[Show abstract][Hide abstract] ABSTRACT: Objective:
Update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA).
GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA patients based on consensus at face-to-face meetings and via online surveys. We published literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin, and nail disease), and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, with an online questionnaire.
Six overarching principles had at least 80% agreement among both health care professionals (HCPs; n=135) and patient research partners (PRPs; n=10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin, and nail disease, and comorbidities in the setting of PsA, using the GRADE process. Over 80% agreement was reached for approval of the individual recommendations and the overall schema.
Herein, we present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other HCPs, and PRPs). Further updates are anticipated as the therapeutic landscape in PsA evolves. This article is protected by copyright. All rights reserved.
Full-text · Article · Jan 2016 · Arthritis and Rheumatology
[Show abstract][Hide abstract] ABSTRACT: Psoriasis is a common, chronic inflammatory skin disease most often appearing in the form of well-demarcated, scaly plaques. These lesions highlight the fundamental processes underlying its pathogenesis, namely, inflammation and epidermal hyperproliferation. Both phenomena are considered consequences of an intimate interplay between the innate and the adaptive immune system. This concept is supported by results of genetic studies, pointing toward the signaling pathways of nuclear factor-κB, interferon-γ, and interleukin (IL)-23 as well as antigen presentation as central axes of the psoriatic inflammation. Efficacy of biologics targeting tumor necrosis factor-α, IL-23, or IL-17 provides further evidence in favor of this model.
No preview · Article · Sep 2015 · Rheumatic Disease Clinics of North America
[Show abstract][Hide abstract] ABSTRACT: Psoriasis primarily affects the skin, but also has a systemic dimension and is associated with severe comorbidities. Since endothelial cells play an important role in psoriasis as well as in the development of cardiovascular comorbidities, we investigated whether a common mechanism, namely cytokine-induced insulin resistance, underlies both pathologies. Activation of the insulin pathway was studied in psoriatic skin and dermal endothelial cells. Expression of adhesion molecules was assessed by flow cytometry, as well as their biological function in flow chamber experiments. The phosphorylation status of Akt, a central kinase in the insulin pathway, suggests that endothelial cells within psoriatic plaques are rendered insulin resistant by pro-inflammatory cytokines. Insulin counteracts the expression of adhesion molecules, but has limited effects on interactions between T cells and endothelial cells. Pro-inflammatory cytokines induce insulin resistance in endothelial cells, which may contribute to the development of the inflammatory infiltrate in psoriasis.
Preview · Article · Aug 2015 · Acta Dermato-Venereologica
[Show abstract][Hide abstract] ABSTRACT: Pseudomonas aeruginosa (PA) is a Gram-negative germ, responsible for severe infections. PA infected chronic wounds are a clinically highly relevant topic. PA has a natural resistance to many antibiotics, and there is no consensus on a first-line antibiotic to be used. In the context of chronic ulcers with an unfavorable evolution, we suggest intravenous antibiotic therapy, ideally on an in-patient basis. Given the sparse evidence from clinical trials, we heavily rely on clinical experience when it comes to managing chronic ulcers infected with PA.
[Show abstract][Hide abstract] ABSTRACT: Psoriasis has long been regarded to be one entity, comprising both plaque-type and non plaque-type manifestations. Genetic studies now provide evidence that some pustular forms should be classified separately: a mutation in the gene encoding for the interleukin 36 receptor antagonist (IL36Ra) was f6und to be associated with generalized pustular psoriasis (GPP) in several Tunesian families. This finding was subsequently confirmed in different psoriasis cohorts around the world. Additionally, gain-of-function mutations in the gene for CARD 14 were identified. Clinical implications comprise a different approach to treat GPP through blocking interleukin 1beta.
No preview · Article · Jan 2015 · Revue médicale suisse
[Show abstract][Hide abstract] ABSTRACT: Actinic keratosis (AK) affects millions of people worldwide, and its prevalence continues to increase. AK lesions are caused by chronic ultraviolet radiation exposure, and the presence of two or more AK lesions along with photodamage should raise the consideration of a diagnosis of field cancerization. Effective treatment of individual lesions as well as field cancerization is essential for good long-term outcomes. The Swiss Registry of Actinic Keratosis Treatment (REAKT) Working Group has developed clinical practice guidelines for the treatment of field cancerization in patients who present with AK. These guidelines are intended to serve as a resource for physicians as to the most appropriate treatment and management of AK and field cancerization based on current evidence and the combined practical experience of the authors. Treatment of AK and field cancerization should be driven by consideration of relevant patient, disease, and treatment factors, and appropriate treatment decisions will differ from patient to patient. Prevention measures and screening recommendations are discussed, and special considerations related to management of immunocompromised patients are provided.
Preview · Article · Dec 2014 · Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
[Show abstract][Hide abstract] ABSTRACT: Numerous guidelines and recommendations exist for the treatment of psoriasis in various populations. One important population is patients with psoriatic arthritis (PsA) who have symptoms of both joint and skin disease. In patients with both facets of psoriatic disease, skin and joints must be treated separately, but also simultaneously. As several systemic therapies are approved for either one or both, the concept of treating both facets with the same drug is feasible. This review summarizes evidence from studies in patients with PsA on the efficacy of these drugs on psoriatic skin disease in these patients.
No preview · Article · Nov 2014 · The Journal of Rheumatology
[Show abstract][Hide abstract] ABSTRACT: In the United States, access to care is the number one issue facing our patients with dermatological conditions. In part, this is because we do not have outcome measures that are useful in clinical practice and available in databases where payers and governmental agencies can compare the performance of physicians and treatments. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials and subsequently in clinical practice. The International Dermatology Outcome Measures group includes all willing stakeholders: patients, physicians, payers, and pharmaceutical scientists. As reported herein, the group's goal is to develop outcome measures in dermatology that address the needs of all involved.
No preview · Article · Jun 2014 · The Journal of Rheumatology
[Show abstract][Hide abstract] ABSTRACT: It is now well established that psoriatic disease is associated with increased cardiovascular (CV) risk. Screening guidelines and expert recommendations for CV risk factors have been published, but these are primarily directed to specific specialists (e.g., cardiologists or diabetologists) and may not be well known in common practice. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and other organizations are interested in adapting current comorbidity screening guidelines for use by dermatologists and rheumatologists. The resulting checklists and algorithms will need to be evaluated for practicability and performance.
No preview · Article · Jun 2014 · The Journal of Rheumatology
[Show abstract][Hide abstract] ABSTRACT: The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) organized its second Fellows Symposium adjacent to the European Academy of Dermatology and Venereology (EADV) congress in Istanbul in October 2013. Wolf-Henning Boehncke from Geneva, Brian Kirby from Dublin, and Diamant Thaci from Lübeck formed the faculty. The 9 best-ranked abstracts submitted to this symposium were presented and discussed in detail. Five abstracts focused on comorbidities in patients with psoriasis or psoriatic arthritis; summaries of all abstracts are included herein.
No preview · Article · Jun 2014 · The Journal of Rheumatology
[Show abstract][Hide abstract] ABSTRACT: Psoriasis is among the most common skin diseases, exhibiting a wide spectrum of clinical manifestations. Joint involvement in the form of psoriatic arthritis is readily recognised, but both frequency and severity of this manifestation have long been underestimated. More recently, additional important diseases have been found to be associated with psoriasis, including the metabolic syndrome (or components thereof), cardiovascular diseases, lymphoma, and anxiety/depression. In the past, psoriasis treatment aimed at suppressing acute rashes. Current concepts regard psoriasis as a chronic systemic inflammatory condition and cardiovascular risk factor. In the light of this concept, long-term disease control through systemic maintenance therapy is increasingly recommended by experts. This approach became feasible with the approval of numerous biologics for the treatment of psoriasis. But to really address all medical needs of psoriasis patients, a truly interdisciplinary, comprehensive management approach is needed. Several national societies have already published algorithms to ensure that this need will be implemented in the daily practice of dermatologists and nondermatologists alike.
[Show abstract][Hide abstract] ABSTRACT: The German psoriasis registry PsoBest records the long-term efficacy, safety, patient benefit and treatment regimens of psoriasis.
Patients with moderate or severe psoriasis are included in PsoBest when treatment with a conventional systemic agent or biologic is started for the first time. Observation time is five years. Standardized physician and patient case report forms are obtained every three to six months. Baseline data of patients included by 31 December 2012 are presented and compared to the national health care study PsoHealth 2007 (n = 2,009).
602 dermatology practices and clinics have been registered and 199 have recruited n = 2,556 patients (63 % by practices, 37 % by clinics). Initially, n = 808 received biologics (316 adalimumab, 34 efalizumab, 209 etanercept, 75 infliximab, 22 golimumab, 152 ustekinumab) and n = 1,651 conventional systemic therapy (928 fumaric acid esters, 518 methotrexate, 161 cyclosporine A, 191 other drugs or UV treatment). Compared to PsoHealth, patients in PsoBest had on average a higher disease severity (PASI 14.7 vs. 10.1; DLQI 11.0 vs. 7.5; EQ-5D VAS 54.0 vs. 64.5), shorter disease duration (18.2 vs. 21.3 yrs.), lower age (47.3 vs. 51.5), higher rates of psoriatic arthritis (20.5 vs. 19.1 %) and nail psoriasis (55.0 vs. 35.6 %). On average patients receiving biologics were younger, more often male and had higher disease severity and comorbidity.
Patients in PsoBest represent patients with a high burden of disease.
No preview · Article · Jan 2014 · Journal der Deutschen Dermatologischen Gesellschaft
[Show abstract][Hide abstract] ABSTRACT: Cytosolic Ca(2+) signals are performed by Ca(2+) releases from the endoplasmic reticulum and Ca(2+) influx from the extracellular medium. Releases rely on the refilling of the intracellular Ca(2+) stores by the Ca(2+) influx "Store Operated Ca(2+) Entry" (SOCE) via the channel Orai1. Here we show that Orai1 expression, SOCE amplitude and epidermal proliferation are decreased in the epidermis of patients with skin fragility when compared to aged non-atrophic skin. Epidermal atrophy was induced in mice by the inhibition of Orai1 with small interfering RNA and the topical application of a SOCE blocker, BTP2. The inhibition of Orai1 impaired the HB-EGF-induced Ca(2+) influxes and fully prevented the mitogen effect of HB-EGF in primary human keratinocytes (PHK). Importantly, epidermal proliferation correlated with Orai1 expression in mice. Conversely, the topical application of an Orai1-activator, the benzohydroquinone (BHQ), increased epidermal thickness and proliferation while the pro-proliferative effect of BHQ was prevented by the inhibition of Orai1. Finally, the topical application of BHQ reversed the epidermal atrophy induced by corticosteroids in mice. The topical modulation of Ca(2+) signals may thus be a promising therapeutic strategy in dermatology.Journal of Investigative Dermatology accepted article preview online, 6 December 2013. doi:10.1038/jid.2013.524.
No preview · Article · Dec 2013 · Journal of Investigative Dermatology