Pain Management in Painful Psoriasis and Psoriatic Arthropathy: Challenging and Intricately Intertwined Issues Involving Several Systems

Kodumudi, Vijay; Rajput, Kanishka

doi:10.1007/s11916-021-00952-5

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…Psoriasis cannot be treated as a disease confined to the skin, but often coexists with or may be associated with various comorbidities, such as metabolic syndrome, diabetes, atherosclerosis, respiratory disease, cognitive problems, heart disease or arterial hypertension [ 2 , 3 , 4 , 5 ]. Approximately 20–30% of patients with psoriasis may also have psoriatic arthritis, which often causes significant musculoskeletal pain that significantly impairs quality of life (QoL) [ 6 , 7 ]. In addition, people with psoriasis frequently experience skin pain and itch, which contributes to reduced QoL [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Sexual Dysfunction in Women and Men with Psoriasis: A Cross-Sectional Questionnaire-Based Study

et al. 2022

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Background and objectives: Psoriasis can lead to feelings of stigmatization, hinder social functioning, and impair quality of life. Psoriasis can also affect sexual activity, but there is still little research on this topic. The present study investigated whether and to what extent psoriasis, its severity, location and extent of skin lesions affect sexual dysfunction. Materials and Methods: A total of 45 women and 64 men aged 18 to 73 years hospitalized for psoriasis exacerbations were included in the study. Psoriasis severity, as assessed by the Psoriasis Area and Severity Index (PASI), ranged from 0.2 to 65 points (mean: 17.0 ± 14.9 points). After collecting demographic and clinical data, each subject was asked to complete the Dermatology Life Quality Index, the 11-item Sexual Life Questionnaire and the International Index of Erectile Function (only men). Results: Our study found that more than 90% of the patients surveyed felt at least a slight unattractiveness due to psoriasis. In approximately 80% of the subjects, the skin lesions at least occasionally affected their sex life, and more than 50% at least sometimes avoided sexual contact. The location of psoriasis, particularly in the genital area (p = 0.01), on the face (p = 0.03) and hands (p = 0.05), also had a significant impact on the level of sexual problems. Psoriasis has a significant impact on the quality of life (QoL), and a deterioration in QoL was strongly correlated with sexual dysfunction (r = 0.6, p < 0.001), PASI scores (r = 0.36, p < 0.001), self-assessment of psoriasis severity and location of psoriatic lesions. Conclusions: Psoriasis leads to various limitations, especially in the sphere of sexual life. Patients with psoriasis feel stigmatized, have lowered self-esteem and consequently experience significant sexual problems. Awareness of the co-occurring psychological aspect of psoriasis and the routine use of validated scales in dermatology practice should contribute to the rapid identification of patients with sexual dysfunction.

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Section: Introductionmentioning

confidence: 99%

Sexual Dysfunction in Women and Men with Psoriasis: A Cross-Sectional Questionnaire-Based Study

et al. 2022

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Interleukin 17 as a central component of the pathogenesis of pain associated with immunoinflammatory process: А new “target” of pharmacotherapy

Karateev,

Polishchuk,

Dubinina

2024

Naučno-praktičeskaâ revmatologiâ

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Modern pathogenetic therapy of inflammatory rheumatic diseases (IRD) is aimed not only at reducing disease activity (although achieving remission and low disease activity remains the main goal of treatment), but also at eliminating as quickly and completely as possible the main symptoms that cause a decrease in the quality of life of patients. Particular importance is attached to effective control of chronic pain – the main and most distressing manifestation of IRD. To solve this problem, the pathogenesis of chronic pain in IRD continues to be actively studied, aimed at finding new ”targets” of pharmacotherapy. Thus, the role of central sensitization (CS) and comorbid fibromyalgia in the formation of clinical manifestations of IRD is now clearly proven. Signs of CS, depending on the instrument of its detection, are determined in 20–40% of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA).Interleukin (IL) 17 plays a fundamental role in the development of chronic pain in IIRD. This cytokine takes a leading position in the development of the ”cytokine cascade”, inducing the synthesis of various cytokines and chemokines, as well as chemotaxis and activation of neutrophils and T cells. Induction of synthesis of inflammatory mediators (including prostaglandin E2) determines the role of IL-17 in activation of nociceptors and their sensitization. IL-17 also takes an active part in neuroimmune interactions by activating glia cells and affecting receptors present on the membrane of neurons of the posterior horns of the spinal cord. This defines the role of IL-17 as one of the inductors of CS development. Pharmacologic blockade of IL-17 is a known pathway to suppress the activity of IIRPs such as PsA and AxSpA. However, this mechanism also allows for significant effects on chronic pain. In particular, the IL-17 inhibitor ixekizumab has shown high analgesic potential in a series of studies in PsA and AxSpA (SPIRIT-P1 and SPIRIT-P2, COAST V and COAST W). It is important to note that this drug demonstrated a very rapid analgesic effect: pain intensity was significantly reduced already 7 days after the first injection. These data suggest a specific effect of ixekizumab on the nociceptive system, independent of the anti-inflammatory effect. This fact allows us to consider ixekizumab as a drug of choice for the treatment of patients with PsA and AxSpA who experience severe pain and have signs of CS and fibromyalgia.

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Pain Management in Painful Psoriasis and Psoriatic Arthropathy: Challenging and Intricately Intertwined Issues Involving Several Systems

Cited by 2 publications

References 36 publications

Sexual Dysfunction in Women and Men with Psoriasis: A Cross-Sectional Questionnaire-Based Study

Sexual Dysfunction in Women and Men with Psoriasis: A Cross-Sectional Questionnaire-Based Study

Interleukin 17 as a central component of the pathogenesis of pain associated with immunoinflammatory process: А new “target” of pharmacotherapy

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