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Psoriasis: HELP
Articles by April Wang Armstrong
Based on 118 articles published since 2008
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Between 2008 and 2019, A. Armstrong wrote the following 118 articles about Psoriasis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. 2019

Menter, Alan / Strober, Bruce E / Kaplan, Daniel H / Kivelevitch, Dario / Prater, Elizabeth Farley / Stoff, Benjamin / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Davis, Dawn M R / Elewski, Boni E / Gelfand, Joel M / Gordon, Kenneth B / Gottlieb, Alice B / Kavanaugh, Arthur / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Leonardi, Craig L / Lichten, Jason / Lim, Henry W / Mehta, Nehal N / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Rupani, Reena N / Siegel, Michael / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Elmets, Craig A. ·Baylor Scott and White, Dallas, Texas. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada. · University of Pittsburgh, Pittsburgh, Pennsylvania. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Emory University School of Medicine, Atlanta, Georgia. · University of Southern California, Los Angeles, San Francisco. · University of Alabama, Birmingham, Alabama. · University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York. · University of California San Diego, San Diego, California. · National Psoriasis Foundation, Portland, Oregon. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Central Dermatology, St. Louis, Missouri. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772098.

ABSTRACT: Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.

2 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. 2019

Elmets, Craig A / Leonardi, Craig L / Davis, Dawn M R / Gelfand, Joel M / Lichten, Jason / Mehta, Nehal N / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Elewski, Boni E / Gordon, Kenneth B / Gottlieb, Alice B / Kaplan, Daniel H / Kavanaugh, Arthur / Kivelevitch, Dario / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Lim, Henry W / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Prater, Elizabeth Farley / Rupani, Reena / Siegel, Michael / Stoff, Benjamin / Strober, Bruce E / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Menter, Alan. ·University of Alabama, Birmingham, Alabama. · Central Dermatology, St. Louis, Missouri. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · National Psoriasis Foundation, Portland, Oregon. · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · University of Southern California, Los Angeles, California. · Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York. · University of Pittsburgh, Pennsylvania. · University of California San Diego, San Diego, California. · Baylor Scott and White, Dallas, Texas. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Icahn School of Medicine at Mount Sinai, New York, New York. · Emory University School of Medicine, Atlanta, Georgia. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772097.

ABSTRACT: Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

3 Guideline Psoriasis in solid organ transplant patients: best practice recommendations from The Medical Board of the National Psoriasis Foundation. 2018

Prussick, Ronald / Wu, Jashin J / Armstrong, April W / Siegel, Michael P / Van Voorhees, Abby S. ·a Department of Dermatology , George Washington University , Washington D.C. , USA. · b Department of Dermatology , Kaiser Permanente Los Angeles Medical Center , Los Angeles , CA , USA. · c Department of Dermatology , University of Southern California , Los Angeles , CA , USA. · d National Psoriasis Foundation , Portland , OR , USA. · e Department of Dermatology , Eastern Virginia Medical School , Norfolk , VA , USA. ·J Dermatolog Treat · Pubmed #28884635.

ABSTRACT: BACKGROUND: Treatment of solid organ transplant patients who have psoriasis can be a therapeutic challenge. Biologic and systemic drugs used to treat psoriasis can result in an increase in infections or malignancies. OBJECTIVE: We sought to develop a treatment algorithm for organ transplant recipients (OTR) diagnosed with psoriasis vulgaris. METHODS: A systematic literature search for psoriasis treatment in organ transplant patients was performed using MEDLINE and GOOGLE. RESULTS: In mild-to-moderate disease, topical therapy should be a first-line treatment. In moderate-to-severe disease, first-line treatment is acitretin with narrow band ultraviolet light (NBUVB), NBUVB, or acitretin. Second-line treatment is increasing the current antirejection drug dose. Other systemic or biologic therapies should be reserved for more severe or refractory cases. CONCLUSION: No systematic clinical studies have been done to explore psoriasis treatments among affected solid organ transplant patients who have psoriasis, and only a few case reports are available. The algorithm for best practices was developed based on these reports and on the clinical experience and judgment of the Medical Board of the National Psoriasis Foundation. There remains a need for further research on the management of psoriasis in the organ transplant patient population.

4 Guideline Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis. 2016

Coates, Laura C / Kavanaugh, Arthur / Mease, Philip J / Soriano, Enrique R / Laura Acosta-Felquer, Maria / Armstrong, April W / Bautista-Molano, Wilson / Boehncke, Wolf-Henning / Campbell, Willemina / Cauli, Alberto / Espinoza, Luis R / FitzGerald, Oliver / Gladman, Dafna D / Gottlieb, Alice / Helliwell, Philip S / Husni, M Elaine / Love, Thorvardur J / Lubrano, Ennio / McHugh, Neil / Nash, Peter / Ogdie, Alexis / Orbai, Ana-Maria / Parkinson, Andrew / O'Sullivan, Denis / Rosen, Cheryl F / Schwartzman, Sergio / Siegel, Evan L / Toloza, Sergio / Tuong, William / Ritchlin, Christopher T. ·Leeds Institute of Rheumatic and Musculoskeletal Medicine and University of Leeds, Leeds, UK. · University of California at San Diego. · Swedish Medical Center and University of Washington School of Medicine, Seattle, Washington. · Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. · University of Southern California, Keck School of Medicine, Los Angeles. · Hospital Militar Central and Universidad Militar Nueva Grenada, Bogotá, Colombia. · Geneva University Hospital, Geneva, Switzerland. · Toronto Western Hospital, Toronto, Ontario, Canada. · University of Cagliari, Monserrato Campus, Cagliari, Italy. · Louisiana State University Health Sciences Center, New Orleans. · St. Vincent's University Hospital, The Conway Institute for Biomolecular Research, and University College Dublin, Dublin, Ireland. · University of Toronto and Toronto Western Research Institute, Toronto, Ontario, Canada. · Tufts Medical Center, Boston, Massachusetts. · Leeds Institute of Rheumatic and Musculoskeletal Medicine and University of Leeds, Leeds, UK, and Bradford Hospitals NHS Foundation Trust, Bradford, UK. · Cleveland Clinic Foundation, Cleveland, Ohio. · University of Iceland and Landspitali University Hospital, Reykjavik, Iceland. · University of Molise, Campobasso, Italy. · Royal National Hospital for Rheumatic Diseases, Bath, UK. · University of Queensland, Brisbane, Queensland, Australia. · University of Pennsylvania, Philadelphia. · Johns Hopkins University School of Medicine, Baltimore, Maryland. · Chapel Allerton Hospital, Leeds, UK. · St. Vincent's University Hospital, Dublin, Ireland. · Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. · Hospital for Special Surgery, New York, New York. · Arthritis and Rheumatism Associates, Rockville, Maryland. · Ministry of Health, San Fernando del Valle de Catamarca, Argentina. · University of California, Davis. · University of Rochester Medical Center, Rochester, New York. ·Arthritis Rheumatol · Pubmed #26749174.

ABSTRACT: OBJECTIVE: To 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). METHODS: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, 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, using an online questionnaire. RESULTS: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. CONCLUSION: 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 health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.

5 Review Treatment preferences and treatment satisfaction among psoriasis patients: a systematic review. 2018

Florek, Aleksandra G / Wang, Catherine J / Armstrong, April W. ·University of Colorado Denver School of Medicine, Denver, CO, USA. · Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. · Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. aprilarmstrong@post.harvard.edu. · University of Southern California, Los Angeles, CA, USA. aprilarmstrong@post.harvard.edu. ·Arch Dermatol Res · Pubmed #29442137.

ABSTRACT: A critical gap exists in determining treatment preferences and treatment satisfaction from patient perspectives, which is paramount to achieving therapeutic success. The objective of this systematic review is to determine factors influencing treatment preferences and treatment satisfaction among psoriasis patients. PubMed, EMBASE, and Web of Science databases were searched between November 1, 2010, and December 1, 2017. Observational and interventional research studies published in the English language that discussed patient preferences and patient satisfaction in the treatment of psoriasis were reviewed and synthesized. We utilized data on treatment preferences and treatment satisfaction from 35,388 psoriasis patients based on 60 articles from the years 2010 to 2017. Treatment preferences were heterogeneous and changed over time among psoriasis patients. Across all treatment modalities, the most important treatment attributes were treatment location, probability of improvement, and delivery method. For biologics specifically, the most important attributes were risk of adverse events and probability of treatment benefit. Factors that influenced patients' preferences for certain treatments included age, sex, comorbidities, disease duration, and prior treatments. Notably, some psoriasis patients placed higher importance on a treatment's process attributes (e.g., access and delivery) over its outcome attributes (e.g., efficacy). Overall, patient satisfaction with existing therapies remains modest; however, those treated with biologic agents exhibited highest treatment satisfaction over oral therapy, phototherapy, and topical therapy.

6 Review Management of psoriasis in patients with inflammatory bowel disease: From the Medical Board of the National Psoriasis Foundation. 2018

Whitlock, Scott M / Enos, Clinton W / Armstrong, April W / Gottlieb, Alice / Langley, Richard G / Lebwohl, Mark / Merola, Joseph F / Ryan, Caitriona / Siegel, Michael P / Weinberg, Jeffrey M / Wu, Jashin J / Van Voorhees, Abby S. ·Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia. · Department of Dermatology, University of Southern California, Los Angeles, California. · Department of Medicine, New York Medical College, Valhalla, New York. · Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts. · Division of Dermatology, Baylor University Medical Center, Dallas, Texas. · National Psoriasis Foundation, Portland, Oregon. · Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. · Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia. Electronic address: vanvooas@evms.edu. ·J Am Acad Dermatol · Pubmed #29332708.

ABSTRACT: BACKGROUND: There is a significant association between psoriasis and inflammatory bowel disease (IBD). Many treatments for psoriasis and psoriatic arthritis are also used for IBD. OBJECTIVE: To assess therapeutic options for patients with psoriasis and concurrent IBD. METHODS: A systematic literature search was performed for clinical studies of biologic and systemic psoriasis medications in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease, for the period from January 1, 1947, to February 14, 2017. Randomized, controlled, double-blinded studies were selected if available. If not, the next highest level of available evidence was selected. RESULTS: Of the 2282 articles identified, 132 were selected. Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative; colitis, and Crohn's disease. Ustekinumab has demonstrated efficacy in psoriasis, psoriatic arthritis, and Crohn's disease. Certolizumab has demonstrated efficacy in psoriatic arthritis and Crohn's disease. Etanercept, secukinumab, brodalumab, and ixekizumab have demonstrated efficacy in psoriasis and psoriatic arthritis but may exacerbate or induce IBD. Guselkumab has demonstrated efficacy in psoriasis. LIMITATIONS: There are no known clinical trials of treatment specifically for concurrent psoriasis and IBD. CONCLUSIONS: Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease; other agents have demonstrated efficacy for some, but not all, of these indications.

7 Review Psoriasis and suicidality: A systematic review and meta-analysis. 2017

Singh, Sanminder / Taylor, Catherine / Kornmehl, Heather / Armstrong, April W. ·University of California Davis School of Medicine, Sacramento, California. · University of California Davis, Davis, California. · Drexel University College of Medicine, Philadelphia, Pennsylvania. · Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: aprilarmstrong@post.harvard.edu. ·J Am Acad Dermatol · Pubmed #28807109.

ABSTRACT: BACKGROUND: Psoriasis is associated with psychiatric comorbidities; however, the relationship between psoriasis and suicidality is not well understood. OBJECTIVE: To perform a systematic review and meta-analysis that elucidates the relationship between psoriasis and suicidality. METHODS: Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched the PubMed, EMBASE, PsycINFO, and Cochrane databases. We searched literature published between 1946 and 2017. RESULTS: We identified 18 studies with a total of 1,767,583 participants, of whom 330,207 had psoriasis. On the basis of random effects modeling, the pooled odds ratio (OR) for suicidal ideation among patients with psoriasis was 2.05 (95% confidence interval [CI], 1.54-2.74). Patients with psoriasis were more likely to exhibit suicidal behaviors (combined attempted and completed suicides) with a pooled OR of 1.26 (95% CI, 1.13-1.40). Subgroup analysis showed that patients with psoriasis were more likely to attempt suicides (OR, 1.32; 95% CI, 1.14-1.54) and complete suicide (OR, 1.20; 95% CI, 1.04-1.39) than those without psoriasis. More severe psoriasis and younger age were associated with greater likelihood of suicidality. LIMITATIONS: There are few studies examining suicidality in conjunction with psoriasis severity. CONCLUSIONS: Patients with psoriasis have a significantly higher likelihood of suicidal ideation, suicide attempts, and completed suicides. Among patients with psoriasis, those who are younger and whose psoriasis is more severe are at particular risk for suicidality.

8 Review Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression. 2017

Koo, J / Marangell, L B / Nakamura, M / Armstrong, A / Jeon, C / Bhutani, T / Wu, J J. ·San Francisco Medical Center, University of California, San Francisco, CA, USA. · Brain Health Consultants, Houston, TX, USA. · University of Southern California, Los Angeles, CA, USA. · Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA. ·J Eur Acad Dermatol Venereol · Pubmed #28681405.

ABSTRACT: Psoriasis can be a socially isolating disease due to debilitating physical symptoms and the stigma patients feel because of the appearance of their skin. Mental health comorbidities such as anxiety, depression and suicidal ideation and behaviour (SIB) are prevalent in patients with psoriasis. Patients with mild psoriasis can experience psychiatric comorbidities; however, disorders such as depression and SIB are more common in patients with severe psoriasis or psoriatic arthritis. Psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms. Proinflammatory cytokines such as interleukin (IL)-1 and IL-6 are elevated in both psoriasis and depression, indicating that the inflammatory process may be involved in the progression of both diseases. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. In this review of the literature, we discuss the evidence that supports the association of psoriasis with mental health disorders and the tools used to detect the presence of these comorbidities. Additionally, we review the most prominent hypotheses on the mechanisms by which the inflammatory response and elevated cytokines can cause depression. These results highlight the role that systemic inflammation plays in the various mental health comorbidities associated with psoriasis, including depression and SIB.

9 Review The International Dermatology Outcome Measures (IDEOM) Initiative: A Review and Update. 2017

Elman, Scott A / Merola, Joseph F / Armstrong, April W / Duffin, Kristina Callis / Latella, John / Garg, Amit / Gottlieb, Alice B. · ·J Drugs Dermatol · Pubmed #28300853.

ABSTRACT:

The International Dermatology Outcome Measures (IDEOM) group, comprising patients, physicians, health economists, industry partners, payers, and regulatory agencies, was established to develop unified and validated patient-centered outcome measures in dermatology in response to increasing demand to quantify effectiveness of treatments and performance outcomes among providers. IDEOM has chosen to start with psoriasis outcome measures, and then apply its methodology to other dermatologic diseases. In this paper, we review the background and progress to date of IDEOM, including an update of IDEOM activities as of our 2016 meeting in Washington DC, USA. Briefly, the progress-to-date of a Delphi process to create outcome measures for psoriasis was reviewed, including preliminary data from the first round of Delphi voting. Updates were also heard from industry partners including the National Psoriasis Foundation (NPF) and the US Food and Drug Administration (FDA). Furthermore, plans to establish outcome measures for hidradenitis suppurativa (HS) were discussed.

J Drugs Dermatol. 2017;16(2):119-124.

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10 Review From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. 2017

Armstrong, April W / Siegel, Michael P / Bagel, Jerry / Boh, Erin E / Buell, Megan / Cooper, Kevin D / Callis Duffin, Kristina / Eichenfield, Lawrence F / Garg, Amit / Gelfand, Joel M / Gottlieb, Alice B / Koo, John Y M / Korman, Neil J / Krueger, Gerald G / Lebwohl, Mark G / Leonardi, Craig L / Mandelin, Arthur M / Menter, M Alan / Merola, Joseph F / Pariser, David M / Prussick, Ronald B / Ryan, Caitriona / Shah, Kara N / Weinberg, Jeffrey M / Williams, MaryJane O U / Wu, Jashin J / Yamauchi, Paul S / Van Voorhees, Abby S. ·Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: aprilarmstrong@post.harvard.edu. · National Psoriasis Foundation, Portland, Oregon. · Windsor Dermatology, East Windsor, New Jersey; University Medical Center of Princeton at Plainsboro, Plainsboro, New Jersey. · Tulane University School of Medicine, New Orleans, Louisiana. · University Hospitals Case Medical Center, Cleveland, Ohio. · University of Utah School of Medicine, Salt Lake City, Utah. · University of California, San Diego School of Medicine, La Jolla, California. · Northwell Health and Hofstra North Shore University Hospital, Long Island Jewish Medical Center School of Medicine, Manhasset, New York. · University of Pennsylvania, Philadelphia, Pennsylvania. · Tufts University School of Medicine, Boston, Massachusetts. · University of California San Francisco Medical Center, San Francisco, California. · Icahn School of Medicine at Mount Sinai, New York, New York. · St Louis University Medical School, St Louis, Missouri. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Baylor University Medical Center and Texas A&M Health Science Center, Dallas, Texas. · Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Eastern Virginia Medical School, Norfolk, Virginia; Virginia Clinical Research Inc, Norfolk, Virginia. · George Washington University, Washington, District of Columbia. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. · Keck School of Medicine, University of Southern California, Los Angeles, California. · Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. · Division of Dermatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. · Eastern Virginia Medical School, Norfolk, Virginia. ·J Am Acad Dermatol · Pubmed #27908543.

ABSTRACT: BACKGROUND: An urgent need exists in the United States to establish treatment goals in psoriasis. OBJECTIVE: We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice. METHODS: The National Psoriasis Foundation conducted a consensus-building study among psoriasis experts using the Delphi method. The process consisted of: (1) literature review, (2) pre-Delphi question selection and input from general dermatologists and patients, and (3) 4 Delphi rounds. RESULTS: A total of 25 psoriasis experts participated in the Delphi process. The most preferred instrument was body surface area (BSA). The most preferred time for evaluating patient response after starting new therapies was at 3 months. The acceptable response at 3 months postinitiation was either BSA 3% or less or BSA improvement 75% or more from baseline. The target response at 3 months postinitiation was BSA 1% or less. During the maintenance period, evaluation every 6 months was most preferred. The target response at every 6 months maintenance evaluation is BSA 1% or less. LIMITATIONS: Although BSA is feasible in practice, it does not encompass health-related quality of life, costs, and risks of side effects. CONCLUSION: With defined treatment targets, clinicians and patients can regularly evaluate treatment responses and perform benefit-risk assessments of therapeutic options individualized to the patient.

11 Review Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. 2017

Yim, Kaitlyn M / Armstrong, April W. ·Department of Dermatology, University of Southern California, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA, 90089, USA. · Department of Dermatology, University of Southern California, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA, 90089, USA. april.armstrong@med.usc.edu. ·Rheumatol Int · Pubmed #27221457.

ABSTRACT: Psoriasis and psoriatic arthritis are associated with a significantly increased risk of cardiovascular risk factors and major adverse cardiovascular events (MACE). Active research is ongoing to elucidate this relationship between psoriatic diseases and cardiovascular comorbidities, as well as their shared pathogenic mechanisms. This review focuses on (1) the epidemiologic association between psoriasis and cardiovascular risk factors, (2) the epidemiologic association between psoriasis and MACE, (3) the epidemiologic association between psoriatic arthritis, cardiovascular risk factors, and MACE, and (4) proposed mechanisms for the contribution of psoriatic diseases to cardiovascular diseases. The proposed mechanisms for shared pathogenesis between psoriatic diseases and cardiovascular diseases are inflammation, insulin resistance, dyslipidemia, angiogenesis, oxidative stress, and endothelial dysfunction. There is complex interplay and overlap among these mechanisms and their contributions to shared pathogenesis. Future translational research is necessary to elucidate the link between psoriatic diseases and cardiovascular diseases. Such findings may be applied clinically to improve the lives of psoriasis patients.

12 Review Relationship between psoriasis and metabolic syndrome: a systematic review. 2016

Singh, Sanminder / Young, Paulina / Armstrong, April W. ·Department of Dermatology, University of California, Davis School of Medicine, Sacramento, CA, USA - aprilarmstrong@post.harvard.edu. ·G Ital Dermatol Venereol · Pubmed #27589483.

ABSTRACT: INTRODUCTION: A number of studies have suggested an epidemiologic association between metabolic syndrome and psoriasis. A systematic review of the literature is necessary to determine whether the synthesis and interpretation of recent studies support the relationship between psoriasis and metabolic syndrome. The objective of this study conducted a comprehensive systematic review that synthesizes and interprets primary observational studies in order to elucidate the relationship between psoriasis and metabolic syndrome. EVIDENCE ACQUISITION: We performed a systematic review search using the MEDLINE, EMBASE, Cochrane Central Register, and SCOPUS databases (1946-2016) and performed a manual search of selected references. We identified English-language, human-subject, observational studies that examined the prevalence of metabolic syndrome in conjunction with psoriasis. EVIDENCE SYNTHESIS: We included data from 17 articles with an aggregate of 28,939 participants, among whom 3791 were psoriasis patients. Overall, the studies reported a higher prevalence of metabolic syndrome in patients with psoriasis. The odds ratio (OR) for metabolic syndrome and psoriasis ranged from 1.39-4.49, and the adjusted OR ranged from 1.29 to 5.14. The studies reported a higher prevalence of the individual components of metabolic syndrome in patients with psoriasis. A dose-response relationship was observed between psoriasis severity and the prevalence of metabolic syndrome. Due to the scarcity of cohort studies, it is difficult to fully examine the impact of psoriasis on the development of metabolic syndrome. Variability in how outcomes were recorded existed among some studies, which made between-study comparisons difficult. CONCLUSIONS: Psoriasis patients have a greater prevalence of metabolic syndrome as well as its individual components when compared to the general population. The odds of metabolic syndrome and its components are higher with increased psoriasis disease severity. Prospective studies are needed to better understand the contribution of psoriasis in the development of metabolic syndrome.

13 Review Comparative efficacy and incremental cost per responder of methotrexate versus apremilast for methotrexate-naïve patients with psoriasis. 2016

Armstrong, April W / Betts, Keith A / Sundaram, Murali / Thomason, Darren / Signorovitch, James E. ·Keck School of Medicine, University of Southern California, Los Angeles, California. · Analysis Group Inc, Boston, Massachusetts. Electronic address: Keith.Betts@analysisgroup.com. · AbbVie, North Chicago, Illinois. · Analysis Group Inc, Boston, Massachusetts. ·J Am Acad Dermatol · Pubmed #27476973.

ABSTRACT: BACKGROUND: To our knowledge, no clinical trials directly compare apremilast with methotrexate (the standard of care for initial systemic treatment of psoriasis). OBJECTIVE: We sought to compare apremilast's relative efficacy with that of methotrexate for moderate to severe psoriasis. METHODS: An anchor-based indirect comparison was conducted for 75% improvement in Psoriasis Area and Severity Index score from baseline to week 16 (PASI 75) rates for systemic-naïve patients from Efficacy and Safety Trial Evaluating the Effects of apreMilast in psoriasis (ESTEEM) 1 and 2 (apremilast vs placebo) and Comparative study of HumirA vs. Methotrexate vs Placebo In psOriasis patieNts (CHAMPION) (adalimumab vs methotrexate vs placebo) trials. The difference-in-difference in PASI 75 response rates was calculated as the difference between the ESTEEM apremilast and placebo rates and the CHAMPION methotrexate versus placebo rates. Number needed to treat and incremental drug cost per responder were also estimated. RESULTS: No statistically significant difference was found between apremilast and methotrexate in PASI 75 (risk difference 13.1%; 95% confidence interval -1.8% to 28.0%; P = .09). Number needed to treat with apremilast versus methotrexate to gain 1 additional PASI 75 responder was 7.6. Annual incremental drug cost of this responder was estimated at $187,888.33. LIMITATIONS: Few trials compare systemic-naïve patients. Only direct medication costs were considered. CONCLUSIONS: There was no statistical evidence of greater efficacy for apremilast versus methotrexate. The $187,888 incremental cost per PASI 75 may exceed what payers are willing to pay.

14 Review From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis. 2016

Choi, Young M / Debbaneh, Maya / Weinberg, Jeffrey M / Yamauchi, Paul S / Van Voorhees, Abby S / Armstrong, April W / Siegel, Michael / Wu, Jashin J. ·Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. · Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. · Dermatology Institute and Skin Care Center, Santa Monica, California; Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California. · Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia. · Department of Dermatology, University of Southern California, Los Angeles, California. · National Psoriasis Foundation, Portland, Oregon. · Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Electronic address: jashinwu@gmail.com. ·J Am Acad Dermatol · Pubmed #27461230.

ABSTRACT: Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.

15 Review A Clinician's Guide to the Diagnosis and Treatment of Candidiasis in Patients with Psoriasis. 2016

Armstrong, April W / Bukhalo, Michael / Blauvelt, Andrew. ·Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Keith Administration Building, Room 510, Los Angeles, CA, 90089, USA. aprilarmstrong@post.harvard.edu. · Altman Dermatology Associates, Arlington Heights, IL, USA. · Oregon Medical Research Center, Portland, OR, USA. ·Am J Clin Dermatol · Pubmed #27435194.

ABSTRACT: Many of the molecular pathways associated with psoriasis pathogenesis are also involved in host defense mechanisms that protect against common pathogens. Candida can stimulate the production of cytokines that trigger or exacerbate psoriasis, and many systemic psoriasis treatments may put patients at increased risk for developing oral, cutaneous, and genitourinary candidiasis. Therefore, dermatologists should regularly screen patients with psoriasis for signs of Candida infection, and take steps to effectively treat these infections to prevent worsening of psoriasis symptoms. This review provides an overview of candidiasis epidemiology in patients with psoriasis, followed by a primer on the diagnosis and treatment of superficial Candida infections, with specific guidance for patients with psoriasis. Candidiasis in patients with psoriasis typically responds to topical or oral antifungal therapy. While biologic agents used to treat moderate-to-severe psoriasis, such as tumor necrosis factor-α inhibitors and interleukin-17 inhibitors, are known to increase patients' risk of developing localized candidiasis, the overall risk of infection is low, and candidiasis can be effectively managed in most patients while receiving systemic psoriasis therapies. Thus, the development of candidiasis does not usually necessitate changes to psoriasis treatment regimens.

16 Review Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners. 2016

Armstrong, April W / Aldredge, Lakshi / Yamauchi, Paul S. ·Department of Dermatology, University of Colorado Denver, Aurora, CO, USA aprilarmstrong@post.harvard.edu. · Department of Dermatology, Portland Veterans Affairs Medical Center, Portland, OR, USA. · Dermatology Institute and Skin Care Center, Santa Monica, CA, USA Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. ·J Cutan Med Surg · Pubmed #26712930.

ABSTRACT: Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy).

17 Review An evidence-based review of the mechanism of action, efficacy, and safety of biologic therapies in the treatment of psoriasis and psoriatic arthritis. 2015

Brezinski, Elizabeth A / Armstrong, April W. ·University of Colorado Denver, School of Medicine, Department of Dermatology, Mail Stop F443, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, USA. aprilarmstrong@post.harvard.edu. ·Curr Med Chem · Pubmed #25921645.

ABSTRACT: Biologic agents have expanded the repertoire of efficacious and safe systemic therapies for the treatment of moderate-to-severe psoriasis and active psoriatic arthritis. The biologics act to inhibit key inflammatory molecules that are thought to be involved in the pathogenesis of these chronic inflammatory disorders as well as physiologic immune responses. In this paper, we discuss the proposed molecular mechanisms of action, efficacy, and safety of the two FDA-approved classes of biologics, the tumor necrosis factor inhibitors and the interleukin-12/23 inhibitor. The tumor necrosis factor inhibitors that are reviewed include etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol. The interleukin- 12/23 inhibitor that is discussed is ustekinumab. Specifically, we review the mechanism of action for each biologic agent and the FDA-approved indications and dosing for these therapeutics. We provide up-to-date evidence for the efficacy of these systemic medications using key phase 3 clinical trial data, we highlight important safety information for each biologic based on long-term open-label extension trials and safety registries, and we discuss studies that investigate off-label dosing with the biologics. Each biologic is reviewed in these specific areas of focus for their indicated treatment of psoriasis and/or psoriatic arthritis.

18 Review Economic Burden of Psoriasis in the United States: A Systematic Review. 2015

Brezinski, Elizabeth A / Dhillon, Jaskaran S / Armstrong, April W. ·Department of Dermatology, University of California Davis, Sacramento. · Department of Dermatology, University of Colorado Denver. ·JAMA Dermatol · Pubmed #25565304.

ABSTRACT: IMPORTANCE: The total cost of psoriasis in the United States is unknown. Defining the US economic burden of psoriasis is needed because it provides the foundation for research, advocacy, and educational efforts. OBJECTIVE: To determine the US economic burden of psoriasis from a societal perspective. EVIDENCE REVIEW: PubMed and MEDLINE databases were searched between January 1, 2008, and September 20, 2013, for economic investigations on the direct, indirect, intangible, and comorbidity costs of adult psoriasis in the United States. The base year costs were adjusted to 2013 US dollars using the Consumer Price Index for All Urban Consumers and multiplied by the estimated number of US patients with psoriasis in 2013 to determine the 2013 psoriasis cost burden. FINDINGS: Among 100 identified articles, 22 studies were included in the systematic review. The direct psoriasis costs ranged from $51.7 billion to $63.2 billion, the indirect costs ranged from $23.9 billion to $35.4 billion, and medical comorbidities were estimated to contribute $36.4 billion annually in 2013 US dollars. Patients with psoriasis would pay a lifetime cost of $11,498 for relief of physical symptoms and emotional health; however, intangible cost data are limited. The annual US cost of psoriasis amounted to approximately $112 billion in 2013. CONCLUSIONS AND RELEVANCE: The economic burden of psoriasis is substantial and significant in the United States.

19 Review Combining biologic therapies with other systemic treatments in psoriasis: evidence-based, best-practice recommendations from the Medical Board of the National Psoriasis Foundation. 2015

Armstrong, April W / Bagel, Jerry / Van Voorhees, Abby S / Robertson, Andrew D / Yamauchi, Paul S. ·Department of Dermatology, University of Colorado Denver. · currently in private practice in East Windsor, New Jersey. · Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia. · National Psoriasis Foundation, Portland, Oregon. · Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California. ·JAMA Dermatol · Pubmed #25517130.

ABSTRACT: IMPORTANCE: While monotherapy with biologic agents is effective for many patients with psoriasis, some patients require combination therapy. Evidence-based recommendations on combination therapy provide guidance for treating appropriately selected patients with psoriasis. OBJECTIVE: To make evidence-based, best-practice recommendations regarding combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologics, for psoriasis treatment. EVIDENCE REVIEW: We searched the MEDLINE database for studies from January 1, 1946, to June 18, 2013, that evaluated therapies combining biologics with phototherapy, oral medications, or other biologic agents. The Medical Board of the National Psoriasis Foundation arrived at best-practice recommendations through group discussion and voting. FINDINGS: Few trials evaluated the efficacy and safety of combination therapies in moderate to severe psoriasis. Combining biologics, such as etanercept or adalimumab, with phototherapy likely results in greater reduction in disease severity than either alone. Etanercept and methotrexate combination is more effective than monotherapy with either medication. A combination of infliximab with methotrexate results in greater efficacy than infliximab alone. With concomitant use of acitretin, the dosing of etanercept can be reduced to maintain similar levels of efficacy. Short-term cyclosporine use has been combined with etanercept or adalimumab to control psoriasis flares. Based on the expert opinion of the Medical Board of the National Psoriasis Foundation, the preferred order for combining a second modality with biologics is biologic and methotrexate combination, biologic and acitretin combination, and then biologic and phototherapy combination. In the psoriasis literature, there are overall insufficient data on combining biologics with acitretin, cyclosporine, or a second biologic. CONCLUSIONS AND RELEVANCE: Among appropriately selected patients with psoriasis, carefully chosen combinations may result in greater efficacy, while minimizing toxicity.

20 Review Effect of tonsillectomy on psoriasis: a systematic review. 2015

Rachakonda, Tara D / Dhillon, Jaskaran S / Florek, Aleksandra G / Armstrong, April W. ·Department of Internal Medicine, University of Utah, Salt Lake City, Utah. · Department of Dermatology, University of California at Davis School of Medicine, Sacramento, California. · Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado. · Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado. Electronic address: aprilarmstrong@post.harvard.edu. ·J Am Acad Dermatol · Pubmed #25455609.

ABSTRACT: BACKGROUND: Streptococcal infection is associated with psoriasis onset in some patients. Whether tonsillectomy decreases psoriasis symptoms requires a systematic review of the literature. OBJECTIVE: We sought to determine whether tonsillectomy reduces psoriasis severity through a comprehensive search of over 50 years of literature. METHODS: We searched MEDLINE, CINAHL, Cochrane, EMBASE, Web of Science, and OVID databases (from August 1, 1960, to September 12, 2013) and performed a manual search of selected references. We identified observational studies and clinical trials examining psoriasis after tonsillectomy. RESULTS: We included data from 20 articles from the last 53 years with 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. Of 410 reported cases of patients with psoriasis who underwent tonsillectomy, 290 experienced improvement in their psoriasis. Although some patients who underwent tonsillectomy experienced sustained improvement in psoriasis, others experienced psoriasis relapse after the procedure. LIMITATIONS: Fifteen of 20 publications were case reports or series that lacked control groups. Publication bias favoring reporting improved cases needs to be considered. CONCLUSION: Tonsillectomy may be a potential option for patients with recalcitrant psoriasis associated with episodes of tonsillitis. Studies with long-term follow-up are warranted to determine more clearly the extent and persistence of benefit of tonsillectomy in psoriasis.

21 Review Treatments for nail psoriasis: a systematic review by the GRAPPA Nail Psoriasis Work Group. 2014

Armstrong, April W / Tuong, William / Love, Thorvardur J / Carneiro, Sueli / Grynszpan, Rachel / Lee, Steve S / Kavanaugh, Arthur. ·From the Psoriasis Program, Department of Dermatology, Colorado Health Outcomes Program (COHO), University of Colorado Denver, Denver, Colorado; Department of Dermatology, University of California Davis, Davis, California, USA; Faculty of Medicine, University of Iceland, Department of Research, Landspitali University Hospital, Reykjavik, Iceland; Sector of Dermatology and Department of Medical Clinic, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Southern California Permanente Medical Group, Fontana, California; and University of California, San Diego, California, USA.A.W. Armstrong, MD, MPH, Vice Chair for Clinical Research, Associate Professor of Dermatology, Director, Clinical Trials and Outcomes Research, Director, Psoriasis Program, Department of Dermatology, COHO, University of Colorado Denver; W. Tuong, BA, Department of Dermatology, University of California Davis; T.J. Love, MD, PhD, Faculty of Medicine, University of Iceland, Department of Research, Landspitali University Hospital; S. Carneiro, MD, PhD; R. Grynszpan, MD, Sector of Dermatology and Department of Medical Clinic, University Hospital and School of Medicine, Federal University of Rio de Janeiro; S.S. Lee, DO, FACR, Southern California Permanente Medical Group; A. Kavanaugh, MD, University of California. ·J Rheumatol · Pubmed #25362716.

ABSTRACT: Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

22 Review Strategies to maximize treatment success in moderate to severe psoriasis: establishing treatment goals and tailoring of biologic therapies. 2014

Brezinski, Elizabeth A / Armstrong, April W. ·Department of Dermatology, University of Colorado Denver, School of Medicine, Denver, CO USA. Email: aprilarmstrong@post.harvard.edu. ·Semin Cutan Med Surg · Pubmed #25085668.

ABSTRACT: Achieving treatment success among patients with moderate to severe psoriasis is a clinically relevant and important issue facing clinicians and patients. Despite advances in systemic therapy, most patients with moderate to severe psoriasis are not satisfied with their treatment. We will discuss strategies to maximize treatment success through the establishment of treatment goals and tailoring of biologic therapy for patients with difficult-to-treat psoriasis. Specifically, we provide evidence-based highlights on the development of biologics, recommendations by psoriasis expert groups on treatment goals, approaches to achieve treatment to defined targets, and therapeutic strategies to customize biologic treatment for nonresponders. The discussion on nonresponders focuses on subpopulations of interest including patients with significant obesity, antidrug antibody formation, personal preferences for medication administration, and treatment nonadherence. We also highlight circumstances where the selection of the systemic medication is driven by safety considerations. As expectation for efficacy and safety increases with continued biologic development for psoriasis, devising real-world treatment strategies to maximize treatment success is critical to improve the overall physical and psychosocial wellbeing of psoriasis patients.

23 Review JAK inhibitors: treatment efficacy and safety profile in patients with psoriasis. 2014

Hsu, Leeyen / Armstrong, April W. ·Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop 8127, Aurora, CO 80045, USA. ·J Immunol Res · Pubmed #24883332.

ABSTRACT: Janus kinase (JAK) pathways are key mediators in the immunopathogenesis of psoriasis. Psoriasis treatment has evolved with the advent of targeted therapies, which inhibit specific components of the psoriasis proinflammatory cascade. JAK inhibitors have been studied in early phase trials for psoriasis patients, and the data are promising for these agents as potential treatment options. Tofacitinib, an oral or topically administered JAK1 and JAK3 inhibitor, and ruxolitinib, a topical JAK1 and JAK2 inhibitor, have been most extensively studied in psoriasis, and both improved clinical symptoms of psoriasis. Additional JAK1 or JAK3 inhibitors are being studied in clinical trials. In phase III trials for rheumatoid arthritis, tofacitinib was efficacious in patients with inadequate responses to tumor necrosis factor inhibitors, methotrexate monotherapy, or disease-modifying antirheumatic drugs. The results of phase III trials are pending for these therapies in psoriasis, and these agents may represent important alternatives for patients with inadequate responses to currently available agents. Further investigations with long-term clinical trials are necessary to verify their utility in psoriasis treatment and assess their safety in this patient population.

24 Review Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. 2014

Mease, Philip J / Armstrong, April W. ·Swedish Medical Center and University of Washington, Seattle, WA, USA, pmease@philipmease.com. ·Drugs · Pubmed #24566842.

ABSTRACT: Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. Up to 40 % of patients with psoriasis will go on to develop PsA, usually within 5-10 years of cutaneous disease onset. Both conditions share common pathogenic mechanisms involving genetic and environmental factors. Because psoriasis is typically present for years before PsA-related joint symptoms emerge, dermatologists are in a unique position to detect PsA earlier in the disease process through regular, routine screening of psoriasis patients. Distinguishing clinical features of PsA include co-occurrence of psoriatic skin lesions and nail dystrophy, as well as dactylitis and enthesitis. Patients with PsA are usually seronegative for rheumatoid factor, and radiographs may reveal unique features such as juxta-articular new bone formation and pencil-in-cup deformity. Early treatment of PsA with disease-modifying anti-rheumatic drugs has the potential to slow disease progression and maintain patient quality of life. Optimally, a single therapeutic agent will control both the skin and joint psoriatic symptoms. A number of traditional treatments used to manage psoriasis, such as methotrexate and cyclosporine, are also effective for PsA, but these agents are often inadequately effective, temporary in benefit and associated with significant safety concerns. Biologic anti-tumour necrosis factor agents, such as etanercept, infliximab and adalimumab, are effective for treating patients who have both psoriasis and PsA. However, a substantial number of patients may lose efficacy, have adverse effects or find intravenous or subcutaneous administration inconvenient. Emerging oral treatments, including phosphodiesterase 4 inhibitors, such as apremilast, and new biologics targeting interleukin-17, such as secukinumab, brodalumab and ixekizumab, have shown encouraging clinical results in the treatment of psoriasis and/or PsA. Active and regular collaboration of dermatologists with rheumatologists in managing patients who have psoriasis and PsA is likely to yield more optimal control of psoriatic dermal and joint symptoms, and improve long-term patient outcomes.

25 Review Psoriasis and smoking: a systematic review and meta-analysis. 2014

Armstrong, A W / Harskamp, C T / Dhillon, J S / Armstrong, E J. ·Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA, 95816, U.S.A. ·Br J Dermatol · Pubmed #24117435.

ABSTRACT: Psoriasis is an inflammatory skin disease associated with increased cardiovascular comorbidity. Smoking is associated with an increased risk of cardiovascular disease, and prior studies have suggested that patients with psoriasis are more likely to be active smokers. Smoking may also be a risk factor in the development of psoriasis. We conducted a systematic review and meta-analysis to assess the prevalence of smoking among patients with psoriasis, and we reviewed the contribution of smoking to the incidence of psoriasis. A total of 25 prevalence and three incidence studies were identified. The meta-analysis of prevalence studies included a total of 146 934 patients with psoriasis and 529 111 patients without psoriasis. Random effects meta-analysis found an association between psoriasis and current smoking [pooled odds ratio (OR) 1·78, 95% confidence interval (CI) 1·52-2·06], as well as between psoriasis and former smoking (pooled OR 1·62, 95% CI 1·33-1·99). Meta-regression analysis did not reveal any sources of study heterogeneity, but a funnel plot suggested possible publication bias. A subset of studies also examined the association between moderate-to-severe psoriasis and smoking, with a pooled OR of 1·72 (95% CI 1·33-2·22) for prevalent smoking. The three incidence studies found an association between smoking and incidence of psoriasis, with a possible dose-effect of smoking intensity and duration on psoriasis incidence. These findings suggest that smoking is an independent risk factor for the development of psoriasis, and that patients with established psoriasis continue to smoke more than patients without psoriasis.

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