[|What I would like to add to chapter 6 is
the fact that psoriatic arthritis may cause disability by permanent damage of
the joints. The dermatologist may recognise psoriatic arthritis in an early
phase and alert the patient that psoriatic arthritis may be the explanation for
her joint complaints. Adequate diagnosis and treatment in an early phase of
psoriatic arthritis is essential.|auteur197]
[|This is an area of intense interest, both personally as well as to all dermatologists, and more recently rheumatologists who appear to have “rediscovered” this spondyloarthropathy as separate from rheumatoid arthritis. Moll and Wright’s 30-year classification of Psoriatic Arthritis is clearly outmoded and has been replaced by the new CASPAR classification. Large patient surveys in Europe and the United States as mentioned by Professor Dubertret, having given an approximately 30% incidence of joint disease. However, I do believe this needs to be better elucidated. We do not have serological markers for psoriatic arthritis like we do for other arthridities, eg rheumatoid arthritis. We also, as mentioned in a previous discussion, do not have any true genetic markers for the various subtypes of psoriatic arthritis. Likewise, can we predict which patient with psoriatic arthritis will progress radiologically and clinically? Should MRIs be routine in patients with skin disease with mild clinical manifestations in an attempt to prevent further joint progression and disability? This is obviously a very expensive exercise and is currently being utilized more as an investigational tool to better understand the radiological manifestations of this form of spondyloarthritis.
Another question that I believe should be discussed is the use of the term “enthesitis”, ie inflammation of the tendon insertions, eg Achilles, and also possibly even smaller joints, ie hands and feet. Thus, immunopathologically speaking, psoriatic arthritis appears to be different from rheumatoid arthritis, even though there are clinical “overlaps” between these two.
Thus, I do believe that a list of questions should be developed by dermatologists, in concert with their rheumatology colleagues, to be evaluated at each and every clinical visit to the dermatologist so that appropriate treatments can be initiated. For too long, we as dermatologists have ignored psoriatic arthritis, when the majority of patients present to us with their skin manifestations 5-10 years before joint symptoms appear.|auteur215]
In 5 to 7% of patients suffering from psoriasis, a link is observed between the skin lesions and a particular inflammatory, enthesopathic rheumatism - psoriatic arthritis. Two recent surveys, one conducted among over 40,000 members of the US Psoriasis Association, the other among over 18,000 patients in Europe, found a 30% incidence of psoriatic arthritis. Half of these patients are being monitored by their dermatologist for skin lesions and rheumatism. Therefore, it is particularly important for dermatologists to know how to take care of this non-cutaneous aspect of psoriasis even though the best care calls, of course, for a close collaboration between dermatologist and rheumatologist.
[|The number of 5-7% may be too
low, more recent data suggest that at least one quarter of the patients may
have joint pain of joint inflammation.|auteur195]
In psoriatic arthritis the sex ratio is one. However, the forms displaying axial predominance are slightly more frequent in the male whereas the forms displaying peripheral predominance are more frequent in the female. Psoriatic arthritis seems to be more common when the psoriasis is severe and involves the nails.
The effects of rheumatism may be familial, so it is often associated with class-1 HLA antigens B36, 17, 27 and CW6. When confronted with an inflammatory rheumatism, the existence of psoriasis in the family, and especially of psoriatic arthritis, is of great diagnostic importance.
Psoriatic rheumatism usually begins around the age of forty, but it can start in childhood, particularly in girls. Early onsets are frequently more severe. In women, the postpartum and menopausal periods are common times for the onset of psoriatic arthritis. Finally, in about 8% of cases, the onset of psoriatic rheumatism is connected with some trauma. The first rheumatic lesions may appear in a very variable context: sometimes an acute onset mimicking the gout, or a very progressive appearance in the form of articular deformations virtually painless. The site of the first affected joints varies greatly.
Development proceeds by attacks, joint pains being predominant in the night and morning. They are associated with stiffness that requires a prolonged session of stretching.
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Recent publications on Psoriasis and Atopic Dermatitis
Seasonal variation in the internet searches for psoriasis.
Arch. Dermatol. Res.. 2019 Aug , 311, (6):461-467.
Some researches with different designs investigated the seasonal pattern of psoriasis; however, the seasonal variation in public interest in psoriasis has not yet been examined. The monitoring of internet search activity has increasingly been used to gain insights into public interest in health-related topics. The aim of the investigation is to employ the Google Trends datasets to evaluate whether a seasonal trend exists in the internet searches of psoriasis by the general public. In the (...)see on pubmed
Ginsenoside compound K ameliorates imiquimod-induced psoriasis-like dermatitis through inhibiting REG3A/RegIIIγ expression in keratinocytes.
Biochem. Biophys. Res. Commun.. 2019 Aug 06, 515, (4):665-671.
Psoriasis is a chronic inflammatory skin disease characterized by keratinocyte hyperproliferation. Ginsenoside compound K (CK), a bioactive metabolite of ginseng, modulates various skin disorders with an impact on keratinocyte biology. However, the effect of Ginsenoside CK in psoriasis has not been explored.see on pubmed
A vivid cytokines interaction model on psoriasis with the effect of impulse biologic (TNF-α inhibitor) therapy.
J. Theor. Biol.. 2019 Aug 07, 474:63-77.
Psoriasis is a chronic skin condition that produces plaques of condensed, scaling skin due to excessively rapid proliferation of keratinocytes. During the disease progression, keratinocyte proliferation is influenced by many immune cells and cytokines. This article deals with a five dimensional deterministic model, which has been derived using quasi-steady-state approximation for describing the dynamics of psoriasis in various cytokines environment. Equilibrium analysis of the system shows (...)see on pubmed
Rhamnus prinoides (gesho): A source of diverse anti-biofilm activity.
J Ethnopharmacol. 2019 Sep 15, 241:111955.
Rhamnus prinoides (gesho) is an evergreen shrub from East Africa traditionally used for the treatment of illnesses including atopic dermatitis, ear, nose and throat infections, pneumonia, arthritis, brucellosis, flu, indigestion and fatigue.see on pubmed
Gardenia jasminoides extract without crocin improved atopic dermatitis-like skin lesions via suppression of Th2-related cytokines in Dfe-induced NC/Nga mice.
J Ethnopharmacol. 2019 Sep 15, 241:112015.
Atopic dermatitis (AD) is a pruritic, chronic, relapsing inflammatory skin disease. Gardenia jasminoides extract (GJE) has been used as a traditional remedy for the treatment of various inflammatory diseases, including AD. The specific effects of the extract components, which include crocin, geniposidic acid, and gardenoside, on inflammatory responses in AD are not entirely (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed