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Psoriatic arthritis (PsA) presents various imaging abnormalities in joints and diverse nail changes, but the link between nail and joint findings remains unclear. This study aimed to gain a better understanding of the relationships between nail manifestations and abnormal articular architectures by investigating the associations between nail abnormalities and articular findings in PsA-affected interphalangeal joints.Methods
A total of 106 nails adjacent to PsA-affected distal interphalangeal joints were examined in 29 patients who underwent comprehensive systemic evaluation and imaging for the diagnosis and treatment of PsA. Imaging studies, including X-ray, magnetic resonance imaging, and iodine-enhanced dual-energy computed tomography, were conducted to examine the acral joints.Results
Nail manifestations were observed in 81 among 106 fingers or toes (76.4%). Pitting, the most common nail finding (75/106, 70.8%), was observed in isolation on 22/75 nails (29.3%), while other nail manifestations were observed in isolation on ≤ 3/50 nails (6.0%). Among the 81 examined nail lesions, 49 (61.3%) preceded the onset of articular symptoms in the adjacent interphalangeal joints, 9 (11.2%) followed the joint symptoms, and 23 (28.8%) occurred simultaneously. Articular bone findings, such as bone erosion and bone proliferation, were positively associated with subungual hyperkeratosis, leukonychia, crumbling, and/or transverse grooves. In contrast, soft tissue findings, including tenosynovitis, synovitis, and periarthritis, were negatively associated with onycholysis, subungual hyperkeratosis, leukonychia, and/or pitting.Conclusion
The study suggests that nail manifestations may be positively associated with bone abnormalities and negatively associated with soft tissue inflammation in PsA. Nail examinations may help estimate articular conditions. Key points • More than 60% of nail manifestations precede the onset of articular symptoms in the adjacent interphalangeal joints. • Nail manifestations may be positively associated with bone abnormalities and negatively with soft tissue inflammation in PsA. • Nail examination may aid in estimating articular status, prompting appropriate evaluation and early treatment for the affected joints.Weiterlesen
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Psoriatic arthritis (PsA) increases cardiovascular disease risk. Emerging evidence suggests biologic Disease-Modifying Antirheumatic Drugs (DMARDs) may offer protective effects, though their advantage over conventional therapy remains under investigation.Methods
A retrospective cohort study was conducted using the Chang Gung Memorial Research Database in Taiwan. Patients with PsA were identified from 2001 to 2022. The study included 2,383 patients who had used at least one disease-modifying antirheumatic drugs (DMARDs), divided into two groups: 1,190 on bDMARDs and 1,193 on conventional DMARDs (cDMARDs). The primary outcome was defined as a major adverse cardiovascular event (MACE), including stroke, myocardial infarction, cardiovascular mortality or coronary revascularization. Potential confounding was mitigated using inverse probability of treatment weighting.Results
The average follow-up period was 5.1 years for the bDMARD group and 5.0 years for the cDMARD group. The incidence of MACE was 0.34 and 0.55 events per 100 person-years in the bDMARDs and cDMARDs groups, respectively. All-cause mortality occurred at rates of 0.73 and 1.86 per 100 person-years in the bDMARDs and cDMARDs groups, respectively. The results showed that the bDMARDs group had lower risks of MACE (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43-0.96), all-cause mortality (HR: 0.44; 95% CI: 0.35-0.57) and cardiovascular mortality (HR: 0.54; 95% CI: 0.32-0.92), but a higher incidence of infection-related admission (subdistribution HR: 1.45; 95% CI: 1.18-1.78).Conclusions
bDMARDs may reduce cardiovascular events and mortality in PsA, but infection risks warrant close monitoring. Further research is needed to refine treatment strategies.Weiterlesen
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This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the benefits and harms of dose reduction and discontinuation of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in adults with rheumatoid arthritis or psoriatic arthritis, who have been in sustained remission or low disease activity. This is a common review protocol, outlining the approach for two separate Cochrane reviews for people with rheumatoid arthritis or psoriatic arthritis. Dose reduction or discontinuation of csDMARDs in adults with rheumatoid arthritis, who have been in sustained remission or low disease activity Dose reduction or discontinuation of csDMARDs in adults with psoriatic arthritis, who have been in sustained remission or low disease activity.Weiterlesen
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Targeted biologic therapies have transformed outcomes for individuals with psoriasis, a common immune-mediated inflammatory skin disease. The widespread use of these highly effective treatments has led to a growing number of individuals with clear or nearly clear skin remaining on continuous, long-term treatment. Personalised strategies to minimise drug exposure may sustain long-term disease control while reducing treatment burden, associated risks and healthcare costs. This study aims to evaluate the feasibility of a definitive pragmatic effectiveness trial of two personalised dose minimisation strategies compared with continuous treatment (standard care) in adults with well-controlled psoriasis receiving the exemplar biologic risankizumab.Methods and analysis
This is a multicentre, assessor-blind, parallel group, open-label randomised controlled feasibility trial in the UK, evaluating two personalised biologic dose minimisation strategies for psoriasis. 90 adults with both physician-assessed and patient-assessed clear or nearly clear skin on risankizumab monotherapy for ≥12 months will be randomised in a 1:1:1 ratio to (1) patient-led 'as-needed' treatment, where risankizumab is administered at the first sign of self-assessed psoriasis recurrence, (2) therapeutic drug monitoring-guided treatment, with personalised dosing intervals determined using a pharmacokinetic model or (3) continuous treatment as per standard care, for 12 months. Participants will be invited to submit self-reported outcomes and self-taken photographs every 3 months using a bespoke remote monitoring system (mySkin app) and will attend an in-person assessment at 12 months. They may also request additional patient-initiated follow-up appointments during the trial if needed. The primary outcome is the practicality and acceptability of the two personalised biologic dose minimisation strategies, assessed as a composite measure including recruitment and retention rates, adherence to the assigned strategies and acceptability to both patients and clinicians. The feasibility of collecting healthcare cost and resource utilisation data will also be evaluated to inform a future cost-effectiveness analysis. A nested qualitative study, involving semistructured interviews with patients and clinicians, will explore perspectives on the personalised biologic dose minimisation strategies. These findings will inform the design of a future definitive trial.Ethics and dissemination
This study received ethical approval from the Seasonal Research Ethics Committee (reference 24/LO/0089). Results will be disseminated through scientific conferences, peer-reviewed publications and patient/public engagement events. Lay summaries and infographics will be codeveloped with patient partners to ensure the findings are accessible for the wider public.Trial registration number
ISRCTN17922845.Weiterlesen
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Improved understanding of the immunopathogenesis of psoriasis has led to the development of effective targeted therapies, but patients who respond to treatment without total skin clearance have residual disease. The aim of this study was to demonstrate the existence of specific residual disease (or residual PASI) anatomical localizations related to different biologic agents.Methods and patients
This retrospective, observational, multi-center study analyzed clinical data of patients affected by psoriasis who had received biologic treatments for at least 6 months. The data analysis focused on patients with residual PASI.Results
A total of 228 of 1,000 patients showed residual disease despite achieving PASI 90 at weeks 24-28 of biologic treatment. The anatomical sites most frequently involved in residual disease were the lower limbs (44.3%). We observed differences among the biologic agents in terms of frequency and localization of residual disease. The localization of residual skin lesions to lower limbs was associated with treatment switching/interruption. The drugs with the highest and lowest proportion of patients with residual disease in the lower limbs were, respectively, secukinumab and risankizumab.Conclusions
Treatment with anti-IL-17 and anti-IL-23 drugs is characterized by the persistence of residual skin lesions with differences in terms of frequency and anatomical localizations.Weiterlesen
- 241 Aufrufe
Difficult-to-treat psoriatic arthritis (D2T-PsA) is increasingly recognized as a complex clinical entity characterized by persistent disease burden despite multiple targeted therapies. Its identification is essential to improve patient outcomes and to guide the development of new therapeutic strategies.Areas covered
In this perspective article, we discuss the evolving concept of D2T-PsA, including its epidemiology, clinical characterization, and underlying pathophysiological mechanisms. We highlight the role of gender differences, psychosocial comorbidities, and central sensitization in shaping disease persistence and patient-reported impact. We also examine the limitations of current disease activity indices (DAPSA, PsAID, PASDAS) in capturing heterogeneity and the need for multidimensional frameworks. A structured literature search was conducted in PubMed/MEDLINE and Scopus databases (January 2020-June 2025), restricted to English-language publications, using combinations of the terms psoriatic arthritis, difficult-to-treat, refractory, and difficult-to-manage. Additional references were identified from conference abstracts and relevant bibliographies.Expert opinion
Recognizing D2T-PsA as a distinct, multifactorial entity is critical to advancing personalized medicine. Future directions will involve harmonizing EULAR and GRAPPA frameworks, integrating biomarker discovery, digital tools, and adaptive trial designs, and embedding patient perspectives. This multidimensional approach is expected to transform treatment from empirical cycling toward precision care in psoriatic arthritis.Weiterlesen
- 232 Aufrufe
Psoriasis is associated with increased risk of depression. Although cognitive behavioral therapy (CBT) is an evidence-based treatment, access remains limited.Objectives
To evaluate the feasibility, acceptability, and preliminary efficacy of a smartphone-delivered, coach-led CBT program for depression among individuals with psoriasis.Methods
This single-arm, 8-week pilot study (Mindset trial, NCT06216691) enrolled adults with psoriasis and at least mild depressive symptoms (PHQ-9 ≥5). Participants engaged in a smartphone-based CBT program guided by bachelor's-level lay coaches. Primary outcomes were feasibility as evaluated by module completion and acceptability as evaluated by the Client Satisfaction Questionnaire-8 (CSQ-8]) and User Version of the Mobile Application Rating Scale (uMARS). Secondary outcomes included changes in the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Appearance Anxiety Inventory, Skindex-16, and Psoriasis Symptom Inventory.Results
Of 30 participants, 63.3% completed ≥4/8 modules and 43.3% completed ≥6/8 modules. Mean CSQ-8 and uMARS scores were 27.2 (SD 4.5) and 4.0 (SD 0.7), respectively, supporting high satisfaction. Statistically and clinically significant improvements were observed in PHQ-9 (mean change -4.4; Cohen's d = 0.92), GAD-7 (-2.8; d = 0.63), and Skindex-16 symptoms (5.0; d = 0.78), emotions (10.0; d = 0.95), and functioning (6.4; Cohen's d = 0.71) subscales as well as the Psoriasis Symptom Inventory (3.1; d = 0.43).Conclusions
This study supports the feasibility, acceptability, and preliminary efficacy of smartphone-delivered CBT for individuals with psoriasis and depressive symptoms. Given the scalability of this model, future randomized trials are warranted to assess broader effectiveness in dermatology care settings.Weiterlesen
- 232 Aufrufe
Psoriasis is a chronic inflammatory skin disease, and the risk of developing cancer has been postulated due to the presence of several plausible underlying mechanisms. Understanding the association between psoriasis and cancer is imperative to the provision of optimal psoriasis care.Objectives
To examine the risk of developing cancer in individuals with psoriasis.Methods
Population-based cohort studies were conducted in Denmark, England, Israel, and Taiwan through the use of linked electronic health records. Individuals aged at least 18 years of age with a diagnosis of psoriasis in the country-specific study period were matched to up to 6 comparators with no record of psoriasis prior to index date. Country-specific hazard ratios for the risk of cancer development overall and for 26 site-specific cancers between individuals with and without psoriasis were calculated through Cox regression. Country-specific estimates were pooled using random effects modelling.Results
We included 702,022 individuals with psoriasis and 4,185,342 matched comparators. In models implicitly controlled for age, sex and calendar time by matching, there was a small association between psoriasis and cancer overall (pooled HR [pHR]:1.08;95%CI, 1.04-1.13; I2= 92.4%). Adjustment for potential confounding factors resulted in a slight attenuation of risk (pHR:1.05; 95%CI, 1.01-1.09; I2=81.2%). When restricted to those with moderate-to-severe psoriasis, the risk of cancer overall was slightly higher (pHR:1.16;95%CI, 1.04-1.28; I2=92.8%) and confounder adjusted models (pHR: 1.09;95%CI, 1.03-1.15; I2=60.6%). Associations with psoriasis were present for oral cavity (pHR: 1.29; 95%CI, 1.12-1.47; I2=55.4%), pharynx (pHR:1.30;95%CI, 1.07-1.58; I2=58.4%), oesophagus (pHR:1.17;95%CI, 1.03-1.33; I2=56.6%), liver (pHR:1.53;95%CI, 1.33-1.77; I2=75.1%), pancreas (pHR:1.09;95%CI, 1.02-1.17; I2=0.0%), kidney (pHR:1.19;95%CI, 1.11-1.27; I2=0.0%), bladder (pHR: 1.13; 95%CI, 1.06-1.20; I2=28.7%), and keratinocyte cancers (pHR:1.37;95%CI, 1.16-1.63; I2=97.5%), Hodgkin lymphoma (pHR:1.56;95%CI, 1.16-2.11; I2=69.7%), non-Hodgkin lymphoma (pHR:1.16;95%CI, 1.07-1.26; I2=35.5%) and leukaemia (pHR:1.18; 95%CI, 1.08-1.29; I2=41.9%). Site-specific associations generally persisted, with slight risk exacerbations and additional associations for lung and ovarian cancers, when limited to people with moderate-to-severe psoriasis.Conclusion
Psoriasis was associated with an increased risk of developing 14 of 26 investigated site-specific cancers, including cancers with poor prognosis, such as liver, lung, and oesophageal cancer. Our findings can be used to reinforce cancer prevention strategies in psoriasis care.Weiterlesen
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While clinical examination remains the diagnostic cornerstone for psoriasis, there is a relative lack of objective, quantitative biomarkers to complement clinical assessment for tracking disease severity and monitoring therapeutic response. We evaluated serum SCCA's utility in identifying psoriasis and assessing its severity across demographic (gender, age) and clinical (comorbidity) subgroups, and its association with therapeutic responses.Methods
A total of 181 adult (≥18 years old) patients with newly diagnosed psoriasis were included in the disease group; 385 patients with other skin-related diseases and 658 healthy adults were included as controls. Patients diagnosed with tumors or renal failure were excluded. Serum SCCA was determined using Roche Cobas e 801 analyzer (Roche, Basel, Switzerland). Dynamic analysis was performed to evaluate the significance of serum SCCA in monitoring psoriasis treatment response.Results
Serum SCCA levels in psoriasis patients were mainly affected by gender and concomitant diseases. Notably, SCCA demonstrated high diagnostic accuracy (AUC: 0.89-0.90) in patients with comorbidities, with sex-specific cutoffs. The cutoff value of serum SCCA for identifying severe psoriasis was 2.64 ng/mL with an AUC greater than 0.9 and an NPV over 95 %. Serum SCCA levels were significantly correlated with the psoriasis area and severity index (PASI) and body surface area (BSA) both before and after treatment. The median decrease rate of serum SCCA was close to 50 % at >5 days post-treatment and 60 % at >10 days post-treatment.Conclusions
Serum SCCA shows promise as a reliable, complementary biomarker for the severity assessment and treatment monitoring of psoriasis. Its application for identification purposes should be stratified by sex and comorbidities.Weiterlesen
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Psoriasis a chronic inflammatory skin disease, poses a substantial economic burden on healthcare systems globally. This study examines psoriasis consultations from the provider's perspective within a dermatology department, aiming to generate detailed cost data to support value-based care. Specifically, it investigates the drivers of consultation-level cost variability, explores opportunities for efficiency, and also estimates one-year treatment costs to inform the development of bundled payment models. The goal is to highlight the importance of patient cost transparency and improving cost structures in chronic disease settings.Methods
Using Time-Driven Activity-Based Costing (TD-ABC), treatment costs associated with nurses, doctors, and total visits for 127 patients with mild and moderate forms of psoriasis were measured. Financial data was collected in collaboration with the hospital's financial department. During consultations, nurses and physicians recorded time and patient-related information. Additional or missing details were retrieved from patient medical files. Descriptive analyses assessed mean costs and variability by patient and disease characteristics.Independent variables
therapy type, patient status (new vs. returning), comorbidities, and treatment changes, were stratified to compare cost differences across groups.Results
Mean consultation costs were €55, with a minimum and maximum of €25 and €110. New patients incurred 40% higher costs than returning ones, mainly due to longer interactions with nurses and physicians. Key cost drivers for a total consultation included patient status, personality traits, nurse experience, and therapy switches. Physician consultations were particularly impacted by treatment changes and patient engagement levels. Annual treatment costs varied substantially by medication type: topical treatments averaged €325 per year, systemic treatments €1,353, and biological therapies €11,920, highlighting the significant impact of medication choice on overall expenses.Conclusions
This study highlighted substantial variability in consultation and yearly treatment costs for psoriasis patients. These findings emphasized the critical need for detailed cost data to optimise departmental workflows, support efficient resource allocation, and inform the design of equitable bundled payment models. Improving cost transparency was shown to strengthen clinical and financial decision-making. Future research was recommended to explore the cost implications of comorbidities and to extend benchmarking efforts across dermatology settings to guide system-wide improvements in care delivery and sustainability.Weiterlesen
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Epidemiological studies have revealed a close association between psoriasis and non-alcoholic fatty liver disease (NAFLD), but the causal relationship and underlying mechanisms remain unclear.Materials and methods
In this study, we used genome-wide association study (GWAS) data from the MRC Integrative Epidemiology Unit (MRC-IEU) to investigate the causal relationship between psoriasis and NAFLD, as well as potential mediators. Two-sample and two-step MR analyses were conducted, followed by bulk and single-cell transcriptomic analyses to validate our MR findings. In vivo validation was performed using Enzyme-Linked Immunosorbent Assay (Sample of patients (n=10)), immunohistochemistry, and liver bulk transcriptomic analysis.Results
The two-sample MR analysis revealed that genetically predicted psoriasis significantly increased the risk of NAFLD (OR = 1.07, 95% CI = 1.03-1.12, p = 0.001). Mediation analysis suggested that psoriasis was associated with elevated plasma Interleukin-1 receptor antagonist protein (IL-1RA) levels (OR = 1.02, 95% CI = 1.00-1.05, p = 0.031), which in turn raised the risk of NAFLD (OR = 1.15, 95% CI = 1.04-1.27, p = 0.006). In vivo experiments demonstrated elevated IL-1RA levels in the skin and plasma of psoriasis patients. Similarly, imiquimod (IMQ)-induced psoriasis mouse models exhibited increased IL-1RA levels in plasma and liver, accompanied by liver inflammation. MR and colocalization analysis indicated a positive correlation between IL-1RA, apolipoprotein B, and cholesterol.Conclusion
Our study demonstrates that genetically predicted psoriasis increases the risk of NAFLD, and plasma IL-1RA may serve as a potential mediator between psoriasis and NAFLD.Weiterlesen
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Psoriasis is a chronic, immune-mediated inflammatory dermatosis associated with an elevated risk of cardiovascular disease (CVD) due to systemic inflammation and metabolic dysregulation. Phenotypic age acceleration (PhenoAge-accel) quantifies accelerated biological aging by comparing an individual's predicted 'phenotypic age' (based on immune/inflammatory markers and chronological age) to their actual age. Notably, both the onset and progression of psoriasis exhibit strong associations with biological aging process. The aim of this study was to investigate their combined effect on the risk of all-cause and CVD mortality.Methods
This study included 11,443 participants from the National Health and Nutrition Examination Survey (NHANES) conducted during 2003-2006 and 2009-2010. Weighted multivariable logistic regression models were used to evaluate the association between PhenoAge-accel and psoriasis risk. PhenoAge-accel ≥ 0 was defined as PhenoAge-accel+. Furthermore, participants were stratified into four groups: psoriasis-/PhenoAge-accel-, psoriasis+/PhenoAge-accel-, psoriasis-/PhenoAge-accel+, and psoriasis+/PhenoAge-accel+. The Cox proportional hazards models were employed to investigate the joint effects of psoriasis and PhenoAge-accel on all-cause and CVD mortality risk.Results
At baseline, 312 participants were diagnosed with psoriasis. After adjusting for covariates, compared to those with PhenoAge-accel < 0, the odds ratios (95% CI) for psoriasis in the PhenoAge-accel ≥ 0 group was 1.83 (1.36-2.45). During a median follow-up of 10.91 years (interquartile range: 9.83-14.75), 1059 deaths event occurred, including 306 caused by CVD. In the multivariable-adjusted model, compared with the reference group, the hazard ratios and 95% CIs for all-cause mortality in the psoriasis-/PhenoAge-accel+, psoriasis+/PhenoAge-accel-, and psoriasis+/PhenoAge-accel+ groups were 1.80 (1.54-2.10), 0.96 (0.56-1.65), and 2.70 (1.66-4.39), respectively. A similar trend was observed for CVD mortality.Conclusions
PhenoAge-accel is positively associated with psoriasis risk. Furthermore, the coexistence of psoriasis and PhenoAge-accel are significantly associated with an increased risk of all-cause and CVD mortality.Weiterlesen
- 242 Aufrufe
While clinical examination remains the diagnostic cornerstone for psoriasis, there is a relative lack of objective, quantitative biomarkers to complement clinical assessment for tracking disease severity and monitoring therapeutic response. We evaluated serum SCCA's utility in identifying psoriasis and assessing its severity across demographic (gender, age) and clinical (comorbidity) subgroups, and its association with therapeutic responses.Methods
A total of 181 adult (≥18 years old) patients with newly diagnosed psoriasis were included in the disease group; 385 patients with other skin-related diseases and 658 healthy adults were included as controls. Patients diagnosed with tumors or renal failure were excluded. Serum SCCA was determined using Roche Cobas e 801 analyzer (Roche, Basel, Switzerland). Dynamic analysis was performed to evaluate the significance of serum SCCA in monitoring psoriasis treatment response.Results
Serum SCCA levels in psoriasis patients were mainly affected by gender and concomitant diseases. Notably, SCCA demonstrated high diagnostic accuracy (AUC: 0.89-0.90) in patients with comorbidities, with sex-specific cutoffs. The cutoff value of serum SCCA for identifying severe psoriasis was 2.64 ng/mL with an AUC greater than 0.9 and an NPV over 95 %. Serum SCCA levels were significantly correlated with the psoriasis area and severity index (PASI) and body surface area (BSA) both before and after treatment. The median decrease rate of serum SCCA was close to 50 % at >5 days post-treatment and 60 % at >10 days post-treatment.Conclusions
Serum SCCA shows promise as a reliable, complementary biomarker for the severity assessment and treatment monitoring of psoriasis. Its application for identification purposes should be stratified by sex and comorbidities.Weiterlesen
- 231 Aufrufe