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Psoriasis is a chronic inflammatory skin disorder affecting 2-3% of the global population. It is increasingly recognized for its systemic comorbidities, especially cardiovascular diseases (CVDs). Notably, severe psoriasis independently increases cardiovascular disease (CVD) risk. This elevation occurs beyond conventional risk factors, such as hypertension and diabetes. It suggests that shared inflammatory pathways underlie the association between severe psoriasis and atherosclerotic conditions, like coronary artery disease (CAD). Atherosclerosis, characterized by lipid-laden plaque formation in arterial walls, remains a leading contributor to CVD-related morbidity and mortality. Emerging evidence underscores the interplay of inflammatory cell heterogeneity and immune dysregulation in its pathogenesis, mirroring mechanisms observed in psoriasis. The overlapping systemic inflammation and immune dysfunction in both diseases suggest potential therapeutic synergies. CD4+ regulatory T cells (Tregs), pivotal immunosuppressive modulators, have shown promise in mitigating autoimmune responses, yet their therapeutic exploitation in psoriasis-atherosclerosis comorbidity remains underexplored. This review summarizes current insights into Tregs' roles in psoriasis and atherosclerosis, emphasizing their dual regulatory functions; in psoriasis, Treg dysfunction exacerbates interleukin-17 (IL-17)/23-driven keratinocyte hyperproliferation, while in atherosclerosis, impaired Treg activity permits pro-inflammatory cytokine cascades and foam cell formation. We, herein, highlight emerging approaches to enhance Treg stability and function, such as nanotechnology-based targeting antibodies and traditional Chinese medicine (TCM). By delineating Treg-centric mechanisms across both diseases, this review proposes a paradigm shift toward immunomodulatory therapies addressing psoriasis-atherosclerosis crosstalk, offering novel strategies to alleviate systemic inflammation and cardiovascular burden in psoriatic patients. Further research into Treg heterogeneity and microenvironmental cues may unlock precision therapies for this comorbid axis.Weiterlesen

Chronic inflammatory diseases such as psoriasis (PsO) and psoriatic arthritis (PsA) are associated with a high disease burden and significant healthcare needs. Given limited specialist resources, the use of medical health apps is increasingly coming into focus as a means of supporting patients in self-management and closing gaps in care. This review highlights digital health applications available in Germany for PsO and PsA. Their functions, objectives, and potential benefits in the context of care are analysed. Six relevant apps were identified based on a systematic literature review and a structured search of the popular app stores. None of the applications are currently approved as digital health applications (German: DiGA). The apps differ in terms of their target groups, range of functions, and scientific evidence. While some primarily deal with dermatological aspects (e.g., Sorea, Psoriasis Monitor), others focus more on rheumatological issues (e.g., Mida Rheuma App, Rheuma-Auszeit). The range is supplemented by educational apps (e.g., PSO Kiosk) and therapy-accompanying apps (e.g., MyTherapy). Such digital apps can promote understanding of the disease, contribute to improving therapy adherence and have a positive effect on mental well-being, especially in patients with PsO and PsA, who often experience stress and mental comorbidities. Even though no app has yet achieved DiGA status, individual applications can be a useful addition to care.Weiterlesen

Rheumatoid arthritis (RA) is the most common inflammatory joint disease worldwide. T-cell inhibitors, tumor necrosis factor inhibitors, interleukin inhibitors (ILIs), Janus kinase inhibitors, and B-cell depletion therapy are indicated as second-line therapy and are prescribed for other inflammatory autoimmune conditions (ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn disease, ulcerative colitis) co-occurring in an estimated 7% to 20% of patients with RA but are routinely excluded from RA studies. There is a lack of real-world evidence documenting treatment patterns in the large segment of patients with RA with inflammatory autoimmune comorbidities. To describe RA medication utilization patterns among biologic-naive patients, with and without similarly treated comorbidities. This retrospective cohort study uses administrative health claims from a large national health insurer between 2016 and 2022. Persistence, medication possession ratio (MPR), and utilization patterns were measured for patients with and without similarly treated comorbidities. Differences in means were calculated using a t-test, and Cox proportional hazards regression modeling was used to estimate persistence and hazard ratio (HR). A total of 22,946 patients with RA persisted on the index therapy for an average of 368.2 days (SD, 436). MPR varied across drug classes, with ILIs having the highest MPR at 0.95 (SD, 0.10) and B-cell depletion class having the lowest at 0.82 (SD, 0.19). Patients with RA with psoriatic arthritis were more likely to end the episode with therapy gap restart (HR, 1.1; CI, 1.02-1.22), yet patients with RA with psoriasis were less likely to experience a therapy gap restart (HR, 0.91; CI, 0.83-0.99). Among patients with RA initiated on ILIs, those with psoriasis are more likely to stop or switch compared with those without psoriasis (HR, 1.19; CI, 1.02-1.39). Among patients with RA initiated on Janus kinase inhibitors, those with psoriatic arthritis were more likely to stop or switch therapy compared with patients with RA without psoriatic arthritis (HR, 1.27; CI, 1.02-1.59). RA medication utilization varied significantly and may be influenced by comorbidities differently across RA drug classes. More research is needed to understand why therapies like tumor necrosis factor inhibitors persist longer in patients with RA with ulcerative colitis yet are discontinued earlier in patients with psoriatic arthritis.Weiterlesen

Psoriasis is a chronic inflammatory skin disease associated with an increased risk of developing cardiovascular disease. Various environmental factors contribute to disease development in genetically susceptible individuals. Although infections have been associated with disease initiation and recurrence, the consequences of early exposure to infections, many years before disease manifestation, is unexplored. To investigate the effect of exposure to infections during formative years on the incidence of psoriasis through to early adulthood. ABIS is a large birth cohort in which parents of participating children have answered comprehensive questionnaires on exposure to infections and medication at different age intervals of the children. Information regarding psoriasis was obtained from the Swedish National Patient Register, while data on medication was obtained from the National Prescribed Drug Register. Statistical analyses were performed with custom-written R scripts. Logistic regression analysis on one-year follow-up data revealed that influenza was associated with an increased risk of developing psoriasis later in life (OR 2.47, CI 1.32-4.39; P= 0.006). In line with this, at the third-year evaluation, we found that participants who had tonsillitis at least once during the first three years of life had almost three times greater risk of developing psoriasis into early adulthood compared to controls (OR 2.90, CI 1.46-5.56; P= 0.003). In contrast, at the eight-year evaluation, we found that psoriasis was less frequent in children who had experienced gastroenteritis episodes between ages six and eight, compared to controls (OR 0.42, CI 0.20-0.92; P =0.0028). We demonstrate for the first time the effect of exposure to infections during the first years of life, and their role in the subsequent development of psoriasis extending into early adulthood. Our study indicates that early exposure to infections may influence the development of the adaptive immune system during formative years. This modulation is evidenced by the higher incidence of psoriasis observed in early adulthood, several years after the initial exposure.Weiterlesen

ObjectivesThe Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is widely used to assess axial disease activity in psoriatic arthritis (PsA). However, 5 of its 6 questions reflect general disease activity rather than axial-specific symptoms. We aimed to evaluate the performance of BASDAI and its back pain subscore in assessing axial disease in PsA.MethodsPatients with BASDAI scores were identified from a longitudinal PsA cohort initiated in 1978. Axial disease was defined radiographically. Trends in BASDAI and back pain scores were compared between patients with and without axial involvement. Associations of total BASDAI and back pain subscore with axial disease were assessed using univariable and multivariable linear mixed models in the entire cohort and stratified subgroups.ResultsOf 1059 patients, 449 (42.4%) had axial and 610 (57.6%) had peripheral disease only. The mean age was 44.4 years (SD 12.8), and 55.9% were male. No difference in the BASDAI and back pain trends was observed between the axial and peripheral disease groups. Axial involvement was not associated with total BASDAI scores (β = -0.14, 95% CI -0.05 to 0.33). However, it was associated with a small, yet significant increase in back pain subscore (0.30, 0.06-0.55). Both BASDAI and back pain scores were associated with active peripheral joints, enthesitis, dactylitis, age, Psoriasis Area and Severity Index, and inversely with male sex. These associations were consistent across axial and peripheral disease subgroups.ConclusionsBASDAI and its back pain subscore are influenced by peripheral musculoskeletal and skin disease activity in PsA, limiting their utility for assessing axial activity.Weiterlesen

Das U-ASAS-HI zeigt ziemlich genau, wie es Menschen mit Spondyloarthritis, einschließlich Psoriasis-Arthritis, gesundheitlich geht[1]. Es gibt einen klaren Zusammenhang zwischen dem U-ASAS-HI und allgemeinen Gesundheitswerten wie dem EQ-5D-3L[1]. Besonders niedrige Werte werden oft durch starke Krankheitsaktivität, eingeschränkte Beweglichkeit, Depressionen, Fibromyalgie und Erschöpfung verursacht[1]. Frauen, Menschen mit Psoriasis-Arthritis, diejenigen ohne Job und mit vielen Symptomen schneiden oft schlechter ab, während Ältere und Leute mit Uni-Abschluss besser abschneiden[1]. Das Land, in dem man lebt, spielt aber kaum eine Rolle[1]. Originaltitel: Evaluation of spondyloarthritis-specific health utility based on ASAS health index (U-ASAS-HI) among the disease subtypes: an ancillary analysis from the ASAS-PerSpA study. Link zur Quelle

Menschen mit Diabetes, die sogenannte **GLP-1-Rezeptor-Agonisten** (zum Beispiel Ozempic oder Wegovy) einnehmen, bekommen seltener **Psoriasis** oder **Hidradenitis suppurativa**. Das zeigen neue Untersuchungen[1][2][3][4]. Die Medikamente wirken eigentlich gegen Diabetes und helfen beim Abnehmen. Sie haben aber auch einen positiven **Einfluss auf Entzündungen** im Körper und damit auf manche Hautkrankheiten. Forscher haben herausgefunden, dass Patienten mit diesen Medikamenten nicht nur besser ihren Blutzucker kontrollieren, sondern auch weniger Hautprobleme bekommen. Die Wirkung ist nicht nur auf das Abnehmen zurückzuführen. Die Medikamente bremsen direkt Entzündungen, die bei Psoriasis und Hidradenitis suppurativa eine wichtige Rolle spielen. Manche Menschen berichten sogar schon vor starkem Gewichtsverlust von einer Besserung ihrer Haut[2][3]. Wichtig zu wissen: Nicht jeder spürt eine Verbesserung, aber gerade wenn Übergewicht und Hautkrankheit zusammen auftreten, lohnt sich ein Gespräch mit dem Arzt. Originaltitel: Decreased incidence of hidradenitis suppurativa and psoriasis in diabetic patients treated with GLP-1 receptor agonists: A retrospective cohort study Link zur Quelle

TNF-Blocker (TNFi) wie Adalimumab oder Etanercept werden oft bei Psoriasis-Arthritis eingesetzt. Viele hatten Sorge, dass sie das Gewicht steigen lassen. Eine neue Studie zeigt aber: Menschen mit Psoriasis-Arthritis nehmen unter TNFi nicht mehr zu, als es sowieso mit dem Alter üblich ist[1][5]. Im Schnitt haben die Patienten zwar in den Jahren nach Beginn der Therapie ein paar Kilo zugenommen, das lag aber im normalen Bereich und war nicht auf das Medikament zurückzuführen. Entscheidend: Wer TNFi nimmt, muss eine Gewichtszunahme nicht befürchten – und falls doch, sollte zuerst mit dem Arzt gesprochen werden. Bei anderen Biologika oder Wirkstoffen kann die Auswirkung aufs Gewicht übrigens anders sein[3]. Originaltitel: Changes in weight associated with tumor necrosis factor inhibition in psoriatic arthritis: results from a retrospective cohort study - Clinical Rheumatology Link zur Quelle

Semaglutid kann Menschen mit Psoriasis und Übergewicht helfen, die Krankheit besser zu kontrollieren und gleichzeitig abzunehmen[2][6]. In Studien verbesserte sich das Hautbild deutlich, die entzündeten Stellen wurden kleiner und der Allgemeinzustand stieg spürbar[2]. Zusätzlich verloren die Patienten Gewicht, was die Symptome der Psoriasis weiter abschwächen kann[1][2]. Semaglutid wirkt nicht nur gegen Diabetes, sondern hemmt auch Entzündungen im Körper[2]. Experten vermuten, dass dadurch weniger Entzündungsbotenstoffe in der Haut entstehen. Die bisherigen Ergebnisse sind positiv, aber es gibt noch wenige große Studien. Semaglutid wird aktuell als Zusatz zu Ernährung und Bewegung bei Übergewicht eingesetzt und könnte eine neue Behandlungsmöglichkeit für einige Menschen mit Psoriasis sein[3][4][6]. Originaltitel: Dermatologic and Metabolic Benefits of Semaglutide in Psoriasis with Obesity: A Six-Month Prospective Cohort Study | Clinical and Experimental Dermatology | Oxford Academic Link zur Quelle

Manche Menschen sprechen besonders gut auf Psoriasis-Medikamente an, sie heißen „Super-Responder“[1][3]. Super-Responder haben nach 12 Wochen fast immer komplett gesunde Haut, wenn sie das richtige Biologikum bekommen. Forscher haben jetzt untersucht, wie oft das passiert und welches Medikament am besten wirkt. In dieser neuen Studie bekamen 116 Erwachsene mit mittlerer bis schwerer Psoriasis ihr erstes Biologikum. Nach 12 Wochen hatten 26 von ihnen (etwa jeder Fünfte) komplett erscheinungsfreie Haut. Das beste Ergebnis zeigte **Bimekizumab**: Von 17 Patienten waren 11 Super-Responder – also fast zwei Drittel. Mit anderen Biologika waren es deutlich weniger[2]. Ob jemand Super-Responder wird, lag vor allem am ausgewählten Medikament. Alter, Geschlecht oder wie lange jemand schon Psoriasis hat, spielten keine Rolle. Die Forscher sagen: Das Wirkprinzip des Medikaments ist entscheidend dafür, wie schnell und wie gut die Haut heilt[2]. Für Menschen mit Psoriasis könnte das bedeuten: Die Wahl des Medikaments macht einen großen Unterschied, besonders am Anfang der Behandlung[2]. Originaltitel: Super Responders in Plaque Psoriasis: A Real-World, Multi-Agent Analysis Showing Bimekizumab Associated with the Highest Odds of PASI = 0 at Week 12 Link zur Quelle

Roflumilast Creme 0,3 % hilft bei chronischer Plaque-Psoriasis deutlich besser als ein Placebo. In Studien mit Menschen ab 2 Jahren, die 2–20 % ihrer Haut betroffen hatten, trugen die Teilnehmenden die Creme einmal täglich für 8 Wochen auf. Nach dieser Zeit erreichten 40 % der Roflumilast-Gruppe ein deutliches Nachlassen der Psoriasis (PASI-75), während das bei der Vergleichsgruppe nur 6,5 % schafften. Mit dem genaueren PASI-HD-Wert waren es sogar rund 60 % gegenüber 18 % der Placebogruppe. Besonders auffällig: Mit PASI-HD lassen sich die Verbesserungen besser erkennen, wenn größere Hautflächen betroffen sind. Insgesamt führte die Behandlung mit Roflumilast zu deutlich weniger und weniger schweren Psoriasis-Stellen als beim Placebo[1]. Originaltitel: Roflumilast Cream 0.3% in Patients with Chronic Plaque Psoriasis: Pooled PASI and PASI-HD Results from the DERMIS Phase III Trials - Dermatology and Therapy Link zur Quelle

Forschende haben ein Modell entwickelt, das vorhersagen kann, wie gut Menschen mit Psoriasis-Arthritis auf bestimmte Medikamente ansprechen. Dafür wurden Daten von 80 Betroffenen ausgewertet, die entweder erstmals oder nach Versagen einer Vorbehandlung Methotrexat, Tofacitinib oder Etanercept bekommen haben. Sie schauten, wer nach 16 Wochen die Krankheitsaktivität stark senken konnte. Besonders bei einem hohen Wert im Gesundheitsfragebogen, vielen schmerzhaften Gelenken, vielen schmerzenden Sehnenansätzen, schlechter Einschätzung durch die Ärztin sowie früheren Therapien mit TNF-Blockern war die Chance auf Besserung geringer. Für die meisten, die noch nie DMARDs bekommen hatten, war die Chance mit Methotrexat besser als mit Tofacitinib. Wer schon andere Mittel ohne Erfolg hatte, sprach auf Etanercept meist besser an als auf Tofacitinib. Das Modell soll bald weiter verbessert werden[1][2]. Originaltitel: The development of a clinical prediction model for response to methotrexate, tofacitinib, and etanercept in patients with Psoriatic Arthritis - Arthritis Research & Therapy Link zur Quelle

Menschen mit Psoriasis haben öfter auch Fibromyalgie als gesunde Menschen[4]. Fibromyalgie tritt vor allem bei Frauen mit Psoriasis auf und besonders häufig, wenn zusätzlich eine Psoriasis-Arthritis vorliegt[4]. Wer beide Krankheiten hat, braucht öfter eine Therapie mit Biologika und muss Behandlungskonzepte häufiger wechseln[4]. Im Vergleich zu Psoriasis-Patienten ohne Fibromyalgie ist die Behandlung komplizierter. Viele spüren stärkere Schmerzen und bekommen öfter und schneller neue Medikamente, weil die erste Therapie weniger lange wirkt (im Schnitt 6 statt 10 Jahre)[4]. Bei Psoriasis-Arthritis und Fibromyalgie sind Müdigkeit, Schlafstörungen und Konzentrationsprobleme besonders häufig[1]. Die Beschwerden betreffen den Alltag und verschlechtern die Lebensqualität. Therapien müssen deshalb individuell angepasst werden, damit Betroffene bestmöglich unterstützt werden[4]. Originaltitel: The Association Between Psoriasis, Psoriatic Arthritis, and Fibromyalgia Syndrome: Effects on Treatment—A Population-Based Study Link zur Quelle

Eine große Studie aus den USA zeigt, dass Frauen mit Psoriasis oft niedrigere Spiegel von weiblichen Geschlechtshormonen im Blut haben als gesunde Frauen[5][7]. Besonders betroffen sind die Hormone **Östrogen** und **Progesteron**. Das kann erklären, warum viele Frauen merken, dass ihre Psoriasis vor den Tagen oder nach den Wechseljahren schlimmer wird[1][3]. Bei einer Schwangerschaft, wenn Östrogen besonders hoch ist, berichten dagegen viele, dass sich die Haut verbessert[3][9]. Die Forscher betonen: Die Schwankungen der Hormonspiegel beeinflussen vermutlich, wie aktiv die Krankheit ist[3][6]. Je weniger weibliche Hormone im Blut sind, desto stärker scheint die Schuppenflechte zu sein[5]. Originaltitel: Negative association of psoriasis with female sex hormone levels: a case-control study using TriNetX Link zur Quelle

Eine neue Studie zeigt: Viele Menschen mit Psoriasis fühlen sich immer noch nicht gut genug behandelt, obwohl es schon viele Medikamente gibt[1][2][3][5]. Mehr als die Hälfte der Befragten sagt, die Krankheit macht ihren Alltag schwer[3]. Egal ob Erwachsene oder Jugendliche – viele wünschen sich andere Therapien. Rund 50 Prozent der Patientinnen und Patienten und fast genauso viele Hautärzte hätten am liebsten eine Tablettenbehandlung, die stark und sicher wirkt[1][2][3][5]. Vor allem: Wer gerade Spritzen bekommt, würde zu 90 Prozent auf Tabletten umsteigen, wenn sie genauso helfen[1][5]. Bequemlichkeit und Sicherheit spielen dabei eine wichtige Rolle[3]. Die Studie macht deutlich: Es braucht noch mehr passende und einfache Therapien, damit das Leben mit Schuppenflechte leichter wird[2][3]. Originaltitel: New study reveals substantial unmet need in psoriasis, shows strong patient and provider preference for highly effective oral treatments with favorable safety profile Link zur Quelle

Digitale Gesundheits-Apps können Menschen mit Psoriasis oder Psoriasis-Arthritis beim Umgang mit ihrer Erkrankung unterstützen[1]. Es gibt Apps, die Hautsymptome dokumentieren, wie Sorea oder Psoriasis Monitor, sowie Apps für Gelenkbeschwerden, zum Beispiel Mida Rheuma App oder Rheuma-Auszeit[1]. Lern-Apps wie PSO Kiosk und Therapie-Begleiter wie MyTherapy runden das Angebot ab[1][5]. Die Apps helfen, die Krankheit besser zu verstehen, am Ball zu bleiben und sich mental wohler zu fühlen. Keine App ist bisher als DiGA zugelassen, aber sie können im Alltag trotzdem nützlich sein[1]. Originaltitel: [Medical health apps for psoriasis and psoriatic arthritis]. Link zur Quelle

IntroductionPsoriasis (PsO) in the genital and scalp areas is associated with increased patient burden and impact on quality of life. Effective treatments for PsO in these high-impact areas are essential, though patients are frequently excluded from both biologic clinical trials and treatment because of their often low overall affected body surface area (BSA) despite the disproportionate impact of PsO on their quality of life. Recent guidance also considers these patients as candidates for advanced therapies. Here, we compare the efficacy and safety of risankizumab, an interleukin-23 inhibitor approved for the treatment of moderate-to-severe plaque psoriasis, versus placebo in the treatment of PsO in the genital or scalp region.MethodsUnlIMMited (NCT05969223) is an ongoing phase 4, multicenter, randomized, double-blind, placebo-controlled study for adult patients with moderate-to-severe genital or scalp PsO in patients with < 10% BSA or ≥ 10% BSA involvement. Two parallel studies were conducted with study-G assessing genital PsO and study-S assessing scalp PsO. Patients were randomized 1:1 within each study to receive either 150 mg risankizumab or placebo at weeks 0 and 4. The primary endpoints for the studies were the achievement of static Physician's Global Assessment - Genital (sPGA-G) 0/1 for study-G and scalp Investigator Global Assessment (IGA) 0/1 for study-S, both assessed at week 16. Secondary endpoints are also reported at week 16 in each study assessing skin clearance, symptom resolution, and impact on quality of life. Safety was reported through the first 16 weeks.ResultsAt week 16, in both studies, a significantly higher proportion of patients receiving risankizumab achieved the primary endpoints compared with placebo. In study-G, 69.1% of patients receiving risankizumab versus 13.0% of patients receiving placebo achieved sPGA-G 0/1 (P < 0.0001). In study-S, 60.8% of patients receiving risankizumab versus 13.0% of patients receiving placebo achieved scalp IGA 0/1 (P < 0.0001). No new safety signals were identified.ConclusionThese results demonstrate that risankizumab is effective in the treatment of genital and scalp psoriasis at week 16, with no new safety signals identified.Trial registration numberClinicalTrials.gov identifier NCT05969223.Weiterlesen

ObjectivesSeveral studies have reported weight gain with tumor necrosis factor inhibitors (TNFi) in psoriatic disease. However, such analyses have not accounted for the natural propensity for weight gain over time. We aimed to investigate whether therapy with TNFi in psoriatic arthritis (PsA) patients is associated with a change in the rate of weight gain post-treatment initiation.MethodsWe included patients with at least two weight measurements prior to, and after commencing TNFi and used change point analysis to assess the differences in the rate of weight gain based on the mean slope before and after TNFi initiation, adjusting for clinically relevant variables.ResultsOf 234 patients eligible for inclusion, 62.8% were males. At the first clinic visit, the mean (standard deviation) age was 41.8 (12.2) years, while the mean disease duration was 5.1 (6.8) years. The mean weight immediately prior to TNFi use was 83.8 (17.2) kg, while that at the last available visit on TNFi was 86.4 (18.6) kg (p = 0.39), over an average period of 7.9 (5.8) years. The mean values of the pre- and post-TNFi slopes were 0.52 (95% confidence interval [CI] 0.18-0.87) and 0.28 (95% CI - 0.05-0.61), respectively (p = 0.09); thus, there was a trend towards lower rate of weight gain followed the initiation of TNFi therapy.ConclusionsTNFi treatment is not associated with an increase in weight above the expected gain in PsA. Prior trajectory of weight gain with age must be considered while studying the impact of treatment on weight.Key points• TNFi are commonly used in the management of psoriatic disease and may influence body weight. • TNFi treatment is not associated with a significant increase in body weight when accounting for the trend of weight gain with time. • The trends in weight change may differ between etanercept and monoclonal antibody TNFi agents.Weiterlesen

ObjectiveThe concept of severity in psoriatic arthritis (PsA) remains inconsistently defined, often conflated with disease activity. This scoping review aimed to explore how severity has been defined in the PsA literature and to identify criteria used to characterize severe disease.MethodsA scoping review was conducted in April 2025 following PRISMA-ScR guidelines. PubMed was searched for English-language articles from the last 25 years, alongside abstracts from major rheumatology conferences. Eligible studies had to explicitly define or discuss PsA severity. Articles focusing solely on activity, isolated disease manifestations, or other conditions were excluded. Data were extracted on the type of article, definitions of severity, and criteria used.ResultsOf 4,014 records screened, 32 studies met inclusion criteria. Definitions of severity varied widely and were categorized into imaging (e.g., erosions), clinical (e.g., dactylitis, joint counts), and functional (e.g., HAQ-DI scores) criteria. The most commonly used indicators were structural damage, polyarticular involvement, dactylitis, arthritis mutilans, and validated composite indices such as CPDAI. Only a few studies incorporated functional impairment or patient-reported outcomes. While some guidelines, including GRAPPA and ACR/NPF, proposed multidomain frameworks, a standardized definition remains lacking.ConclusionThe concept of PsA severity has evolved beyond mere disease activity to encompass long-term outcomes, radiographic damage and overall disease burden. However, considerable heterogeneity persists across studies, reflecting the complexity of PsA. A standardized, multidimensional definition of severity, distinct from disease activity, would enhance patient stratification, guide treatment decisions, and support clinical research.Weiterlesen

Psoriasis (Pso) is a chronic inflammatory skin disease driven by T helper 17 (TH17) cells, with several clinical subtypes. While self-reactive immune responses have been observed, the role of autoantigens in Pso remains unclear. Using immunopeptidomics, we identified serpin family B member 3 (SERPINB3) and SERPINB4 as candidate autoantigens in Pso skin. In a mouse model, the SERPINB3 ortholog Serpinb3b enhanced inflammation, promoted tissue-resident memory T cells, and skewed immunity toward a TH2 phenotype. In humans, SERPINB3 reactivity was specifically associated with "eczematized psoriasis" (EczPso), a subtype marked by TH2/TH17 immune signatures. SERPINB3 protein was enriched in EczPso lesions and highly secreted by keratinocytes under combined TH2/TH17 stimulation. Lesional T cells from EczPso-but not from eczema or classical plaque Pso-proliferated in response to SERPINB3 and induced EczPso-like features in a skin model. Our findings identify SERPINB3 as an autoantigen driving a distinct Pso subtype, supporting more precise diagnosis and therapy.Weiterlesen

PurposeTo seek recommendations from a panel of experts in psoriatic arthritis (PsA) on the current management challenges, local practices, and role of interleukin (IL)-17 inhibitors in the United Arab Emirates (UAE) using evidence from phase III trials as background.MethodsNine rheumatologists who treat PsA in the UAE completed a structured survey and attended a meeting to discuss topics/issues identified in the survey. A literature search was performed to identify phase III randomized trials of IL-17 inhibitors available in the UAE for PsA.ResultsThere was general agreement among the panel on the most common PsA domains presenting in patients (most commonly psoriasis [75-95% of patients], peripheral arthritis [50-90%], and enthesitis [40-90%]). In general, IL-17 inhibitors were among the preferred treatment options for managing PsA, particularly for patients with axial-, enthesitis-, or psoriasis-related symptoms. Current unmet needs and challenges included a lack of disease awareness among the general population and other healthcare professionals; the lack of a single medication to cover all domains/comorbidities; and lack of universal insurance coverage. The panel had experienced success with the IL-17 inhibitors ixekizumab and secukinumab, with many citing no preference for either agent. The literature search identified publications relating to 10 key phase III clinical trials of IL-17 inhibitors.ConclusionThe panel advocates for the use of the domain-based Group for Research and Assessment of Psoriasis and Psoriatic Arthritis treatment recommendations and generally considers IL-17 inhibitors (ixekizumab or secukinumab) as the preferred treatment options for managing PsA.Weiterlesen

BackgroundPsoriasis is a chronic inflammatory skin disease often associated with obesity and metabolic dysfunction, which may worsen disease severity. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have shown metabolic and anti-inflammatory effects, but their impact on psoriasis in non-diabetic patients with obesity remains unclear.ObjectiveTo evaluate the effects of a six-month semaglutide treatment on psoriasis severity and clinical, metabolic, inflammatory, and psychosocial parameters in patients with psoriasis and obesity.MethodsIn this prospective cohort study, 43 patients received weekly semaglutide along with lifestyle counseling. Psoriasis severity (PASI), quality of life (DLQI), depressive symptoms (BDI), nutritional ultrasound, and biochemical markers were assessed baseline and after six months. Correlations between PASI improvement (ΔPASI) and baseline variables and their changes were analyzed, adjusting for age and weight loss.ResultsAfter six months, participants showed significant reductions in PASI (-48%), BMI, preperitoneal and superficial fat, along with improvements in DLQI, BDI, and metabolic markers. Baseline disease severity, depressive symptoms, insulin resistance, and preperitoneal fat were negatively associated with PASI improvement. These associations remained significant after adjustment (e.g., HOMA-IR, r = -0.82; preperitoneal fat, r = -0.66). ΔPASI was most strongly correlated with reductions in superficial fat (r = 0.89), DLQI (r = 0.55), and BDI (r = 0.51). Changes in BMI and glycemic markers were not significantly associated after adjustment.ConclusionsIn patients with psoriasis and obesity, semaglutide improves both skin disease and systemic health. The clinical benefit appears associated with specific fat loss and psychosocial improvement, beyond overall weight reduction.Weiterlesen

Mitochondrial structural and functional changes accompany psoriasis, yet the mitochondrial response to psoriatic inflammation in keratinocytes and fibroblasts remains unexplored. In this study, we investigated the effect of psoriasis-like inflammation (PLI) induced by a cytokine cocktail (interleukin (IL)-17A, IL-22 and tumour necrosis factor (TNF)-α) on mitochondrial network morphology and function in cultured keratinocytes (HaCaT) and fibroblasts (BJ-5ta). In both cell types, PLI triggered the expression of psoriasis-related Elafin and high amounts of cytokines (IL-1, IL-6), interferons (IFN-α, IFN-β, IFN-γ), and chemokines (C-C motif chemokine 5 (CCL5) and IL-8), accompanied by increased mitochondrial membrane potential, reactive oxygen species (ROS) production, respiration suppression, network fragmentation, swelling and cristae disassembly. Stimulated emission depletion (STED) nanoscopy revealed the disappearance of mitochondrial cristae in response to PLI, with the process starting more quickly and being more pronounced in keratinocytes than in fibroblasts. These findings highlight cell-specific mitochondrial responses to psoriatic inflammation, guiding future investigations towards new pharmacological targets for managing psoriasis.Weiterlesen

IntroductionCardiovascular disease is a leading co-morbidity in psoriasis patients. The cutaneous benefits of biologic therapies for severe plaque psoriasis are well-established, but the impact of biologics on major adverse cardiovascular events (MACE) in psoriatic patients requires further elucidation. This study aimed to investigate the impact of biologic therapies on the risk of MACE in patients with chronic plaque psoriasis.MethodsWe conducted a systematic review and meta-analysis on 10 May 2022, using Medline, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and EMBASE databases for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology was applied, and all studies were critically appraised. All studies selected for inclusion were randomised control trials (RCTs) that contained data on MACE and compared licensed biologic therapies with placebo or other biologics in adults with moderate-severe plaque psoriasis.ResultsThe search of the databases revealed 36 papers (reporting on 43 RCTs) which met the inclusion criteria. No statistically significant difference in the risk for MACE between biologic therapies and placebo was found [Peto odds ratio (POR) 1.26, 95% confidence interval (CI) 0.53-3.01, P = 0.59]. A comparison of specific types of biologics also revealed no significant effect in adult patients with moderate-to-severe plaque psoriasis: tumour necrosis factor (TNF)-alpha inhibitors (adalimumab, infliximab, etanercept) (POR 1.13, 95% CI 0.29-4.32 P = 0.86), interleukin (IL)-17 inhibitors (secukinumab, ixekizumab, brodalumab, bimekizumab) (POR 0.60, 95% CI 0.16-2.25, P = 0.45); IL 12/23 inhibitors (usetekinumab) (POR 3.80, 95% CI 0.37-39.44, P = 0.26) and IL-23 (guselkumab, risankizumab, tildrakizumab) (POR 1.75, 95% CI 0.25-12.43 P = 0.58).ConclusionsAnti-psoriatic biologics were not associated with an increased risk of MACE in psoriasis patients. Given that most included RCTs were of relatively short duration, longer-term studies and post-marketing surveillance are needed to clarify the cardiovascular safety profile of biologic therapies. Further large-scale studies with extended follow-up are warranted.Study registrationThis study was prospectively registered on PROSPERO (identification number CRD42022325792).Weiterlesen

Online health information (OHI) in dermatology often exceeds the recommended sixth-grade reading level, hindering patient comprehension. This study aimed to assess the utility of three artificial intelligence large language models (LLMs) - ChatGPT-3.5, ChatGPT-4, and Google Gemini - in enhancing the readability of OHI on generalized pustular psoriasis (GPP) while preserving the reliability and quality of the source material. Texts from the top 20 search results for GPP were reworded by LLMs to a sixth-grade level and evaluated using the enhanced DISCERN instrument and readability indices. Pairwise comparisons of means for each reading scale and DISCERN scores with Tukey's test were also performed. All LLMs significantly reduced readability (p<0.01) but scored lower on the DISCERN instrument compared to the original text (p<0.01). While LLMs improved readability, they did not preserve the original content's reliability and quality. These findings suggest hesitancy in using LLMs for dermatological patient education.Weiterlesen