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International Journal of Molecular... Mar 2023Psoriatic arthritis (PsA), a heterogeneous chronic inflammatory immune-mediated disease characterized by musculoskeletal inflammation (arthritis, enthesitis,... (Review)
Review
Psoriatic arthritis (PsA), a heterogeneous chronic inflammatory immune-mediated disease characterized by musculoskeletal inflammation (arthritis, enthesitis, spondylitis, and dactylitis), generally occurs in patients with psoriasis. PsA is also associated with uveitis and inflammatory bowel disease (Crohn's disease and ulcerative colitis). To capture these manifestations as well as the associated comorbidities, and to recognize their underlining common pathogenesis, the name of psoriatic disease was coined. The pathogenesis of PsA is complex and multifaceted, with an interplay of genetic predisposition, triggering environmental factors, and activation of the innate and adaptive immune system, although autoinflammation has also been implicated. Research has identified several immune-inflammatory pathways defined by cytokines (IL-23/IL-17, TNF), leading to the development of efficacious therapeutic targets. However, heterogeneous responses to these drugs occur in different patients and in the different tissues involved, resulting in a challenge to the global management of the disease. Therefore, more translational research is necessary in order to identify new targets and improve current disease outcomes. Hopefully, this may become a reality through the integration of different omics technologies that allow better understanding of the relevant cellular and molecular players of the different tissues and manifestations of the disease. In this narrative review, we aim to provide an updated overview of the pathophysiology, including the latest findings from multiomics studies, and to describe current targeted therapies.
Topics: Humans; Arthritis, Psoriatic; Comorbidity; Cytokines; Psoriasis
PubMed: 36902329
DOI: 10.3390/ijms24054901 -
Clinical Medicine (London, England) Feb 2017Psoriatic arthritis (PsA) accounts for around 20% of referrals to the early arthritis clinic and presents a significant diagnostic and management challenge. Early... (Review)
Review
Psoriatic arthritis (PsA) accounts for around 20% of referrals to the early arthritis clinic and presents a significant diagnostic and management challenge. Early diagnosis is important to prevent long term functional disability and to ensure optimal management of arthritis and key comorbidities. From the rheumatologist's perspective, the differential diagnosis includes rheumatoid arthritis, gout and other inflammatory arthritides. Once diagnosed, it is essential to assess the disease fully, including arthritis, enthesitis, dactylitis, skin/nail disease and axial involvement. Using this information, appropriate treatment can be planned using therapies that are effective at treating the relevant domains of disease. Despite poor data, traditional disease-modifying anti-rheumatic drugs are commonly used and have been effective in observational studies. Following tumour necrosis factor inhibitors, which have proven excellent efficacy in multiple domains of PsA, new biologics are available or in development and will improve treatment options for people with refractory PsA.
Topics: Arthritis, Psoriatic; Humans
PubMed: 28148584
DOI: 10.7861/clinmedicine.17-1-65 -
Joint Bone Spine Jan 2023
Topics: Humans; Arthritis, Psoriatic; Psoriasis; Rheumatology
PubMed: 36184036
DOI: 10.1016/j.jbspin.2022.105469 -
Rheumatology (Oxford, England) Mar 2020Psoriatic arthritis (PsA) is a complex inflammatory musculoskeletal and skin disease. The treatment of PsA has changed substantially over the past 10 years. Clinical... (Comparative Study)
Comparative Study Review
Psoriatic arthritis (PsA) is a complex inflammatory musculoskeletal and skin disease. The treatment of PsA has changed substantially over the past 10 years. Clinical practice guidelines are developed to help busy clinicians rapidly integrate evolving knowledge of therapeutic management into practice. In this review, we compare PsA treatment recommendations or guidelines developed by one national organization [ACR and National Psoriasis Foundation (NPF) in 2018], one regional organization (EULAR in 2015), and one international organization (the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis in 2015). We examine the development of guidelines in PsA more broadly and examine similarities and differences in the three sets of recommendations.
Topics: Antirheumatic Agents; Arthritis, Psoriatic; Biological Factors; Biomarkers; Comorbidity; Disease Management; Humans; Molecular Targeted Therapy; Practice Guidelines as Topic; Rheumatology; Treatment Outcome
PubMed: 32159790
DOI: 10.1093/rheumatology/kez383 -
F1000Research 2019Psoriasis is a multisystemic, inflammatory skin condition that can affect many areas of the body, but most commonly the extensor surfaces of the elbows and knees, and... (Review)
Review
Psoriasis is a multisystemic, inflammatory skin condition that can affect many areas of the body, but most commonly the extensor surfaces of the elbows and knees, and sometimes the intergluteal and umbilical area. It has a prevalence of 2-4% in western adults, and 20--30% of psoriasis patients will develop psoriatic arthritis (PsA). PsA is an inflammatory musculoskeletal disease associated with cutaneous psoriasis. It affects men and women almost equally with a peak age at onset of 40 and 50 years. It is a diverse disease that affects multiple organ systems includes peripheral and axial joints, entheses, skin, and nails. PsA is associated with comorbidities such as osteoporosis, uveitis, subclinical bowel inflammation, and cardiovascular disease. Given this heterogeneity, its diagnosis has been difficult. Here we present an updated review of its classification criteria CASPAR (classification criteria for PsA), use of screening tools to aid in early diagnosis, recent findings on pathogenesis, and new therapeutic approaches including new biologic medications.
Topics: Arthritis, Psoriatic; Comorbidity; Humans; Skin
PubMed: 31583079
DOI: 10.12688/f1000research.19144.1 -
The American Journal of Managed Care Jun 2016Psoriasis and psoriatic arthritis (PsA) are chronic immune-mediated diseases that primarily affect the skin and joints, respectively; these diseases are also associated... (Review)
Review
Psoriasis and psoriatic arthritis (PsA) are chronic immune-mediated diseases that primarily affect the skin and joints, respectively; these diseases are also associated with high rates of cardiovascular and other comorbidities. Despite over 40 genes proven to be related to the disease, the exact causes of psoriasis and PsA are still to be determined. Recent insights into the underlying pathophysiology of these diseases have revealed novel therapeutic targets. Effective management requires timely diagnosis and initiation of treatment. Yet, both psoriasis and PsA remain underrecognized and undertreated in current clinical practice. Recognizing the true physical, social, and emotional burden of psoriasis and PsA, as well as their associated comorbidities, is the first step to improving the prognosis for affected patients.
Topics: Antirheumatic Agents; Arthritis, Psoriatic; Autoimmune Diseases; Disease Management; Female; Humans; Immunosuppressive Agents; Male; Prognosis; Psoriasis; Quality of Life; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 27356193
DOI: No ID Found -
International Journal of Molecular... Mar 2020Psoriasis is a chronic inflammatory skin disease characterized by scaly indurated erythema. It impairs patients' quality of life enormously. It has been recognized not... (Review)
Review
Psoriasis is a chronic inflammatory skin disease characterized by scaly indurated erythema. It impairs patients' quality of life enormously. It has been recognized not only as a skin disease but as a systemic disease, since it also causes arthritis (psoriatic arthritis) and mental disorders. Furthermore, an association with cardiovascular events is indicated. With the advent of biologics, treatment of psoriasis dramatically changed due to its high efficacy and tolerable safety. A variety of biologic agents are available for the treatment of psoriasis nowadays. However, characteristics such as rapidity of onset, long-term efficacy, safety profile, and effects on comorbidities are different. Better understanding of those characteristic leads to the right choice for individual patients, resulting in higher persistence, longer drug survival, higher patient satisfaction, and minimizing the disease impact of psoriasis. In this paper, we focus on the efficacy and safety profile of biologics in psoriasis patients, including plaque psoriasis and psoriatic arthritis. In addition, we discuss the impact of biologics on comorbidities caused by psoriasis.
Topics: Arthritis, Psoriatic; Biological Products; Comorbidity; Humans; Psoriasis; Treatment Outcome
PubMed: 32121574
DOI: 10.3390/ijms21051690 -
Expert Review of Clinical Immunology May 2018Psoriatic arthritis (PsA) is a multi-organ chronic inflammatory disease which impacts patients both physically and psychologically. The highest priority for patients... (Review)
Review
Psoriatic arthritis (PsA) is a multi-organ chronic inflammatory disease which impacts patients both physically and psychologically. The highest priority for patients goes to pain relief, but also to ability to function and participate in social life, fatigue, and psychological distress. Areas covered: In the present article, we will review current knowledge on impairments of health-related quality of life related to PsA, as well as patient priorities and patient-reported outcome measures such as the PsA Impact of Disease or the PsA Quality of Life questionnaires. The impact of PsA appears to be very broad, covering all aspects of life, i.e. activities and participation, physical and emotional aspects, but also domains such as fatigue, coping or sleep disturbance. Some of these aspects which are important for PsA patients have been included in the recently updated PsA Core Domain Set to be reported in clinical studies. Expert commentary: A better understanding of quality of life issues faced by patients with PsA could improve patient-physician communication and ultimately, quality of care. QoL is altered in PsA due both to the physical impact, but also the psychological impact of this disease. Several scores are available to better assess these aspects of PsA.
Topics: Arthritis, Psoriatic; Fatigue; Humans; Quality of Life; Social Behavior; Stress, Psychological; Surveys and Questionnaires
PubMed: 29681202
DOI: 10.1080/1744666X.2018.1468252 -
Clinical and Experimental Rheumatology Sep 2022Psoriatic arthritis is a systemic autoimmune disease, in which a characteristic heterogeneous inflammatory involvement of entheses and both peripheral and axial joints... (Review)
Review
Psoriatic arthritis is a systemic autoimmune disease, in which a characteristic heterogeneous inflammatory involvement of entheses and both peripheral and axial joints tends to be associated with different clinical features, in particular skin or nail psoriasis, but also inflammatory bowel diseases, or acute anterior uveitis. Patients with PsA are at higher risk of developing comorbidities, in particular metabolic syndrome, with a significant impact on their quality of life. Although the advanced knowledge in the pathogenetic mechanisms of PsA helped in developing an abundant therapeutical armamentarium, the available drugs might still show a suboptimal efficacy. However, the frontier of "personalised medicine" could promote further future improvement in the quality of care of patients. In this paper we reviewed the literature on PsA of 2020 and 2021 (Medline search of articles published from 1st January 2020 to 31th December 2021).
Topics: Arthritis, Psoriatic; Humans; Psoriasis; Quality of Life; Skin; Uveitis, Anterior
PubMed: 36129799
DOI: 10.55563/clinexprheumatol/x3sfxe -
Journal of the American Academy of... Jan 2021Psoriasis is a chronic, immune-mediated, systemic, inflammatory disorder characterized by skin plaques and, often, nail disease and arthritis that contribute to reduced... (Review)
Review
Psoriasis is a chronic, immune-mediated, systemic, inflammatory disorder characterized by skin plaques and, often, nail disease and arthritis that contribute to reduced quality of life. Psoriatic arthritis-a heterogeneous, inflammatory, musculoskeletal disease that can cause permanent damage to both peripheral and axial joints-is the most common comorbidity of psoriasis. Axial disease occurs in 25% to 70% of patients with PsA, with some patients exclusively experiencing axial joint involvement. Early therapeutic intervention is important for preventing permanent joint and spine damage and loss of functionality in these patients. Because skin symptoms associated with psoriasis often precede psoriatic arthritis, dermatologists are uniquely positioned to play an important role in identifying and treating patients with psoriatic arthritis. Proactive screening of patients with all severities of psoriasis for the signs and symptoms of psoriatic arthritis is key to early diagnosis and intervention. In this review, we discuss the clinical presentation, risk factors, and treatment options for psoriatic arthritis with axial involvement, with the aim of helping dermatologists understand the disease and identify patients who might benefit from further assessment, treatment, and/or referral to a rheumatology practice.
Topics: Antirheumatic Agents; Arthritis, Juvenile; Arthritis, Psoriatic; Early Diagnosis; Humans; Quality of Life; Risk Factors
PubMed: 32747079
DOI: 10.1016/j.jaad.2020.05.089