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The prevalence of PsA among patients with psoriasis was relatively higher in Greece compared to other ethnic-based studies. Comorbidities related to life expectancy were more frequent. As there is a high percentage of undiagnosed cases with active arthritis among patients with psoriasis, dermatologists should be aware of PsA clinical signs in order to recognize it earlier and provide successful treatment.

Background: Lobomycosis, also known as Jorge Lobo's disease, represents a rare chronic subcutaneous mycosis caused by the fungus Lacazia loboi, an organism that is found within lesions but has not been cultured to date. The natural reservoir of L. loboi is unknown but it is believed to be aquatic, or associated with soil and vegetation. More than 550 human cases have been reported, especially in patients with a history of travel or residence in endemic areas (Central and South America, particularly Brazil) or in communities along rivers. Main observations:We describe a 64-year-old Greek female farmer living in a coastal region, who presented with an erythematous plaque on her left inner thigh resembling a keloid. The diagnosis was based on the triad: 1) absence of fungal growth in cultures, 2) positive direct microscopic examination of the lesion and 3) histopathology, all consistent with lobomycosis. Particularly, skin biopsy showed deep cutaneous fungal infection with granulomatous reaction. Fungal cells were found inside giant cells. The fungi were thick-walled with some budding, isolated or in short chains. Dermal fibrosis was present. Our patient had a medical history of common variable immunodeficiency but no history of travel to South or Central America. She probably acquired this rare infection by injury during her agricultural works. Conclusion:Our case represents probably the first documented case of human lobomycosis in Southeastern Europe. This case is unusual due to the rarity of lobomycosis in Mediterranean countries, particularly in Southeastern Europe. (J Dermatol Case Rep. 2012; 6(3): 65-69)

The phosphodiesterase 4 inhibitor apremilast is used for the treatment of psoriasis. We investigated the effects of apremilast on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in psoriasis. One hundred and fifty psoriatic patients were randomized to apremilast (n = 50), anti-tumor necrosis factor-α (etanercept; n = 50), or cyclosporine (n = 50). At baseline and 4 months post-treatment, we measured: (1) Perfused boundary region (PBR), a marker of glycocalyx integrity, in sublingual microvessels with diameter 5–25 μm using a Sidestream Dark Field camera (GlycoCheck). Increased PBR indicates damaged glycocalyx. Functional microvascular density, an index of microvascular perfusion, was also measured. (2) Pulse wave velocity (PWV-Complior) and (3) LV global longitudinal strain (GLS) using speckle-tracking echocardiography. Compared with baseline, PBR5–25 μm decreased only after apremilast (−12% at 4 months, p < 0.05) whereas no significant changes in PBR5–25 μm were observed after etanercept or cyclosporine treatment. Compared with etanercept and cyclosporine, apremilast resulted in a greater increase of functional microvascular density (+14% versus +1% versus −1%) and in a higher reduction of PWV. Apremilast showed a greater increase of GLS (+13.5% versus +7% versus +2%) than etanercept and cyclosporine (p < 0.05). In conclusion, apremilast restores glycocalyx integrity and confers a greater improvement of vascular and myocardial function compared with etanercept or cyclosporine after 4 months.

Background:Psoriatic arthritis (PsA) affects both sexes equally, however there seem to be significant differences in disease expression between the genders.Objectives:To investigate gender differences in disease manifestations, patient-reported outcomes and comorbidities among patients with PsA.Methods:This cross-sectional study of patients with PsA followed at an academic rheumatology outpatient clinic between 1/6/2017 and 1/12/2019. We compared clinical characteristics, patient-reported outcomes, disease activity and comorbidities in male and female patients with PsA. All patients were over 18 years of age and fulfilled the CASPAR criteria for PsA. Differences between gender in values of continuous variables were assessed by T-tests or Mann-Whitney tests. The association between categorical variables and gender was assessed by Pearson chi-square test or Fisher’s exact test.Results:135 patients, 83 (62%) women and 52 (38%) men were included. Factors studied for gender differences are shown in Table 1. Women had significantly more tender (11 vs 3 p 0.001) and swollen (10 vs 3, p 0.013) joints, worse VAS (Visual Analogue Scale 0-10) pain (6 vs 5, p <0.001), higher ESR (20 vs 11, p 0.001) and worse DAPSA(Disease Activity in Psoriatic Arthritis) (33 vs 18 p 0.006) and presented with more enthesitis (32.5% vs 13.5%, p 0.013). In contrast, men achieved Minimal Disease Activity (MDA) more frequently (26.9% vs 3.6% p<0.001)and had significantly more comorbidities than women. Polyarthritic disease was more frequent in women (62% vs 31%), although at non-significant levels.Conclusion:Male patients with PsA have more comorbidities, while female patients have greater disease activity, worse patient reported outcomes and achieve MDA less frequently.References:[1]Determinants of Patient-Reported Psoriatic Arthritis Impact of Disease: An Analysis of the Association with Gender in 458 Patients from 14 Countries.[2]Orbai AM, Perin J, et al Arthritis Care Res (Hoboken). 2019 Oct 14. doi: 10.1002/acr.24090.FactorWomen (n=83)Men (n=52)P valueMedian (25th-75thpercentile)Age55.1 (46.8-63)56.6 (50-65.7)0.419*BMI27.9 (24.9-35)30.1 (26.8-33.3)0.181#Pso duration/ PsA duration (years)8.3 (3.9-24.5)/ 2.4 (0-5.7)14.3 (4.7-22.7)/ 2.8 (0-6.4)0.451#/0.605#Smoking (Packyears)15 (5-30)27.5 (0-46)0.002#TJC/SJC11 (4-16)/ 10 (5-17)3 (0-13)/ 3 (0-14)0.001#/0.013#VASPain/ VASGA6 (5-8)/ 5 (3-6)5 (1-6)/ 4 (2-5)<0.001*/0.121*CRP/ ESR1.4 (0.4-3.2)/20(11-33)1.1 (0.2-2.7)/ 11 (7-18)0.398#/0.001#BSA/PASI0 (0-2)/0(0-2)2 (0-6)/1(0-4.8)0.139#/0.258#DAPSA33 (24.1-45)18 (9.3-45)0.006#n (%)Enthesitis/ Dactylitis27 (32.5)/ 20 (24.1)7 (13.5)/ 10 (19.2)0.013***/ 0.508***Dyslipidemia33 (40.2)31 (59.6)0.029***Liver3 (3.6)7 (13.5)0.046**Eyes0 (0)3 (5.8)0.055**Uricemia3 (3.6)8 (15.4)0.023**Depression or anxiety16 (19.3)11 (21.1)0.817***CAD2 (2.4)12 (23.1)<0.001**DM14 (16.9)12 (23.1)0.392MDA3 (3.6)14 (26.9)<0.001*: T-test with unequal variances;#: Mann-Whitney test; **: Fisher’s exact test; ***: Pearson chi2 test;Pso: Psoriasis; PsA: Psoriatic arthritis; BMI: Body mass index; TJC: Tender joint count; SJC: Swollen joint count; VASPain: Visual analogue scale 0-10 for pain; VASGA: Visual analogue scale 0-10 for general assessement; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; BSA: Body surface area; PASI: Psoriasis area severity index; DAPSA: Disease activity in psoriatic arthritis; CAD: Coronary artery disease; DM: Diabetes mellitus; MDA: Minimal disease activity;Disclosure of Interests:ALEXANDROS GRIVAS: None declared, IRENE KAPNIARI: None declared, KIMON TZANNIS: None declared, Dimitrios Tseronis: None declared, Michail Aggelakos: None declared, Dimitra Kassara: None declared, KATERINA HAVATZA: None declared, Sofia Flouda: None declared, Dionysis Nikolopoulos: None declared, Theofanis Karageorgas: None declared, EVAGELIA PAPADAVID: None declared, DIMITRIOS BOUMPAS Grant/research support from: Unrestricted grant support from various pharmaceutical companies, PELAGIA KATSIMPRI: None declared

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Background/Introduction Psoriatic arthritis is characterized by systemic inflammation leading to an increased risk of cardiovascular diseases. Purpose We aimed to investigate the effects of biologics on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in patients with psoriatic arthritis. Methods One hundred twenty patients (mean age: 51±11 years) with psoriatic arthritis were randomized to receive biologics [n=60; anti-tumor necrosis factor-α (etanercept, adalimumab, infliximab), anti-interleukin (IL)-12/23 (ustekinumab) or anti-IL-17 (secukinumab)] or nonbiologics (n=60; methotrexate or cyclosporine). At baseline and 4 months post-treatment, we measured: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates impaired glycocalyx integrity. (2) Pulse wave velocity (PWV - Complior; ALAM Medical), (3) Coronary flow reserve (CFR) in the distal left anterior descending coronary artery, (4) Flow-mediated dilation (FMD) of the brachial artery and (5) LV global longitudinal strain (GLS) using speckle-tracking echocardiography. Results Compared with baseline, all patients had reduced PWV (11±2.1 versus 10.3±1.5m/s, p=0.001) and increased FMD (5.45±3.2 versus 9.77±4.7, p=0.004) at 4 months. PBR remained unchanged in both study groups (p&gt;0.05). Compared with nonbiologics, biologics resulted in a greater reduction of PWV (−10% versus −4%) and in a greater increase of CFR (+11% versus −1%), FMD (+102% versus +56%) and GLS (+10% versus −2%) (p&gt;0.05 for all comparisons) 4 months post-treatment. In patients treated with biologics, the percent increase of GLS post-treatment was related with the percent reduction of PWV (r=−0.28, p=0.034) and with the percent increase of FMD (r=0.42, p=0.006). Conclusion In psoriasis arthritis, biologics confers a greater improvement of endothelial, vascular and LV myocardial function compared with nonbiologics after 4-month treatment. Funding Acknowledgement Type of funding sources: None.