-hip ratio (WHR), age, and gender. The present study aimed to investigate the association between METS-VF and psoriasis prevalence, using information gathered from the National Health and Nutrition Examination Survey (NHANES).Methods
This study utilized the data from a nationally representative cohort of 8023 adults from NHANES from 2003-2006 to 2009-2014, of which 234 declared a psoriasis history. Multivariate logistic regression analysis and restricted cubic spline (RCS) analyses were used to investigate the association between METS-VF and psoriasis, followed by subgroup analysis to identify populations that may exhibit higher sensitivity.Results
After adjusting for confounding variables, the results of the multivariate logistic regression analysis showed a significant positive association between METS-VF and the risk of psoriasis. One-unit increasement in METS-VF corresponded to a 47% rise in psoriasis risk (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.10-1.96). Finally, the results were uniform across all subgroups (P for interaction > 0.05). The results from the RCS analysis indicated a notable linear association.Conclusion
This research indicated that elevated levels of METS-VF are linked to a higher occurrence of psoriasis, suggesting the potential of METS-VF as a predictive anthropometric index for assessing the risk of developing psoriasis.Weiterlesen
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There are only limited histomorphological data on the response of psoriatic skin lesions to topical dithranol. In vivo reflectance confocal microscopy (RCM) in psoriatic skin is highly correlated with histopathological findings and allows non-invasive monitoring of treatment effects on a cellular level.Patients and methods
Prospective, single-center pilot study at a university-based clinic of dermatology between January 1st and August 30th, 2016. Psoriatic lesions of 20 patients receiving dithranol treatment were assessed by RCM at baseline, day 4 and 8 of treatment.Results
RCM measurements of psoriatic lesions receiving dithranol treatment revealed epidermal histomorphological changes with a strong median reduction of baseline hyperkeratosis by 45.0% (p < 0.001), acanthosis by 38.2% (p < 0.001), and epidermal thickness by 66.5% (p < 0.001) from baseline until day 8. Moreover, semiquantitative measurements of parakeratosis also showed a significant reduction until day 8 (p < 0.001). Correspondingly, RCM revealed dermal histomorphological changes with a decrease in diameter of dermal papillae by 32.1% (p < 0.001), decrease in diameter of papillary vessels by 16.9% (p = 0.002) and a strong semiquantitative reduction of the inflammatory infiltrate (p < 0.001).Conclusions
Results from our pilot study indicate that topical dithranol treatment of psoriatic lesions may induce a rapid and marked reduction of pathologic epidermal and dermal RCM features.Weiterlesen
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The pathogenesis of nummular eczema (NE) remains unclear, and no targeted therapy has been approved. Apremilast is a small molecule inhibitor targeting phosphodiesterase-4.Patients and methods
A phase IIb randomized, double-blind, placebo-controlled study evaluating the effects of apremilast or placebo in patients with NE. Patients received apremilast (30 mg BID) or placebo until week 16 followed by an open label phase in which all patients were treated with apremilast until week 32. The primary endpoint was the number of patients achieving an improvement in Physician's Global Assessment (PGA) by two or more points or an absolute PGA of 0 or 1 at week 16. Secondary endpoints included changes in skin physiology, life quality, or dermato-pathology.Results
33 patients were enrolled, of whom 31 were randomized to apremilast (n = 15) or placebo (n = 16). 1/15 (6.7%) patients in the apremilast group and 4/16 (25.0%) in the placebo group reached the primary endpoint (p = 0.369). There was no difference between placebo and apremilast with regard to all secondary endpoints at week 16 and week 32. The safety profile was in accordance with the known safety profile of apremilast.Conclusion
Phosphodiesterase-4 inhibition by apremilast showed no beneficial effects for the treatment of NE.Weiterlesen
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