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ABSTRACT: OBJECTIVE: To identify soluble biomarkers associated with response to therapy with tumor necrosis factor inhibitors (TNFi) in patients with psoriatic arthritis (PsA). METHODS: The study was conducted at a PsA clinic where patients are assessed every 6 months, and serum samples are collected and stored once a year at the time of clinical assessment. Forty patients with active PsA who gave serum samples prior to treatment with TNFi and after at least 3 months of therapy were identified. Patients were classified as TNFi responders if tender joint count was < 3, swollen joint count was 0, and Psoriasis Area and Severity Index score was < 4 at the time the second sample was collected. The following biomarkers were tested by ELISA: TNF superfamily 14, matrix metalloprotease-3 (MMP-3), receptor activator of nuclear factor kappa-B ligand, osteoprotegerin, cartilage oligomeric matrix protein (COMP), CPII, C2C and C1-2C, CS-846, and highly sensitive C-reactive protein. Paired t tests and logistic regression was used for statistical analyses. RESULTS: After a mean treatment duration of 11 months with TNFi (etanercept 28 patients, adalimumab 6, golimumab 4, infliximab 2), 29 patients were classified as TNFi responders. Baseline level of MMP-3 was independently associated with responder status (OR 1.067 for each 1-unit increase, p = 0.045). A reduction in MMP-3 levels with therapy increased the odds of achieving response (OR 1.213 for each 1-unit change, p = 0.030), whereas a reduction in COMP decreased the odds (OR 0.587, for each 100-unit increase, p = 0.039). None of the other biomarkers was associated with response. CONCLUSION: Baseline as well as reduction in serum MMP-3 and increase in serum COMP are independently associated with response to TNFi therapy in patients with PsA.
The Journal of Rheumatology 05/2013; · 3.69 Impact Factor
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ABSTRACT: AIM: To determine whether tumour necrosis factor α (TNFα) blockers are more effective than methotrexate in inhibiting the progression of radiographic joint damage in patients with psoriatic arthritis (PsA). METHODS: A cohort analysis of patients followed prospectively in a large PsA clinic was conducted. Patients who received a TNFα blocker were compared to those treated with methotrexate. Patients who had records of at least 12 months of treatment with either medication for active peripheral PsA and had radiographic bone erosions were analysed. Radiographs of the hands and feet were performed at baseline, 1-2 years (time 1) and 3-4 years (time 2). Radiographic joint damage was scored according to the modified Steinbrocker score. The outcome of interest was the occurrence of radiographic progression. Multivariate logistic regression analysis using generalised estimating equations for repeated measures was used to compare progression in radiographic joint damage between the two treatment groups. RESULTS: 65 patients treated with TNFα blockers and 70 patients treated with methotrexate were analysed. The proportion of patients who demonstrated progression of radiographic damage score at time 1 and time 2 was higher in the methotrexate group compared to the TNFα blockers group (at time 1: 80% vs 58.9% p=0.005; at time 2: 88% vs 61% p=0.005). In the multivariate regression analysis methotrexate treatment was associated with an increase in radiographic damage compared to TNFα blockers (p=0.001). CONCLUSIONS: In a clinic setting, patients with erosive PsA receiving TNFα blockers had a better radiographic outcome compared to those treated with methotrexate.
Annals of the rheumatic diseases 04/2013; · 8.11 Impact Factor
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ABSTRACT: Objective. We aimed to determine the degree of agreement between patient self-report and physician assessment of joint disease activity and damage and degree of skin disease.Methods. Patients were followed up in the PsA clinic for homunculus for tender joints, swollen joints, deformed joints and problematic joints, as well as the severity of their psoriasis. A rheumatologist documented tender joints, swollen joints and damaged joints as well as psoriasis area and severity index score. The scores were compared using the concordance correlation coefficient and Bland-Altman plots were constructed.Results. One hundred and forty outpatients participated in the study (60 females and 80 males) with a mean age of 52.8 years. Their mean age at onset of psoriasis was 27.4 years and at PsA onset was 36.9 years. The average duration of psoriasis at the time of the study was 25.3 years and of PsA was 16.2 years. The correlation between patient and physician scores was poor for tender and swollen joints, although it was better for deformed joints and psoriasis area and severity index score but still did not reach a level of good agreement.Conclusion. PsA patient's self-report has a poor correlation with physician assessment. Thus patient self-reported data are insufficient to accurately monitor PsA disease activity when compared with a physician's joint examination and skin score. Expert physical examination should remain the gold standard for the assessment of actively inflamed joint and skin disease in patients with PsA in both clinical trials and observational cohort studies.
Rheumatology (Oxford, England) 12/2012; · 4.24 Impact Factor
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ABSTRACT: OBJECTIVE: To compare the prevalence of metabolic syndrome (MetS) and the levels of related biomarkers in patients with psoriatic arthritis (PsA) and psoriasis without arthritis (PsC). METHODS: This study compared patients with PsA and patients with PsC. The presence of MetS was determined. Serum levels of insulin, adiponectin and leptin were measured. The homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. HOMA-IR, adiponectin and leptin were log-transformed. Continuous variables were compared using the t test and the χ(2) test was used for discrete variables. Multivariate regression models were used to investigate the association of MetS and adiponectin with PsA compared to PsC after adjusting for potential confounding variables. RESULTS: 203 PsA and 155 PsC patients were analysed. The prevalence of MetS was higher in PsA patients compared to those with PsC. However, this did not reach statistical significance (36.5% vs 27.1%, p=0.056). The levels of adipokines were significantly higher in PsA compared to PsC: adiponectin (8.8±5.2 vs 7.4±4.5 log (µg/ml), p=0.009) and leptin in women (3.1±0.8 vs 2.8±0.8, log (ng/ml), p=0.04). HOMA-IR was also higher in PsA (0.97±0.63 vs 0.68±0.81, p<0.001). No difference was observed in leptin levels in men. In multivariate regression analysis, PsA (p=0.04) and the psoriasis area and severity index score (p=0.02) were associated with MetS. Adiponectin was significantly associated with PsA (p=0.005), the use of anti-tumour necrosis factor α therapy (p=0.03) and active joint count (p=0.001). CONCLUSIONS: MetS and related adipokines correlated with an increased burden of skin and joint inflammation.
Annals of the rheumatic diseases 12/2012; · 8.11 Impact Factor
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ABSTRACT: To determine the presence of psoriasis and psoriatic arthritis (PsA) in aboriginal people living in the Andean Mountains of Peru.
Consecutive patients with psoriasis and PsA attending an arthritis clinic in Juliaca, Puno, Peru, located 3824 m above sea level were examined. The CASPAR (ClASsification of Psoriatic ARthritis) criteria were used for classification of PsA. Diagnosis of psoriasis was confirmed by a dermatologist.
Seventeen patients [11 (65%) men and 6 (35%) women] fulfilled classification criteria for PsA; one patient was of European ancestry and is not included in this report. Of the 16 aboriginal patients in this report, 5 were natives of Quechua ancestry and one was native Aymara. At the time of their first clinic visit, no native patient with PsA had a family history of psoriasis or PsA, and all patients exhibited an established disease of long duration and severity. Methotrexate was the drug of choice for all patients; 2 patients are currently receiving biological therapy.
Contrary to what has been reported in the literature, both psoriasis and PsA are present in aboriginal people from the Andean Mountains of Peru. More studies are needed to further define the phenotype of these disorders, as well as the pathogenetic role of genetic and environmental factors.
The Journal of Rheumatology 11/2012; 39(11):2216-9. · 3.69 Impact Factor
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Azza Eissa,
Daniela Cretu,
Antoninus Soosaipillai,
Arane Thavaneswaran,
Fawnda Pellett,
Anastasia Diamandis,
Ferda Cevikbas,
Martin Steinhoff,
Eleftherios P Diamandis,
Dafna Gladman, Vinod Chandran
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ABSTRACT: Abstract Background: About 30% of cutaneous psoriasis (PsC) patients develop psoriatic arthritis (PsA) in the joint, which is under-recognized by dermatologists. Biomarkers for PsA are needed so that early referral to a rheumatologist is made. Kallikreins (KLKs) are secreted serine proteases implicated in skin desquamation and inflammation. This study examined KLK potential as serum biomarkers of PsA in cutaneous psoriasis patients. Methods: KLKs were measured by ELISAs in synovial fluids of three PsA patients and three control early osteoarthritis (OA) patients, as well as in a cohort of 152 serum samples collected from age- and sex-matched PsC patients, with (n=76) or without PsA (n=76). KLK expression in psoriatic plaques was examined by immunohistochemistry. Univariate and multivariate logistic regression analyses were conducted to analyze the association between serum KLK levels and disease class (PsC, PsA). Serum KLKs that associated with PsA were correlated with clinical parameters of skin and joint activity. Results: Among the seven KLKs tested, KLK6 and KLK8 were elevated in both PsA synovial fluids and psoriatic plaques, but only serum KLK8 levels were associated with psoriatic disease (odds ratio=2.56, p=0.03). Although significantly elevated in PsC and PsA sera compared to healthy controls, KLK8 did not discriminate PsA from PsC patients. KLK8 correlated positively with the psoriasis area and severity index (PASI) (r=0.43, p=0.001) independent of age, sex and psoriasis duration (β=1.153, p=0.0003) and exhibited no correlations with tender or swollen joint counts. Conclusions: Increased KLK8 serum level in PsA patients reflects disease activity in the skin but not in the joints. Serum KLK levels are not useful for screening psoriasis patients for PsA.
Clinical Chemistry and Laboratory Medicine 08/2012; · 2.15 Impact Factor
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ABSTRACT: We aimed to determine disease severity and treatment of patients with psoriatic arthritis (PsA) in rheumatology practices in Canada through the PsA Assessment in Rheumatology (PAIR) study.
Rheumatologists who were members of the Canadian Rheumatology Association were asked to complete a form for each patient addressing demographic questions, history, clinical examination, and patient-reported outcomes. Results were compared with a cohort seen in a PsA clinic during the same period.
From across Canada, 22 rheumatologists from 5 provinces submitted information about 233 consecutive patients with PsA [145 men (62.2%), 88 women (37.8%), mean age 53.2 yrs (±12.7), 88.4% disease duration>2 yrs]. A majority (80.7%) fulfilled ClASsification for Psoriatic ARthritis (CASPAR) criteria, and 30% had taken no disease-modifying antirheumatic drugs. Clinical joint damage was documented in 60% of the patients, active skin disease in 70%, and nail lesions in 32%. Only 22% were rated as having moderate to high disease activity, while 52% were rated as low disease activity and 26% were deemed in remission. The decision was based on joint counts, patient global assessment, physician global assessment, and acute-phase reactants. Twenty-seven percent of the patients were to have their medications changed based on the current visit, the majority for inadequate response to medications. Patients in the PAIR cohort had more inflamed joints but similar damage to those in the PsA clinic.
Patients with PsA seen in regular rheumatology practice fulfill CASPAR criteria, have active disease, and more than half have joint damage. The majority have low activity or are in remission.
The Journal of Rheumatology 08/2012; 39(9):1850-3. · 3.69 Impact Factor
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ABSTRACT: AIM: To compare the extent of atherosclerosis in patients with psoriatic arthritis (PsA) and patients with cutaneous psoriasis without arthritis (PsC). METHODS: In this cross-sectional study the authors compared patients with PsA with PsC patients. Psoriasis patients underwent a rheumatological assessment to exclude inflammatory arthritis. Ultrasonographic measurements of carotid total plaque area (TPA) and carotid intima-media thickness (cIMT) were performed. t Test was used to compare the imaging findings between the two groups. Multivariate linear regression analysis was used to assess the association between disease status and imaging findings after adjusting for potential confounders. RESULTS: Overall, 125 PsA and 114 PsC patients were compared. There were no significant differences in age, gender or cardiovascular risk factors between the two groups. Patients with PsA exhibited greater TPA than did PsC patients (TPA (square root of area in mm(2)) 3.33±3.34 vs 2.43±2.72, p=0.03). This difference remained statistically significant in the multivariate regression analysis after adjusting for potential confounders (p=0.03). The difference in cIMT between the groups did not achieve statistical significance (p=0.09). The following disease-related variables were associated with increase in TPA in multivariate regression analysis among PsA patients: duration of PsA (p=0.04), highest Psoriasis Area and Severity Index recorded in the first 3 years of follow-up (p=0.02) and erythrocyte sedimentation rate (p=0.005). CONCLUSIONS: PsA patients suffer from more severe subclinical atherosclerosis compared with patients with PsC. This difference is independent of traditional cardiovascular risk factors and correlates with PsA disease duration, more severe skin disease and increased inflammatory markers.
Annals of the rheumatic diseases 06/2012; · 8.11 Impact Factor
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ABSTRACT: OBJECTIVE: The authors aimed to assess gender-related differences in severity of psoriatic arthritis (PsA) as reflected by measures of disease activity, joint damage, quality of life and disability. METHODS: A cross-sectional analysis was performed among patients who have been followed in a large PsA clinic. Demographic, clinical and radiographic data as well as information about quality of life and function were retrieved from the clinic database. Radiographic damage was assessed according to modified Steinbrocker score (mSS). The association between gender and the following outcome variables, radiographic joint damage, axial involvement and measures of quality of life and function, was assessed by multivariate regression analysis after adjustment for potential confounders. RESULTS: Three hundred and forty-five men and 245 women were included in the study. Axial involvement was more frequent in men (42.9% vs 31%, p=0.003). In multivariate analysis, adjusting for potential confounders, men were more likely to develop axial involvement (OR 1.8, p=0.003). Men were also more likely to develop more severe radiographic damage in the peripheral joints as evident by mSS. Men were more likely to be in a higher mSS damage category compared with women after adjusting for potential confounders in multivariate analysis (OR 1.6, p=0.007). Women suffered from more severe limitations in function and worse quality of life compared with men based on several patients' reported outcomes. CONCLUSIONS: Men with PsA are more likely to develop axial involvement and radiographic joint damage, while women are more likely to report about limitation in function and impaired quality of life.
Annals of the rheumatic diseases 05/2012; · 8.11 Impact Factor
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ABSTRACT: A recent population-based study identified several HLA alleles as conferring a risk for psoriatic arthritis (PsA) among patients with psoriasis. The authors aimed to confirm these results using a family-based association study.
PsA probands, psoriasis probands and their first-degree family members were included. All participants were evaluated for the presence of psoriasis and inflammatory arthritis. HLA-B and -C genotyping was performed. The family-based association test was used to test for differences between PsA and psoriasis patients in transmission of candidate alleles from parents to offspring.
A total of 178 PsA and 30 psoriasis probands and 561 first degree family members were analysed. The following HLA alleles were over-transmitted to PsA compared with psoriasis: HLA-C*12 (p=0.005), HLA-B*38 (p=0.04), HLA-B*39 (p=0.03), HLA-B*27 (p=0.002).
HLA-B*27, HLA-B*38, HLA-B*39 and HLA-C*12 alleles are potential PsA-specific genetic markers among patients with psoriasis.
Annals of the rheumatic diseases 05/2012; 71(8):1361-5. · 8.11 Impact Factor
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Catherine T Jordan,
Li Cao,
Elisha D O Roberson,
Shenghui Duan,
Cynthia A Helms,
Rajan P Nair,
Kristina Callis Duffin,
Philip E Stuart,
David Goldgar,
Genki Hayashi, [......],
Michelle A Lowes,
Lynette Peddle, Vinod Chandran,
Wilson Liao,
Proton Rahman,
Gerald G Krueger,
Dafna Gladman,
James T Elder,
Alan Menter,
Anne M Bowcock
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ABSTRACT: Psoriasis is a common inflammatory disorder of the skin and other organs. We have determined that mutations in CARD14, encoding a nuclear factor of kappa light chain enhancer in B cells (NF-kB) activator within skin epidermis, account for PSORS2. Here, we describe fifteen additional rare missense variants in CARD14, their distribution in seven psoriasis cohorts (>6,000 cases and >4,000 controls), and their effects on NF-kB activation and the transcriptome of keratinocytes. There were more CARD14 rare variants in cases than in controls (burden test p value = 0.0015). Some variants were only seen in a single case, and these included putative pathogenic mutations (c.424G>A [p.Glu142Lys] and c.425A>G [p.Glu142Gly]) and the generalized-pustular-psoriasis mutation, c.413A>C (p.Glu138Ala); these three mutations lie within the coiled-coil domain of CARD14. The c.349G>A (p.Gly117Ser) familial-psoriasis mutation was present at a frequency of 0.0005 in cases of European ancestry. CARD14 variants led to a range of NF-kB activities; in particular, putative pathogenic variants led to levels >2.5× higher than did wild-type CARD14. Two variants (c.511C>A [p.His171Asn] and c.536G>A [p.Arg179His]) required stimulation with tumor necrosis factor alpha (TNF-α) to achieve significant increases in NF-kB levels. Transcriptome profiling of wild-type and variant CARD14 transfectants in keratinocytes differentiated probably pathogenic mutations from neutral variants such as polymorphisms. Over 20 CARD14 polymorphisms were also genotyped, and meta-analysis revealed an association between psoriasis and rs11652075 (c.2458C>T [p.Arg820Trp]; p value = 2.1 × 10(-6)). In the two largest psoriasis cohorts, evidence for association increased when rs11652075 was conditioned on HLA-Cw*0602 (PSORS1). These studies contribute to our understanding of the genetic basis of psoriasis and illustrate the challenges faced in identifying pathogenic variants in common disease.
The American Journal of Human Genetics 04/2012; 90(5):796-808. · 10.60 Impact Factor
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ABSTRACT: To determine whether there is seasonal variation in disease activity of patients with psoriatic arthritis (PsA).
The authors identified the first available set of consecutive summer and winter visits for every patient from the prospective cohort of PsA. Comparison between summer and winter visits, and comparison of the repeated summer/winter visits, from 1978 until 2011 for the same identified patients was conducted for demographics, disease activity outcomes, laboratory results and treatment. The authors categorised disease activity into high, moderate and low states, and improvement versus flare/worsening. Descriptive statistics were computed and multivariate analyses using logistic regression and generalised estimating equations were conducted.
The first available summer and winter visit were identified for 253 patients, and 1789 observations were analysed. There was no statistically significant difference in patients' demographics, disease activity outcomes, laboratory results and treatment between summer and winter visits. Bath Ankylosing Spondylitis Disease Activity Index scores were greater for summer visits and patients graded their disease as being worse in winter as compared with summer in the univariate analysis, but this difference did not hold in the multivariate analysis.
The change in season does not affect PsA patients' characteristics and disease activity outcomes as determined by the physicians and patients.
Annals of the rheumatic diseases 04/2012; 71(8):1370-3. · 8.11 Impact Factor
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ABSTRACT: Biomarkers may be used to screen patients with psoriasis for psoriatic arthritis (PsA) and to assess disease activity and severity. Candidate biomarkers should fulfil the key features of the OMERACT (Outcome Measures in Rheumatology) filter, that is, truth, discrimination, and feasibility. A number of biomarkers are currently being investigated in psoriatic disease for important clinical outcomes. Serum high sensitivity C-reactive protein, cartilage oligomeric matrix protein, interleukin 6 (IL-6), osteoprotegerin, matrix metalloprotease-3 (MMP-3), and the ratio of C-propeptide of type II collagen (CPII) to collagen fragment neoepitopes Col2-3/4 (long mono) (C2C) show promise as serum biomarkers that distinguish subjects with PsA from those with psoriasis alone. Serum MMP-3 and melanoma inhibitory activity, synovial fluid IL-1, IL-1 receptor-α, IL-6, IL-8, and chemokine CCL3 and synovial tissue CD3-positive T cells may prove useful as biomarkers of PsA activity. Circulating osteoclast precursors, Dickkopf-1, macrophage colony stimulating factor, receptor activator of nuclear factor-κB ligand, and bone alkaline phosphatase are strong candidates as biomarkers of radiographic change. Prospective studies to identify biomarkers for psoriatic disease are high on the research agenda of the Group for Research and Assessment of Psoriasis and PsA.
The Journal of Rheumatology 02/2012; 39(2):427-30. · 3.69 Impact Factor
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ABSTRACT: PsA is an inflammatory arthritis present in ∼30% of people with psoriasis (PsC). Both conditions have a significant impact on quality of life (QoL). Our objective was to test the hypothesis that people with PsA have poorer QoL than patients with PsC because of the added burden of arthritis, age and comorbidities.
Consecutive patients with PsA (CASPAR criteria) and PsC were approached to participate in this study. Patients with PsC were examined by a rheumatologist using a standardized protocol to exclude PsA. Patients completed the HAQ, Medical Outcome Study 36-item Short Form Health Survey, Dermatology Life Quality Index (DLQI), EuroQoL 5 domains (EQ-5D) and Fatigue Severity Scale (FSS). Mean scores were compared and multivariate analyses were conducted to compare the QoL measures between the two patient groups.
Two hundred and one patients with PsC and 201 patients with PsA were studied. A significant decrease in QoL for patients with PsA compared with those with PsC was identified by all questionnaires except for the DLQI. This skin-specific questionnaire revealed a lower QoL in patients with PsC. Multivariate analyses for each QoL measure confirmed the results of these analyses. After adjusting for age, sex, duration of PsC, comorbidities, DMARDs and biologic therapy, HAQ and DLQI were independently associated with PsA in a logistic regression.
Patients with PsA have a poorer QoL compared with those with PsC as measured by all questionnaires except the DLQI.
Rheumatology (Oxford, England) 12/2011; 51(3):571-6. · 4.24 Impact Factor
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ABSTRACT: The tumor necrosis factor-alpha-induced protein 3 (TNFAIP3) gene has been associated with psoriasis, rheumatoid arthritis, type 1 diabetes mellitus, systemic lupus erythematosus, and celiac disease. TNFAIP3 encodes A20, a tumor necrosis factor (TNF)-α-inducible zinc finger protein thought to limit NF-κB-mediated immune responses. In this study, we report association of response of psoriasis to TNF blockers with two TNFAIP3 single-nucleotide polymorphisms (rs2230926 in exon 7 and rs610604 in intron 3) and their haplotypes. Treatment response was self-evaluated using a 0-5 visual analog scale in 433 psoriasis patients who received TNF blockers. Confirmation was sought in 199 psoriasis and psoriatic arthritis patients from Toronto who were followed up prospectively. Response variables were dichotomized separately in the two cohorts, yielding similar proportions of good responses. Whereas significant associations were observed only for the Michigan cohort, fixed-effects meta-analysis retained significant association between dosage of the G allele of rs610604 and good combined response to all TNF blockers (odds ratio (OR) = 1.50, P(corr) = 0.050) and etanercept (OR = 1.64, P(corr) = 0.016). The rs2230926 T-rs610604 G haplotype was similarly associated. By demonstrating an association with therapeutic response, these results provide a clinically relevant functional correlate to the recently described genetic association between psoriasis and TNFAIP3.
Journal of Investigative Dermatology 11/2011; 132(3 Pt 1):593-600. · 6.31 Impact Factor
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ABSTRACT: Patients followed in observational cohorts often complete patient-reported outcomes on paper questionnaires. With advances in technology, Web-based (WB) formats have been developed. The aims of our study were to determine whether WB and paper-based questionnaires (PB) completed by patients followed in the psoriatic arthritis (PsA) clinic are comparable; whether there is a patient preference for one method or the other; and whether any preference is related to patient characteristics.
Consecutive patients followed at the PsA clinic completed the Health Assessment Questionnaire, Medical Outcomes Study Short Form-36, fatigue scale, Dermatology Life Quality Index, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Instrument, and EQ-5D both on paper (PB) and on computer by Internet (WB). Patients were also asked to complete questionnaires regarding their preference for one method or the other. Descriptive statistics and interclass correlation coefficients (ICC) were calculated.
Of 110 patients who agreed to participate, 67 (57.3%) successfully completed both PB and WB questionnaires. These patients did not differ from those who did not complete the questionnaires. WB and PB questionnaires took the same length of time to complete, with 20% of the patients complaining of more pain following completion of the questionnaires, more so with the PB. There was excellent agreement between the PB and WB (ICC 0.89-0.97) for all questionnaires.
The PB and WB versions of 10 standardized self-administered questionnaires in patients with PsA were comparable. The WB format was well accepted by PsA outpatients. Patients may thus be offered a choice of format as well as the choice to complete the questionnaires either in the clinic or remotely by Internet.
The Journal of Rheumatology 11/2011; 38(12):2619-24. · 3.69 Impact Factor
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ABSTRACT: Objective. Vitamin D insufficiency appears to be a pandemic problem and is more common in inhabitants of high latitude compared to low latitude areas. We aimed to determine the prevalence of vitamin D deficiency/insufficiency in patients with psoriatic arthritis (PsA), its seasonal and geographic variation, and the possible association with demographics and disease activity.Methods. This study was conducted in a northern geographic area and in a subtropical region from March 2009 to August 2009. Most subjects were assessed in both winter and summer. Demographics, clinical data, skin photo type, and serum 25-hydroxyvitamin D (25[OH]D) levels were determined. Multivariate linear and logistic mixed models were used to assess the relationship with serum 25(OH)D levels.Results. In total, 302 PsA patients were enrolled. Two hundred fifty-eight patients were evaluated during the winter,while 214 patients were evaluated during the summer. 25(OH)D levels in winter and summer were adequate (north: 41.3%winter and 41.4% summer, south: 42.1% winter and 35.1% summer), insufficient (north: 55.7% winter and 58.6% summer,south: 50.9% winter and 62.2% summer), and deficient (north: 3% winter and 0% summer, south: 7% winter and 2.7%summer) among patients. There was no association between 25(OH)D levels, geographic and seasonal interaction, race,employment status, and skin photo type or disease activity in both seasons. No association between disease activity in summer and vitamin D levels in winter could be found.Conclusion. A high prevalence of vitamin D insufficiency among PsA patients was found. There was no seasonal variation in 25(OH)D levels among PsA patients in the southern and northern sites. No association could be established between disease activity and vitamin D level.
Arthritis care & research. 10/2011; 63(10):1440-7.
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ABSTRACT: To investigate the association between smoking and psoriatic arthritis (PsA) among patients with psoriasis and its interaction with the HLA-C*06 allele.
In this exploratory case-control study, smoking status was determined at the time of the diagnosis of arthritis for PsA patients and at their first study visit for psoriasis patients, when they were confirmed not to have PsA. The proportions of patients exposed to smoking were compared in patients with PsA to those with psoriasis alone. A logistic regression model was constructed to test the independent association of smoking and PsA after adjusting for potential confounders. The statistical interaction between HLA-C*06 and smoking was tested through a regression model.
The proportions of current and past smokers were higher in the psoriasis group compared with the PsA group (30.2% vs 23.4% and 26.7% vs 22.3%, p=0.001, respectively). On multivariate analysis being a current smoker versus a lifetime non-smoker remained inversely associated with PsA (OR 0.57, p=0.002), while past smoker versus lifetime non-smoker status was no longer significant. In a subgroup analysis, smoking remained inversely associated with PsA only among patients who were HLA-C*06 negative. Regression analysis revealed that the interaction between smoking status (ever smoked vs lifetime non-smoker) and HLA-C*06 was statistically significant (p=0.01).
Smoking may be inversely associated with PsA among psoriasis patients. This association is not present among HLA-C*06-positive individuals.
Annals of the rheumatic diseases 09/2011; 71(2):219-24. · 8.11 Impact Factor
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ABSTRACT: This investigation aimed to determine whether patients presenting to a psoriatic arthritis (PsA) clinic early in the course of the disease had less severe disease at presentation, and whether disease duration at presentation predicts progression of joint damage.
Patients followed prospectively in a specialised clinic were divided into those first seen within 2 years of diagnosis (group 1) and those seen with more than 2 years of disease (group 2). The groups were compared with regard to demographics and disease characteristics at presentation. A multivariate analysis using a negative binomial model was conducted to determine whether patients with early disease had less progression of joint damage.
436 patients were identified in group 1 and 641 patients in group 2. Patients in group 2 were older, had longer duration of psoriasis and PsA, more joint damage and were less likely to be treated with disease-modifying antirheumatic drugs, but had similar level of education and degree of psoriasis severity. After adjusting for age, sex, education level, clinical joint damage at first visit and treatment, group 2 had significantly greater rate of clinical damage progression compared with group 1.
Disease progression is more marked in patients presenting with established disease of more than 2 years' duration. These results suggest that patients with PsA should be treated earlier in the course of their disease.
Annals of the rheumatic diseases 09/2011; 70(12):2152-4. · 8.11 Impact Factor
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ABSTRACT: To determine whether the presence of psoriatic arthritis (PsA) is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis.
Six hundred eleven patients with PsA were recruited from the University of Toronto Psoriatic Arthritis Clinic and 449 psoriasis without arthritis patients were recruited from the University of Toronto Psoriasis Cohort. The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both PsA and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios (ORs), comparing the odds of ever having a given comorbid disease in PsA patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities.
The prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus, and at least 1 cardiovascular event in PsA patients was 37.1%, 30.0%, 20.7%, 12.0%, and 8.2%, respectively. This was significantly higher than in psoriasis without arthritis patients, with unadjusted ORs ranging from 1.54 to 2.59. In the multivariate analyses, hypertension remained significantly elevated (adjusted OR 2.17). PsA was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted ORs 2.83, 4.76, 21.53, and 7.74, respectively). Infections treated with antibiotics and depression/anxiety were relatively common in PsA, with a prevalence of 30.5% and 20.7%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments.
The results suggest that inflammatory joint disease may play a role in both cardiovascular and noncardiovascular morbidity in PsA.
Arthritis care & research. 09/2011; 63(12):1729-35.
