Strategies to Improve Outcomes in Psoriatic Arthritis

AbstractPurpose of ReviewThe therapeutic response to biologic agents in psoriasis is significantly higher than observed in psoriatic arthritis (PsA). In this review, specific actions to improve treatment outcomes in PsA are discussed.Recent FindingsIncreased understanding of disease pathogenesis derived from improved preclinical models and advances in cell-based and molecular technologies provide new tools to identify therapeutic targets. In addition to the important contributions of metabolic comorbidities, chronic pain and the lack of a diagnostic biomarker signal the need for new strategies to improve outcomes. Potential strategies include the following: (1) discover a novel pathway or cellular subset, (2) apply stratification biomarkers to individualize therapy, (3) preclinical intervention, (4) combination therapy, (5) lifestyle modification, (6) address chronic pain and fatigue, and (7) multidisciplinary care.SummaryThe future holds great promise for enhanced treatment responses in PsA based on improved understanding of individual variation in disease pathophysiology coupled with comprehensive and integrated treatment programs.
Source: Current Rheumatology Reports - Category: Rheumatology Source Type: research

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AbstractPsoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-ba...
Source: Rheumatology International - Category: Rheumatology Source Type: research
AbstractStreptococcus is well associated with a myriad of inflammatory diseases. Among others, this bacterium is linked to the triggering of psoriasis and to post-streptococcal reactive arthritis (PSRA), an arthritis which is typically confined to peripheral joints. Three patients who developed acute psoriatic spondyloarthritis (SpA) following a recent streptococcal infection are described in this article. We searched the existing literature for cases of axial involvement in PSRA and reviewed the association between streptococcal infection and psoriasis or psoriatic arthritis )PsA). In all patients, psoriatic SpA occurred ...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
AbstractTo report the simultaneous occurrence of psoriatic arthritis (PsA) and chronic regional pain syndrome type I (CRPS I) both triggered by intense walking in a male golfer with a history of scalp psoriasis. Sequential existence of these two conditions have been reported in the literature; however, to our knowledge, this is the first report of a simultaneous occurrence of PsA and CRPS I. This case illustrates the complex interplay between genetic predisposition and environmental risk factors with the central nervous and immune systems. As the pathogenesis of PsA has been better understood in recent years, we propose a ...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
Conclusions: PET has the advantage of being able to detect degenerative joint changes at a molecular level even before the structural changes have taken place. Hence, it has superiority over other conventional imaging modalities to detect arthritis in the early stages as well as investigate multiple joints in a single scan. As the resolution of PET is relatively low, combining PET with CT provides structural information to better assess the joint. Quantifying disease activity has the benefit of surveilling disease activity over the course of time and monitoring treatment response, remission and relapse of the disease.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Educational Exhibit Posters Source Type: research
The recent rise in opioid overdose deaths in the United States has been attributed to an increase in prescriptions written to patients for chronic pain. Patients with psoriasis have higher rates of comorbidities that may make them more likely to receive a prescription for an opioid, including psoriatic arthritis, obesity, anxiety and depression, but little is known about opioid prescribing practices in adults with psoriasis. We performed a cohort study using OptumInSight's electronic health records database to compare the rate of opioid prescriptions written to patients with psoriasis compared to adults without psoriasis.
Source: Journal of Investigative Dermatology - Category: Dermatology Authors: Tags: Epidemiology Source Type: research
DiscussionAnkylosing spondylitis (also known as Bechterew disease and Marie Str ümpell disease). More common in males with 3:1 ratio.Spondyloarthritis is a group of diseases with common clinical, laboratory, and genetic features&association with human leukocyte antigen HLA-B27. Ankylosing spondylitis is the prototypic disease in the spectrum of spondyloarthritis which usually has axial skeletal manifestations. Other representative disorders in this spectrum of disease which usually have peripheral articular involvement, but axial skeleton manifestations are also frequently seen are --psori...
Source: Sumer's Radiology Site - Category: Radiology Authors: Source Type: blogs
Conclusions: This study suggests that PsO patients, including those with PsA, have a higher prevalence of GI signs and symptoms. Physicians should recognize and consider this concern in PsO patient management. J Drugs Dermatol. 2018;17(12):1298-1308. PMID: 30586262 [PubMed - as supplied by publisher]
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
CONCLUSION: HRQOL was diminished in PsA at time of diagnosis compared to the Dutch reference population, and tender joints, enthesitis at clinical examination, and back pain as indicators of pain affected HRQOL. PMID: 29961685 [PubMed - as supplied by publisher]
Source: J Rheumatol - Category: Rheumatology Authors: Tags: J Rheumatol Source Type: research
In this report, a-46-year-old male patient was referred to our clinic with the complaint of pain in the bilateral TMJs, and a limited jaw movement. Medical anamnesis revealed he had psoriasis for the last 21 years, and developed a seronegative polyarthritis with destructive changes for 8 years. On extra-oral examination, crepitation at TMJs and limitation of jaw movements was detected. The radiographic examination with cone-beam CT revealed the bilaterally decreased joint spaces, erosion, and the loss of cortical edge of the joint on the condylar heads. The definitive diagnosis of PA was made with the help of patient's...
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
We present a case of a 72-year-old female with a history of psoriasis on ustekinumab and liver failure secondary to methotrexate who was admitted with 4 days of erythroderma, fever, and abdominal pain.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Source Type: research
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