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Biologika verursachen bei Psoriasis deutlich höhere Kosten für **Labor-Kontrollen** als nicht-biologische Systemtherapien.[1] Ältere Menschen und Personen mit höherer **Komorbiditätslast** (CCI) brauchen häufiger Labortests, was medizinisch sinnvoll ist, um **Sicherheitsrisiken** früh zu erkennen.[1] Warum ist das wichtig? - Biologika sind schon bei den **Medikamentenkosten** teurer als klassische Systemtherapien.[4] - Trotz höherer Monitoring-Kosten bei Methotrexat und Co. liegen die **Gesamtkosten** bei Biologika meist darüber.[4] - Studien zeigen seit Jahren steigende **Ausgaben** für Biologika.[2] Für die Praxis: - Wer **älter** ist oder mehrere **Begleiterkrankungen** hat, braucht oft engere **Laborkontrollen**.[1] - Das Monitoring kann Nebenwirkungen früh zeigen und **Therapie sicherer** machen.[1] Hinweis: Die genauen Euro-Beträge hängen vom Gesundheitssystem ab, der Trend ist aber klar.[2][4] Quellen: PubMed-Analyse zu Monitoring bei Psoriasis[1], Kostenstudien zu Biologika und Systemtherapien[2][4]. [1] https://pubmed.ncbi.nlm.nih.gov/40785802/ [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC4295913/ [4] https://jamanetwork.com/journals/jamadermatology/fullarticle/420949 Originaltitel: Utilization and Costs of Laboratory Monitoring in Biological and Non-Biological Psoriasis Treatment - Large-Scale Claims Data Analysis - PubMed Link zur Quelle

Viele Menschen mit Psoriasis-Arthritis sehen ihre Krankheitsaktivität anders als ihre Ärztin oder ihr Arzt[2][3]. Vor allem dann, wenn Patientinnen und Patienten sich sehr krank fühlen, schätzen sie ihr Wohlbefinden oft schlechter ein als die Fachleute[2][3]. In mehr als einem Drittel der Fälle gibt es deutliche Unterschiede bei der Einschätzung[2][3]. Ein Grund dafür ist häufig die psychische Verfassung. Vor allem wer unter depressiven Symptomen leidet, schätzt seine Krankheit oft schlimmer ein als medizinisch messbar wäre[2][3]. Ärztinnen und Ärzte achten stärker auf Entzündungswerte, während Betroffene Schmerzen, Müdigkeit und ihr seelisches Wohl stärker wahrnehmen[2][3]. Deshalb ist es wichtig, dass Patientinnen und Patienten offen über ihre Beschwerden, auch über ihre Stimmung sprechen. Nur so können beide Seiten gemeinsam die bestmögliche Behandlung finden[2][3]. Originaltitel: Discordance between patient and physician reported global disease activity in PsA is associated with mental health—a cross-sectional analysis Link zur Quelle

Psoriasis, a chronic autoimmune skin disease, arises from both genetic predisposition and environmental factors, including Adverse Childhood Experiences (ACEs). This cross-sectional study investigated the association between ACEs, family history, and early-onset psoriasis (≤ 18 years), with particular attention to gender differences. Among 102 psoriasis patients (54 early-onset, 48 late-onset), the early-onset group demonstrated a higher proportion of females, greater prevalence of parental psoriasis, and elevated anxiety levels compared to the late-onset group. However, multivariable regression analysis revealed that parental psoriasis was not significantly associated with early-onset psoriasis. Exposure to three or more ACEs significantly associated with early-onset psoriasis (adjusted OR = 2.61, p = 0.014), with specific associations observed for emotional neglect, domestic violence, and loneliness. Gender-stratified analysis showed a stronger association in females (adjusted OR = 6.609, p = 0.016) than in males (adjusted OR = 2.494, p = 0.115), though no significant gender-ACEs interaction was detected (p = 0.289). These findings demonstrate a gender differences, dose-response relationship between ACEs and early-onset psoriasis, highlighting the potential value of early psychological interventions for at-risk individuals, particularly females with high ACE exposure.Weiterlesen

UnlabelledThis study analyzed over 2000 images of psoriasis across major web-based platforms and found a significant underrepresentation of darker skin tones, highlighting a critical gap in dermatologic representation that may contribute to misdiagnoses and health disparities among patients with skin of color.Weiterlesen

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) psoriatic arthritis (PsA) working group provided updates at the GRAPPA 2024 annual meeting on their assessment of composite outcome measures for PsA. The group presented the progress of a systematic literature review on the psychometric properties of the following candidate composite outcome measures using the OMERACT filter 2.2: (1) minimal disease activity (MDA), (2) Disease Activity for Psoriatic Arthritis (DAPSA), (3) American College of Rheumatology (ACR) response criteria, (4) Psoriatic Arthritis Disease Activity Score (PASDAS), (5) Composite Psoriatic Disease Activity Index (CPDAI), (6) 3-item visual analog scale (3VAS), and (7) 4VAS. A Delphi exercise for patient research partners (PRPs) on domain match and feasibility is ongoing. Following analysis and endorsement of domain match and feasibility by PRPs, the working group will seek endorsement from the GRAPPA community. In addition, the group illustrated a new research proposal for using network metaanalysis to quantitatively compare the responsiveness of these various composite outcome measures.Weiterlesen

Background: Psoriasis is a chronic inflammatory disease associated with high morbidity and few cases of sustained remission. Innovative immunomodulatory therapies, including fibroblast-based cell therapies, offer promising alternatives. This study investigates the therapeutic potential of human dermal fibroblasts (HDFs) organized into three-dimensional (3D) spheroids in a mouse model of imiquimod (IMQ)-induced psoriasis. Methods HDF spheroids were cultured using Elplasia microcavity plates, and their size, viability, and phenotype were compared with single cells in 2D monolayer cultures. Cellular responses in whole blood and acute inflammatory responses were evaluated at various time points following intravenous injection of HDFs. The therapeutic efficacy of HDF spheroids was assessed using an IMQ-induced psoriasis mouse model, with disease severity scored using the Psoriasis Area and Severity Index (PASI). Optimized HDF spheroids (~150 um, 1x106 cells/mouse) were administered intravenously in a single dose for mild psoriasis or multiple doses for moderate-to-severe psoriasis. The efficacy of HDF spheroids was compared to a pre-clinical monoclonal antibody targeting interleukin 23 (anti-IL-23). Results Spheroid cultures of HDFs showed reduced cell size, enhanced viability, and distinct phenotypic changes compared to monolayer cultures. Intravenous injection of HDF spheroids resulted in less thrombocytopenia and reduced acute inflammatory responses compared to single-cell injection. A single dose of HDF spheroids reduced the severity of mild psoriasis by 35%, while repeated doses resulted in a 36% reduction in moderate-to-severe psoriasis. Single-dose administration normalized blood cell counts, alleviated spleen enlargement, and improved cytokine dysregulation. Although HDF spheroids and anti-IL-23 reduced epidermal thickening and immune cell infiltration, HDF spheroids uniquely inhibited monocyte production and infiltration, a benefit not observed with anti-IL-23. No acute or chronic toxicity was observed. Conclusions HDF spheroids offer comparable therapeutic efficacy to anti-IL-23 in treating psoriasis, with a distinct mechanism involving inhibiting monocyte production and infiltration. Their safety profile and broader immunomodulatory potential support their development as a novel therapeutic strategy for psoriasis and other inflammatory diseases.Weiterlesen

BackgroundPsoriasis has been associated with an increased risk of various cancers, including thyroid cancer (TC), yet the molecular mechanisms linking these two diseases remain unclear.ObjectiveThis study aimed to identify and analyze the differentially expressed genes (DEGs) between TC and psoriasis using bioinformatics approaches to explore potential molecular mechanisms and shared pathways. To the best of our knowledge, this is the first bioinformatics-based study to systematically identify and validate shared hub genes between thyroid cancer and psoriasis.MethodsA TC dataset from the TCGA database and five GEO datasets (GSE35570, GSE13355, GSE14905, GSE53431, and GSE29265) were analyzed, with GSE53431 and GSE29265 serving as validation sets. Differential expression was identified using Xiantao and GEO2R, followed by a series of bioinformatics analyses, including Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO) enrichment, protein-protein interaction (PPI) network construction, transcription factor (TF)-gene interaction, TF-miRNA coregulatory network analysis, and drug molecule prediction.ResultsA total of 79 DEGs associated with TC were identified. Key Enrichr KEGG pathways included a response to the bacterium, NABA MATRISOME ASSOCIATED, negative regulation of cell population proliferation, response to wounding, and HALLMARK KRAS SIGNALING UP. Six hub genes (SERPINA1, S100A9, CCL20, SLPI, LCN2, and CXCL8) were identified from the PPI network, with three genes (SERPINA1, CCL20, and LCN2) showing high diagnostic value for both TC and psoriasis. TF gene and miRNA interactions involving these hub genes and potential drug molecules were also identified.ConclusionThis study provides insight into potential biomarkers and therapeutic targets relevant to TC and psoriasis, identifying shared molecular pathways and hub genes that may guide future diagnostic and therapeutic approaches for these diseases.Weiterlesen

Anoikis is a programmed cell death that occurs when cells detach from the extracellular matrix (ECM). Its role in psoriasis remains unclear. This study aims to explore the relationship between psoriasis and apoptosis, focusing on anoikis-related mechanisms. Differentially expressed genes (DEGs) in psoriasis were identified using the GEO database and overlapped with anoikis-related genes from GeneCards to find differentially expressed anoikis-related genes (DE-ARGs). A PPI network was constructed, revealing eight hub DE-ARGs. These were then analyzed using GO, KEGG and ssGSEA. Immune infiltration cells and molecules were examined, and single-cell data analysis, immunohistochemistry, qRT-PCR, Western blotting, gene mapping, and drug prediction were performed. Eighteen DE-ARGs were identified, with STAT3 and BIRC5 as key DEGs. Enrichment analysis showed DE-ARGs were related to the regulation of anoikis and positive regulation of epithelial cell proliferation. Notable differences in dendritic and mast cells were observed between psoriasis lesions and no-lesion samples. Elevated expression of BIRC5 and STAT3 in psoriasis lesions was confirmed through qRT-PCR, western blotting and immunohistochemistry. This study establishes a relationship between anoikis and psoriasis, where STAT3 and BIRC5 play important roles. STAT3 and BIRC5 may serve as potential targets for the prevention and treatment of psoriasis.Weiterlesen

ObjectiveThis study aims to investigate the relationship between Relative Fat Mass (RFM) and the risk of psoriasis based on data from the US National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014.MethodsThis cross-sectional study included 19,565 adults aged 20 years and older. Psoriasis diagnosis was determined using self-reported questionnaires, and RFM was calculated based on established formulas. Multivariable logistic regression models were used to analyze the association between RFM and psoriasis risk, adjusting for covariates such as age, gender, race, socioeconomic factors, and health behaviors. Nonlinear relationships and potential threshold effects between RFM and psoriasis were assessed using restricted cubic splines.ResultsThe analysis revealed a significant positive association between RFM and psoriasis risk. Each 1-unit increase in RFM was associated with a 3% higher likelihood of psoriasis (OR=1.03, 95% CI: 1.02-1.05, P<0.05). The restricted cubic spline analysis showed a nonlinear relationship between RFM and psoriasis risk (P_non-linear=0.028). Subgroup analysis further demonstrated that income level (with lower associations observed among those with a poverty-to-income ratio ≤1.3) moderated the relationship. RFM exhibited moderate predictive performance for psoriasis risk, with an area under the receiver operating characteristic curve (AUC) of 0.549.ConclusionRFM is significantly associated with increased psoriasis risk, with a dose-response relationship observed. These findings suggest that RFM may serve as a useful predictor for psoriasis risk and could be incorporated into screening strategies for early detection and prevention.Weiterlesen

ObjectivesPsoriatic arthritis (PsA) is a heterogeneous inflammatory disease in which a significant proportion of patients remain refractory to existing therapies. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) initiated a project aimed at unravelling the reasons for treatment failures in PsA, culminating in the establishment of definitions for difficult-to-treat PsA (D2T-PsA) and complex-to-manage PsA (C2M-PsA). This study explores patient perspectives on treatment-resistant PsA, incorporating a broader patient perspective into the overarching GRAPPA project.MethodsA multilingual (10 languages), online survey to explore PsA patients' perspectives on treatment inefficacies was used. It was developed collaboratively by GRAPPA members and patient research partners. It included sections on demographic data, structured questions about treatment failures, and open-ended questions. Data analysis used descriptive statistics and inductive coding of qualitative responses via Dedoose.ResultsAmong 570 respondents, most were female (68.8%) and White (72.6%), with an average PsA diagnosis delay of 4.3 years. Key contributors to D2T- and C2M-PsA were persistent joint pain and psoriasis (65.7%), fatigue (52.8%) and medication side effects (41.7%). Ranked by impact, arthritis was the most debilitating symptom. Quality of life concerns were notable, with sleep impairment and reduced life enjoyment being reported by 66.4%. Language differences emerged; for instance, Dutch and Italian respondents prioritized fatigue and daily life impact, respectively.ConclusionThis is the first international study to highlight patient-driven insights in the management of resistant PsA, emphasizing a multidimensional approach that considers biological and psychosocial factors. These insights will inform the ongoing GRAPPA initiative to standardize definitions for treatment-resistant PsA, ultimately improving patient care.Weiterlesen

At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, Drs. Dennis McGonagle and Wilson Liao discussed "MHC-I-opathies," a class of immune-mediated diseases genetically associated with major histocompatibility complex class I (MHC-I) and class I peptide processing. MHC-I-opathies demonstrate epistatic interactions, genetic associations, and immunopathology that are distinct from classic B cell and autoantibody-driven autoimmune diseases. Investigations into the pathomechanisms of MHC-I-opathies have revealed a blend of tissue-specific innate immunity and CD8 T cell responses. Several functional pathomechanisms by which MHC-I molecules increase psoriasis (PsO) susceptibility were presented by McGonagle and Liao, and there were multiple associations within the HLA-C locus. Antigen presentation to T cells, HLA regulation of natural killer cells and CD8 T cells through killer immunoglobulin-like receptors, and HLA regulation of dendritic cells through leukocyte immunoglobulin-like receptors were discussed. Interestingly, MHC-I associations are not only linked to excessive inflammation in MHC-I-opathies but also to the spontaneous suppression of infection (eg, HIV-1 elite controllers). This striking prominence of MHC-I in PsO and antiviral immunity provides insight into why autoimmune alleles are maintained in the human genome and how protective antiviral pathways may be linked to aberrant activation of MHC-I-opathies. Outside of spinal inflammation in HLA-B27-positive axial psoriatic arthritis (PsA), the basis for MHC-I genetics in PsA remains less clear and is at least partly linked to greater PsA heterogeneity. Understanding the contribution of MHC-I in PsO and PsA may have important implications for therapy development.Weiterlesen

Guttate psoriasis (GP) is a variant of psoriasis. Approximately 2-4% of the world population is affected by psoriasis; of this, about 30% will be diagnosed with guttate psoriasis. GP primarily affects children and young adults. Like other psoriasis, guttate psoriasis is an immune-mediated dermatological disorder. GP is distinct, given it is classically an acute rash following a streptococcal infection.Weiterlesen

Menschen mit generalisierter pustulöser Psoriasis (GPP) leiden oft sehr stark unter ihrer Krankheit. Die häufigsten Beschwerden sind starker Juckreiz, trockene Haut, Hautrötungen und Müdigkeit[1]. Viele Betroffene haben diese Symptome dauerhaft, oft an Kopfhaut, Armen und Handflächen. Die Hautkrankheit beeinträchtigt das tägliche Leben und kann selbst einfache Dinge wie die Kleiderwahl schwierig machen. Besonders belastend ist der seelische Stress, viele fühlen sich beschämt und ziehen sich zurück. Die Behandlungen helfen nicht immer vollständig. Deshalb wünschen sich viele gezielte Therapien und mehr Unterstützung im Alltag[1]. Originaltitel: A Global Assessment of Patient Experience and Quality of Life in Generalized Pustular Psoriasis: Results from Interviews and Online Surveys. Link zur Quelle

Pityriasis rubra pilaris ist eine seltene Hautkrankheit, für die es keine zugelassene Therapie gibt[1]. Forscher haben herausgefunden, dass eine Veränderung im CARD14-Gen bei einigen Kindern diese Krankheit auslöst und eine bestimmte Entzündungsreaktion im Körper aktiviert[1]. In einem aktuellen Fallbericht wurde ein Kind mit einer neuen CARD14-Gen-Veränderung erfolgreich mit Ixekizumab behandelt. Dieser Wirkstoff blockiert gezielt den Botenstoff IL-17A, der an der Entzündung beteiligt ist[1]. Dieser Erfolg zeigt, dass moderne Antikörpertherapien auch für schwierige Hautkrankheiten wie PRP eine Chance bieten können, besonders wenn klassische Therapien versagen. Originaltitel: Case Report: Successful treatment of a novel variant of <i>CARD14</i>-mutated juvenile Pityriasis rubra pilaris with ixekizumab. Link zur Quelle

Das AXIS-Projekt untersucht, wie oft bei Menschen mit Psoriasis-Arthritis (PsA) auch Rücken und Kreuzbein betroffen sind. 409 Patientinnen und Patienten aus 19 Ländern haben mitgemacht, jeder bekam Röntgen- und MRT-Bilder von Becken und Wirbelsäule. Mehrere Ärzteteams schauten sich diese Bilder an. Bei etwa 27 Prozent fanden sie Anzeichen für einen Befall von Wirbelsäule oder Kreuzbein. Das Ziel: eine einheitliche Definition, wann PsA als „axial“ gilt. Die endgültigen Ergebnisse werden bald veröffentlicht [1][2][4]. Originaltitel: Update on the Axial Involvement in Psoriatic Arthritis (AXIS) Project. Link zur Quelle