Psoriatic arthritis as a distinct disease entity

Leung, YY; Tam, Lai‐Shan; Kun, E; Ek, Li

doi:10.4103/0022-3859.30334

Cited by 35 publications

(27 citation statements)

References 49 publications

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“…It most commonly affects the distal joints in the hands and feet, but can also cause inflammation, swelling and pain in larger joints, including the knees, elbows, hips and the spine. PsA presents with a wide spectrum of clinical symptoms including morning stiffness, dactylitis, distal interphalangeal (DIP) joint disease, enthesitis, actively inflamed joints, and joint deformities 18,23 . PsA was previously considered a mild disease.…”

Section: Psoriatic Arthritismentioning

confidence: 99%

Psoriasis and systemic inflammation: underdiagnosed enthesopathy

Girolomoni¹,

Gisondi

2009

Acad Dermatol Venereol

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Our understanding of the pathogenesis of psoriasis is changing rapidly and the traditional view that it is a disease limited to the skin continues to be challenged. Indeed, there is convincing evidence that psoriasis patients have a higher prevalence of comorbid disease, particularly cardio-metabolic disorders and psoriatic arthritis (PsA). The results of recent investigations into psoriasis and cardiovascular or metabolic comorbidities provide increasing evidence for a possible shared pathogenic mechanism for these disorders, linked by an underlying chronic systemic inflammatory state. This highlights the importance of investigating associated comorbidities beyond skin manifestations. Psoriatic arthritis is a chronic inflammatory arthropathy that can occur in association with psoriasis and most commonly affects the distal joints in the hands and feet. Skin lesions precede arthritic symptoms in approximately 75% of cases; typically, the cutaneous manifestations of the disease develop 10 years prior to the onset of joint symptoms. This disease course, therefore, provides a potential window of opportunity to initiate effective and aggressive therapies to prevent long-term damage, if symptoms of PsA can be detected early. One of the major features of PsA is enthesitis, yet clinically asymptomatic cases of entheseal abnormalities are likely to go undiagnosed. This concept was evaluated in a prospective study in which entheseal changes in clinically asymptomatic psoriasis patients were compared with findings from a control group. Ultrasonography detected a significantly higher incidence of entheseal abnormalities in patients with psoriasis, despite the absence of clinical symptoms of arthropathy. Ongoing monitoring of these patients has also revealed that a higher baseline score for enthesitis may be associated with a more severe psoriasis outcome. These findings demonstrate that detecting early signs of PsA in asymptomatic patients with psoriasis may have the potential to positively influence disease prognosis and ultimately clinical outcome. Dermatologists can, therefore, play a key role in the early detection and management of PsA.

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Section: Psoriatic Arthritismentioning

confidence: 99%

Psoriasis and systemic inflammation: underdiagnosed enthesopathy

Girolomoni¹,

Gisondi

2009

Acad Dermatol Venereol

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“…Different studies have shown that up to 30% of patients with psoriasis have psoriatic arthritis of which 70-80% have nail involvement. [1011] Therefore, being a dermatologist, one should look for early signs and symptoms of psoriatic arthritis in a patient with nail psoriasis in order to avoid progressive joint damage. [11121314]…”

Section: Introductionmentioning

confidence: 99%

Nail psoriasis: The journey so far

Dogra

Arora

2014

Indian J Dermatol

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Nail involvement is an extremely common feature of psoriasis and affects approximately 10-78% of psoriasis patients with 5-10% of patients having isolated nail psoriasis. However, it is often an overlooked feature in the management of nail psoriasis, despite the significant burden it places on the patients as a result of functional impairment of manual dexterity, pain, and psychological stress. Affected nail plates often thicken and crumble, and because they are very visible, patients tend to avoid normal day-to-day activities and social interactions. Importantly, 70-80% of patients with psoriatic arthritis have nail psoriasis. In this overview, we review the clinical manifestations of psoriasis affecting the nails, the common differential diagnosis of nail psoriasis, Nail Psoriasis Severity Index and the various diagnostic aids for diagnosing nail psoriasis especially, the cases with isolated nail involvement. We have also discussed the available treatment options, including the topical, physical, systemic, and biological modalities, in great detail in order to equip the present day dermatologist in dealing with a big clinical challenge, that is, management of nail psoriasis.

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“…The clinical spectrum is very heterogeneous depending on involvement of the nail bed, matrix, or folds, and includes pitting, grooving, and stippling, as well as discoloration, leukonychia, and onychodystrophy ranging to onycholysis 4. Combined nail matrix and nail bed psoriasis can develop in cases of very severe inflammation, a possible consequence of which is the formation of only parakeratotic, crumbly material by the matrix and bed, a condition referred to as “psoriatic crumbly nail” 5. This finding constitutes a risk factor for secondary mycotic infections, which can occur in up to 27% of psoriasis patients, and calls for more detailed diagnostic tests and therapy adapted to the findings 6.…”

Section: Introductionmentioning

confidence: 99%

Nail psoriasis as a severity indicator: results from the PsoReal study

Radtke¹,

Langenbruch²,

Reich³

et al. 2010

PROM

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Background:Although nail psoriasis affects a substantial proportion of psoriasis patients and causes significant psychologic distress, few epidemiologic data characterizing patients with nail involvement are available. The aim of this research was to elucidate differences between patients with nail psoriasis and those without any nail involvement, taking quality indicators of health care from the patient’s perspective into account.Methods:In total, 2449 patient members of the Deutscher Psoriasis Bund, the largest patient organization for psoriasis in Germany, were interviewed in this nationwide, noninterventional, cross-sectional study. Patients with nail psoriasis were compared with patients without any nail involvement with regard to gender, age, disease duration, affected body surface area, health-related quality of life (Dermatology Life Quality Index [DLQI] ED-5D), patient-defined treatment benefit, amount of inpatient treatments, disease duration, and numbers of work days lost.Results:Data from 2449 patients with psoriasis were analyzed. Overall, 44.8% (1078) of patients were female, mean age was 57.0 ± 11.7 years, and 72.8% had nail involvement and showed higher values for affected body surface area than those without nail involvement (8.3% versus 5.6%, respectively; P < 0.004). Health-related quality of life was significantly lower in patients with nail psoriasis (DLQI 7.2 versus 5.3; ED-5D 60.1 versus 67.3), who had more days off work (9.8 versus 3.3).Conclusion:Nail involvement is an important symptom of psoriasis and is associated with greater disease severity and quality of life impairment. Accordingly, management of psoriasis should include a special focus on nail involvement.

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Psoriatic arthritis as a distinct disease entity

Cited by 35 publications

References 49 publications

Psoriasis and systemic inflammation: underdiagnosed enthesopathy

Psoriasis and systemic inflammation: underdiagnosed enthesopathy

Nail psoriasis: The journey so far

Nail psoriasis as a severity indicator: results from the PsoReal study

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