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Psoriasis: HELP
Articles from Tufts Medical Center
Based on 74 articles published since 2008
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These are the 74 published articles about Psoriasis that originated from Tufts Medical Center during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 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.

2 Guideline Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference. 2010

Rosmarin, David M / Lebwohl, Mark / Elewski, Boni E / Gottlieb, Alice B / Anonymous5570643. ·Department of Dermatology at Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA. ·J Am Acad Dermatol · Pubmed #19932926.

ABSTRACT: BACKGROUND: Cyclosporine is a valuable option for the treatment of psoriasis. This report summarizes studies regarding the use of cyclosporine since the last guidelines were published in 1998. OBJECTIVE: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to achieve a consensus on new updated guidelines for the use of cyclosporine in the treatment of psoriasis. METHODS: Reports in the literature were reviewed regarding cyclosporine therapy. LIMITATIONS: There are few evidence-based studies on the treatment of psoriasis with cyclosporine. RESULTS: A consensus was achieved on the use of cyclosporine in psoriasis including specific recommendations on dosing, monitoring, and use of cyclosporine in special situations. The consensus received approval from members of the National Psoriasis Foundation Medical Board. CONCLUSIONS: Cyclosporine is a safe and effective drug for the treatment of psoriasis. It has a particularly useful role in managing psoriatic crises, treating psoriasis unresponsive to other modalities, bridging to other therapies, and treating psoriasis within a rotational scheme of other medications. Appropriate patient selection and monitoring will significantly decrease the risks of side effects.

3 Guideline Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. 2008

Gottlieb, Alice / Korman, Neil J / Gordon, Kenneth B / Feldman, Steven R / Lebwohl, Mark / Koo, John Y M / Van Voorhees, Abby S / Elmets, Craig A / Leonardi, Craig L / Beutner, Karl R / Bhushan, Reva / Menter, Alan. ·Department of Dermatology, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. ·J Am Acad Dermatol · Pubmed #18423261.

ABSTRACT: Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this second of 5 sections of the guidelines of care for psoriasis, we give an overview of psoriatic arthritis including its cardinal clinical features, pathogenesis, prognosis, classification, assessment tools used to evaluate psoriatic arthritis, and the approach to treatment. Although patients with mild to moderate psoriatic arthritis may be treated with nonsteroidal anti-inflammatory drugs and/or intra-articular steroid injections, the use of disease-modifying antirheumatic drugs, particularly methotrexate, along with the biologic agents, are considered the standard of care in patients with more significant psoriatic arthritis. We will discuss the use of disease-modifying antirheumatic drugs and the biologic therapies in the treatment of patients with moderate to severe psoriatic arthritis.

4 Review Psoriasis. 2016

Greb, Jacqueline E / Goldminz, Ari M / Elder, James T / Lebwohl, Mark G / Gladman, Dafna D / Wu, Jashin J / Mehta, Nehal N / Finlay, Andrew Y / Gottlieb, Alice B. ·Tufts University School of Medicine, Boston, Massachusetts, USA. · Tufts Medical Center, Department of Dermatology, Boston, Massachusetts, USA. · Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA. · Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan, USA. · Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. · University of Toronto, Toronto, Ontario, Canada. · Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada. · Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. · National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA. · Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK. · Department of Dermatology, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, New York 10595, USA. ·Nat Rev Dis Primers · Pubmed #27883001.

ABSTRACT: Psoriasis is a chronic, immune-mediated disorder with cutaneous and systemic manifestations and substantial negative effects on patient quality of life. Psoriasis has a strong, albeit polygenic, genetic basis. Whereas approximately half of the accountable genetic effect of psoriasis maps to the major histocompatibility complex, >70 other loci have been identified, many of which implicate nuclear factor-κB, interferon signalling and the IL-23-IL-23 receptor axis. Psoriasis pathophysiology is characterized by abnormal keratinocyte proliferation and immune cell infiltration in the dermis and epidermis involving the innate and adaptive immune systems, with important roles for dendritic cells and T cells, among other cells. Frequent comorbidities are rheumatological and cardiovascular in nature, in particular, psoriatic arthritis. Current treatments for psoriasis include topical agents, photo-based therapies, traditional systemic drugs and biologic agents. Treatments can be used in combination or as monotherapy. Biologic therapies that target specific disease mediators have become a mainstay in the treatment of moderate-to-severe disease, whereas advances in the treatment of mild-to-moderate disease have been limited.

5 Review Systematic Review of Health-Related Quality of Life in Adolescents with Psoriasis. 2016

Gonzalez, Jessica / Cunningham, Kiera / Perlmutter, Jason / Gottlieb, Alice. ·Department of Dermatology, Tufts Medical Center, and Tufts University School of Medicine, Boston, Mass., USA. ·Dermatology · Pubmed #27811471.

ABSTRACT: BACKGROUND: Many cases of psoriasis begin in adolescence. The affected adolescents face the combined physical and psychosocial challenges of their disease-free peers with the added complexity of a visible disease. OBJECTIVE: To review the impact of psoriasis on the health-related quality of life (HRQL) in adolescents as compared to their peers with other chronic diseases and to determine the best tools to measure HRQL in this population. METHODS: A systematic literature review was completed using PubMed. RESULTS: 256 publications were screened for inclusion, 37 were relevant to objectives and included in the systematic review. Most studies are pediatric psoriasis studies with an adolescent subgroup, very few are dedicated to solely addressing HRQL in adolescents with psoriasis. Adolescents with psoriasis face both the challenges similar to an adult psoriasis population in addition to the complexities inherent to healthy adolescents. Studies often use a general pediatric HRQL measure, PedsQL 4.0, or a dermatology-specific measure adapted from an adult questionnaire. Only one psoriasis-specific measurement tool exists, and it is specifically for scalp psoriasis. CONCLUSION: Both dermatologists and primary care physicians should treat the visible cutaneous lesions and disease comorbidities and address the psychosocial impact of psoriasis in their adolescent patients. Use of both a general and dermatology-specific HRQL questionnaire may allow physicians to better identify the impact of the disease and recognize improvement or impairment over time.

6 Review Psoriasis Trends and Practice Gaps. 2016

Gottlieb, Alice B / Greb, Jacqueline E / Goldminz, Ari M. ·Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box 114, Boston, MA 02111, USA. Electronic address: Agottlieb@tuftsmedicalcenter.org. · Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box 114, Boston, MA 02111, USA. ·Dermatol Clin · Pubmed #27363878.

ABSTRACT: The present article addresses several high-impact practice gaps affecting psoriatic patients, current practices, the barriers that prevent the delivery of optimal care, and recommendations to improve patient outcomes. Discussions of treatment, cardiovascular risk factor screening, psoriatic arthritis screening, and biologics are included. Finally, an overview of current resident exposure to psoriatic care and recommendations for improvements in resident education are made.

7 Review Secukinumab for treating plaque psoriasis. 2016

Rothstein, Brooke / Gottlieb, Alice. ·a Department of Dermatology , Tufts Medical Center, Tufts University School of Medicine , 800 Washington St, #114, Boston , MA 02111 , USA. ·Expert Opin Biol Ther · Pubmed #26577956.

ABSTRACT: INTRODUCTION: Plaque psoriasis is a chronic inflammatory disease that can result in significant physical, psychological and quality of life impairments. Until recently, biologic treatment for psoriasis was limited to tumor necrosis factor-α inhibitors and an interleukin (IL)-12/23 p40 subunit inhibitor. Newly developed biologics targeting the pro-inflammatory IL-17A cytokine have shown success in providing higher levels of clinical efficacy in patients with psoriasis. Secukinumab, a member of this novel class of IL-17 inhibitors, is the latest biologic to receive US FDA approval for the treatment of moderate-to-severe plaque psoriasis. AREAS COVERED: This comprehensive review will cover the pharmacology, efficacy, safety and future role of secukinumab and other IL-17 blockers in the treatment of plaque psoriasis. EXPERT OPINION: While biologics have revolutionized patient care for chronic plaque psoriasis, they are associated with loss of response over time. When treatment failure occurs with existing biologics, physicians are left with few alternative treatment options to offer patients. The introduction of secukinumab has provided an additional therapeutic agent that offers improved skin clearance, better health related quality of life and a favorable side-effect profile.

8 Review Psoriatic arthritis for the dermatologist. 2015

Tintle, Suzanne J / Gottlieb, Alice B. ·Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA. Electronic address: suzanne.tintle@gmail.com. · Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA. ·Dermatol Clin · Pubmed #25412788.

ABSTRACT: Psoriatic arthritis (PsA) is a chronic, progressive, inflammatory spondyloarthropathy that affects approximately one-third of patients with all types of psoriasis. Dermatologists are in a unique position to recognize early symptoms of PsA, initiate appropriate therapy, and prevent development of further disability. The course of PsA can be modulated by immunosuppressive therapy; patients with moderate-to-severe disease require aggressive management with medications proven to halt disease progression. It is essential for the dermatologist to understand the safety, tolerability, efficacy, cost, and potential to halt disease progression with available medications for this relatively common and potentially disabling disease.

9 Review Safety and efficacy of therapies for skin symptoms of psoriasis in patients with psoriatic arthritis: a systematic review. 2014

Boehncke, Wolf-Henning / Alvarez Martinez, David / Solomon, James A / Gottlieb, Alice B. ·From the Department of Dermatology, Geneva University Hospital, Geneva, Switzerland; Ameriderm Research, Ormond Beach, Florida; University of Central Florida College of Medicine, Orlando, Florida; University of Illinois College of Medicine, Urbana, Illinois; and Tufts Medical Center, Boston, Massachusetts, USA.W-H. Boehncke, MD; D. Alvarez Martinez, BS, Department of Dermatology, Geneva University Hospital; J.A. Solomon, MD, PhD, Ameriderm Research, University of Central Florida College of Medicine, University of Illinois College of Medicine; A.B. Gottlieb, MD, PhD, Tufts Medical Center. ·J Rheumatol · Pubmed #25362715.

ABSTRACT: Numerous guidelines and recommendations exist for the treatment of psoriasis in various populations. One important population is patients with psoriatic arthritis (PsA) who have symptoms of both joint and skin disease. In patients with both facets of psoriatic disease, skin and joints must be treated separately, but also simultaneously. As several systemic therapies are approved for either one or both, the concept of treating both facets with the same drug is feasible. This review summarizes evidence from studies in patients with PsA on the efficacy of these drugs on psoriatic skin disease in these patients.

10 Review Apremilast for the treatment of psoriatic arthritis. 2014

Varada, Sowmya / Tintle, Suzanne J / Gottlieb, Alice B. ·Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box #114, Boston, MA 02111, USA. ·Expert Rev Clin Pharmacol · Pubmed #24702658.

ABSTRACT: Psoriatic arthritis occurs in about one-third of patients with psoriasis, and is a severely disabling, progressive inflammatory spondyloarthropathy typically treated with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, TNF-α inhibitors and ustekinumab. These medications moderately improve the arthritis, dactylitis, and enthesitis that characterize psoriatic arthritis, however, they are associated with serious long-term adverse effects, issues with safety and tolerability, and high cost. Moreover, many patients do not respond or have resistant or recurrent manifestations to these agents. Apremilast is an orally available phosphodiesterase type 4 inhibitor that may block the pathogenic inflammatory Th17 and Th1 pathways upstream of current biologics, which target extracellular molecules of the immunological response.

11 Review Specific targeting of interleukin-23p19 as effective treatment for psoriasis. 2014

Levin, Adriane A / Gottlieb, Alice B. ·Boston University School of Medicine, Boston, Massachusetts; Department of Dermatology, Tufts Medical Center, Boston, Massachusetts. Electronic address: adriane.levin@gmail.com. · Department of Dermatology, Tufts Medical Center, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts. ·J Am Acad Dermatol · Pubmed #24373779.

ABSTRACT: Interleukin (IL)-23 is a heterodimeric cytokine composed of a distinct p19 subunit and a p40 subunit, which it shares with IL-12. The dermatology and rheumatology communities have long surmised that anti-IL-12/23p40 antibodies suppress autoinflammatory disease owing to their effect on IL-12. The aim of this review is to bring to light new data from murine and human studies demonstrating that in fact IL-23 and its resulting Th17 pathway mediate the inflammatory cascade that induces psoriatic plaque formation. Evidence derives from lesional immunohistochemical analyses, genetic studies, and research in other autoimmune diseases. Although current IL-12/23p40 inhibitors have shown good efficacy and safety, data regarding the functional role of IL-12 in immune defense suggest that preserving this cytokine would be beneficial. To date, evidence from mouse models and preliminary data in human beings show that specifically targeting IL-23p19 may be a safer but equally efficacious treatment option.

12 Review Research gaps in psoriasis: opportunities for future studies. 2014

Ryan, Caitriona / Korman, Neil J / Gelfand, Joel M / Lim, Henry W / Elmets, Craig A / Feldman, Steven R / Gottlieb, Alice B / Koo, John Y M / Lebwohl, Mark / Leonardi, Craig L / Van Voorhees, Abby S / Bhushan, Reva / Menter, Alan. ·Psoriasis Research Center, Baylor University Medical Center, Dallas, Texas. · Department of Dermatology, Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, Cleveland, Ohio. · Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. · Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts. · Department of Dermatology, University of California-San Francisco, California. · Department of Dermatology, Mount Sinai School of Medicine, New York, New York. · Saint Louis University, St Louis, Missouri. · Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. · American Academy of Dermatology, Schaumburg, Illinois. Electronic address: rbhushan@aad.org. ·J Am Acad Dermatol · Pubmed #24126079.

ABSTRACT: Over the past 2 decades, considerable progress has been made to further elucidate the complex pathogenesis of psoriasis, facilitating the development of a new armamentarium of more effective, targeted therapies. Despite these important advances, substantial deficits remain in our understanding of psoriasis and its treatment, necessitating further research in many areas. In the sixth section of the American Academy of Dermatology Psoriasis Guidelines of Care, gaps in research and care were identified. We discuss the most important gaps in research that currently exist and make suggestions for studies that should be performed to address these deficits. These encompass both basic science and clinical research studies, including large, prospective epidemiologic studies to determine the true prevalence and natural history of psoriasis; further molecular studies in patients with psoriatic and psoriatic arthritis to understand the function of psoriasis susceptibility genes and to identify novel therapeutic targets; studies to examine the role of environmental factors in the development of psoriasis; further investigation of the relationship between psoriasis and cardiometabolic disease; studies that examine the role of adjunctive therapies such as psychological interventions in appropriate patient groups; and finally, studies to identify biomarkers of disease severity and treatment response to optimize patient therapy.

13 Review Continuous versus intermittent therapy for moderate-to-severe psoriasis. 2013

Ramirez-Fort, Marigdalia K / Levin, Adriane A / Au, Shiu-Chung / Gottlieb, Alice B. ·Department of Dermatology, Tufts Medical Center, Boston, MA, USA. mramirezfort@tuftsmedicalcenter.org. ·Clin Exp Rheumatol · Pubmed #24129141.

ABSTRACT: Psoriasis is a chronic immune-mediated inflammatory disease of unknown etiology. Unlike other chronic inflammatory diseases receiving continuous treatment, psoriasis has traditionally been treated intermittently secondary to concern for cumulative toxicity of conventional systemic therapies. However, the development of targeted anti-inflammatory biologic agents allowed for continuous therapy for most patients. Herein, we review the literature for intermittent versus continuous use of widely available therapies for moderate-to-severe psoriasis: phototherapy, topical corticosteroids, conventional systemic therapies and biologic agents. These data support continuous treatment in biologic therapy, such as etanercept, adalimumab, infliximab, and ustekinumab. Intermittent therapy with biologic agents leads to decreased efficacy and sometimes increased side effects. When conventional systemic therapy is used continuously, it is more efficacious; however the data support intermittent use of methotrexate and cyclosporine due to cumulative toxicities. Psoriasis severity may wax and wane, but it is a chronic disease requiring continuous treatment for optimal control of inflammatory activity and to minimise cutaneous involvement.

14 Review Long-term safety of ustekinumab for psoriasis. 2013

Kumar, Neal / Narang, Kirti / Cressey, Brienne D / Gottlieb, Alice B. ·Tufts Medical Center, Department of Dermatology, 800 Washington Street, Box 114, Boston, MA 02111, USA. neal.kumar@tufts.edu ·Expert Opin Drug Saf · Pubmed #23745965.

ABSTRACT: INTRODUCTION: The biologic, Ustekinumab (Stelara®, Centocor, Inc., Malvern, PA, USA), is a fully human monoclonal antibody with a high affinity for the shared p40 subunit of interleukins 12 and 23 (IL-12 and IL-23). Approved for use in treating moderate-to-severe psoriasis in 2009, there has been considerable interest in the long-term safety of ustekinumab. AREAS COVERED: This review discusses the use of ustekinumab in the treatment of psoriasis and its potential to be an effective and well-tolerated therapy. A literature search was performed for articles published through April 2013 to identify any safety concerns. EXPERT OPINION: Our results indicate that ustekinumab has demonstrated higher efficacy rates as compared to traditional therapies; and with a favorable dosing schedule and stable safety profile, patients with recalcitrant disease will now have another option for treatment.

15 Review NF-κB: an essential transcription factor in psoriasis. 2013

Goldminz, A M / Au, S C / Kim, N / Gottlieb, A B / Lizzul, P F. ·Department of Dermatology, Tufts Medical Center, Boston, MA 02111, USA. ari.goldminz@gmail.com ·J Dermatol Sci · Pubmed #23219896.

ABSTRACT: Nuclear factor kappa B (NF-κB) is a protein transcription factor that orchestrates inflammation and other complex biological processes. It is a key regulatory element in a variety of immune and inflammatory pathways, in cellular proliferation and differentiation and in apoptosis. Therefore NF-κB is a crucial mediator involved in the pathogenesis of psoriasis. Psoriasis, an inflammatory dermatosis, is marked by elevated levels of active, phosphorylated NF-κB. Genomic studies have also linked psoriasis with mediators in the NF-κB pathway. NF-κB has been hypothesized to connect the altered keratinocyte and immune cell behavior that characterizes the psoriatic milieu. Several anti-psoriatic therapies, including tumor necrosis factor-α blockers and glucocorticoids, reduce active NF-κB levels and related down-stream elements, and other biologics currently in development, including interleukin-17 blockers, may also target this pathway. Compounds that specifically target NF-κB signaling may be developed as novel therapeutics for chronic inflammatory disorders including psoriasis. However, chronic NF-κB inhibition could also result in immunodeficiencies. Therefore, a delicate balance must be found that maximizes therapeutic potential while limiting harmful effects, and may be achieved through several possible approaches, including localized therapy, selective inhibition of NF-κB signaling in pathologic cells, incomplete pathway inhibition or short treatment durations.

16 Review Ustekinumab for psoriasis and psoriatic arthritis. 2012

Goldminz, Ari Michael / Gottlieb, Alice Bendix. ·Department of Dermatology, Tufts Medical Center, Boston, Massachusetts 02111, USA. agottlieb@tuftsmedicalcenter.org ·J Rheumatol Suppl · Pubmed #22751602.

ABSTRACT: Ustekinumab, which is approved for the treatment of moderate to severe psoriasis, has been shown in phase II clinical trials to be efficacious in controlling the signs and symptoms of psoriatic arthritis. Ustekinumab appears to be well tolerated, but its longterm safety profile is not yet known.

17 Review Etanercept: efficacy and safety for approved indications. 2012

Kerensky, Todd A / Gottlieb, Alice B / Yaniv, Shimrat / Au, Shiu-chung. ·Tufts Medical Center, Department of Dermatology, 800 Washington St. Box 114, Boston, MA 02111, USA. ·Expert Opin Drug Saf · Pubmed #22074366.

ABSTRACT: INTRODUCTION: Etanercept is a tumor necrosis factor alpha (TNF-α) inhibitor, which is approved for the treatment of immune-mediated inflammatory conditions including rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and psoriasis (PsO). AREAS COVERED: Clinical efficacy and safety data of etanercept for the approved indications are reviewed in this paper. Data were obtained from published clinical trials, registries, post-marketing data as well as information provided by Amgen. EXPERT OPINION: Etanercept is a generally well-tolerated treatment for the approved inflammatory diseases. The most common adverse effect of etanercept treatment is injection site reaction, which is generally self-limiting and often does not require treatment. Etanercept may be associated with an increased risk for infection, the development of malignancy, demyelinating disease and congestive heart failure. Fewer patients withdraw from etanercept due to adverse events than with other biologics. For pediatric patients, there are more data for etanercept than other biologics, and etanercept may have lower rates for the development of malignancy.

18 Review Management of psoriatic arthritis from the view of the dermatologist. 2011

Chang, Caroline A / Gottlieb, Alice B / Lizzul, Paul F. ·Department of Dermatology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA. ·Nat Rev Rheumatol · Pubmed #21912431.

ABSTRACT: Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.

19 Review Perioperative management of tumor necrosis factor antagonists in patients with psoriasis and other inflammatory disorders. 2011

Hession, Meghan T / Gottlieb, Alice B. ·Tufts Medical Center, Department of Dermatology, Boston, MA 02111, USA. ·J Dermatolog Treat · Pubmed #20673155.

ABSTRACT: Tumor necrosis factor alpha (TNF-α) plays an important role in host defense and possibly wound healing. It is also linked to the pathophysiology of many inflammatory diseases, including psoriasis. The TNF antagonists are a class of agents that have proven effective in treating psoriasis and psoriatic arthritis, yet the immunosuppressive effects of these agents raise concern over their use perioperatively. Currently, there is no consensus as to when TNF antagonists should be discontinued prior to surgery. Furthermore, data on the topic are limited to inflammatory bowel disease (IBD) and rheumatoid arthritis (RA). This paper reviews the literature on post-surgical outcomes in patients with RA and IBD receiving anti-TNF therapy. Although most studies reveal no statistically significant increased risk of post-surgical complications in these patients, the retrospective design and small sample size of these studies limits interpretation. Furthermore, when applying these data to psoriasis and psoriatic arthritis, physicians must also consider disease severity, individual comorbidities, and the pharmacokinetics of the different TNF antagonists. Additional studies are needed in psoriasis and psoriatic arthritis in order to develop truly evidence-based dermatologic guidelines for perioperative management of the TNF antagonists.

20 Review Pharmacologic immunomodulation and cutaneous malignancy in rheumatoid arthritis, psoriasis, and psoriatic arthritis. 2010

Krathen, Michael S / Gottlieb, Alice B / Mease, Philip J. ·Department of Dermatology, Tufts Medical Center, 800 Washington Street, Box 114, Boston, MA 02111, USA. mkrathen@tuftsmedicalcenter.org ·J Rheumatol · Pubmed #20810498.

ABSTRACT: OBJECTIVE: It is unclear if skin cancer risk is affected by the use of immunomodulatory medications in rheumatoid arthritis (RA), psoriasis, and psoriatic arthritis (PsA). The purpose of this study is to evaluate and summarize the available data pertinent to this question. METHODS: The English language literature on PubMed was searched with a combination of phrases, including "malignancy," "skin cancer," "squamous cell carcinoma," "basal cell carcinoma," "melanoma," "psoriasis," "psoriatic arthritis," and "rheumatoid arthritis" in addition to the generic names of a variety of common immunomodulatory drugs. Relevant articles were identified and data were extracted. RESULTS: In total, 2218 potentially relevant articles were identified through the search process. After further screening, 20 articles relevant to RA were included. An additional 19 articles relevant to either psoriasis or PsA were included as well. RA may be a risk factor for the development of cutaneous malignancy. Treatment with tumor necrosis factor inhibitors increases the rates of non-melanoma skin cancer (NMSC) in RA and psoriasis. This risk doubles when combination methotrexate therapy is used in RA. Methotrexate may increase the risk of malignant melanoma in patients with RA and the risk of NMSC in psoriasis. Cyclosporine and prior phototherapy significantly increase the risk of NMSC. CONCLUSION: RA may potentiate the risk of cutaneous malignancy and therefore dermatologic screening in this population should be considered. The use of immunomodulatory therapy in RA, psoriasis, and PsA may further increase the risk of cutaneous malignancy and therefore dermatologic screening examinations are warranted in these groups. More careful recording of skin cancer development during clinical trials and cohort studies is necessary to further delineate the risks of immunomodulatory therapy.

21 Review Comorbidities in patients with psoriasis. 2009

Gottlieb, Alice B / Dann, Frank. ·Tufts Medical Center, Boston, Mass., USA. agottlieb@tuftsmedicalcenter.org ·Am J Med · Pubmed #19958894.

ABSTRACT: Psoriasis is a common chronic inflammatory disease that is associated with serious comorbidities, including psoriatic arthritis, reduced quality of life, depression, malignancy, and cardiovascular comorbidities. Patients with psoriasis have been shown to have an increased incidence of metabolic syndrome and cardiovascular disease compared with the general population. The chronic inflammatory nature of psoriasis has been suggested to be a contributing and potentially independent risk factor for the development of cardiovascular comorbidities. Understanding the interrelationship between these conditions is important for the management of psoriasis and the associated comorbidities. This review will focus on the range of comorbidities associated with psoriasis, with emphasis on cardiometabolic conditions and the aim of encouraging primary care physicians to screen psoriatic patients for cardiometabolic disorders and risk factors.

22 Review Evaluation and management of psoriasis: an internist's guide. 2009

Levine, Danielle / Gottlieb, Alice. ·Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA. ·Med Clin North Am · Pubmed #19932332.

ABSTRACT: Psoriasis is a debilitating chronic skin condition that afflicts millions of patients worldwide. Patients experiencing psoriasis report a magnitude of impaired quality of life that is often similar to that of patients who have heart failure and cancer. Many patients who have psoriasis are even themselves at risk for developing heart disease, metabolic syndrome, certain cancers, and psychiatric illness. Therefore, primary care physicians must appreciate the current psoriatic disease model and share a basic understanding of psoriasis management. This article reviews the epidemiology, clinical features, pathogenesis, comorbidities, and treatment of psoriasis, with special emphasis placed on the new class of medications, biologics, which are revolutionizing the management of the disease.

23 Review Current biologic treatments for psoriasis. 2009

Gottlieb, Alice B / Kardos, Marisa / Yee, Millicent. ·Department of Dermatology, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA. ·Dermatol Nurs · Pubmed #19873691.

ABSTRACT: Psoriasis is a common inflammatory disorder. Modes of treatment include topical, UVA/UVB, systemic, and recently, biologic treatments. As the development ofbiologics continues, biologics have a marked effect on the physical and emotional burdens of patients with psoriasis.

24 Review Treatment of psoriasis in patients with hepatitis C: from the Medical Board of the National Psoriasis Foundation. 2009

Frankel, Amylynne J / Van Voorhees, Abby S / Hsu, Sylvia / Korman, Neil J / Lebwohl, Mark G / Bebo, Bruce F / Gottlieb, Alice B / Anonymous1160640. ·Department of Dermatology, Tufts Medical Center, Boston, Massachusetts 02111, USA. ·J Am Acad Dermatol · Pubmed #19811848.

ABSTRACT: BACKGROUND: Treating psoriasis in patients with concomitant hepatitis C virus (HCV) infection presents a special challenge. Not only is psoriasis exacerbated by interferon therapy, the standard of care for HCV, but many psoriasis therapies are potentially hepatotoxic, immunosuppressive, or both, which has been generally thought to be a contraindication in chronic infections such as HCV. OBJECTIVE: Our aim was to arrive at a consensus on treating psoriasis in patients with concomitant HCV infection. METHODS: Reports in the literature were reviewed regarding common psoriasis therapies and liver toxicity. RESULTS: Topical therapies are first-line therapy for patients with limited psoriasis and HCV. Ultraviolet B phototherapy may be considered as a second-line treatment when needed. Ultraviolet B phototherapies in combination with topical therapies are first line for patients with moderate to severe psoriasis, and are considered safe in those patients with concomitant HCV infection. Other systemic therapies, such as acitretin, etanercept, and, possibly, other tumor necrosis factor inhibitors, are considered second line. Psoralen plus ultraviolet A should also be considered a second-line therapy. LIMITATIONS: There are few evidence-based studies on treating psoriasis with systemic therapy in patients with pre-existing liver disease. CONCLUSIONS: There are no large double-blind clinical trials addressing the treatment of psoriasis in patients with HCV infection and more studies are needed.

25 Review Dermatological complications and safety of anti-TNF treatments. 2009

Kerbleski, Joseph F / Gottlieb, Alice B. ·Department of Dermatology, Tufts Medical Center, Boston, MA 02111, USA. JKerbleski@tuftsmedicalcenter.org ·Gut · Pubmed #19592682.

ABSTRACT: -- No abstract --

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