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Psoriasis: HELP
Articles by Vinod Chandran
Based on 139 articles published since 2010
(Why 139 articles?)
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Between 2010 and 2020, V. Chandran wrote the following 139 articles about Psoriasis.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
76 Article Increased burden of inflammation over time is associated with the extent of atherosclerotic plaques in patients with psoriatic arthritis. 2015

Eder, Lihi / Thavaneswaran, Arane / Chandran, Vinod / Cook, Richard / Gladman, Dafna D. ·Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. · Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada. ·Ann Rheum Dis · Pubmed #24827532.

ABSTRACT: AIM: To investigate whether a higher burden of inflammation is associated with more severe atherosclerosis in patients with psoriatic arthritis (PsA). METHODS: Patients from a large PsA cohort were analysed. The cumulative effect of inflammation was measured by a time-adjusted arithmetic mean of all measurements from the first visit to the clinic. The following variables were considered as predictors: Psoriasis Activity and Severity Index (PASI), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, tender and swollen joint counts, C-reactive protein, Psoriatic Arthritis Disease Activity Score (PASDAS) and Disease Activity for PsA (DAPSA). Vascular ultrasound of the carotid arteries was performed, and total plaque area was measured. This measure represented the extent of atherosclerosis and was considered the outcome of interest. The association between inflammation over time and atherosclerosis was assessed by regression models adjusted for age, sex and cardiovascular risk factors. RESULTS: A total of 235 patients with PsA were analysed. Patients with more severe atherosclerosis were older (p<0.001), more likely to be obese (p=0.01), smokers (p=0.008) and have hypertension (p=0.001), diabetes (p<0.0001) and dyslipidaemia (p<0.0001). In a multivariate regression model adjusted for age and sex, higher ESR (p=0.009), WBC count (p=0.015) and DAPSA (p=0.04) were associated with more severe atherosclerosis. These associations were not significant after adjustment for traditional cardiovascular risk factors. No association was found between disease duration and atherosclerosis. CONCLUSIONS: Exposure to an increased burden of inflammation is associated with more severe atherosclerosis in patients with PsA. This association may be mediated by traditional cardiovascular risk factors.

77 Article Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. 2015

Eder, Lihi / Thavaneswaran, Arane / Chandran, Vinod / Cook, Richard J / Gladman, Dafna D. ·University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases-Toronto Western Hospital, Toronto, Ontario, Canada. · Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada. ·Ann Rheum Dis · Pubmed #24431392.

ABSTRACT: AIM: To assess whether overweight and obese patients with psoriatic arthritis (PsA) are less likely to achieve sustained minimal disease activity (MDA) state compared to patients with normal weight. METHODS: A cohort of patients was assessed at the University of Toronto PsA clinic at 6-12-month intervals according to a standard protocol from 2003 to 2012. Patients were categorised into the following groups according to their body mass index (BMI): normal (<25), overweight (25-30), and obese (>30). Sustained MDA was defined as achieving low disease activity state in five or more of the following domains for at least 1 year: skin, enthesitis, tender and swollen joint counts, pain, patient global assessment and function. Proportional odds discrete time to event analysis was used to investigate the association between BMI category and the achievement of sustained MDA. RESULTS: Of the 557 patients included in the study, 36.2% were classified as overweight and 35.4% were obese. Overall, 66.1% of the patients achieved sustained MDA during the follow-up period. A dose-response association was found between obesity and the probability of achieving sustained MDA in the multivariate regression analysis. Patients in the higher BMI categories were less likely to achieve sustained MDA compared those in the lowest BMI category (overweight: OR 0.66 p=0.003; obese: OR 0.53 p<0.0001) after adjusting for potential confounding variables. CONCLUSIONS: Overweight and obese patients with PsA are less likely to achieve sustained MDA compared to those of normal weight.

78 Article Immunoglobulin G subclass analysis in psoriatic arthritis. 2014

Haddad, Amir / Thavaneswaran, Arane / Abji, Fatima / Pellett, Fawnda / Chandran, Vinod / Wither, Joan E / Gladman, Dafna D. ·From the Division of Rheumatology, Department of Medicine, University of Toronto Psoriatic Arthritis Program, and the Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.A. Haddad, MD, Clinical Research Fellow; A. Thavaneswaran, MMath, Biostatistician; F. Abji, MSc; F. Pellett, BSc; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor of Medicine; J.E. Wither, MD, PhD, FRCPC, Professor of Medicine and Immunology; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Department of Medicine, Division of Rheumatology, and Director, University of Toronto Psoriatic Arthritis Program, and Deputy Director, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital. ·J Rheumatol · Pubmed #25320220.

ABSTRACT: OBJECTIVE: The occurrence of monoclonal gammopathy of undetermined significance (MGUS) is common in chronic immune mediated disorders. This increased monoclonal antibody production could result from chronic stimulation of lymphocytes, with the immunoglobulin G (IgG) subtype accounting for the majority of cases in psoriatic arthritis (PsA). We aimed to identify IgG subclass profiles in patients with PsA and to determine association with specific disease characteristics. METHODS: Serum samples from 221 patients with PsA from a single cohort were analyzed for their serum IgG subclass levels. All patients fulfilled the ClASsification for Psoriatic ARthritis (CASPAR) criteria and were followed at 6-month to 12-month intervals according to a standard protocol. MGUS was defined as the occurrence of a discrete band in the gammaglobulin region on at least 2 separate serum protein electrophoresis tests performed 6 months apart. Patients with high abnormal IgG subclass levels were compared to patients with normal levels using descriptive tests. RESULTS: Elevations of IgG1-4 were common in PsA, with ∼20%-49% of patients having elevations of each subclass, IgG2 being the most common subclass abnormality. However, no clinical-serological correlation was found in the group with abnormal IgG2 levels. Of the 38 patients with MGUS, elevations in IgG1 were most common. Patients with an abnormal IgG1 subclass level were more likely to have a discrete band in the gammaglobulin region, higher prevalence of MGUS, and abnormal erythrocyte sedimentation rate or C-reactive protein levels. CONCLUSION: Determination of the IgG subclass concentration in PsA did not seem to add any significant value in identifying specific disease manifestations. However, this study provides insight into the pathological process leading to MGUS in PsA.

79 Article The effectiveness of leflunomide in psoriatic arthritis. 2014

Asiri, Alhussain / Thavaneswaran, Arane / Kalman-Lamb, Gideon / Chandran, Vinod / Gladman, Dafna D. ·Aseer Central Hospital, King Khalid University, Abha, Saudi Arabia, and Psoriatic Arthritis Program, Centre for Prognosis Studies in Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Canada. alhussain.asiri@yahoo.com. ·Clin Exp Rheumatol · Pubmed #25151858.

ABSTRACT: OBJECTIVES: This study aimed to evaluate the effectiveness and safety of leflunomide alone and in combination with methotrexate in the treatment of psoriatic arthritis (PsA). METHODS: Patients were followed at the University of Toronto PsA Clinic. PsA patients who received leflunomide alone or in combination with methotrexate were identified from the PsA clinic database. Effectiveness was defined by drug persistence, a ≥40% reduction in actively inflamed joints, a ≥40% reduction in swollen joint count, and PASI50 and PASI75 response following treatment with leflunomide. Descriptive statistics and logistic regression analyses with stepwise selection were used for data analysis. RESULTS: 85 patients were identified. 43 patients (50.6%) were on leflunomide alone and 42 (49.4%) patients were on combined leflunomide and methotrexate therapy. 30 patients discontinued leflunomide mainly due to toxicity. Of the 55 patients who continued the drug, 38%, 48% and 56% achieved a ≥40% reduction of actively inflamed joint count at 3, 6 and 12 months, respectively. PASI50 was achieved by 27%, 28% and 38% at 3, 6 and 12 months, whereas PASI75 was achieved by 19% at 3 and 6 months and 32% at 12 months. Longer duration of PsA and higher swollen joint count at baseline were predictive for improvement of the swollen joint count at 3 months. The use of concomitant MTX was predictive of achieving PASI50 at 12 months. CONCLUSIONS: Leflunomide led to improvement in almost 50% of the patients by 1 year. Those also taking methotrexate were more likely to achieve a PASI50 response.

80 Article Fine mapping major histocompatibility complex associations in psoriasis and its clinical subtypes. 2014

Okada, Yukinori / Han, Buhm / Tsoi, Lam C / Stuart, Philip E / Ellinghaus, Eva / Tejasvi, Trilokraj / Chandran, Vinod / Pellett, Fawnda / Pollock, Remy / Bowcock, Anne M / Krueger, Gerald G / Weichenthal, Michael / Voorhees, John J / Rahman, Proton / Gregersen, Peter K / Franke, Andre / Nair, Rajan P / Abecasis, Gonçalo R / Gladman, Dafna D / Elder, James T / de Bakker, Paul I W / Raychaudhuri, Soumya. ·Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-0085, Japan; Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA. · Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA. · Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI 48109, USA. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI 48109, USA. · Institute of Clinical Molecular Biology, Kiel University, Kiel 24105, Germany. · Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON M5T 2S8, Canada; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Research Institute, University of Toronto, Toronto, ON M5T 2S8, Canada. · Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Research Institute, University of Toronto, Toronto, ON M5T 2S8, Canada. · National Heart and Lung Institute, Imperial College, London SW7 2AZ, UK. · Department of Dermatology, University of Utah, Salt Lake City, UT 84112, USA. · Department of Dermatology, Christian-Albrechts-Universität zu Kiel, Kiel 24105, Germany. · Memorial University of Newfoundland, St. John's, NL A1C5S7, Canada. · The Feinstein Institute for Medical Research, North Shore - Long Island Jewish Health System, Manhasset, NY 11030, USA. · Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON M5T 2S8, Canada; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Research Institute, University of Toronto, Toronto, ON M5T 2S8, Canada; Toronto Western Research Institute, University of Toronto, Toronto, ON M5G 2M9, Canada. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI 48105, USA. · Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht 3584 CG, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3584 CG, the Netherlands. Electronic address: pdebakker@umcutrecht.nl. · Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA; Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester M13 9PT, UK. Electronic address: soumya@broadinstitute.org. ·Am J Hum Genet · Pubmed #25087609.

ABSTRACT: Psoriasis vulgaris (PsV) risk is strongly associated with variation within the major histocompatibility complex (MHC) region, but its genetic architecture has yet to be fully elucidated. Here, we conducted a large-scale fine-mapping study of PsV risk in the MHC region in 9,247 PsV-affected individuals and 13,589 controls of European descent by imputing class I and II human leukocyte antigen (HLA) genes from SNP genotype data. In addition, we imputed sequence variants for MICA, an MHC HLA-like gene that has been associated with PsV, to evaluate association at that locus as well. We observed that HLA-C(∗)06:02 demonstrated the lowest p value for overall PsV risk (p = 1.7 × 10(-364)). Stepwise analysis revealed multiple HLA-C(∗)06:02-independent risk variants in both class I and class II HLA genes for PsV susceptibility (HLA-C(∗)12:03, HLA-B amino acid positions 67 and 9, HLA-A amino acid position 95, and HLA-DQα1 amino acid position 53; p < 5.0 × 10(-8)), but no apparent risk conferred by MICA. We further evaluated risk of two major clinical subtypes of PsV, psoriatic arthritis (PsA; n = 3,038) and cutaneous psoriasis (PsC; n = 3,098). We found that risk heterogeneity between PsA and PsC might be driven by HLA-B amino acid position 45 (Pomnibus = 2.2 × 10(-11)), indicating that different genetic factors underlie the overall risk of PsV and the risk of specific PsV subphenotypes. Our study illustrates the value of high-resolution HLA and MICA imputation for fine mapping causal variants in the MHC.

81 Article GRAPPA 2013 Annual Meeting, rheumatology updates: psoriatic arthritis (PsA) biomarker project, arthritis mutilans, PsA-peripheral spondyloarthritis epidemiology project. 2014

FitzGerald, Oliver / Mease, Philip J / Helliwell, Philip S / Chandran, Vinod. ·From the Department of Rheumatology, St. Vincent's University Hospital and Conway Institute for Biomolecular Research, University College, Dublin, Ireland; Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington, USA; Academic Unit of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK; Division of Rheumatology, Department of Medicine, University of Toronto; Centre for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.O. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital and Conway Institute for Biomolecular Research, University College; P.J. Mease, MD, Rheumatology Research, Swedish Medical Center and Clinical Professor, University of Washington School of Medicine; P.S. Helliwell, DM, PhD, Academic Unit of Musculoskeletal Disease, Chapel Allerton Hospital; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, Department of Medicine, University of Toronto, and Centre for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network. ·J Rheumatol · Pubmed #24882863.

ABSTRACT: At the 2013 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), several key GRAPPA projects on musculoskeletal aspects of psoriatic disease were reviewed. In this article, lead investigators summarize the progress made in a multicenter study, the PsA BioDam (Psoriatic Arthritis Biomarkers for Joint Damage), to identify soluble biomarkers for joint damage, as well as developing classification criteria for arthritis mutilans. Also reviewed are concepts and rationale behind a proposal to study classification criteria for peripheral spondyloarthritis, including PsA, reactive arthritis, inflammatory bowel disease-associated arthritis, and undifferentiated arthritis.

82 Article Radiological characteristics of the calcaneal spurs in psoriatic arthritis. 2014

Gladman, D D / Abufayyah, M / Salonen, D / Thavaneswaran, A / Chandran, V. ·University of Toronto, Toronto Western Research Institute, Psoriatic Arthritis Program, University Health Network, Toronto, Canada. dafna.gladman@utoronto.ca. ·Clin Exp Rheumatol · Pubmed #24850064.

ABSTRACT: OBJECTIVES: Inflammation at the entheses is a distinguishing feature of psoriatic arthritis (PsA). Enthesitis at the heel is the most common location at the Achilles and plantar fascia insertions on the calcaneus. This study aimed to 1) describe the morphological features and measurements of plantar calcaneal spurs in subjects with PsA and controls and 2) determine radiological features that differentiate between inflammatory and non-inflammatory calcaneal spurs. METHODS: Weight bearing lateral foot radiographs of 101 subjects with PsA and 38 control subjects without inflammatory arthritis were examined for plantar calcaneal and Achilles spurs. Three measurements were taken from each radiograph: plantar spur base, mid-segment, and length in millimeters. The differences in radiographic measurements, and the presence of fluffy periostitis of the plantar spurs were then compared between PsA patients and controls. RESULTS: Of the 101 subjects with PsA, 76 (75%) had at least one plantar calcaneal spur and 32 (31.5%) had at least one Achilles tendon spur, compared to 18 (47%) and 3 (8%) respectively in control group (p=0.004). Fluffy plantar periostitis was identified in 14 PsA subjects and none of the controls (p=0.01). The dimensions of plantar spurs were significantly different between groups - longer mid-segment distinguished patients with PsA from controls. CONCLUSIONS: Calcaneal spurs are more common in subjects with PsA than controls. Longer mid-segment measurement was associated with PsA. This study indicates that the presence of fluffy plantar periostitis and broad based and longer mid-segment dimensions are radiological features for inflammatory spurs.

83 Article Prevalence and predictors of reduced work productivity in patients with psoriatic arthritis. 2014

Kennedy, M / Papneja, A / Thavaneswaran, A / Chandran, V / Gladman, D D. ·University of Toronto, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Canada. matt.kennedy@mail.utoronto.ca. ·Clin Exp Rheumatol · Pubmed #24708934.

ABSTRACT: OBJECTIVES: Psoriatic arthritis (PsA) is a unique inflammatory musculoskeletal disorder associated with psoriasis. Although high rates of absenteeism have been associated with PsA, less is known about the impact of the disease on the productivity of patients who remain at work. The aim of this study was to identify factors associated with reduced work productivity, as measured by the Work Limitations Questionnaire (WLQ), among patients with PsA. METHODS: Patients attending a single Psoriatic Arthritis Clinic were recruited for participation. Employed participants (including homemakers) first completed a Questionnaire for the Assessment of Work-Related Factors (QAWRF). Eligible participants then completed the WLQ. WLQ scores were used as the dependent variable in linear and logistic regression analyses. Independent variables assessed in this study include work characteristics, demographic factors, and clinical measures. RESULTS: One hundred and eighty-six eligible patients (60.9% males) returned their assessment forms for analysis. The mean reduction in work productivity due to illness was 4.3%. In univariate linear regression analysis, work productivity was significantly associated with sex, education status, Psoriasis Area and Severity Index (PASI), AJC, ESR, Functional Co-morbidity Index (FCI), and support at work; associations with gender, ESR, FCI, and medications were also significant in a reduced multivariate model. CONCLUSIONS: Work productivity was associated with demographic, clinical, and work-related factors in PsA. These variables may be useful in identifying patients who require more aggressive intervention, including the use of effective drugs to control disease activity and advocacy for a more supportive work environment.

84 Article Depression and anxiety in psoriatic disease: prevalence and associated factors. 2014

McDonough, Emily / Ayearst, Renise / Eder, Lihi / Chandran, Vinod / Rosen, Cheryl F / Thavaneswaran, Arane / Gladman, Dafna D. ·From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; Division of Dermatology, Toronto Western Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. ·J Rheumatol · Pubmed #24692521.

ABSTRACT: OBJECTIVE: (1) To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA) and to identify associated demographic and disease-related factors. (2) To determine whether there is a difference in the prevalence of depression and anxiety between patients with PsA and those with psoriasis without PsA (PsC). METHODS: Consecutive patients attending PsA and dermatology clinics were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale. Patients underwent a clinical assessment according to a standard protocol and completed questionnaires assessing their health and quality of life. T tests, ANOVA, and univariate and multivariate models were used to compare depression and anxiety prevalence between patient cohorts and to determine factors associated with depression and anxiety. RESULTS: We assessed 306 patients with PsA and 135 with PsC. There were significantly more men in the PsA group (61.4% vs 48% with PsC) and they were more likely to be unemployed. The prevalence of both anxiety and depression was higher in patients with PsA (36.6% and 22.2%, respectively) compared to those with PsC (24.4% and 9.6%; p = 0.012, 0.002). Depression and/or anxiety were associated with unemployment, female sex, and higher actively inflamed joint count as well as disability, pain, and fatigue. In the multivariate reduced model, employment was protective for depression (OR 0.36) and a 1-unit increase on the fatigue severity scale was associated with an increased risk of depression (OR 1.5). CONCLUSION: The rate of depression and anxiety is significantly higher in patients with PsA than in those with PsC. Depression and anxiety are associated with disease-related factors.

85 Article Reliability of radiographic scoring methods in axial psoriatic arthritis. 2014

Biagioni, Bradly J / Gladman, Dafna D / Cook, Richard J / Eder, Lihi / Wakhlu, Anupam / Shen, Hua / Chandran, Vinod. ·Toronto Western Hospital, Toronto, Ontario, Canada, and University of British Columbia, Vancouver, British Columbia, Canada. ·Arthritis Care Res (Hoboken) · Pubmed #24515627.

ABSTRACT: OBJECTIVE: Important differences exist between axial psoriatic arthritis (AxPsA) and ankylosing spondylitis (AS). The Bath Ankylosing Spondylitis Radiology Index (BASRI), the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS), and the Radiographic Ankylosing Spondylitis Spinal Score (RASSS) were developed to score AS, and the Psoriatic Arthritis Spondylitis Radiology Index (PASRI) to score AxPsA. We aimed to develop a computerized scoring application and compare the intra- and interrater reliability of these scoring systems in AS and AxPsA. METHODS: A computerized scoring application was developed to facilitate the scoring of radiographic features and calculate total scores for established scoring methods for AS and AxPsA. Digital spinal radiographs of 18 patients with AS and 40 patients with AxPsA were read in random order individually by 4 rheumatologists, data were entered into the application, and scores were obtained. The intraclass correlation coefficients (ICC) of the intra- and interrater reliability of scores for each method were then computed. RESULTS: In AS, the intra- and interrater ICC was 0.91 and 0.80 for sacroiliitis grade, 0.96 and 0.86 for BASRI-spine, 0.98 and 0.86 for mSASSS, 0.96 and 0.75 for RASSS, and 0.99 and 0.93 for PASRI, respectively. In AxPsA, the intra- and interrater ICC was 0.81 and 0.67 for sacroiliitis grade, 0.77 and 0.52 for BASRI-spine, 0.91 and 0.65 for mSASSS, 0.90 and 0.68 for RASSS, and 0.92 and 0.88 for PASRI, respectively. CONCLUSION: Available radiographic scoring systems perform well in AS and have moderate intra- and interrater reliability when applied to AxPsA. However, PASRI may be superior for assessing structural damage in AxPsA.

86 Article Is the MAdrid Sonographic Enthesitis Index useful for differentiating psoriatic arthritis from psoriasis alone and healthy controls? 2014

Eder, Lihi / Jayakar, Jai / Thavaneswaran, Arane / Haddad, Amir / Chandran, Vinod / Salonen, David / Rosen, Cheryl F / Gladman, Dafna D. ·From the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Western University, London; Division of Rheumatology, Department of Medicine, University of Toronto; Department of Medical Imaging, University of Toronto; Musculoskeletal Imaging, Mount Sinai Hospital; Department of Medical Imaging, University of Toronto; Division of Dermatology, Toronto Western Hospital and University Health Network Hospitals; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Psoriatic Arthritis Clinic, Toronto, Ontario, Canada. ·J Rheumatol · Pubmed #24488414.

ABSTRACT: OBJECTIVE: To assess the usefulness of the MAdrid Sonographic Enthesitis Index (MASEI) in classifying patients as having psoriatic arthritis (PsA) and comparing entheseal abnormalities between patients with PsA, psoriasis alone (PsC), and healthy controls (HC). METHODS: Patients with PsC were assessed to exclude inflammatory arthritis. The MASEI scoring system was used to quantify the extent of ultrasonographic (US) entheseal abnormalities. The total MASEI score was categorized into items that reflected inflammatory abnormalities (MASEI-inflammatory) and chronic damage (MASEI-damage). Nonparametric tests were used to compare MASEI scores across the groups. A cutoff point of MASEI ≥ 20 was used to calculate the sensitivity and specificity of the MASEI to classify patients as having PsA. RESULTS: Patients with PsA (n = 50), PsC (n = 66), and HC (n = 60) were assessed. Total MASEI scores were higher in patients with PsA than in those with PsC, and both those groups were higher than HC (p < 0.0001). MASEI-inflammatory showed a similar trend (p < 0.0001). MASEI-damage was higher in patients with PsA compared to both patients with PsC and HC (p < 0.0001); however, no difference was observed between patients with PsC and HC. No significant difference in MASEI scores was found across the 3 groups in patients with a body mass index > 30. The sensitivity of the MASEI score to correctly classify patients as having PsA was 30% and the specificity was 95% when compared to HC and 89% when compared to PsC. CONCLUSION: The severity of US entheseal abnormalities is highest in patients with PsA followed by PsC and is lowest in healthy controls. MASEI can specifically classify patients as having PsA.

87 Article Killer-cell immunoglobulin-like receptor gene polymorphisms and susceptibility to psoriatic arthritis. 2014

Chandran, Vinod / Bull, Shelley B / Pellett, Fawnda J / Ayearst, Renise / Pollock, Remy A / Gladman, Dafna D. ·Psoriatic Arthritis Program, Toronto Western Research Institute, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, 399 Bathurst Street, Room 1E-410, Toronto, ON, Canada M5T 2S8. dafna.gladman@utoronto.ca. ·Rheumatology (Oxford) · Pubmed #24185760.

ABSTRACT: OBJECTIVES: We conducted a case-control study to determine the association between KIR2D and KIR3D gene polymorphisms and their interaction with HLA alleles in PsA. METHODS: A total of 678 subjects with PsA and 688 healthy controls were studied. Differences between cases and controls in the frequency of individual KIR polymorphisms were tested for significance by an asymptotic χ(2) test and Fisher's exact test. Trends for increasing susceptibility to PsA from combined genotypes (HLA-KIR and HLA) were evaluated by the Cochran-Armitage trend test. Multigene logistic regression analysis was conducted to identify independent associations and interactions. RESULTS: In univariate analyses, KIR2DL2 and KIR2DS2 polymorphisms were significantly associated with PsA. Only KIR2DS2 was associated with PsA compared with healthy controls in multivariate analysis [odds ratio (OR) 1.25, 95% CI 1.01, 1.54, P = 0.044]. The presence of HLA-C group 2 alleles was associated with a higher risk of PsA (trend test P = 0.006). The risk of PsA is higher when KIR2DS2 is present with the HLA-C ligands (C group 1) for the corresponding inhibitory KIRs, and is highest when KIR2DS2 is present in the absence of HLA-C ligands for homologous inhibitor KIRs, compared with the state when KIR2DS2 is absent (trend test P = 0.027). The presence of HLA-C alleles that have high cell surface expression was also associated with a higher risk of PsA (trend test P < 0.001). HLA-B Bw4 and HLA-B Bw4 80ile allele groups were associated with a higher PsA risk (trend test P < 0.0001 for both analyses). CONCLUSION: This study confirms the association of the KIR2DS gene, especially KIR2DS2, with PsA.

88 Article The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease. 2014

Eder, Lihi / Chandran, Vinod / Gladman, Dafna D. ·Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital, Toronto, Ontario, Canada. ·Ann Rheum Dis · Pubmed #23887287.

ABSTRACT: AIM: To investigate the usefulness of carotid atherosclerosis assessment in cardiovascular risk stratification of patients with psoriatic disease compared with the Framingham Risk Score (FRS). METHODS: Patients with psoriatic arthritis (PsA) and psoriasis alone (PsC), who had no previous history of cardiovascular disease, chronic kidney disease or diabetes mellitus were recruited. They underwent assessment of their cardiovascular risk factors and the FRS was calculated. Based on the FRS, the participants were classified into low, intermediate and high-risk categories. Ultrasound assessment of the carotid artery was performed, and carotid intima-media thickness (cIMT) and total plaque area (TPA) were measured. Patients were stratified into three ultrasound-based risk categories (low, intermediate and high) according to the severity of atherosclerosis. The extent of reclassification from FRS-based category into US-based risk category was assessed. RESULTS: A total of 226 patients with psoriatic disease were assessed. FRS correlated moderately with TPA (r=0.36) and cIMT (r=0.37) and explained only 19% of their variability. 56.1% of the patients in the FRS-based low to intermediate risk groups were found to have carotid plaques. 55.9% of the patients from the FRS-based intermediate risk category were reclassified into an ultrasound-based high-risk category, while 47.1% of the patients in the FRS-based low-risk category were reclassified into a higher US-based risk group. The extent of reclassification into a higher risk category was particularly high among patients with PsA. CONCLUSIONS: Ultrasound assessment of subclinical atherosclerosis may improve risk stratification of patients with psoriatic disease, particularly of those with PsA.

89 Article Tumour necrosis factor α blockers are more effective than methotrexate in the inhibition of radiographic joint damage progression among patients with psoriatic arthritis. 2014

Eder, Lihi / Thavaneswaran, Arane / Chandran, Vinod / Gladman, Dafna D. ·University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, , Toronto, Ontario, Canada. ·Ann Rheum Dis · Pubmed #23619157.

ABSTRACT: AIM: To determine whether tumour necrosis factor α (TNFα) blockers are more effective than methotrexate in inhibiting the progression of radiographic joint damage in patients with psoriatic arthritis (PsA). METHODS: A cohort analysis of patients followed prospectively in a large PsA clinic was conducted. Patients who received a TNFα blocker were compared to those treated with methotrexate. Patients who had records of at least 12 months of treatment with either medication for active peripheral PsA and had radiographic bone erosions were analysed. Radiographs of the hands and feet were performed at baseline, 1-2 years (time 1) and 3-4 years (time 2). Radiographic joint damage was scored according to the modified Steinbrocker score. The outcome of interest was the occurrence of radiographic progression. Multivariate logistic regression analysis using generalised estimating equations for repeated measures was used to compare progression in radiographic joint damage between the two treatment groups. RESULTS: 65 patients treated with TNFα blockers and 70 patients treated with methotrexate were analysed. The proportion of patients who demonstrated progression of radiographic damage score at time 1 and time 2 was higher in the methotrexate group compared to the TNFα blockers group (at time 1: 80% vs 58.9% p=0.005; at time 2: 88% vs 61% p=0.005). In the multivariate regression analysis methotrexate treatment was associated with an increase in radiographic damage compared to TNFα blockers (p=0.001). CONCLUSIONS: In a clinic setting, patients with erosive PsA receiving TNFα blockers had a better radiographic outcome compared to those treated with methotrexate.

90 Article Human leukocyte antigen alleles and susceptibility to psoriatic arthritis. 2013

Chandran, Vinod / Bull, Shelley B / Pellett, Fawnda J / Ayearst, Renise / Rahman, Proton / Gladman, Dafna D. ·Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. ·Hum Immunol · Pubmed #23916976.

ABSTRACT: OBJECTIVE: Our purpose was to determine associations between HLA alleles and psoriatic arthritis (PsA). METHODS: 678 PsA cases and 688 healthy controls were analyzed in a case-control design. The difference in the proportion of cases and controls with at least 1 copy of HLA alleles were tested for significance using χ(2) test and Fisher's exact test. Association analyses of haplotypes inferred by the Expectation-Maximization algorithm were performed. In the family-based association study, data from 283 families were analyzed. RESULTS: Univariate analysis revealed that cases were more likely to be carriers of HLA-C*01, -C*02, -C*06, -C*12, -B*27, -B*38 and -B*57, whereas controls were more likely to be carriers of HLA-C*03, -C*07, -B*07, -B*51, -DRB1*15 and -DQB1*0602. In haplotype analyses, PsA cases were more likely to be carriers of the HLA haplotypes -C*01/-B*27, -C*02/-B*27, -C*12/-B*38, and -C*06/-B*57, while controls were more likely to be carriers of the haplotypes -C*07/-B*07 and -C*15/-B*51. In the family-based association analysis, the HLA alleles -A*02, -B*27 and -DRB1*07 were preferentially transmitted to cases, whereas the alleles -A*03, -A*28, -B*51, -DRB1*11 and -DQB1*0301 were under transmitted. CONCLUSION: This large case-control and family based association study shows that HLA-C*12/B*38, HLA-B*27 and HLA-C*06/B*57 are haplotypes (alleles) robustly associated with PsA. However, since patients with PsA also have psoriasis it is difficult to determine whether the primary association is with arthritis or psoriasis.

91 Article Dactylitis in psoriatic arthritis: prevalence and response to therapy in the biologic era. 2013

Gladman, Dafna D / Ziouzina, Olga / Thavaneswaran, Arane / Chandran, Vinod. ·University of Toronto, Toronto, Ontario, Canada. dafna.gladman@utoronto.ca ·J Rheumatol · Pubmed #23818708.

ABSTRACT: OBJECTIVE: To determine the prevalence of acute dactylitis in patients with psoriatic arthritis (PsA) and to compare the response of new acute dactylitis to treatment with traditional disease-modifying antirheumatic drug (DMARD) and anti-tumor necrosis factor-α (anti-TNF) agents in a longitudinal PsA cohort. METHODS: Patients with PsA followed at 6 months according to a standard protocol from January 2000 to January 2010 were included in our study. Acute dactylitis was defined as the presence of painful swelling of an entire digit. Response was defined as either complete resolution of dactylitis or > 50% improvement in the number of dactylitic digits. A multivariate generalized estimating equations analysis using a negative binomial model to account for repeated measures was conducted to determine predictors for response to treatment of dactylitis. RESULTS: Of the 752 patients seen in the clinic during this period, 294 had dactylitis in at least 1 visit, giving a prevalence of 39%. Patients with acute dactylitis and data available for response at 6 and 12 months (n = 252; 34% women, mean age 47 yrs, PsA duration 11 yrs) were included in the study on predictors of response to treatment. Multivariate analysis showed that treatment with anti-TNF agents was a significant predictor of improvement in dactylitis at 12 months (relative risk 0.528, 95% CI 0.283-0.985, p = 0.045). CONCLUSION: The prevalence of dactylitis on at least 1 visit was 39%. Treatment was associated with improvement of dactylitis. Patients treated with biologics had better response to treatment compared with those treated with nonbiologic DMARD alone.

92 Article Diffuse idiopathic skeletal hyperostosis in psoriatic arthritis. 2013

Haddad, Amir / Thavaneswaran, Arane / Toloza, Sergio / Chandran, Vinod / Gladman, Dafna D. ·Centre for Prognosis Studies in the Rheumatic Diseases University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada. ·J Rheumatol · Pubmed #23772085.

ABSTRACT: OBJECTIVE: To determine the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with psoriatic arthritis (PsA) and to identify the features associated with its occurrence. METHODS: Patients were recruited from the University of Toronto PsA observational cohort initiated in 1978. All patients fulfilled the CASPAR criteria. Radiographs of peripheral joints and spine were obtained every 2 years. DISH was defined as flowing bony bridges in at least 4 contiguous thoracic vertebrae. Each PsA patient with DISH was matched by sex to 3 PsA patients without DISH. Demographics, disease characteristics, and radiographic features were compared using McNemar test, Fisher's exact test, chi-square test, and paired t test as appropriate. Logistic regression analyses models with stepwise regression were conducted. RESULTS: DISH was observed in 78 (8.3%) of 938 patients with PsA. Patients with DISH were older and had longer disease duration, higher body mass index (BMI), and higher uric acid levels. Diabetes and hypertension were more prevalent in patients with DISH than in those without. The severity of radiographic damage to peripheral joints was also greater in patients with DISH. The presence of inflammatory back pain, HLA-B*27 allele, and sacroiliitis was similar in both groups. Patients with DISH had more syndesmophytes and calcaneal spurs. Older age, higher BMI, and the presence of radiographic damage to peripheral joints were associated with DISH in multivariate analysis. CONCLUSION: The diagnosis of DISH is possible in the presence of axial PsA. DISH was associated with known DISH-related factors including older age and high BMI, as well as the presence of radiographic damage to peripheral joints.

93 Article Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. 2013

Husted, Janice A / Thavaneswaran, Arane / Chandran, Vinod / Gladman, Dafna D. ·Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada. ·J Rheumatol · Pubmed #23772076.

ABSTRACT: OBJECTIVE: To assess the added effect of comorbidity on quality of life (QOL) in psoriatic arthritis (PsA). METHODS: Between 2006 and 2012, 631 patients were recruited from the University of Toronto PsA Clinic. Using the clinical database, we ascertained the frequency of 15 comorbidities. The Medical Outcomes Study Short Form-36 (SF-36) physical (PCS) and mental component (MCS) summary scales were used to assess QOL. Linear regression analyses were conducted to estimate the magnitude of the association between number and type of comorbidities and PCS and MCS scores, after adjustment for disease-related and sociodemographic variables. RESULTS: Prevalence of comorbidity was high, with 42% of patients having 3 or more comorbid conditions. After adjustment for inflammatory disease-related and sociodemographic factors, a history of 3 or more comorbid conditions accounted for only 2% and 1% of the R(2) value explained in PCS and MCS scores, respectively. In terms of added burden, type of comorbid condition was more significant than number of comorbidities. After adjustment for disease-related and sociodemographic factors, fibromyalgia (FM), neurological disorders, and obesity jointly accounted for 6% of R(2) value explained in PCS scores, while FM and depression/anxiety jointly accounted for about 9% of the R(2) explained in MCS scores. The point decrease in PCS and MCS scores associated with each of these disorders was clinically significant. The 11 other comorbid conditions failed to achieve statistical significance in the models. CONCLUSION: The added effect of comorbidity on patient-reported physical and mental health in PsA was more related to type of comorbidity than number of comorbidities.

94 Article Soluble biomarkers associated with response to treatment with tumor necrosis factor inhibitors in psoriatic arthritis. 2013

Chandran, Vinod / Shen, Hua / Pollock, Remy A / Pellett, Fawnda J / Carty, Adele / Cook, Richard J / Gladman, Dafna D. ·Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Canada. ·J Rheumatol · Pubmed #23637322.

ABSTRACT: OBJECTIVE: To identify soluble biomarkers associated with response to therapy with tumor necrosis factor inhibitors (TNFi) in patients with psoriatic arthritis (PsA). METHODS: The study was conducted at a PsA clinic where patients are assessed every 6 months, and serum samples are collected and stored once a year at the time of clinical assessment. Forty patients with active PsA who gave serum samples prior to treatment with TNFi and after at least 3 months of therapy were identified. Patients were classified as TNFi responders if tender joint count was < 3, swollen joint count was 0, and Psoriasis Area and Severity Index score was < 4 at the time the second sample was collected. The following biomarkers were tested by ELISA: TNF superfamily 14, matrix metalloprotease-3 (MMP-3), receptor activator of nuclear factor kappa-B ligand, osteoprotegerin, cartilage oligomeric matrix protein (COMP), CPII, C2C and C1-2C, CS-846, and highly sensitive C-reactive protein. Paired t tests and logistic regression was used for statistical analyses. RESULTS: After a mean treatment duration of 11 months with TNFi (etanercept 28 patients, adalimumab 6, golimumab 4, infliximab 2), 29 patients were classified as TNFi responders. Baseline level of MMP-3 was independently associated with responder status (OR 1.067 for each 1-unit increase, p = 0.045). A reduction in MMP-3 levels with therapy increased the odds of achieving response (OR 1.213 for each 1-unit change, p = 0.030), whereas a reduction in COMP decreased the odds (OR 0.587, for each 100-unit increase, p = 0.039). None of the other biomarkers was associated with response. CONCLUSION: Baseline as well as reduction in serum MMP-3 and increase in serum COMP are independently associated with response to TNFi therapy in patients with PsA.

95 Article The functional MICA-129 polymorphism is associated with skin but not joint manifestations of psoriatic disease independently of HLA-B and HLA-C. 2013

Pollock, R A / Chandran, V / Pellett, F J / Thavaneswaran, A / Eder, L / Barrett, J / Rahman, P / Farewell, V / Gladman, D D. ·University of Toronto Psoriatic Arthritis Program, Toronto Western Research Institute, Toronto, Ontario, Canada. ·Tissue Antigens · Pubmed #23611695.

ABSTRACT: A methionine/valine polymorphism at amino acid 129 of the major histocompatibility complex class I chain-related gene A (MICA-129) categorizes alleles into strong and weak binders of the natural killer (NK) and T-cell receptor NKG2D. We investigated whether MICA-129 is differentially associated with skin and joint manifestations of psoriatic disease (PsD) independently of human leukocyte antigen (HLA)-C and HLA-B in patients and controls from Toronto and St. John's. The MICA-129 methionine (Met) allele, particularly Met/Met homozygosity, was strongly associated with both cutaneous psoriasis (PsC) and psoriatic arthritis (PsA) independently of HLA-B and HLA-C in Toronto patients, and was also associated with PsA in St. John's patients, but with no additional effect of Met/Met homozygosity. No association remained after adjustment for HLA alleles in St. John's patients. MICA-129 was not associated with PsA when compared with PsC. We conclude that MICA-129 is a marker of skin manifestations of PsD that is independent of HLA class I in Toronto patients.

96 Article Physician scores vs patient self-report of joint and skin manifestations in psoriatic arthritis. 2013

Chaudhry, Salman R / Thavaneswaran, Arane / Chandran, Vinod / Gladman, Dafna D. ·Internal Medicine Department, McMaster University, Hamilton, Ontario, Canada. ·Rheumatology (Oxford) · Pubmed #23267168.

ABSTRACT: OBJECTIVE: We aimed to determine the degree of agreement between patient self-report and physician assessment of joint disease activity and damage and degree of skin disease. METHODS: Patients were followed up in the PsA clinic for homunculus for tender joints, swollen joints, deformed joints and problematic joints, as well as the severity of their psoriasis. A rheumatologist documented tender joints, swollen joints and damaged joints as well as psoriasis area and severity index score. The scores were compared using the concordance correlation coefficient and Bland-Altman plots were constructed. RESULTS: One hundred and forty outpatients participated in the study (60 females and 80 males) with a mean age of 52.8 years. Their mean age at onset of psoriasis was 27.4 years and at PsA onset was 36.9 years. The average duration of psoriasis at the time of the study was 25.3 years and of PsA was 16.2 years. The correlation between patient and physician scores was poor for tender and swollen joints, although it was better for deformed joints and psoriasis area and severity index score but still did not reach a level of good agreement. CONCLUSION: PsA patient's self-report has a poor correlation with physician assessment. Thus patient self-reported data are insufficient to accurately monitor PsA disease activity when compared with a physician's joint examination and skin score. Expert physical examination should remain the gold standard for the assessment of actively inflamed joint and skin disease in patients with PsA in both clinical trials and observational cohort studies.

97 Article Serum adipokines in patients with psoriatic arthritis and psoriasis alone and their correlation with disease activity. 2013

Eder, Lihi / Jayakar, Jai / Pollock, Remy / Pellett, Fawnda / Thavaneswaran, Arane / Chandran, Vinod / Rosen, Cheryl F / Gladman, Dafna D. ·Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, , Toronto, Ontario, Canada. ·Ann Rheum Dis · Pubmed #23243196.

ABSTRACT: OBJECTIVE: To compare the prevalence of metabolic syndrome (MetS) and the levels of related biomarkers in patients with psoriatic arthritis (PsA) and psoriasis without arthritis (PsC). METHODS: This study compared patients with PsA and patients with PsC. The presence of MetS was determined. Serum levels of insulin, adiponectin and leptin were measured. The homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. HOMA-IR, adiponectin and leptin were log-transformed. Continuous variables were compared using the t test and the χ(2) test was used for discrete variables. Multivariate regression models were used to investigate the association of MetS and adiponectin with PsA compared to PsC after adjusting for potential confounding variables. RESULTS: 203 PsA and 155 PsC patients were analysed. The prevalence of MetS was higher in PsA patients compared to those with PsC. However, this did not reach statistical significance (36.5% vs 27.1%, p=0.056). The levels of adipokines were significantly higher in PsA compared to PsC: adiponectin (8.8±5.2 vs 7.4±4.5 log (µg/ml), p=0.009) and leptin in women (3.1±0.8 vs 2.8±0.8, log (ng/ml), p=0.04). HOMA-IR was also higher in PsA (0.97±0.63 vs 0.68±0.81, p<0.001). No difference was observed in leptin levels in men. In multivariate regression analysis, PsA (p=0.04) and the psoriasis area and severity index score (p=0.02) were associated with MetS. Adiponectin was significantly associated with PsA (p=0.005), the use of anti-tumour necrosis factor α therapy (p=0.03) and active joint count (p=0.001). CONCLUSIONS: MetS and related adipokines correlated with an increased burden of skin and joint inflammation.

98 Article Serum kallikrein-8 correlates with skin activity, but not psoriatic arthritis, in patients with psoriatic disease. 2013

Eissa, Azza / Cretu, Daniela / Soosaipillai, Antoninus / Thavaneswaran, Arane / Pellett, Fawnda / Diamandis, Anastasia / Cevikbas, Ferda / Steinhoff, Martin / Diamandis, Eleftherios P / Gladman, Dafna / Chandran, Vinod. ·Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. ·Clin Chem Lab Med · Pubmed #23096109.

ABSTRACT: BACKGROUND: About 30% of cutaneous psoriasis (PsC) patients develop psoriatic arthritis (PsA) in the joint, which is under-recognized by dermatologists. Biomarkers for PsA are needed so that early referral to a rheumatologist is made. Kallikreins (KLKs) are secreted serine proteases implicated in skin desquamation and inflammation. This study examined KLK potential as serum biomarkers of PsA in cutaneous psoriasis patients. METHODS: KLKs were measured by ELISAs in synovial fluids of three PsA patients and three control early osteoarthritis (OA) patients, as well as in a cohort of 152 serum samples collected from age- and sex-matched PsC patients, with (n=76) or without PsA (n=76). KLK expression in psoriatic plaques was examined by immunohistochemistry. Univariate and multivariate logistic regression analyses were conducted to analyze the association between serum KLK levels and disease class (PsC, PsA). Serum KLKs that associated with PsA were correlated with clinical parameters of skin and joint activity. RESULTS: Among the seven KLKs tested, KLK6 and KLK8 were elevated in both PsA synovial fluids and psoriatic plaques, but only serum KLK8 levels were associated with psoriatic disease (odds ratio=2.56, p=0.03). Although significantly elevated in PsC and PsA sera compared to healthy controls, KLK8 did not discriminate PsA from PsC patients. KLK8 correlated positively with the psoriasis area and severity index (PASI) (r=0.43, p=0.001) independent of age, sex and psoriasis duration ( β=1.153, p=0.0003) and exhibited no correlations with tender or swollen joint counts. CONCLUSIONS: Increased KLK8 serum level in PsA patients reflects disease activity in the skin but not in the joints. Serum KLK levels are not useful for screening psoriasis patients for PsA.

99 Article The burden of carotid artery plaques is higher in patients with psoriatic arthritis compared with those with psoriasis alone. 2013

Eder, Lihi / Jayakar, Jai / Shanmugarajah, Sutha / Thavaneswaran, Arane / Pereira, Daniel / Chandran, Vinod / Rosen, Cheryl F / Gladman, Dafna D. ·Department of Rheumatology, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Psoriatic Arthritis Program, Toronto, Ontario, Canada. ·Ann Rheum Dis · Pubmed #22736087.

ABSTRACT: AIM: To compare the extent of atherosclerosis in patients with psoriatic arthritis (PsA) and patients with cutaneous psoriasis without arthritis (PsC). METHODS: In this cross-sectional study the authors compared patients with PsA with PsC patients. Psoriasis patients underwent a rheumatological assessment to exclude inflammatory arthritis. Ultrasonographic measurements of carotid total plaque area (TPA) and carotid intima-media thickness (cIMT) were performed. t Test was used to compare the imaging findings between the two groups. Multivariate linear regression analysis was used to assess the association between disease status and imaging findings after adjusting for potential confounders. RESULTS: Overall, 125 PsA and 114 PsC patients were compared. There were no significant differences in age, gender or cardiovascular risk factors between the two groups. Patients with PsA exhibited greater TPA than did PsC patients (TPA (square root of area in mm(2)) 3.33±3.34 vs 2.43±2.72, p=0.03). This difference remained statistically significant in the multivariate regression analysis after adjusting for potential confounders (p=0.03). The difference in cIMT between the groups did not achieve statistical significance (p=0.09). The following disease-related variables were associated with increase in TPA in multivariate regression analysis among PsA patients: duration of PsA (p=0.04), highest Psoriasis Area and Severity Index recorded in the first 3 years of follow-up (p=0.02) and erythrocyte sedimentation rate (p=0.005). CONCLUSIONS: PsA patients suffer from more severe subclinical atherosclerosis compared with patients with PsC. This difference is independent of traditional cardiovascular risk factors and correlates with PsA disease duration, more severe skin disease and increased inflammatory markers.

100 Article Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. 2013

Eder, Lihi / Thavaneswaran, Arane / Chandran, Vinod / Gladman, Dafna D. ·Correspondence to Dafna D Gladman, University of Toronto, Toronto Western Research Institute, Psoriatic Arthritis Clinic, Centre for Prognostic Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto 97914, Canada. ·Ann Rheum Dis · Pubmed #22589379.

ABSTRACT: OBJECTIVE: The authors aimed to assess gender-related differences in severity of psoriatic arthritis (PsA) as reflected by measures of disease activity, joint damage, quality of life and disability. METHODS: A cross-sectional analysis was performed among patients who have been followed in a large PsA clinic. Demographic, clinical and radiographic data as well as information about quality of life and function were retrieved from the clinic database. Radiographic damage was assessed according to modified Steinbrocker score (mSS). The association between gender and the following outcome variables, radiographic joint damage, axial involvement and measures of quality of life and function, was assessed by multivariate regression analysis after adjustment for potential confounders. RESULTS: Three hundred and forty-five men and 245 women were included in the study. Axial involvement was more frequent in men (42.9% vs 31%, p=0.003). In multivariate analysis, adjusting for potential confounders, men were more likely to develop axial involvement (OR 1.8, p=0.003). Men were also more likely to develop more severe radiographic damage in the peripheral joints as evident by mSS. Men were more likely to be in a higher mSS damage category compared with women after adjusting for potential confounders in multivariate analysis (OR 1.6, p=0.007). Women suffered from more severe limitations in function and worse quality of life compared with men based on several patients' reported outcomes. CONCLUSIONS: Men with PsA are more likely to develop axial involvement and radiographic joint damage, while women are more likely to report about limitation in function and impaired quality of life.

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