Factores de riesgo cardiovascular en pacientes con artritis psoriásica / Cardiovascular Risk Factors in Patients with Psoriatic Arthritis

Introducción: La presencia de factores de riesgo cardiovascular agrava el pronóstico de los pacientes con artritis psoriásica. Objetivo: Determinar los factores de riesgo cardiovascular en pacientes con diagnóstico de artritis psoriásica. Métodos: Se realizó un estudio descriptivo de corte transversal, en el Servicio de Reumatología del Hospital Hermanos Ameijeiras, en el período de enero de 2021 a abril de 2022. Se recogieron variables demográficas, clínicas y hemoquímicas relacionadas con la enfermedad, así como el score de riesgo de Framingham y la evaluación de aterosclerosis carotídea subclínica. Resultados: Se incluyeron 89 pacientes con edad media de 56,3 ± 11,8 años, 69,7 por ciento del sexo femenino 48,3 por ciento con evolución mayor de 10 años y 77,5 por ciento con afectación periférica. La actividad de la enfermedad por el índice ASDAS fue alta (55,1 por ciento) igual que por BASDAI (68,5 por ciento). Los factores de riesgo cardiovascular más frecuentes fueron: dislipidemia (61,8 por ciento), obesidad (59,6 por ciento) hipertensión arterial (50,6 por ciento). La obesidad, la diabetes y la hipertensión arterial fueron mayores en pacientes con elevada actividad de la enfermedad. La aterosclerosis carotídea fue mayor en pacientes con tabaquismo, diabetes y dislipidemia. El 39,3 por ciento presentó grosor íntima media aumentado, y el 27,0 por ciento con presencia de placa carotídea. En pacientes con aterosclerosis carotídea el 25,7 por ciento fue considerado como riesgo bajo por Framingham. Conclusiones: Los factores de riesgo cardiovascular se presentaron con una frecuencia elevada, asociado a la aterosclerosis subclínica, a la actividad inflamatoria y a una subestimación de riesgo por la escala de Framingham(AU)

Introduction: The presence of cardiovascular risk factors aggravates the prognosis of patients with psoriatic arthritis. Objective: To determine cardiovascular risk factors in patients diagnosed with psoriatic arthritis. Methods: A descriptive cross-sectional study was carried out at the Rheumatology Service of Hermanos Ameijeiras Hospital from January 2021 to April 2022. Demographic, clinical, and hemochemical variables related to the disease were collected, as well as Framingham risk score and he evaluation of subclinical carotid atherosclerosis. Results: Eighty nine patients with mean age of 56.3 ± 11.8 years were included, 69.7percent female, 48.3percent with evolution older than 10 years and 77.5percent with peripheral involvement. Disease activity by ASDAS index was high (55.1percent), the same as by BASDAI (68.5percent). The most frequent cardiovascular risk factors were dyslipidemia (61.8percent), obesity (59.6percent) and arterial hypertension (50.6percent). Obesity, diabetes and arterial hypertension were higher in patients with high disease activity. Carotid atherosclerosis was higher in patients with smoking habits, diabetes, and dyslipidemia. 39.3percent showed increased intima media thickness and 27.0% had carotid plaque. In patients with carotid atherosclerosis, 25.7percent were considered low risk by Framingham. Conclusions: Cardiovascular risk factors occurred with high frequency, associated with subclinical atherosclerosis, inflammatory activity and underestimation of risk by the Framingham scale(AU)

Comorbilidades en pacientes con artropatía psoriásica / omorbidities in patients with psoriatic arthropathy

Introducción: En los últimos años, diversas investigaciones han demostrado que la presencia de comorbilidad agrava el pronóstico de los pacientes con artritis psoriásica. Objetivo: Determinar las comorbilidades en pacientes con diagnóstico de artritis psoriásica. Métodos: Se realizó un estudio descriptivo de corte transversal, en el servicio de Reumatología del Hospital Clínico Quirúrgico Hermanos Ameijeiras, que incluyó 111 pacientes con artritis psoriásica durante el periodo comprendido entre enero de 2016 a febrero de 2018. Resultados: El grupo de edad más representado fue el de 50 a 60 años, predominó el sexo femenino (63,1 por ciento) y el color de piel blanca (77,5 por ciento). El 50,5 por ciento presentó un tiempo de evolución de la artritis psoriásica mayor de 10 años. El 94,5 por ciento expresó el patrón articular periférico y la forma clínica articular más frecuente fue la oligoarticular (56,7 por ciento). Las comorbilidades identificadas con mayor frecuencia fueron la obesidad (80,18 por ciento), dislipidemia (68,46 por ciento), hipertensión arterial (HTA) (54,95 por ciento) y el hígado graso no alcohólico (53,15 por ciento). El 73,0 por ciento presentó tres o más comorbilidades. El sexo y el tiempo de evolución de la enfermedad y la actividad inflamatoria no mostraron una relación significativa. La actividad inflamatoria de la enfermedad se demostró en el 83,8 por ciento. Conclusiones: Se evidenció la presencia de comorbilidades asociadas en pacientes con APs, presentándose con mayor frecuencia, la obesidad, dislipidemia, HTA e hígado graso no alcohólico. Un porcentaje elevado de pacientes presentaron más de tres comorbilidades y no se demostró asociación significativa entre el número de comorbilidades y variables de la enfermedad(AU)

Introduction: In recent years, various investigations have shown that the presence of comorbidity worsens the prognosis of patients with psoriatic arthritis. Objective: To determine the comorbidities in patients diagnosed with psoriatic arthritis. Methods: A descriptive cross-sectional study was conducted in the Rheumatology service of the Hermanos Ameijeiras Clinical-Surgical Hospital, which included 111 patients with psoriatic arthritis from January 2016 to February 2018. Results: The age group most represented was that of 50 to 60 years, female sex (63.1`percent) and white skin color (77.5percent) patients predominated. 50.5percent had a psoriatic arthritis evolution time greater than 10 years. 94.5percent expressed the peripheral joint pattern and the most frequent joint clinical form was oligoarticular (56.7percent). The most frequently identified comorbidities were obesity (80.18percent), dyslipidemia (68.46percent), arterial hypertension (HBP) (54.95percent) and non-alcoholic fatty liver (53.15percent). 73.0percent had three or more comorbidities. The sex and the time of evolution of the disease and the inflammatory activity did not show significant relationship. The inflammatory activity of the disease was demonstrated in 83.8percent. Conclusions: The presence of associated comorbidities was evidenced in patients with PsA, with obesity, dyslipidemia, hypertension, and non-alcoholic fatty liver occurring more frequently. A high percentage of patients had more than three comorbidities and no significant association was demonstrated between the number of comorbidities and disease variables(AU)

Prevalence of psoriatic arthritis among patients with plaque psoriasis: a Brazilian retrospective study

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.

Ambulatório conjunto de dermatologia e reumatologia para tratamento de psoríase e artrite psoriásica: experiência de um hospital terciário do sul do Brasil / Combined dermatology and rheumatology outpatient clinic for the management of psoriasis and psoriatic arthritis: a Southern Brazilian experience

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)

Cambio de diagnóstico y de categoría diagnóstica en pacientes con artritis idiopática juvenil en 7 años de seguimiento / Change of diagnosis and diagnostic category in patients with juvenile idiopathic arthritis within 7 years of follow-up

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.

Acrodermatitis continua de Hallopeau y artritis psoriática: reporte de caso / Acrodermatitis continua of Hallopeau and psoriatic arthritis: a case report

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.

Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area

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.

Qué debe saber el reumatólogo del compromiso de piel para el manejo de la artritis psoriática / Which must be known by the rheumatologist of the skin commitment for the management of psoriatic arthritis

La artritis psoriática es una patología inflamatoria crónica que puede afectar a articulaciones periféricas y/o axiales, las que pertenecen al “espectro psoriático”. Es una enfermedad subdiagnosticada y subtratada, que puede traer consecuencias funcionales, laborales y de calidad de vida en los individuos que la padecen. Se estima que el 30 por ciento de los pacientes con psoriasis presentan compromiso articular. Entre los factores de riesgo para desarrollarla se encuentran; psoriasis cutáneas severas, evolución prolongada de más de 10 años, obesidad y psoriasis ungueal. Esta última puede presentar alteraciones de la matriz y/o del lecho ungueal, las que se pueden manifestar aisladamente o en conjunto. El diagnóstico de la artritis psoriática y de la psoriasis ungueal puede representar un verdadero desafío. Es de gran relevancia el diagnóstico temprano y el tratamiento correcto, ya que permiten preservar una mejor funcionalidad y calidad de vida de los pacientes.

Psoriatic arthritis is a chronic inflammatory pathology that can affect both axial and peripheral joints, belonging to the “psoriatic spectrum”. It is an underdiagnosed and undertreated condition, which can bring functional, labor and quality of life consequences in individuals suffering from it. About 30 percent of patients with psoriasis also have joint involvement. Risk factors for developing the disease include severe cutaneous psoriasis of more than 10 years, obese patients and nail psoriasis. Within the nail psoriasis, there are manifestations of the nail matrix and the nail bed, which can be manifested in isolation or in conjunction. However, the differential diagnosis of these lesions and psoriatic arthritis itself can be a real challenge. Early diagnosis and correct treatment depend to a large extent on our patients having better functionality and quality of life.

Psoriasis: classical and emerging comorbidities

Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis.

La videocapilaroscopía en la enfermedad psoriásica / The videocapillaroscopy in psoriasis disease

The videocapillaroscopy (VCP) has become a valuable tool for early diagnosis of different diseases that affect connective tissue, becoming a reproducible, noninvasive method of high sensitivity that allows assessment of vascular involvement in some connective tissue disease. Its use has been extended to the study of other diseases such as psoriatic arthritis where it has been shown to play an important role in evaluating the psoriatic plaque as monitoring of the disease, highlighting its potential as a powerful tool for evaluation clinical and...

La Videocapilaroscopia (VCP) se ha convertido en una herramienta valiosa para el diagnóstico precoz de diferentes patologías que afectan el tejido conectivo, convirtiéndose en un método no invasivo, reproducible, de alta sensibilidad que permite la evaluación del compromiso vascular en algunas colagenopatías, sin embargo su utilización se ha extendido al estudio de otras patologías como la artritis psoriásica, en donde se ha demostrado que juega un papel importante en la evaluación de la placa psoriásica como en el monitoreo de la enfermedad, destacando su potencial como una herramienta poderosa para la evaluación clínica y de investigación...

Validez diagnóstica de los anticuerpos de los péptidos anticíclicos citrulinados (Ac anti-CCP) para artritis psoriásica / Diagnostic validity of the antibodies of citrullinated anticyclical peptides (anti-CCP ac) for psoriatic arthritis

INTRODUCCIÓN: La artritis psoriásica, es una patología articular inflamatoria, asociada a psoriasis cutánea. Para su diagnóstico se han utilizado diferentes criterios y se ha explorado el rendimiento operativo de algunas pruebas de laboratorio relacionadas. En ese contexto han aparecido los denominados anticuerpos de los péptidos anticíclicos citrulinados (Ac anti-CCP), utilizados en el diagnóstico de la artritis reumatoidea y frente a los cuales algunos investigadores han evaluado un posible papel en el diagnóstico de la artritis psoriásica. OBJETIVO: Establecer la validez diagnóstica (sensibilidad y especificidad) de la prueba de anticuerpos de los péptidos anticíclicos citrulinados, para el diagnóstico de artritis psoriásica. MÉTODOS: Se realizó una búsqueda sistemática de estudios publicados que compararan la validez diagnostica de los Ac anti-CCP para artritis psoriásica. Se incluyeron los estudios que cumplieron con los criterios de selección establecidos. Se presentó el diagrama de flujo de los estudios seleccionados empleando la propuesta del grupo PRISMA. Se realizó una evaluación de calidad metodológica con la herramienta QUADAS 2 y manualmente se extrajeron los datos de los estudios incluidos. Se llevó acabo un meta-análisis exploratorio y se evaluaron posibles fuentes de heterogeneidad empleando la técnica de meta-regresión. RESULTADOS: La búsqueda realizada arrojó 212 resultados, de los cuales 13 estudios cumplieron con los criterios de inclusión. El meta-análisis exploratorio y la meta regresión mostraron una alta heterogeneidad explicada en múltiples fuentes. Debido al riesgo de sesgo de los estudios seleccionados, y a su alta heterogeneidad, solo un estudio fue tomado para la estimación de las características operativas de la prueba (Taylor y cols. 2006). Este estudio que evaluó el rendimiento operativo de los Ac anti-CCP, para el diagnóstico de la artritis psoriásica, estableció que un resultado negativo de los Ac anti-CCP tiene una sensibilidad estimada del 92% (IC 95%: 89-95) y una especificidad del 55%, (IC 95%: 49-60). CONCLUSIONES: Debido al rendimiento operativo de los Ac anti-CCP para el diagnóstico de artritis psoriásica, y comparado con las alternativas existentes, se concluye que esta tecnología no es útil para el diagnóstico de esta enfermedad.

Caracterização clínica de pacientes com artrite psoriásica / Clinical characterization of patients with psoriatic arthritis

JUSTIFICATIVA E OBJETIVO: A artrite psoriásica é doença de apresentação clínica variável e heterogênea, seja do ponto de vista dermatológico ou reumatológico, podendo haver múltiplas combinações entre seus subtipos. Esse estudo teve por objetivo caracterizar clinicamente uma população portadora de artrite psoriásica para traçar um perfil dos pacientes e contribuir para o entendimento da doença. MÉTODOS: Estudo com delineamento transversal com 45 pacientes com diagnóstico de artrite psoriásica em tratamento no serviço de Reumatologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Os dados demográfico e clínicos-sociais, cutâneos e articulares obtidos foram analisados de modo descritivo. RESULTADOS: Pertencem ao sexo masculino 57,8% dos pacientes. A média de idade foi de 52,9 anos. A maior parte tem sobrepeso e dislipidemia. Utilizam metotrexato 64,4% dos pacientes e inibidores do TNF-α 31,1%. A psoríase em placas foi observada em 88,9% dos casos. As articulações mais comumente afetadas foram as mãos e os punhos acompanhadas de manifestações extra-articulares em 86,7% dos pacientes. CONCLUSÃO: A população estudada foi composta majoritariamente por pacientes do sexo masculino, portadores de fatores de risco cardiovascular, psoríase em placas, poliartrite periférica e com presença marcante de manifestações extra-articulares...

BACKGROUND AND OBJECTIVE: Psoriatic arthritis is a disease with variable and heterogeneous clinical presentation at the dermatological or rheumatological point of view. Multiple combinations within their subtypes are possible. This survey had the aim to characterize a group of patients with psoriatic arthritis and describe a pattern of them to contribute to better understanding the disease. METHODS: This study had cross- sectional design and had evaluated 45 patients with psoriatic arthritis under treatment at the Rheumatology Department of University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Demographic and clinical data obtained were treated descriptively. RESULTS: Male patients are 57.8% of the sample. They are 52.9 years-old at average. Most of them are overweight and dyslipidemic. Utilize methotrexate 64.4% of patients and TNF-α inhibitors 31.1%. Plaque type psoriasis was found in 88.9%. Joints most affected are hands and wrists accompanied by 86.7% of extra-articular manifestations. CONCLUSION: Sample studied is composed mostly by male gender, with cardiovascular risk factors, plaque type psoriasis, peripherical polyarthritis and with extra-articular manifestations...

Diagnosis and management of psoriatic arthritis.

Psoriatic arthritis (PsA) is a multi-faceted disease marked by varying combinations of peripheral arthritis, dactylitis, spondylitis, and enthesitis. Rarely, recurrent uveitis occurs. Skin involvement may or may not exist. However, patients with nail psoriasis have a higher probability of developing PsA. Untreated patients have significant morbidity and mortality. Timely diagnosis and aggressive treatment of the disease can lead to lower morbidity. Drug therapy of PsA includes symptomatic therapy and therapy with disease-modifying antirheumatic drugs. Biologics are the only agents that address all the pathological changes, of this chronic condition.

Diagnosis and management of psoriatic arthritis.

Psoriatic arthritis (PsA) is a multi-faceted disease marked by varying combinations of peripheral arthritis, dactylitis, spondylitis, and enthesitis. Rarely, recurrent uveitis occurs. Skin involvement may or may not exist. However, patients with nail psoriasis have a higher probability of developing PsA. Untreated patients have significant morbidity and mortality. Timely diagnosis and aggressive treatment of the disease can lead to lower morbidity. Drug therapy of PsA includes symptomatic therapy and therapy with disease-modifying anti-rheumatic drugs. Biologics are the only agents that address all the pathological changes, of this chronic condition.

Risk factors and predictors of psoriatic arthritis in patients with psoriasis / Fatores de risco e preditivos do desenvolvimento de artrite psoriásica em pacientes portadores de psoríase

Given the potential consequences of joint damage for patients with psoriatic arthritis, we believe that the optimization of screening methods and the investigation of arthritis in patients with psoriasis are a medical priority. It is very useful to identify predictors of arthritis in patients with psoriasis. In fact, there is a consensus among doctors that the large gap between the diagnosis of psoriasis and that of psoriatic arthritis should be narrowed. In order to better manage patients with psoriasis, the authors review and discuss recent publications on the evidence of current predictors of arthritis in patients with psoriasis.

Em virtude das potenciais sequelas envolvidas no dano articular da artrite psoriásica, configura-se em uma prioridade médica a otimização dos métodos de rastreio e investigação de artrite nos pacientes com psoríase. Identificar preditores de artrite em pacientes com psoriase é fundamental para a prática clinica, além disso há um reconhecimento de que o grande intervalo entre o diagnóstico de psoríase e o diagnóstico de Artrite psoriásica em sua fase inicial deve ser reduzido. No sentido de contribuir com uma melhor abordagem de pacientes com psoríase, os autores revisam e discutem recentes publicações com evidencias de alguns fatores preditores de inicio de artrite nestes pacientes.

Artrite psoriásica: entidade clínica distinta da psoríase? / Psoriatic arthritis: a clinical entity distinct from psoriasis?

Psoríase e artrite psoriásica são entidades clínicas complexas e heterogêneas que podem apresentar-se por meio de múltiplas combinações entre seus subtipos; há dúvidas, inclusive, se são entidades distintas ou apenas variantes de uma mesma doença. Epidemiologicamente, a psoríase pode ser considerada doença comum, por afetar cerca de 2% da população mundial. Em relação à artrite psoriásica, não há consenso na literatura atual sobre suas reais incidência e prevalência na população geral. Fatores genéticos, imunológicos e ambientais interagem entre si até culminarem nas manifestações clínicas cutâneas e articulares da doença psoriásica. Atualmente, é reconhecido o papel central do linfócito T ativado na patogenia tanto da psoríase quanto da artrite psoriásica. Além disso, citocinas pró-inflamatórias podem ser encontradas em concentrações aumentadas tanto na sinóvia quanto na pele de portadores de artrite psoriásica. Desde 1964, quando a relação entre psoríase e artrite psoriásica foi reconhecida oficialmente, muitos estudos foram conduzidos na tentativa de melhor compreender o mecanismo em comum das duas doenças. O antígeno leucocitário humano já foi considerado o centro da imunopatogenicidade psoriásica - hoje, o fator de necrose tumoral alfa exerce tal papel. Trata-se, portanto, da revisão de variados fatores que associam psoríase e artrite psoriásica e que convergem para a hipótese de se tratar de doença única com múltiplas apresentações, dentre elas a artropatia característica.

Psoriasis and psoriatic arthritis are complex and heterogeneous clinical entities, whose presentations comprise multiple combinations of subtypes. There are doubts even if they are distinct entities or merely variants of the same disease. Epidemiologically, psoriasis can be considered a common disease because it affects about 2% of the world population. Regarding psoriatic arthritis, there is no consensus in the literature about its true incidence and prevalence in the general population. Genetic, immune, and environmental factors interact culminating in skin and joint manifestations of psoriatic disease. The central role of activated T lymphocytes in the pathogenesis of both psoriasis and psoriatic joints is now recognized. Furthermore, proinflammatory cytokines can be found in increased concentrations in both skin and synovium of patients with psoriatic arthritis. Since 1964, when the relationship between psoriasis and psoriatic arthritis was recognized, many studies have been conducted to better understand the common mechanism of both diseases. The HLA has already been considered the center of the psoriatic arthritis immunopathogenesis; today, TNF-α plays such a role. This paper is a review of various factors associating psoriasis and psoriatic arthritis leading to the hypothesis of a single disease with multiple presentations.

Psoriatic arthritis in patients with psoriasis: evaluation of clinical and epidemiological features in 133 patients followed at the University Hospital of Brasília / Artrite psoriásica em pacientes com psoríase: avaliação de características clínicas e epidemiológicas em 133 pacientes atendidos no Hospital Universitário de Brasília

BACKGROUND: Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. Its prevalence in patients with psoriasis varies from 7 to 42% but its exact prevalence is unknown. OBJECTIVES: Considering the lack of national data related to its diagnosis in patients with psoriasis, this study aims to describe the clinical, laboratorial and radiological manifestations of psoriatic arthritis in these patients. METHODS: We evaluated 133 patients with psoriasis, treated as outpatients. These patients were asked to fill in the forms with data about the disease and were submitted to a clinical evaluation by a dermatologist and a rheumatologist. Suspected cases of arthritis were referred for further investigation and were classified according to presence or absence of psoriatic arthritis according to CASPAR criteria. RESULTS: The number of patients with psoriatic arthritis was 47 (35%), 17 of them were new cases. There was no difference between the groups regarding the type of psoriasis, nail involvement, presence of scalp lesions and psoriatic arthritis. Patients with psoriatic arthritis had more enthesitis and dactylitis (46.7%) than those without arthritis. CONCLUSIONS: Despite the high prevalence of arthritis found, we know that results from epidemiological studies are variable, which limits their use and interpretation. We conclude that more studies are needed to draw a profile of rheumatic manifestations in our population of psoriasis patients.

FUNDAMENTOS: A artrite psoriásica é uma artrite inflamatória associada à psoríase. Sua prevalência nos pacientes com psoríase de 7 a 42% mas sua exata prevalência ainda é desconhecida. OBJETIVOS: Considerando a escassez de dados nacionais relacionados ao seu diagnóstico em pacientes com psoríase o presente estudo visa descrever o quadro clínico, laboratorial e radiológico da doença nesses pacientes. MÉTODOS: Foram avaliados 133 pacientes com diagnóstico de psoríase acompanhados no ambulatório de Psoríase: Esses pacientes foram submetidos ao preenchimento de fichas com dados sobre sua doença e depois a uma avaliação clínica pelo dermatologista e reumatologista. Casos suspeitos de artrite foram encaminhados para realização de investigação complementar e foram classificados quanto à presença ou não de artrite psoriásica segundo critérios de CASPAR. RESULTADOS: O número de pacientes com Artrite Psoriásica foi de 47 pacientes (35% ) sendo 17 desses casos novos. Não houve diferença entre os grupos quanto ao tipo de psoríase, envolvimento ungueal e de couro cabeludo e presença de artrite psoriásica. Pacientes com artrite psoriásica apresentaram mais entesites e dactilite (46,7%) do que os sem artrite. CONCLUSÕES: Apesar da alta prevalência de artrite encontrada como sabemos que resultados de estudos epidemiológicos são variáveis levando a limitação em seu uso e interpretação concluímos que mais estudos são necessários para se traçar um perfil de manifestações reumatológicas em nossa população de pacientes psoriásicos.