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Up to one-third of people living with psoriasis develop psoriatic arthritis (PsA), and the majority have active psoriasis prior to the development of arthritis. Clinical risk factors, such as nail involvement, in conjunction with novel blood biomarkers, could improve PsA risk monitoring and early diagnosis.Objectives
The aim of the HIPPOCRATES Prospective Observational Study (HPOS-www.hpos.study) is to follow a cohort living with psoriasis and identify risk factors for the development of PsA.Design
HPOS is a patient-driven online prospective European observational cohort.Methods
Adult participants with psoriasis but with no prior diagnosis of PsA are eligible. Participants are invited to provide consent and join the study online. They complete a semi-structured questionnaire to collect data on demographics, psoriasis, comorbidities, risk factors for PsA, and the Psoriasis Epidemiology Screening Tool screening questionnaire. Follow-up is conducted through a questionnaire every 6 months. The primary outcome is the new onset of PsA confirmed by a diagnosis from their doctor. The study will also collect peripheral blood samples from a subset of participants for biomarker identification.Ethics
This study follows the principles of the Declaration of Helsinki. To date, ethical approval has been granted by independent ethical committees in 10 countries.Discussion
Studying a cohort of individuals with psoriasis will allow us to identify risk factors for arthritis development and to develop a risk calculator. This can support focused efforts on screening, patient education, and even studies looking to delay or prevent the onset of arthritis. This study, run via remote online data collection, provides an efficient way to recruit a large cohort (25,000) across multiple countries. However, challenges have had to be addressed with some key changes in study design, ethical review, and recruitment strategies required for each individual country.Trial registration
HPOS, Clinicaltrials.gov ID: NCT05858528, IRAS number 325080; https://clinicaltrials.gov/study/NCT05858528?locStr=United%20Kingdom&country=United%20Kingdom&cond=Psoriasis&term=HPOS&aggFilters=status%3Anot%20rec&rank=1.Weiterlesen
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Psoriasis and psoriatic arthritis (PsA) are chronic inflammatory diseases that affect not only the skin and joints but also the cardiovascular system.Aim
To investigate the relationship between epicardial adipose tissue (EAT) thickness and anthropometric measurements, laboratory parameters, and clinical variables in patients with psoriasis and PsA.Methods
This cross-sectional study included 65 patients with psoriasis vulgaris (with or without PsA) and 54 healthy controls. Demographic, clinical, and laboratory data of the participants were recorded. EAT, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVS), and ejection fraction (EF) were measured by echocardiography. Associations between EAT thickness and patient parameters were evaluated using Spearman correlation and multivariate linear regression analyses.Results
The mean ages of the patient and control groups were 43.88 ± 13.1 years and 44.81 ± 12.88 years, respectively. Low-density lipoprotein cholesterol, LVESD, and IVS were significantly higher in the control group compared with psoriasis patients (P = 0.021, P < 0.001, P < 0.001, respectively). C-reactive protein (CRP) levels (P < 0.001), systolic blood pressure (P < 0.001), diastolic blood pressure (P = 0.023), and EAT thickness (P < 0.001) were significantly higher in the patient group. Disease duration (P = 0.028) and PASI (P = 0.012) were significantly greater in psoriasis patients with PsA. EAT positively correlated with body mass index (BMI) (r = 0.307, P = 0.024), CRP (r = 0.344, P < 0.001), and systolic blood pressure (r = 0.185, P = 0.044).Conclusions
EAT thickness was higher in patients with psoriasis than in control participants. EAT positively correlated with BMI, CRP, and systolic blood pressure.Weiterlesen
- 181 Aufrufe
Palmoplantar psoriasis exhibits greater treatment resistance compared to other psoriatic plaques and presents clinical and histopathological overlap with palmoplantar eczema. This study aimed to investigate treatment resistance mechanisms in palmoplantar psoriasis and assess the contribution of IL-17, IL-23, and IL-36α to the differential diagnosis of palmoplantar psoriasis and eczema. Immunohistochemical levels of these cytokines were measured in paired acral and non-acral psoriatic samples.Methods
We retrospectively included 73 patients: 25 with only palmoplantar psoriasis, 25 with palmoplantar eczema, and 23 with both conditions and concurrent plaque psoriasis. Clinical and histopathological diagnoses were confirmed. Immunohistochemical analyses were conducted using preparations stained for IL-17, IL-23, and IL-36α.Results
In psoriasis cases, immunohistochemical examination of biopsies from both body and palmoplantar regions showed lower IL-17 and IL-36α expression in acral regions compared to non-acral regions. In palmoplantar eczema patients, IL-17 and IL-23 expression was higher than in palmoplantar psoriasis patients; however, IL-36α expression was similar in both conditions.Conclusions
The diminished expression of IL-17 and IL-36α in palmoplantar psoriasis compared to other body sites may contribute to variable responses to targeted treatments. These findings suggest the potential for developing distinct biological treatments for these regions.Weiterlesen
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Psoriasis is recognized as a systemic inflammatory disease associated with metabolic dysregulation. Understanding these metabolic changes may reveal biomarkers to elucidate disease mechanisms and predict comorbidities. While previous studies have identified psoriasis-associated metabolites, findings are often limited by sample sizes and lack validation.Objectives
To identify circulating metabolites associated with psoriasis, including disease severity and psoriatic arthritis. Further, we investigated whether the metabolic signature was disease-specific compared to other immune-mediated inflammatory diseases (IMIDs).Methods
We performed a cross-sectional analysis of 470,352 White/European individuals from the UK Biobank (n=453,428) and HUNT (n=16,924). Nuclear Magnetic Resonance spectroscopy was used to quantify metabolite levels, covering lipoprotein fractions and subfractions, fatty acids, and small-molecular metabolites. For each metabolite, we performed multivariable linear regression adjusting for age, sex, BMI, smoking status, and use of lipid-lowering medications.Results
The metabolomic profile of psoriasis was largely consistent across the two populations. In the model adjusted for age and sex, 123 metabolic measures were associated with psoriasis. After full adjustment, only Glycoprotein acetyls (GlycA) remained associated with psoriasis (coefficient [95% CI]: 0.09 [0.07-0.11] in UK Biobank and 0.11 [0.06-0.17] in HUNT). In HUNT, severe psoriasis exhibited more pronounced metabolic alterations compared to non-severe psoriasis. Across both populations, phenylalanine levels were highly elevated in psoriatic arthritis compared to cutaneous psoriasis (0.44 [0.29-0.60] in UK Biobank and 0.47 [0.28-0.67] in HUNT). In comparisons across IMIDs, atopic dermatitis and cutaneous-limited psoriasis exhibited milder metabolic alterations, and psoriasis in HUNT showed a distinct lipoprotein profile.Conclusions
This large-scale study confirms metabolic alterations in individuals with psoriasis and highlights phenylalanine as a potential biomarker for joint involvement in psoriasis. The distinct metabolomic profile of psoriasis relative to other IMIDs suggests a potentially unique systemic profile. These findings offer a foundation for advancing biomarker research and mechanistic studies for psoriasis.Weiterlesen
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We aimed to identify and characterize distinct subgroups of patients with psoriatic arthritis (PsA) based on their responses to the Assessment of SpondyloArthritis international Society Health Index (ASAS HI), using latent class analysis (LCA).Methods
We performed an exploratory LCA on 17 dichotomous ASAS HI items in a cohort of patients with PsA (n = 90). Model adequacy was evaluated by log-likelihood, Akaike information criterion (AIC), Bayesian information criterion (BIC), entropy, and average posterior probabilities (AvePP). Clinical measures (Psoriatic Arthritis Impact of Disease [PsAID], Disease Activity Index for Psoriatic Arthritis [DAPSA], tender/swollen joint counts, treatment) were compared across classes. Sensitivity analyses with 3 to 4 classes assessed robustness.Results
A 6-class solution was retained, ordered from class 0 (lowest impact) to class 5 (highest impact). Mean ASAS HI ranged from 1.2 in class 0 to 11.6 in class 5, with parallel increases in PsAID and DAPSA. Conditional probabilities revealed distinct profiles: class 0 had minimal impairment, classes 1-2 showed predominantly physical function limitations of mild to moderate severity, class 3 combined physical and emotional function burden, class 4 was characterized by dominant participation and social impact, and class 5 displayed severe multidimensional impairment. All classes had AvePP > 0.86. Sensitivity analyses with K = 3 and K = 4 reproduced the same gradient of impact but provided less granular separation.Conclusion
LCA of the ASAS HI identified 6 clinically meaningful health impact profiles in PsA. These findings support the use of the ASAS HI as a multidimensional tool capable of capturing diverse patient experiences and may help inform individualized management strategies in PsA.Weiterlesen
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Atopic dermatitis and psoriasis are chronic inflammatory skin diseases often linked to psychological stress. Integrative care models are lacking. This randomized pilot study aimed to develop and test a psychoeducational intervention for dermatology patients.Patients and methods
Patients with a PHQ-2 score ≥ 3 at an outpatient inflammation center were randomized into an intervention or control group. The intervention group received three standardized educational sessions focusing on maladaptive schemas, coping strategies, psychoeducation, and emotion-focused techniques (e.g. chair-dialogues, imaginary rescripting).Results
19 patients received the intervention; 13 were in the control group. Post-intervention, significant improvements were observed in dermatological quality of life (DLQI), subjective well-being (WHO-5), and depressive symptoms (PHQ-9, BDI-II). Psychological benefits were largely independent of disease severity (PASI, EASI). Qualitative feedback highlighted usability, learning specific techniques, and a trusting therapeutic relationship.Conclusions
A brief psychoeducational intervention significantly reduced psychological stress in dermatology outpatients. Further studies are needed to evaluate long-term effects and broader implementation.Weiterlesen
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Psoriasis is one of the chronic inflammatory skin conditions, affecting about 2-3% of the world population. Steroidal treatment are only best choice of treatments, but it is often associated with side effects due to higher lipophilicity.Objectives
In this work, a nanoparticle-loaded transdermal film was developed to maintain nanoparticle integrity in the skin.Methods
Fluticasone propionate loaded chitosan nanoparticles (NPs) were developed, and their particle size, zeta potential, drug loading, entrapment efficiency and scanning electron microscope (SEM) images were determined. The NPs-loaded film was further characterized for appearance, thickness and Fourier Transform Infrared (FTIR) spectra, and an in vitro and in vivo permeation study was conducted.Results
The particle size of FSNPs was found to be 250nm with +32.4 ±1.5 mV zeta potential, great entrapment efficiency and spherical in shape. In vivo dermato-kinetic studies showed long-term, confined drug release from the NP-formulated film in the epidermal layers, compared with the film containing free drug.Conclusion
The study demonstrated that the FSNPs-loaded film showed higher skin permeation, which is effective for managing psoriasis and warrants further evaluation.Weiterlesen
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Data on the prevalence of sensitive skin in patients with chronic inflammatory skin diseases are lacking. The aim of this study was to address this gap.Methods
This observational study included patients with psoriasis, atopic dermatitis or chronic hand eczema who attended the Unit of Dermatology of Ferrara and Messina, Italy, between June and December 2023. All participants completed a 10-item questionnaire for the diagnosis of sensitive skin (score range: 0-10). Participants were classified as having sensitive skin if they scored ≥4.Results
A total of 188 subjects were included, of whom 82 had psoriasis (mean Psoriasis Area and Severity Index [PASI] 4.2±5.1), 59 had atopic dermatitis (Eczema Area and Severity Index [EASI] 3.5±6.7) and 47 had hand eczema (Hand Eczema Severity Index [HECSI] 39.3±3.26). The mean questionnaire scores were 2.6±2.4 for psoriasis, 4.7±2.9 for atopic dermatitis, and 3.0±2.1 for hand eczema, with significant differences observed between atopic dermatitis and both psoriasis (P<0.001) and hand eczema (P<0.001). The prevalence of sensitive skin was higher among atopic dermatitis patients compared to those with psoriasis (P<0.001) and hand eczema (P<0.01).Conclusions
In the present study, which should be regarded as a pilot due to the relatively small number of cases included, sensitive skin was both more prevalent and more severe in patients with atopic dermatitis compared to those with psoriasis and hand eczema. Atopic dermatitis appears to promote skin sensitivity, independently of its clinical severity.Weiterlesen
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Psoriasis is a chronic immune-mediated skin disease influenced by genetic, environmental, and lifestyle factors, with increasing burden among working-age adults.Objective
To examine global trends in psoriasis prevalence among working-age adults, evaluate associations with lifestyle factors using a simplified Life's Essential 4 (LE4) index, and explore potential dietary causal relationships through Mendelian randomization (MR).Methods
Global prevalence trends from 1990 to 2021 were analyzed using GBD 2021 data, calculating age-standardized rates (ASR) and estimated annual percentage changes (EAPC), with projections to 2031. Regional variations across SDI levels were also assessed. The LE4 index, derived from core lifestyle components of the Life's Essential 8 framework using NHANES data, was evaluated via survey-weighted logistic regression and restricted cubic spline analysis. Two-sample MR analyses were conducted using the inverse-variance weighted (IVW) method to assess dietary traits.Results
The global prevalence of psoriasis among working-age adults increased from 555.7 to 600.6 per 100,000 (EAPC: 0.22%), with projections reaching 631.6 by 2031; Notably, upward trends were consistently observed across all SDI regions. Higher LE4 scores (≥81.2) were associated with lower odds of psoriasis (OR: 0.518, P=0.040). MR analyses suggested that genetically predicted fizzy drink consumption increased risk (OR: 1.57, P=0.0215), whereas salad vegetable intake showed a protective association (OR: 0.85, P=0.0224).Conclusion
The burden of psoriasis among working-age adults shows a modest global increase with regional heterogeneity. Healthier lifestyle patterns and favorable dietary factors were associated with reduced risk, highlighting the importance of modifiable behaviors in prevention strategies.Weiterlesen
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To disentangle tobacco constituents in psoriasis, we contrasted nicotine exposure-proxied by the nicotine metabolite ratio (NMR)-with smoking intensity (cigarettes per day, CPD) and evaluated cross-ancestry effects.Methods
This study applied multivariable Mendelian randomization (MR) jointly modeling genetically proxied NMR (instrumented using variants from a European-ancestry GWAS) and CPD to estimate their independent effects on liability to psoriasis and psoriatic arthritis (PsA). Chronic obstructive pulmonary disease (COPD) served as a positive control. Cross-ancestry generalizability was tested using a trans-ethnic MR (TEMR) framework under conditional likelihood with Nelder-Mead optimization. Sensitivity analyses assessed pleiotropy, heterogeneity, directionality (Steiger), MRLap, RadialMR, and multiple testing (Benjamini-Hochberg).Results
NMR showed an independent association with higher PsA risk irrespective of CPD (OR = 1.104, 95% CI: 1.039-1.174). CPD retained an independent effect on overall psoriasis after conditioning on NMR (OR = 1.305, 95% CI: 1.082-1.573), while the NMR effect on psoriasis attenuated (P > 0.05). In univariable MR, genetically predicted NMR increased psoriasis risk in Europeans (EUR; OR = 1.032, 95% CI: 1.013-1.051). CPD associated with psoriasis in EUR (OR = 1.130, 95% CI: 1.031-1.239) and strongly in Hispanics (HIS; OR = 1.448, 95% CI: 1.434-1.463), with suggestive evidence in East Asians. Reverse-direction MR indicated psoriasis liability correlated with lower CPD across EUR, EAS, AFR, and HIS (β < 0, Padj < 0.05).Conclusion
This study supports ancestry-specific differences and suggests distinct roles of nicotine-related versus non-nicotine tobacco smoke constituents in psoriasis and its subtypes, while the underlying biological mechanisms remain to be clarified.Weiterlesen
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