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Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO.Patients and methods
This non-interventional, prospective, epidemiological, cross-sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types.Results
One hundred ninety-five patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (< 45%). Especially, ultrasounds (≤ 5%) and MRIs (< 6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences.Conclusions
Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening.Weiterlesen
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De-escalation strategies of biologics in psoriasis treatment are widespread in clinical practice. Dose spacing consists of de-escalating the time range between biological drug injections.Patients and methods
Major objectives were: to describe trends in mean PASI, PASI 100, 90, and ≤ 1 from baseline to 12 months after dose spacing, provide drug survival analysis of dose-spaced regimens, and concurrently describe phenotypic characteristics related to the selection of patient candidates for therapeutic dose spacing. A pre-post analysis was made between mean PASI at dose spacing and baseline, and after 3, 6, 9, and 12 months following dose spacing.Results
Of 1,144 patients treated with IL-23 or IL-17 inhibitors, 61 patients underwent dose spacing. They presented with lower mean baseline Body Mass Index (BMI) (p = 0.011) and PASI (Psoriasis Area Severity Index) (p = 0.044) and were more frequently bio-experienced (p = 0.033). 12 months after dose spacing 42.9%, 85.7%, and 92.9% of observed patients achieved PASI 100, 90, and ≤1. There were no significant differences in mean PASI between dose spacing and subsequent time points. The dose spacing survival was 70% at 1 year.Conclusions
Therapeutic modulation, such as dose spacing, is an effective strategy for most psoriasis patients, resulting in a clear or almost clear skin response that is maintained over time.Weiterlesen
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Generalized pustular psoriasis (GPP) is a rare, chronic, potentially life-threatening skin disease. We aimed to establish criteria to accurately approximate GPP prevalence in Germany.Methods
A retrospective analysis of the WIG2 health claims database (1/1/2016-31/12/2020) was conducted. Patients aged ≥ 12 years continuously enrolled in their statutory health insurance with one inpatient or confirmed outpatient diagnosis code for GPP (International Classification of Diseases, 10th Revision [ICD-10] L40.1) were included. Scenarios with increasingly strict criteria were used to identify the GPP population.Results
From 2016-2020, 5,236 potential GPP cases were identified based on a recorded GPP diagnosis. The scenario of ≥ 1 GPP diagnosis yielded the highest prevalence (336-390 patients/million) followed by > 1 GPP diagnosis in ≥ 2 quarters (189-288 patients/million); scenarios resulting in the lowest prevalence were diagnosis in ≥ 2 quarters AND two independent diagnoses (17-28/million) and diagnosis in ≥ 2 quarters AND two independent diagnoses or diagnosis by a specialist AND potential flare (58-61 patients/million).Conclusions
This study suggests that diagnosis in ≥ 2 quarters by a specialist or two independent physicians may be the most clinically robust and reliable criteria for estimating GPP prevalence; therefore, 50-100 patients/million may represent a reasonable prevalence estimate range for Germany.Weiterlesen
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To analyze a published study on all-cause mortality between psoriatic arthritis and matched population comparator-subjects to derive comparative mortality statistics applicable to life insurance underwriting.Method.—
The pixel method was employed for extracting cumulative survivals. It was chosen for its capability to extract data from published graphs despite potential precision and reliability limitations.Results.—
The mortality analysis indicated an increase in mortality starting in year 4, aligning with the Table rating for Psoriatic arthritis. Pharmacological treatment data from the study revealed only 28% were on advanced therapies such as targeted synthetic or biologic DMARDs. This low percentage suggests most of the cohort had milder PsA, as advanced treatments are generally reserved for moderate to severe psoriatic arthritis. The distribution of treatment regimens provides essential insights into disease severity and its implications for mortality assessment.Conclusion.—
The comparative mortality findings correspond to Table rating for psoriatic arthritis. This finding underscores the importance of understanding treatment profiles and disease severity in life insurance underwriting to accurately assess risk.Weiterlesen
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To explore the extent to which skin severity is reflected in the Psoriatic Arthritis Disease Activity Score (PASDAS).Methods
Cross-sectional baseline data from the British Society for Rheumatology PsA register (BSR-PsA) and the GRAPPA Composite Exercise (GRACE) dataset was included. The body surface area score (BSA) and the Dermatology Life Quality Index (DLQI) were used to assess skin disease activity. BSA was categorized as none (0%), mild (<3%), moderate (3-10%) and severe (>10%) skin involvement. DLQI was categorized as no (0-1), small (2-5), moderate (6-10), large (11-20) and extreme (21-30) effect on quality of life. Mean and standard deviation PASDAS scores, physician and patient global VAS scores were calculated for each category of skin severity by both BSA and DLQI. Within each cohort, two groups were created based on the severity of skin disease (BSA cut-off of 10). Propensity score matching was applied to match groups for musculoskeletal disease activity and differences between the groups were assessed.Results
In both the BSR-PsA (N = 1126) and GRACE (N = 588) datasets, PASDAS, VAS physician global and VAS patient global scores increased with increasing skin scores. For the subjects grouped by severity of skin involvement, and matched for musculoskeletal activity, significant differences in PASDAS, physician global score and DLQI were observed for the BSR-PsA, and physician and patient global scores, DLQI and age for the GRACE dataset.Conclusion
These data suggest that psoriasis disease activity is represented in the composite PASDAS score, possibly through the global (patient and physician) VAS scores.Weiterlesen
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To test the hypothesis that recently-developed total body-positron emission tomography (TB-PET) imaging with integrated computed tomography (CT) will enable low-dose, quantitative, domain-specific evaluation of the total inflammatory burden of psoriatic arthritis (PsA) and associate with established outcome measures of the clinical domains of PsA.Methods
Seventy-one adult participants (40 with PsA, 16 with rheumatoid arthritis (RA), and 15 with osteoarthritis (OA)) underwent 20-min TB-PET/CT scans using [18F]FDG, a glucose analogue radiotracer. [18F]FDG uptake was assessed qualitatively and quantitatively. Rheumatological examinations were performed prior to the scan. For both evaluations, domain-specific assessments included 68 joints, 6 entheses, 20 nails, axial disease and dactylitis.Results
[18F]FDG PET uptake consistent with joint involvement and enthesitis was noted in 100% of participants with PsA. Other features included nail matrix pathology (53%), spinal involvement (60%), active sacroiliitis (13%) and dactylitis (10%). Patterns of [18F]FDG uptake in PsA differed from those in participants with RA or OA. There was a high concordance between TB-PET measures and the domain-specific assessments of the joint (75%), entheseal (79%) and nail (65%) pathology. TB-PET was positive for an additional 15% of joints, 20% of entheses and 13% of nails that were negative on clinical assessments.Conclusion
TB-PET/CT identified inflammatory pathologies characteristic to all clinical domains of PsA and thus provided an in vivo evaluation of systemic PsA inflammatory burden. This promising tool may further contribute to identifying pathologies that may be occult, provide biomarkers to diagnose and differentiate PsA at an early stage, and to monitor early treatment response.Weiterlesen
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Although the data on psoriasis epidemiology included in the Global Psoriasis Atlas (GPA) provide valuable information on psoriasis prevalence worldwide, the GPA database is still incomplete. Therefore, the aim of the study was to assess the prevalence, incidence, and mortality rates of psoriasis and its types in Poland based on the data registered by the National Health Fund (NHF).Methods
The study included psoriasis patients registered at least twice in the Polish NHF database between 2010 and 2023.Results
At the end of 2023, 639,662 living psoriasis patients had been registered in the Polish NHF database, which constituted 1.70% of the Polish general population. The percentage of female psoriasis patients was found to be higher (54.95%) than male patients (45.05%). Of all the Polish NHF-registered psoriasis patients, plaque psoriasis affected 95.66%, pustular psoriasis 3.05%, psoriatic arthritis 7.20%, and guttate psoriasis 0.27%. In comparison to the general Polish population, psoriasis prevalence was observed to be lower in children (0.84%). The all-cause mortality rate among psoriasis patients was found to be higher in comparison to the general Polish population, with a higher mortality rate noted in male psoriasis patients.Conclusions
The NHF database we studied suggests a direct relationship between the prevalence, incidence, and all-cause mortality rates in psoriasis and patients' age and sex. However, the study also revealed a decrease in mortality rates and a slow increase in the prevalence of psoriasis in the Polish population, which calls for further studies.Weiterlesen
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Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis compared to healthy individuals. Interleukin (IL)-17 and IL-23 inhibitors may have beneficial effects on MASLD by reducing systemic inflammation and improving metabolic parameters.Objectives
To assess the effect of IL-17 and IL-23 inhibitors on MASLD and liver fibrosis in patients with psoriasis.Design
We performed a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Data sources and methods
A literature search was conducted across four databases: MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from database inception to September 27, 2024. Observational studies and clinical trials that reported the presence of MASLD and/or liver fibrosis in patients with psoriasis/psoriatic arthritis treated with IL-17 or IL-23 inhibitors were included. The Newcastle Ottawa Scale (NOS) was used for risk of bias assessment in cohort studies, the Revised Cochrane Risk of Bias Tool (RoB2.0) in randomized controlled trials, and the Risk of Bias in non-randomized studies-of Interventions (ROBINS-I v.2) tool in non-randomized trials.Results
Fourteen studies were included: four clinical trials, five retrospective cohort studies, three prospective cohort studies, and two post hoc studies. Two cohort studies and one clinical trial showed a low risk of bias. Both post hoc studies had a high risk of bias. Eleven studies assessed the effect of IL-17 inhibitors on MASLD or liver fibrosis; six reported a neutral effect, while five demonstrated improvements in liver tests. Three studies evaluated IL-23 inhibitors; one showed neutral effects, another reported improvement in fibrosis-4 index (FIB-4) scores at 6 months, and the third was still in the recruitment phase.Conclusion
IL-17 and IL-23 inhibitors may provide beneficial effects on MASLD and liver fibrosis in patients with psoriasis. Larger, well-designed studies are needed to confirm these findings.Trial registration
PROSPERO CRD42024599350.Weiterlesen
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Psoriasis is a systemic immune disease associated with the development of various cancers. However, the causal nature of this association remains unclear. This study aims to systematically investigate the potential causal relationship between psoriasis and 32 types of cancer.Methods
We utilized data from two large genomic databases, the UK Biobank and FinnGen, to extract GWAS summary statistics for 32 cancer types as outcomes and psoriasis-related data as exposures. Mendelian randomization (MR) analysis was performed to assess the causal effects of psoriasis on cancer risk. Sensitivity analyses, including heterogeneity and horizontal pleiotropy tests, were conducted to ensure robustness. Additionally, meta-analysis and FDR correction were applied to enhance the reliability of the results.Results
Our findings revealed significant causal relationships between psoriasis and four cancer types: Psoriasis was associated with an increased risk of laryngeal cancer (OR = 1.15, 95% CI: 1.05-1.26). Psoriasis exhibited a protective effect against oral cavity and pharyngeal cancer (OR: 0.91; 95% CI: 0.86-0.97), prostate cancer (OR: 0.97; 95% CI: 0.95-0.99), and malignant non-melanoma cancer (OR: 0.89; 95% CI: 0.82-0.96).Conclusion
Psoriasis may exert bidirectional effects on the development of specific cancers through distinct mechanisms. Specifically, psoriasis may increase the risk of laryngeal cancer while reducing the risk of oral cavity and pharyngeal cancer, prostate cancer, and malignant non-melanoma cancer. These findings provide new insights into the causal relationship between psoriasis and cancer and could inform prevention and treatment strategies for these diseases.Weiterlesen
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In recent years, the prevalence of uveitis among patients with psoriasis has shown a noticeable upward trend. Previous studies have investigated the immunological mechanisms underlying the potential connection between psoriasis and uveitis, but systematic studies exploring their bidirectional relationship is absent. This study aims to systematically evaluate the bidirectional association between psoriasis and uveitis to provide evidence.Methods
We thoroughly searched PubMed, Embase, and the Cochrane Library for relevant observational studies published from the inception of these databases up to Mar 11th, 2024. Our systematic review was based on priori protocol pre-registered in PROSPERO (No. CRD42024522464). Risk and bias assessments were analyzed using STATA 16.0.Results
We analyzed the results from 7 studies involving 81,775,820 subjects. The results showed that the incidence of uveitis was higher in patients with psoriasis compared to patients without psoriasis (OR = 1.16, 95% CI: 1.11-1.21). At the same time, patients with uveitis showed heightened susceptibility to psoriasis (OR = 1.52, 95% CI: 1.34-1.70, I2: 90.6%, P < 0.01). The subgroup analysis found that uveitis affects the severity and type of psoriasis.Conclusions
The current systematic review and meta-analysis found a bidirectional association between psoriasis and uveitis. Notably, patients with severe psoriasis and psoriasis with joint symptoms should be informed about their increased risk to developing uveitis.Weiterlesen
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Psoriatic Arthritis (PsA), an immune mediated inflammatory arthritis, affects a quarter of patients with cutaneous psoriasis, usually after psoriasis onset. Early diagnosis of PsA is challenging. A biomarker-based diagnostic test may facilitate early diagnosis.Objectives
We aimed to determine whether specific clinical features or genetic and protein markers, alone or in combination, can distinguish patients with PsA from those with psoriasis without PsA (PsC).Methods
Patients with PsA and PsC were identified from a database of patients with psoriatic disease. Detailed demographic and clinical information were collected at time of assessment. Single-nucleotide polymorphisms (SNPs) of 19 "PsA weighted" genes were genotyped. Serum samples were used to assess 15 protein markers by ELISA. Association between clinical, genetic and protein markers and PsA were determined, and models were developed to discriminate PsA from PsC using machine learning algorithms.Results
Demographic and clinical information had low predictive value in distinguishing PsA from PsC (AUC - 0.607, P < .01). SNP and protein panels also had low value in discriminating PsA from PsC (AUC - 0.691, P < .001 and AUC - 0.694, P < .001, respectively). Combining protein, SNPs and clinical features provided better discriminatory value (best performing model: Random Forest, AUC - 0.733, P < .001).Conclusion
Combining previously identified clinical, genetic and protein markers have a fair ability to differentiate PsA from PsC. Further studies are required for identifying better diagnostic signatures.Weiterlesen
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