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1.
An. bras. dermatol ; 96(3): 324-327, May-June 2021. graf
Article in English | LILACS | ID: biblio-1285063

ABSTRACT

Abstract Systemic amyloidosis secondary to psoriatic arthritis is rare, and published data are based mainly on case reports and are associated with increased mortality. This is the report of a patient with long-term psoriatic arthritis and chronic sialadenitis, who showed an inadequate response to therapy. The diagnosis of secondary amyloidosis was attained through biopsies of genital skin lesions. Although very rare, it is important that dermatologists and general practitioners consider the possibility of amyloidosis in patients with chronic inflammatory diseases, since an early intervention can be implemented, and thus, the prognosis of this condition can be improved.


Subject(s)
Humans , Psoriasis , Arthritis, Psoriatic/complications , Immunoglobulin Light-chain Amyloidosis , Amyloidosis/complications , Amyloidosis/diagnosis , Skin
2.
Säo Paulo med. j ; 139(5): 476-480, May 2021. tab, graf
Article in English | LILACS | ID: biblio-1290263

ABSTRACT

ABSTRACT BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.


Subject(s)
Humans , Psoriasis/complications , Psoriasis/epidemiology , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies
4.
Rev. Méd. Paraná ; 79(1): 36-39, 2021.
Article in Portuguese | LILACS | ID: biblio-1282395

ABSTRACT

Introdução: A psoríase é uma doença inflamatória crônica, imunomediada, de base genética, com grande polimorfismo de expressão clínica. É caracterizada pelo envolvimento de pele, unhas e, eventualmente, articulações. De ocorrência mundial, possui prevalência entre 2 a 3% na população geral. Entre 20-30% dos pacientes com psoríase desenvolvem a artrite psoriática (AP) a qual pode preceder, estar associada ou suceder o aparecimento da psoríase. A hiperuricemia é uma condição frequentemente associada a pacientes psoriásicos. Objetivos: Estudar a prevalência de hiperuricemia em pacientes com psoríase e sua possível associação com o fenótipo da doença, atividade articular e cutânea. Metodologia: Trata-se de um estudo transversal e analítico realizado através da avaliação de ácido úrico de 58 pacientes diagnosticados com psoríase (com e sem AP) acompanhados pelos ambulatórios de dermatologia e reumatologia do Hospital Universitário Evangélico Mackenzie de Curitiba, PR. Resultados: Cerca de 58 indivíduos foram analisados; dentre eles 24 mulheres e 34 homens, com mediana da idade é de 57 anos. Dos pacientes acometidos pela psoriase, a hiperuricemia esteve presente em 13,7%, sendo mais prevalente no sexo masculino (p=0.01)., nos com artrite psoriásica (p=0.04) e naqueles com envolvimento ungueal (p=0.006) e mais rara naqueles com a forma vulgar da psoríase (p<0.0001). Nenhum paciente apresentou artrite gotosa. A atividade da doença de pele e da doença articular não interferiram nos níveis de ácido úrico (p=ns). Conclusão: Pacientes com artrite psoriásica têm maior incidência de hiperuricemia do que aqueles com psoríase só de pele. Hiperuricemia é mais comum nos pacientes masculinos, com envolvimento ungueal e menos comum naqueles com psoríase vulgar


Introduction: Psoriasis is a chronic, immunomodulated, genetic-based inflammatory disease with great polymorphism of clinical expression. It is characterized by the involvement of skin, nails and eventually joints. It has a worldwide occurrence, with prevalence between 2 and 3% in the general population. Between 20-30% of patients with psoriasis develop psoriatic arthritis (PA), which may precede, be associated with, or succeed psoriasis. Hyperuricemia is a condition often associated with psoriatic patients. Objectives: To study the prevalence of hyperuricemia in patients with psoriasis and its possible association with the phenotype of the disease, joint and skin activity. Methodology: This is a cross-sectional and analytical study conducted through the evaluation of uric acid in patients diagnosed with psoriasis (with and without PA) followed by dermatology and rheumatology outpatient clinics of the Mackenzie Evangelical University Hospital of Curitiba, PR. Results: About 58 individuals were analyzed; among them 24 women and 34 men, with a median age of 57 years. Of the patients affected by psoriasis, hyperuricemia was present in 13.7%, being more prevalent in males (p=0.01), in those with psoriatic arthritis (p=0.04) and in those with nail involvement (p=0.006) and less common in those with the vulgar form of psoriasis (p<0.0001). No patient had gouty arthritis. Skin disease and joint disease activities did not interfere with uric acid levels (p=ns). Conclusion: Patients with psoriatic arthritis have a higher incidence of hyperuricemia than those with skin-only psoriasis. Hyperuricemia is more common in male patients, with nail involvement and less common in those with psoriasis vulgaris


Subject(s)
Humans , Male , Female , Arthritis , Arthritis, Psoriatic , Hyperuricemia
5.
Adv Rheumatol ; 61: 13, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152732

ABSTRACT

Abstract Introduction: Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that can cause joint destruction and impair quality of life. The Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) was the first disease-specific tool for determining the impact of the disease on the quality of life of people with PsA. Objectives: The primary objective was to develop and validate a Brazilian Portuguese version of the PsAQoL. Methods: The UK PsAQoL was translated into Brazilian Portuguese using two translation panels. This translation then checked for face validity and construct validity with new samples of patients. Finally, a test-retest validation study was conducted with 52 patients with PsA. The survey included the Nottingham Health Profile (NHP) as a comparator instrument. Results: Internal consistency and reproducibility were both excellent for the new adaptation (0.91 and 0.90 respectively Scores on the PsAQoL were found to correlate as expected with the comparator measure and the instrument was able to detect differences in score related to perceived severity of PsA, general health status and presence of a flare. Conclusions: The Brazilian PsAQoL was found easy to understand and complete and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine PsA practice and clinical trials.


Subject(s)
Humans , Quality of Life , Arthritis, Psoriatic/physiopathology , Surveys and Questionnaires , Reproducibility of Results
6.
Clin. biomed. res ; 41(4): 313-318, 20210000. tab
Article in Portuguese | LILACS | ID: biblio-1349510

ABSTRACT

Introdução: Diversas diretrizes enfatizam as vantagens do manejo multidisciplinar no cuidado ao paciente com psoríase (PSO) e artrite psoriásica (PSA). O diagnóstico precoce de PSA se relaciona com melhores desfechos em 5 anos. No entanto, o diagnóstico precoce de PSA ainda é um desafio. Métodos: Estudo transversal retrospectivo de pacientes com diagnóstico prévio ou suspeito de PSO e/ou PSA atendidos em ambulatório conjunto de dermatologia e reumatologia do sul do Brasil de janeiro de 2013 a janeiro de 2017. Resultados: Entre os 55 pacientes previamente diagnosticados com PSO, 30,9% (n = 17) foram diagnosticados com PSA. Alterações do tratamento foram feitas em 58,5% (n = 48) dos pacientes, principalmente devido ao mau controle da pele e das articulações. Os imunobiológicos foram a classe de medicamentos mais comumente iniciada, correspondendo a 35,4% (n = 17) das modificações terapêuticas. O metotrexato foi o segundo medicamento mais comumente iniciado (18,8%, n = 9) ou com modificação da dose ou via de administração (20,8%, n = 10), totalizando 39,6% (n = 19) de modificações terapêuticas. Houve um aumento na proporção de pacientes em uso de tratamento sistêmico (79,3%, n = 65). Conclusão: Este estudo reforça a importância da abordagem multidisciplinar no diagnóstico precoce da PSA e demonstra que a abordagem conjunta entre dermatologia e reumatologia é possível de ser realizada no Brasil, com resultados semelhantes aos reportados na literatura internacional. (AU)


Introduction: Several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA is associated with better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: We conducted a retrospective cross-sectional study of patients with previous or suspected diagnosis of PSO and/or PSA treated at a combined dermatology and rheumatology outpatient clinic in southern Brazil from January 2013 to January 2017. Results: Of 55 patients previously diagnosed with PSO, 30.9% (n = 17) were diagnosed with PSA. Changes in treatment were made in 58.5% (n = 48) of patients, mainly due to poor control of cutaneous and articular symptoms. Immunobiological agents were the most commonly prescribed class of drugs, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most commonly prescribed drug (18.8%; n = 9) and the second drug to undergo most changes in dose or route of administration (20.8%; n = 10), accounting for 39.6% (n = 19) of changes in medical therapy. There was an increase in the number of patients undergoing systemic therapies (79.3%; n = 65). Conclusions: This study reinforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a collaborative approach between dermatology and rheumatology is feasible in Brazil, with outcomes similar to those reported in the international literature. (AU)


Subject(s)
Patient Care Team , Psoriasis/therapy , Rheumatology , Arthritis, Psoriatic/diagnosis , Dermatology , Ambulatory Care Facilities
7.
Adv Rheumatol ; 61: 2, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152742

ABSTRACT

Abstract Large epidemiologic and clinical estimates of spondyloarthritis (SpA) in Latin America are not available. In this narrative review, our goal was to descriptively summarize the prevalence and features of SpA in Latin America, based on available small studies. A review of peer-reviewed literature identified 41 relevant publications. Of these, 11 (mostly based on Mexican data) estimated the prevalence of SpA and its subtypes, which varied from 0.28 to 0.9% (SpA), 0.02 to 0.8% (ankylosing spondylitis), 0.2 to 0.9% (axial SpA), and 0.004 to 0.08% (psoriatic arthritis). Demographic and/or clinical characteristics were reported in 31 of the 41 publications, deriving data from 3 multinational studies, as well as individual studies from Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, Uruguay, and Venezuela. Data relating to treatment, disease manifestations (articular and extra-articular), and comorbidities were summarized across the countries. Available data suggest that there is a variability in prevalence, manifestations, and comorbidities of SpA across Latin America. Basic epidemiologic and clinical data are required from several countries not currently represented. Data relating to current treatment approaches, patient outcomes, and socioeconomic impact within this large geographic region are also needed.(AU)


Subject(s)
Humans , Spondylarthritis/epidemiology , Prognosis , Spondylitis, Ankylosing/epidemiology , Arthritis, Psoriatic/epidemiology , Demography , Prevalence , Risk Factors , Latin America/epidemiology
8.
Chinese Medical Journal ; (24): 2564-2572, 2021.
Article in English | WPRIM | ID: wpr-921186

ABSTRACT

BACKGROUND@#Although there are few studies mentioned there may be some relationship between psoriatic arthritis (PsA) and osteoporosis, clinical data in real world still need to be clarified in China. The aim of this study was to assess the areal and volumetric bone mineral density (BMD), frequency of fracture, and risk factors in patients with PsA.@*METHODS@#A total of one hundred PsA patients who visited Peking University First Hospital and one hundred age- and sex-matched healthy controls with DXA data were enrolled in the study. Patients with clinical fractures confirmed by X-ray during follow-up were also recorded. Clinical characteristics of the patients were recorded and compared between the abnormal BMD group and the normal BMD group, as well as between the fracture and non-fracture groups. Risk factors for fracture and low BMD were analyzed.@*RESULTS@#Mean BMD at the total hip and femoral neck was significantly lower in PsA patients than that in healthy controls (0.809 ± 0.193 vs. 0.901 ± 0.152 g/cm2, P  = 0.041; 0.780 ± 0.146 vs. 0.865 ± 0.166 g/cm2, P  = 0.037, respectively). Moreover, lumbar spine BMD was negatively correlated with psoriasis duration, swollen joint count and DAS28-CRP (r = -0.503, -0.580, -0.438; P < 0.05). Total hip BMD and femoral neck BMD were negatively correlated with HAQ (r = -0.521, -0.335; P < 0.05). Fractures occurred in 29 patients during the follow-up period. Logistic regression analysis showed that older age (OR 1.132 [95%CI: 1.026-1.248), P < 0.05], higher HAQ score (OR 1.493, 95%CI: 1.214-1.836, P < 0.01), higher disease activity index for psoriatic arthritis (OR 1.033, 95% CI: 1.002-1.679, P < 0.05) and hip joint involvement (OR 6.401, 95% CI: 4.012-44.180, P < 0.05) were risk factors for fracture in the multivariate model.@*CONCLUSIONS@#Increased risks of osteoporosis and fracture were found in PsA patients compared to healthy controls. Besides age, high disease activity and hip joint involvement were risk factors for decreased BMD and fracture.


Subject(s)
Absorptiometry, Photon , Aged , Arthritis, Psoriatic/complications , Bone Density , Humans , Lumbar Vertebrae , Osteoporosis/etiology , Osteoporotic Fractures , Risk Factors
9.
Rev. chil. pediatr ; 91(4): 521-528, ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138666

ABSTRACT

Resumen: Introducción: Al menos 50% de los pacientes pediátricos portadores de artritis idiopática juvenil (AIJ) continuará control en reumatología adulto. La clasificación de la Liga Internacional de Asociaciones de Reumatología (ILAR) vigente, actualmente en revisión, difiere de la clasificación de las artritis inflamatorias del adulto. Se ha reportado cambios de categoría en 10,8% de los pacientes durante el seguimiento. Objetivo: Analizar los pacientes con AIJ seguidos al menos 7 años para objetivar cambios de diagnós tico en la transición, e identificar factores de mal pronóstico funcional. Pacientes y Método: Estudio retrospectivo en base a registros clínicos. Se incluyó a la totalidad de los pacientes con AIJ controla dos en policlínico pediátrico del Hospital de Puerto Montt entre el año 2005 y 2017, que cumplieron siete o más años de seguimiento. Se realizó análisis descriptivo en base a variables clínicas: categoría diagnóstica, tiempo de evolución al diagnóstico, actividad clínica y serológica, y tiempo de evolución al inicio de la terapia farmacológica. Resultados: Se evaluaron 18 pacientes, 3 Oligo-articular (OA) persistente, 1 OA extendida, 4 Poli-articular (PA) factor reumatoide (FR) negativo, 4 PA FR positivo, 5 Sistémicas, 1 Psoriática, todos con seguimiento mayor a 7 años. Once de 18 niños fueron transfe ridos a adultos. Tres de 11 cambiaron de diagnóstico a Artritis Reumatoide (AR) más otra enferme dad autoinmune: Síndrome de Sjögren + Lupus eritematoso sistémico, Púrpura trombocitopénico inmune, Enfermedad autoinmune no clasificada y cinco de 11 niños de categoría ILAR: OA a Artritis reumatoide juvenil, OA extendida a PA FR negativo, 3 Sistémicas a PA FR negativo. Edad de inicio, formas poli-articulares, retrasos en diagnóstico y comienzo de terapia se asociaron a secuelas e infla mación persistente. Conclusiones: Ocho de once pacientes transferidos cambiaron denominación diagnóstica y/o presentaron otras enfermedades autoinmunes. Algunos factores de mal pronóstico deben mejorar.


Abstract: Introduction: At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. Objective: To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. Patients and Method: Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. Results: We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. Conclusions: Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.


Subject(s)
Humans , Male , Female , Young Adult , Arthritis, Juvenile/diagnosis , Transition to Adult Care , Arthritis, Juvenile/classification , Arthritis, Juvenile/complications , Arthritis, Juvenile/therapy , Arthritis, Rheumatoid/classification , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/therapy , Prognosis , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , Retrospective Studies , Follow-Up Studies , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/therapy , Aftercare , Disease Progression , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/therapy
10.
Rev. argent. reumatolg. (En línea) ; 31(2): 10-17, jun. 2020. ilus, graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1143926

ABSTRACT

Existen diversos índices capaces de valorar el daño radiográfico en pacientes con artritis psoriásica (APs), sin embargo la mayoría fueron creados para su uso en Artritis Reumatoidea y luego modificados para APs, por lo tanto no valoran lesiones características como la osteoproliferación. El objetivo de este estudio fue validar el Reductive X-Ray Score for Psoriatic Arthritis (ReXSPA), el cual fue recientemente desarrollado para su uso en cohortes observacionales. Material y métodos: Estudio de corte transversal, en el cual se incluyeron pacientes ≥18 años de edad, en forma consecutiva, con diagnóstico de APs según criterios CASPAR. A todos los pacientes se les realizaron radiografías de manos y pies en proyección anteroposterior. Dos lectores ciegos para las características clínicas de los pacientes y previamente entrenados, analizaron las mismas por medio de los índices Sharp van der Heijde modificado para APs (SvdHmAPs) y ReXSPA. Se midió el tiempo empleado para la lectura de los índices radiográficos y para el cálculo de los mismos. Resultados: Se incluyeron 66 pacientes, 50% mujeres, con tiempo de evolución de la APs mediano de 8 años (RIC: 4-14.3). 132 radiografías fueron evaluadas según los índices SvdHmAPs [m 35 (RIC: 16.3-72.5)] y el ReXSPA [m 22 (RIC: 7-46.3)]. El tiempo para la lectura radiográfica fue significativamente menor para ReXSPA comparado con SvdHmAPs [media 5.8±2.1 vs media 7.5±2.5 minutos, p<0.0001], al igual que el tiempo para calcularlo [media 26.5±14.7 vs media 55.3±38.3 segundos, p<0.0001]. La correlación entre estos últimos fue excelente (Rho: 0.93). En el análisis multivariado se observó asociación de ambos índices con el tiempo de evolución de la enfermedad y en el caso de ReXSPA también con la edad. Conclusión: El índice ReXSPA ha demostrado validez y una excelente correlación con el índice SvdHmAPs, con menor tiempo para su lectura y cálculo. Evaluaciones longitudinales posteriores permitirán demostrar la validez de estos hallazgos.


There are many scores available to measure radiographic joint damage in patients with Psoriatic Arthritis (PsA), but most of them were developed for Rheumatoid Arhtritis and then modified for PsA. These scores do not evaluate juxtaarticular bone proliferation. The aim of our study was to validate the Reductive X-Ray Score for Psoriatic Arthritis (ReXSPA), which was recently developed to be used in observational cohorts. Methods: A cross-sectional study was carried out. Consecutive patients ≥18 years old with PsA according to CASPAR criteria were included. All patients underwent X-rays of the hands and feet in an anteroposterior view. Two blind readers for the clinical characteristics of the patients and previously trained, scored them by Sharp van der Heijde modified for PsA (PsA-SvdH) and ReXSPA indexes. Time to read and calculate both scores were measured. Results: A total of 66 patients were included, half of them were female, median (m) disease duration of 8 years (IQR: 4-14.3). 132 X-Rays were scored according to PsA-SvdH [m 35 (IQR: 16.3-72.5)] and ReXSPA [m 22 (IQR: 7-46.3)]. Time to read was significantly shorter for ReXSPA than PsA-SvdH [mean 5.8±2.1 vs mean 7.5±2.5 minutes, p<0.0001], as well as, time to calculate them [mean 26.5±14.7 vs mean 55.3±38.3 seconds, p<0.0001]. The correlation between both indexes was excellent (Rho: 0.93). In the multivariate analysis, using both radiographic scores as dependent variable, association of each of the indices with disease duration was observed, and ReXSPA also had association with age. Conclusion: The ReXSPA index has shown validity and a very good correlation with PsA-SvdH. It is quicker to read and to calculate than PsA-SvdH. Subsequent longitudinal evaluations will allow demonstrating the validity of these findings.


Subject(s)
Humans , Arthritis, Psoriatic , X-Rays , Disease , Cross-Sectional Studies , Diagnosis
11.
Rev. méd. Chile ; 148(5): 657-664, mayo 2020. tab
Article in Spanish | LILACS | ID: biblio-1139350

ABSTRACT

The financial coverage granted by law in Chile for patients with psoriatic arthritis who require biological treatment is of paramount importance and a great advance. However physicians must be knowledgeable about the advantages and limitations of this therapy. The challenge of clinicians is to choose the drug with the greater odds of achieving therapeutic success, with less adverse events and lower costs for our health system. This article aims to help doctors to select the best biological treatment for a specific patient, trying to optimize its effectiveness, minimizing adverse effects, always looking for an efficient use of resources.


Subject(s)
Humans , Physicians/psychology , Biological Factors/therapeutic use , Arthritis, Psoriatic/drug therapy , Clinical Decision-Making , Chile
12.
An. bras. dermatol ; 95(2): 203-206, Mar.-Apr. 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130837

ABSTRACT

Abstract Hidradenitis suppurativa is a chronic inflammatory skin disease, which affects 1% of the population, being more common in young, obese and smokers, and mainly affects armpits and groin, with formation of pustules, nodules, abscesses, scars and fistulas. Recently, its association with other autoimmune diseases such as psoriasis, psoriatic arthritis, pyoderma gangrenosum, pyogenic arthritis and ulcerative colitis have been reported. These associated forms are usually resistant to standard treatment, with immunobiologicals as promising therapy. The case of a rare form of association is reported, with only one case previously described in the literature: psoriasis arthritis, pyoderma gangrenosum, acne and hidradenitis suppurativa.


Subject(s)
Humans , Female , Young Adult , Arthritis, Psoriatic/pathology , Pyoderma Gangrenosum/pathology , Hidradenitis Suppurativa/pathology , Acne Vulgaris/pathology , Autoimmune Diseases/pathology , Syndrome
13.
Clin. biomed. res ; 40(1): 1-6, 2020.
Article in English | LILACS | ID: biblio-1104373

ABSTRACT

Introduction: Registries of spondyloarthritis (SpA) patients' follow-up provided evidence that tumor necrosis factor inhibitors (TNFi) increase the incidence of active tuberculosis infection (TB). However, most of these registries are from low burden TB areas. Few studies evaluated the safety of biologic agents in TB endemic areas. This study compares the TB incidence rate (TB IR) in anti-TNF-naïve and anti-TNF-experienced subjects with SpA in a high TB incidence setting.Methods: In this retrospective cohort study, medical records from patients attending a SpA clinic during 13 years (2004 to 2016) in a university hospital were reviewed. The TB IR was calculated and expressed as number of events per 105 patients/year; the incidence rate ratio (IRR) associated with the use of TNFi was calculated.Results: A total of 277 patients, 173 anti-TNF-naïve and 104 anti-TNF-experienced subjects, were evaluated; 35.7% (N = 35) of patients who were prescribed an anti-TNF drug were diagnosed with latent tuberculosis infection (LTBI). Total follow-up time (person-years) was 1667.8 for anti-TNF-naïve and 394.9 for anti-TNF-experienced patients. TB IR (95% CI) was 299.8 (37.4-562.2) for anti-TNF naïve and 1012.9 (25.3-2000.5) for anti-TNF experienced subjects. The IRR associated with the use of TNFi was 10.4 (2.3- 47.9).Conclusions: In this high TB incidence setting, SpA patients exposed to anti-TNF therapy had a higher incidence of TB compared to anti-TNF-naïve subjects, although the TB incidence in the control group was significant.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tuberculosis/chemically induced , Tuberculosis/epidemiology , Biological Products/adverse effects , Antirheumatic Agents/adverse effects , Spondylarthritis/drug therapy , Tumor Necrosis Factor Inhibitors/adverse effects , Spondylitis, Ankylosing/drug therapy , Biological Products/therapeutic use , Arthritis, Psoriatic/drug therapy , Incidence , Retrospective Studies , Follow-Up Studies , Antirheumatic Agents/therapeutic use , Endemic Diseases , Latent Tuberculosis/drug therapy , Tumor Necrosis Factor Inhibitors/therapeutic use
15.
Medwave ; 20(8): e8021, 2020.
Article in Spanish | LILACS | ID: biblio-1128609

ABSTRACT

Un hombre de 44 años, previamente sano, consultó por poliartralgias asimétricas de características inflamatorias de tres meses de evolución, que comprometió pequeñas y grandes articulaciones. Poco tiempo después desarrolló pústulas periungueales sobre una base eritematosa y degeneración progresiva de la lámina ungueal del pulgar izquierdo, limitando severamente su funcionalidad. Destacó al examen físico la presencia de placas eritemato-escamosas y pustulosas bien delimitadas en el primer y tercer dedo de la mano izquierda con onicodistrofia severa, que fue un aspecto clave para establecer el diagnóstico de acrodermatitis continua de Hallopeau. Adicionalmente, se observaron otros hallazgos del espectro psoriático: parches eritematosos en el escroto, placas eritemato-escamosas con costras hemorrágicas en ambas rodillas y dactilitis. Se confirmó histológicamente el diagnóstico de psoriasis inversa, psoriasis en placas y psoriasis pustular, respectivamente y con los criterios de Classification Criteria for Psoriatic Arthritis, CASPAR, el diagnóstico de artritis psoriática.


A 44-year-old man, previously healthy, consulted for a three-month history of asymmetrical polyarthralgia with inflammatory features involving small and large joints. A few days later, he developed erythema covered by pustules in the nail folds and progressive degeneration of the nail plate of the left thumb, with severe functional limitation. The physical exam showed well-defined erythematous scaly and pustular plaques in the first and third fingers of the left hand, with severe onychodystrophy, which was a key aspect in the diagnosis of acrodermatitis continua of Hallopeau. Other signs of the psoriatic spectrum were observed: erythematous patches of the scrotum, erythematous scaly plaques with hemorrhagic crusts on both knees, and dactylitis. The diagnosis of inverse psoriasis, plaque psoriasis, and pustular psoriasis, respectively, were confirmed by histopathology and, with the CASPAR criteria, psoriatic arthritis. This case is of particular dermatological interest due to the variety of psoriatic manifestations recognized in a single patient and because of the poorly described association between acrodermatitis continua of Hallopeau with psoriatic arthritis.


Subject(s)
Humans , Male , Adult , Psoriasis/diagnosis , Acrodermatitis/diagnosis , Arthritis, Psoriatic/diagnosis , Psoriasis/pathology , Acrodermatitis/pathology , Arthritis, Psoriatic/pathology
16.
Clinics ; 75: e1870, 2020. tab
Article in English | LILACS | ID: biblio-1133406

ABSTRACT

OBJECTIVES: To retrospectively evaluate the performance and distinctive pattern of latent tuberculosis (TB) infection (LTBI) screening and treatment in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) under anti-tumor necrosis factor (TNF) therapy and determine the relevance of re-exposure and other risk factors for TB development. METHODS: A total of 135 and 83 patients with AS and PsA, respectively, were evaluated for LTBI treatment before receiving anti-TNF drugs via the tuberculin skin test (TST), chest radiography, and TB exposure history assessment. All subjects were evaluated for TB infection at 3-month intervals. RESULTS: The patients with AS were more often treated for LTBI than were those with PsA (42% versus 30%, p=0.043). The former also presented a higher frequency of TST positivity (93% versus 64%, p=0.002), although they had a lower frequency of exposure history (18% versus 52%, p=0.027) and previous TB (0.7% versus 6%, p=0.03). During follow-up [median, 5.8 years; interquartile range (1QR), 2.2-9.0 years], 11/218 (5%) patients developed active TB (AS, n=7; PsA, n=4). TB re-exposure was the main cause in seven patients (64%) after 12 months of therapy (median, 21.9 months; IQR, 14.2-42.8 months) and five LTBI-negative patients. TB was identified within the first year in four patients (36.3%) (median, 5.3 months; IQR, 1.2-8.8 months), two of whom were LTBI-positive. There was no difference in the TB-free survival according to the anti-TNF drug type/class; neither synthetic drug nor prednisone use was related to TB occurrence (p>0.05). CONCLUSION: Known re-exposure is the most critical factor for incident TB cases in spondyloarthritis. There are also some distinct features in AS and PsA LTBI screening, considering the higher frequency of LTBI and TST positivities in patients with AS. Annual risk reassessment taking into consideration these peculiar features and including the TST should be recommended for patients in endemic countries.


Subject(s)
Humans , Spondylitis, Ankylosing/drug therapy , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/drug therapy , Arthritis, Psoriatic/epidemiology , Latent Tuberculosis/diagnosis , Latent Tuberculosis/epidemiology , Spondylitis, Ankylosing/epidemiology , Retrospective Studies , Follow-Up Studies , Tumor Necrosis Factor Inhibitors/therapeutic use
17.
Adv Rheumatol ; 60: 01, 2020. tab
Article in English | LILACS | ID: biblio-1088652

ABSTRACT

Abstract Background: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. Methods: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. Results: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). Conclusion: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.(AU)


Subject(s)
Humans , Fibromyalgia/etiology , Arthritis, Psoriatic/physiopathology , Fatigue/etiology , Visual Analog Scale
18.
Article in Chinese | WPRIM | ID: wpr-828038

ABSTRACT

To explore the main target and signal pathway of Simiao Yongan Decoction in the treatment of psoriatic arthritis(PsA) by network pharmacology, so as to reveal the intervention mechanism of Simiao Yongan Decoction in the treatment of psoriatic arthritis. The platform of pharmacology technology of traditional Chinese medicine system(TCMSP) was used to predict and screen the active ingredients of Simiao Yongan Decoction, and GeneCards database was searched to obtain the disease target related to the psoriatic arthritis. Protein interaction network model was constructed with STRING platform; drug-component-target-disease network map was constructed with Cytoscape Software; Wayne Diagram of common target of Simiao Yongan Decoction and psoriasis arthritis was drawn with the help of ClusterProfiler R Software. At the same time, the genetic ontology(GO) enrichment analysis and the Kyoto encyclopedia of genes and genomes(KEGG) pathway analysis were conducted. Through database analysis, 1 128 targets related to 70 main active components of Simiao Yongan Decoction and psoriatic arthritis were selected. On this basis, the interaction network between Simiao Yongan Decoction and psoriatic arthritis was constructed, and 38 common targets were screened out. By GO and KEGG enrichment analysis, 135 signal pathways related to the main components of Simiao Yongan Decoction were selected. It was found that Simiao Yong-an Decoction may play a role in the treatment of psoriatic arthritis through antiviral effect, anti-inflammatory repair, protection of vascular endothelial cells, regulation of immunity and other multiple targets. The mechanism of Simiao Yongan Decoction in the treatment of psoriatic arthritis from multi-component, multi-target and multi-pathway was revealed, which provided a research direction for screening its subsequent clinical effect evaluation indexes.


Subject(s)
Arthritis, Psoriatic , Drugs, Chinese Herbal , Endothelial Cells , Humans , Medicine, Chinese Traditional , Protein Interaction Maps
19.
Rev. colomb. reumatol ; 26(3): 214-215, jul.-set. 2019. graf
Article in Spanish | LILACS | ID: biblio-1126338

ABSTRACT

Resumen Se presenta una imagen gammagráfica que muestra en forma didáctica características típicas de la artritis psoriásica.


Abstract A scintigraphic image is presented that shows the typical characteristics of psoriatic arthritis as a teaching aid.


Subject(s)
Humans , Female , Middle Aged , Arthritis , Arthritis, Psoriatic , Psoriasis , Spondylarthritis , Joint Diseases
20.
Rev. colomb. reumatol ; 26(3): 194-200, jul.-set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1126335

ABSTRACT

Resumen La psoriasis es una enfermedad cutánea común, con prevalencia mundial entre el 0,9-8,5%. Es una condición inflamatoria crónica, inmunológicamente mediada, que lleva a hiperplasia epidérmica con gran variedad de formas clínicas. La psoriasis ostrácea es una variante hiperqueratósica infrecuente, reportada pocas veces en la literatura y que con frecuencia se asocia a artritis psoriásica, una artropatía inflamatoria, seronegativa, crónica, cuyos síntomas usualmente comienzan después de las lesiones cutáneas. Este es el caso de un paciente con una presentación inusual de artritis psoriásica asociada a psoriasis ostrácea posterior a 10 arios de manejo adecuado con infliximab.


Abstract Psoriasis is a common cutaneous disease with a world prevalence of 0.9-8.5%. It is a chronic, inflammatory, immune mediated condition that leads to epidermal hyperplasia and an array of clinical presentations. Psoriasis ostracea is a rare hyperkeratotic variant of psoriasis. Although frequently associated with psoriatic arthritis, there are few reports in the literature. Psoriatic arthritis is a chronic, seronegative, inflammatory arthritic disease, in which the symptoms usually emerge years after skin lesions appear. The case is presented of a patient, who after 10-years of adequate Infliximab treatment, had an unusual presentation of psoriatic arthritis associated with psoriasis ostracea.


Subject(s)
Humans , Male , Adult , Psoriasis , Arthritis, Psoriatic , Infliximab , Skin Diseases , Hyperplasia
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