ABSTRACT
BACKGROUND: Depression is a common mental health condition that has been associated with psoriasis. In the absence of prospective data, it remains unclear whether depression precedes psoriasis as a risk factor. OBJECTIVES: To examine the association between depression and the risk of new-onset psoriasis. METHODS: A prospective cohort of 86 880 US female nurses, The Nurses' Health Study II, was followed up from 1993 to 2005. Participants reported anti-depressant use and completed the Mental Health Index (MHI), a subscale of the Short-Form 36 in 1993. The MHI assessed for depression and scores was categorized into four strata: 0-52, 53-75, 76-85 and 86-100, with lower scores associated with increasing depressive symptoms. We excluded participants with a history of psoriasis prior to 1993. A self-report of incident physician-diagnosed psoriasis constituted the main outcome measure. For a sensitivity analysis, we had a subset of confirmed psoriasis cases. RESULTS: Depression was associated with an increased risk of incident psoriasis. Compared to women in the non-depressed group (MHI 86-100), women who reported either having high depressive symptomatology (MHI scores < 52) or who were on anti-depressants had a multivariate relative risk (RR) of 1.59 for developing subsequent psoriasis (95% confidence interval [CI], 1.21-2.08). These associations became stronger among confirmed psoriasis cases. CONCLUSIONS: We found that depression was independently associated with an increased risk of psoriasis in this population of US women.
Subject(s)
Depression/complications , Psoriasis/epidemiology , Psoriasis/etiology , Adult , Female , Humans , Prospective Studies , Risk Factors , United StatesABSTRACT
BACKGROUND: There is a need to validate psoriasis self-reports in epidemiological studies, where individuals may not be seeing dermatologists or other health care providers. OBJECTIVES: To develop and pilot test the Psoriasis Screening Tool (PST) in an ambulatory setting. PATIENTS AND METHODS: The PST was designed with eight closed-ended questions requiring a 'yes' or 'no' response. Typical images of skin, nail and scalp changes in psoriasis were included with respective questions. We administered the PST to 222 consecutive individuals being seen at a dermatology clinic. All English-speaking subjects completed the PST without assistance. A board-certified dermatologist established the diagnosis of psoriasis or excluded psoriasis in all participants. RESULTS: A total of 222 completed PST questionnaires were included for analysis. There were 111 individuals in the psoriasis group and 111 individuals in the nonpsoriasis group. A combination of three questions resulted in a sensitivity of 96.4% [95% confidence interval (CI) 93.2-98.0] and specificity of 97.3% (95% CI 94.1-98.9) for psoriasis. Adding a pictorial question increased the sensitivity of the screening tool to 98.2% (95% CI 95.0-99.5). Of the 111 individuals with psoriasis, 69% answered yes to having plaque-type psoriasis, 50% answered yes to having nail involvement, 66% answered yes to having scalp involvement, and 59% answered yes to having inverse-type psoriasis. CONCLUSIONS: This pilot study suggests that the PST can distinguish individuals with psoriasis from individuals without psoriasis in an English-speaking population being seen at an outpatient dermatology clinic. Furthermore, the PST may be used to identify psoriasis phenotypes. Although the PST may be limited by spectrum bias in this pilot study, we believe it remains a reliable tool to collect information on psoriasis in remote populations.
Subject(s)
Psoriasis/diagnosis , Surveys and Questionnaires , Adolescent , Adult , Age of Onset , Algorithms , Child , Child, Preschool , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Pilot Projects , Prevalence , Psoriasis/epidemiology , Psoriasis/genetics , Sensitivity and Specificity , Young AdultSubject(s)
Cysts/complications , Hemangioma/complications , Liver Diseases/complications , Liver Neoplasms/complications , Cysts/diagnosis , Cysts/diagnostic imaging , Female , Hemangioma/diagnosis , Hemangioma/diagnostic imaging , Humans , Liver Diseases/diagnosis , Liver Diseases/diagnostic imaging , Liver Neoplasms/diagnosis , Liver Neoplasms/diagnostic imaging , Middle Aged , Radionuclide Imaging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Nine cases of primary septic arthritis in heroin addicts are reported. Fibrous and cartilaginous joint localizations are prominent (four sternoarticular, three sacroiliac, one sacroccocygeal, and one knee). In all patients but one, conventional roentgenographic studies were negative. In six cases the causative agent was Staphylococcus aureus and in two cases, Candida albicans. In one case, it could not be determined. Our clinical observations, correlating the radioisotopic studies, suggest that in the first week of evolution the diagnostic procedure of choice is the [67Ga]citrate scintigram. Indeed, during this period the [99Tc]MDP bone scan is usually negative. The early demonstration and localization of the disease, together with the rapid bacteriologic diagnosis, allows for an early and more appropriate antibiotic treatment and better results.
