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Psoriasis: HELP
Articles from University Health Network of Toronto
Based on 180 articles published since 2008
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These are the 180 published articles about Psoriasis that originated from University Health Network of Toronto during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Guideline Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. 2018

Smolen, Josef S / Schöls, Monika / Braun, Jürgen / Dougados, Maxime / FitzGerald, Oliver / Gladman, Dafna D / Kavanaugh, Arthur / Landewé, Robert / Mease, Philip / Sieper, Joachim / Stamm, Tanja / Wit, Maarten de / Aletaha, Daniel / Baraliakos, Xenofon / Betteridge, Neil / Bosch, Filip van den / Coates, Laura C / Emery, Paul / Gensler, Lianne S / Gossec, Laure / Helliwell, Philip / Jongkees, Merryn / Kvien, Tore K / Inman, Robert D / McInnes, Iain B / Maccarone, Mara / Machado, Pedro M / Molto, Anna / Ogdie, Alexis / Poddubnyy, Denis / Ritchlin, Christopher / Rudwaleit, Martin / Tanew, Adrian / Thio, Bing / Veale, Douglas / Vlam, Kurt de / van der Heijde, Désirée. ·Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria. · 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria. · Health Consult, Vienna, Austria. · Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Paris Descartes University, Paris, France. · Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland. · Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada. · Division of Rheumatology, University of California, San Diego, CA, USA. · Amsterdam Rheumatology & Immunology Center, Amsterdam, The Netherlands. · Division of Rheumatology Research, Swedish-Providence St. Joseph Health System, University of Washington, Seattle, WA, USA. · Department of Gastroenterology, Infectiology and Rheumatology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany. · Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands. · Neil Betteridge Associates, UK. · Ghent University Hospital, Ghent, Belgium. · Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK. · Department of Medicine, University of California, San Francisco, CA, USA. · Department of Rheumatology, UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France. · Institute of Molecular Medicine, University of Leeds, Leeds, UK. · Seayn Medical, Voorschoten, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · University Health Network and University of Toronto, Toronto, Ontario, Canada. · University of Glasgow, College of Medical Veterinary and Life Sciences, Glasgow, UK. · A.DI.PSO. (Associazione per la Difesa degli Psoriasici)-PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), Rome, Italy. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA. · German Rheumatism Research Centrer, Berlin, Germany. · Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center Rochester, New York, NY, USA. · Division of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. · Department of Rheumatology, Klinikum Bielefeld, Bielefeld, Germany. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. ·Ann Rheum Dis · Pubmed #28684559.

ABSTRACT: Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field.

2 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.

3 Editorial Does a positive HLA-B27 test increase your risk of mortality? 2015

Haroon, Nigil. ·Division of Rheumatology, Department of Medicine, University of Toronto; Clinician Scientist and Attending Physician, University Health Network, Affiliate Scientist, Toronto Western Research Institute Toronto, Ontario, Canada. nigil.haroon@uhn.ca. ·J Rheumatol · Pubmed #25834237.

ABSTRACT: -- No abstract --

4 Review Functional impairment measurement in psoriatic arthritis: Importance and challenges. 2018

Mease, Philip / Strand, Vibeke / Gladman, Dafna. ·University of Washington and Swedish Medical Center, 601 Broadway, Suite 600, Seattle, WA 98122. Electronic address: pmease@philipmease.com. · Stanford University, 306 Ramona Road, Portola Valley, CA 94028. · University of Toronto and Toronto Western Hospital, 399 Bathurst Street 1E-410B, Toronto, ON, Canada M5T 2S8. ·Semin Arthritis Rheum · Pubmed #30029795.

ABSTRACT: OBJECTIVES: Patients with psoriatic arthritis (PsA) experience substantial physical impairment. This is commonly assessed using the patient-reported Health Assessment Questionnaire-Disability Index (HAQ-DI), which was originally developed in rheumatoid arthritis. The purpose of this review is to examine the value and challenges of using the HAQ-DI in patients with PsA, and to discuss alternative measures of functional impairment in this condition. METHODS: A literature search was performed in the MEDLINE, BIOSIS Previews, Embase, Derwent Drug File, and SciSearch databases using relevant terms and key words. Additional references from personal libraries were identified by the authors. RESULTS: Although validated in PsA, the HAQ-DI has limitations, including marked floor effects, lack of responsiveness to treatment effects in later disease stages, and underestimation of physical impairment in patients whose symptoms are predominantly skin related. Nonetheless, it has been widely used in clinical trials of PsA treatment and is generally responsive to change with effective therapy, discriminating between active and placebo treatments. Other generic or arthritis-specific patient-reported questionnaires with a focus on physical impairment include the Medical Outcomes Study Short Form-36 Health Survey, the EuroQol-5D, the Arthritis Impact Measurement Scales, and the Routine Assessment of Patient Index Data 3. There are currently no PsA-specific instruments to assess physical function, but health-related quality-of-life questionnaires with elements related to functional impairment include the PsA Quality of Life questionnaire, the PsA Impact of Disease questionnaire, and VITACORA-19. As the available measures of physical impairment may not reflect the impact of all aspects of PsA on a patient, additional health-related quality-of-life instruments, such as the Dermatology Life Quality Index, may be used in parallel to obtain a more complete picture of the disease burden. CONCLUSIONS: The HAQ-DI is a valuable assessment tool that clinicians should continue to use in clinical trials and practice. Because instruments to specifically assess physical function in patients with PsA are currently lacking, clinicians should consider using a combination of instruments to conduct the most thorough evaluation possible.

5 Review Inflammation: A Contributor to Depressive Comorbidity in Inflammatory Skin Disease. 2018

Farzanfar, Delaram / Dowlati, Yekta / French, Lars E / Lowes, Michelle A / Alavi, Afsaneh. ·University Health Network, University of Toronto, Toronto, Ontario, Canada. · Centre for Addiction and Mental Health, Toronto, Ontario, Canada. · Zurich Hospital University, Zurich, Switzerland. · The Rockefeller University, New York, New York, USA. · Department of Medicine, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada. ·Skin Pharmacol Physiol · Pubmed #29953999.

ABSTRACT: The prevalence of affective disorders such as depression and anxiety is particularly high in patients with autoimmune diseases, including inflammatory skin diseases such as psoriasis, atopic dermatitis, and hidradenitis suppurativa. A dysregulated immune response has been linked to the precipitation of depression in many patient populations. However, studies examining the extent to which the underlying skin disease inflammatory processes contribute to depression and a subsequent decline in quality of life are limited. The published literature over the past 5 years was reviewed for evidence of a relationship between depression and inflammatory processes in the context of skin pathology. The findings, particularly the evidence from interventional clinical trials of targeted anti-cytokine therapies, suggest that pro-inflammatory cytokines associated with several skin diseases may be causally linked with the coexistent depressive symptomology.

6 Review Role of Methotrexate in the Management of Psoriatic Arthritis. 2018

Elmamoun, Musaab / Chandran, Vinod. ·Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada. · Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, 1E 416, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. · Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada. vinod.chandran@uhnresearch.ca. · Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, University Health Network, 1E 416, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. vinod.chandran@uhnresearch.ca. · Department of Laboratory Medicine and Pathobiology & Institute of Medical Science, University of Toronto, Toronto, ON, Canada. vinod.chandran@uhnresearch.ca. ·Drugs · Pubmed #29616495.

ABSTRACT: Methotrexate is known to be safe and efficacious in the management of rheumatoid arthritis and psoriasis and thus has been used for the management of psoriatic arthritis despite a lack of evidence to support efficacy in psoriatic arthritis from randomized controlled trials. Although the largest randomized trial to date did not support its use as a disease-modifying therapy, observational studies have supported its role, and current treatment recommendations approve of its use as a first-line agent for the management of psoriatic arthritis with predominant peripheral arthritis. The first treat-to-target study in psoriatic arthritis, comparing tight control with standard care, has shown the efficacy of methotrexate as monotherapy in the first 12 weeks. This trial demonstrated the effectiveness of methotrexate with improvement in peripheral arthritis, skin and nail disease, enthesitis, and dactylitis over the course of 12 weeks. There is conflicting evidence about the role of combination (concomitant methotrexate and anti-tumor necrosis factor) therapy. However, drug survival and immunogenicity of certain anti-tumor necrosis factors seem to be better when used in combination with methotrexate. This report reviews the available evidence on the efficacy and effectiveness of methotrexate in psoriatic arthritis and its role in treating psoriatic arthritis to target, as well as in combination with biologic agents. Ideally, randomized placebo-controlled clinical trials evaluating methotrexate (using subcutaneous route of delivery) would provide much-needed clarity on the role of methotrexate in the management of psoriatic arthritis; however, issues around using a placebo in patients with active psoriatic arthritis may render such a trial unfeasible.

7 Review A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis: A GRAPPA-OMERACT initiative. 2018

Højgaard, Pil / Klokker, Louise / Orbai, Ana-Maria / Holmsted, Kim / Bartels, Else M / Leung, Ying Ying / Goel, Niti / de Wit, Maarten / Gladman, Dafna D / Mease, Philip / Dreyer, Lene / Kristensen, Lars E / FitzGerald, Oliver / Tillett, William / Gossec, Laure / Helliwell, Philip / Strand, Vibeke / Ogdie, Alexis / Terwee, Caroline B / Christensen, Robin. ·The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Denmark. · The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen, Denmark. · Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD. · Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Rd, the Academia, S169856, Singapore. · Division of Rheumatology, Duke University School of Medicine, Advisory Services, QuintilesIMS, Durham, NC. · VU University Amsterdam, Department of Medical Humanities, Amsterdam, the Netherlands. · Division of Rheumatology and Krembil Research Institute, University Health Network, Toronto Western Hospital, 399 Bathurst St, 1E-410B, Toronto, Ontario, Canada M5T 2S8. · Division of Rheumatology Clinical Research, Swedish Medical Center, Seattle, WA. · Department of Rheumatology, St Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin, Ireland. · Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Pharmacy and Pharmacology, University of Bath, Bath, UK. · Sorbonne Universités, UPMC Univ Paris 06, GRC-08, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Pitie-Salpétrière Hospital, AP-HP, Rheumatology Department, 47-83 Bd de l'Hopital, Paris 75013, France. · Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Harehills Lane, Leeds LS7 4SA, UK. · Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA. · Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · VU University Medical Center, Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. · The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, DK-2000, Copenhagen, Denmark. Electronic address: Robin.christensen@regionh.dk. ·Semin Arthritis Rheum · Pubmed #29037523.

ABSTRACT: BACKGROUND: An updated psoriatic arthritis (PsA) core outcome set (COS) for randomized controlled trials (RCTs) was endorsed at the Outcome Measures in Rheumatology (OMERACT) meeting in 2016. OBJECTIVES: To synthesize the evidence on measurement properties of patient reported outcome measures (PROMs) for PsA and thereby contribute to development of a PsA core outcome measurement set (COMS) as described by the OMERACT Filter 2.0. METHODS: A systematic literature search was performed in EMBASE, MEDLINE and PsycINFO on Jan 1, 2017 to identify full-text articles with an aim of assessing the measurement properties of PROMs in PsA. Two independent reviewers rated the quality of studies using the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, and performed a qualitative evidence synthesis. RESULTS: Fifty-five studies were included in the systematic review. Forty-four instruments and a total of 89 scales were analyzed. PROMs measuring COS domains with at least fair quality evidence for good validity and reliability (and no evidence for poor properties) included the Stockerau Activity Score for PsA (German), Psoriasis Symptom Inventory, visual analogue scale for Patient Global, 36 Item Short Form Health Survey Physical Function subscale, Health Assessment Questionnaire Disability Index, Bath Ankylosing Spondylitis Functional Index, PsA Impact of Disease questionnaire, PsA Quality of Life questionnaire, VITACORA-19, Functional Assessment of Chronic Illness Therapy Fatigue scale and Social Role Participation Questionnaire. CONCLUSIONS: At least one PROM with some evidence for aspects of validity and reliability was available for six of the eight mandatory domains of the PsA COS.

8 Review Psoriatic Arthritis. 2017

Ritchlin, Christopher T / Colbert, Robert A / Gladman, Dafna D. ·From the Allergy, Immunology, and Rheumatology Division, University of Rochester Medical School, Rochester, NY (C.T.R.) · the Pediatric Translational Research Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD (R.A.C.) · and the University Health Network (UHN) Krembil Research Institute, the Psoriatic Arthritis Program, and the Centre for Prognosis Studies in the Rheumatic Diseases - all at Toronto Western Hospital, Toronto (D.D.G.). ·N Engl J Med · Pubmed #28273019.

ABSTRACT: -- No abstract --

9 Review Incident myocardial infarction associated with major types of arthritis in the general population: a systematic review and meta-analysis. 2017

Schieir, Orit / Tosevski, Cedomir / Glazier, Richard H / Hogg-Johnson, Sheilah / Badley, Elizabeth M. ·Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada. · Rouge Valley Health System, Toronto, Ontario, Canada. · Department of Family and Community Medicine, Institute for Clinical Evaluative Sciences, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. · Institute for Work and Health, Toronto, Ontario, Canada. · Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada. ·Ann Rheum Dis · Pubmed #28219882.

ABSTRACT: OBJECTIVE: To synthesise, quantify and compare risks for incident myocardial infarction (MI) across five major types of arthritis in population-based studies. METHODS: A systematic search was performed in MEDLINE, EMBASE and CINAHL databases with additional manual/hand searches for population-based cohort or case-control studies published in English of French between January 1980 and January 2015 with a measure of effect and variance for associations between incident MI and five major types of arthritis: rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), gout or osteoarthritis (OA), adjusted for at least age and sex. All search screening, data abstraction quality appraisals were performed independently by two reviewers. Where appropriate, random-effects meta-analysis was used to pool results from studies with a minimum of 10 events. RESULTS: We identified a total of 4, 285 articles; 27 met review criteria and 25 criteria for meta-analyses. In studies adjusting for age and sex, MI risk was significantly increased in RA (pooled relative risk (RR): 1.69, 95% CI 1.50 to 1.90), gout (pooled RR: 1.47, 95% CI 1.24 to 1.73), PsA (pooled RR: 1.41, 95% CI 1.17 to 1.69), OA (pooled RR: 1.31, 95% CI 1.01 to 1.71) and tended towards increased risk in AS (pooled RR: 1.24, 95% CI 0.93 to 1.65). Traditional risk factors were more prevalent in all types of arthritis. MI risk was attenuated for each type of arthritis in studies adjusting for traditional risk factors and remained significantly increased in RA, PsA and gout. CONCLUSIONS: MI risk was consistently increased in multiple types of arthritis in population-based studies, and was partially explained by a higher prevalence of traditional risk factors in all types of arthritis. Findings support more integrated cardiovascular (CV) prevention strategies for arthritis populations that target both reducing inflammation and enhancing management of traditional CV risk factors.

10 Review Epigenetics of psoriatic disease: A systematic review and critical appraisal. 2017

Pollock, Remy A / Abji, Fatima / Gladman, Dafna D. ·University of Toronto Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 1-412 East Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Krembil Research Institute, University Health Network, 5KD-405, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada. Electronic address: rpollock@uhnresearch.ca. · University of Toronto Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 1-412 East Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Krembil Research Institute, University Health Network, 5KD-405, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada. Electronic address: fabji@uhnresearch.ca. · University of Toronto Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 1-412 East Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Krembil Research Institute, University Health Network, 5KD-405, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada. Electronic address: dafna.gladman@utoronto.ca. ·J Autoimmun · Pubmed #27965059.

ABSTRACT: Psoriasis is an inflammatory disease of the skin that is sometimes accompanied by an auto-inflammatory arthritis called psoriatic arthritis (PsA). Psoriasis and PsA are multifactorial diseases that result from complex interactions of environmental and genetic risk factors. Epigenetic marks, which are labile chemical marks with diverse functions, form a layer of biological information that sits at the interface of genetics and the environment. Aberrant epigenetic regulation has been previously implicated in other rheumatological disorders. The purpose of this review is to summarize and critically evaluate the nascent literature on epigenetics in psoriasis and PsA. A systematic review yielded 52 primary articles after applying inclusion and exclusion criteria. Data were extracted using a standardized template and study quality assessed using a methodological quality checklist. Studies reflect a broad range of epigenetic sub-disciplines, the most common being DNA methylation, followed by the parent of origin effect or genomic imprinting, expression or activity of epigenetic modifying enzymes, and histone modifications. Epidemiological studies demonstrating excessive paternal transmission provided the earliest evidence of epigenetic deregulation in psoriatic disease, however few studies have examined its molecular mechanisms. Methylation studies evolved rapidly from low resolution global to targeted analyses of known psoriatic disease susceptibility loci such as HLA-C*0602. The recent explosion of epigenome-wide association studies has provided us with novel insights into psoriasis pathogenesis, and the mechanism of action of UVB, methotrexate, and anti-TNF therapies, as well as molecular signatures of psoriasis that may have clinical relevance. Finally, recent studies of pharmacological inhibitors of epigenetic modifier enzymes demonstrate their potential applicability as novel treatment modalities for psoriasis. Challenges of epigenetics research in psoriasis and PsA were identified and future perspectives are discussed herein.

11 Review Treatment of psoriatic arthritis with traditional DMARD's and novel therapies: approaches and recommendations. 2017

Maharaj, Ajesh B / Chandran, Vinod. ·a Department of Internal Medicine, Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa. · b Department of Clinical Immunology and Rheumatology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands. · c Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute , University Health Network , Toronto , Canada. · d Division of Rheumatology, Department of Medicine , University of Toronto , Toronto , Canada. · e Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Canada. · f Institute of Medical Science , University of Toronto, Toronto Western Hospital , Toronto , Canada. ·Expert Rev Clin Immunol · Pubmed #27826996.

ABSTRACT: INTRODUCTION: Recent advances in the therapeutics of psoriatic arthritis (PsA) have provided more options to clinicians managing PsA. The purpose of this review is to update the reader on treatment options for PsA using conventional synthetic disease modifying agents (csDMARDs) and novel therapies including tumour necrosis factor alpha inhibitors, interleukin 12/23 inhibitor (ustekinumab), the interleukin 17 antagonists including secukinumab, brodalumab, ixekizumab, and the phosphodiesterase-4 inhibitor, apremilast. Areas covered: We reviewed published articles on the treatment of PsA. Our main sources of data included treatment recommendations, registry studies, systematic literature reviews, major randomised controlled trials for more recently approved drugs, and abstracts from the American College of Rheumatology and EULAR meetings. Expert commentary: An overview of the evidence for the use of various pharmacotherapeutic agents for treatment of this heterogeneous disease was compiled. Treatment options for the various domains of PsA are also discussed.

12 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.

13 Review Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review. 2016

Chandran, Shelly / Aldei, Ali / Johnson, Sindhu R / Cheung, Angela M / Salonen, David / Gladman, Dafna D. ·Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. · Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. · Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. · Centre of Excellence in Skeletal Health Assessment, University of Toronto, University Health Network, Toronto, Ontario, Canada. · Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada. · Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada; Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. Electronic address: dafna.gladman@utoronto.ca. ·Semin Arthritis Rheum · Pubmed #27346576.

ABSTRACT: OBJECTIVE: Prevalence and impact of low bone mineral density (BMD) in psoriatic arthritis (PsA) is not well understood. We aimed to synthesize current evidence regarding the prevalence, impact, and risk factors for low BMD and fractures in PsA. METHODS: A systematic literature search limited to human studies was conducted without language restriction. Data on BMD, prevalence of osteoporosis, osteopenia and fractures, risk factors, morbidity, and mortality due to low BMD in PsA patients were collected. RESULT: A total of 21 studies (16 case-control, 4 cross-sectional, and 1 prospective cohort) were reviewed after screening 639 titles and abstracts. In all, 17 studies compared PsA patients with one or more control group (four normal controls, five psoriasis, and eight other rheumatic diseases with or without healthy controls). The number of PsA patients in the studies ranged from 8 to 2212 with a mean (standard deviation) age of 35 (10) to 63.4 (6.2), and mean PsA duration of 2.25-13.65 years. Reported prevalence of osteoporosis varied from 1.4% to 68.8%. Low BMD was identified as a significant problem in 13 of the 21 studies. Age, female sex, postmenopausal status, PsA duration, presence of erosions, and cumulative steroid dose were associated with lower BMD. Fractures (12-40%) were associated with postmenopausal status and axial disease. No studies reported on hospitalization and mortality due to low BMD. CONCLUSION: This systematic review synthesizes current evidence on BMD and its impact in PsA. High likelihood of bias and inconsistent results suggest a need for well-designed longitudinal studies on bone health in PsA.

14 Review Assessing disease activity in psoriasis and psoriatic arthritis: impact on management and therapy. 2016

Chandran, Vinod / Maharaj, Ajesh B. ·a Department of Medicine, and Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario , Canada. · b Institute of Medical Science , University of Toronto , Toronto , Ontario , Canada. · c Krembil Research Institute , University Health Network , Toronto , Ontario , Canada. · d Department of Internal Medicine , Prince Mshiyeni Memorial Hospital, Nelson R Mandela School of Medicine, University of Kwazulu-Natal , Durban , South Africa. · e Department of Clinical Immunology and Rheumatology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands. ·Expert Rev Clin Immunol · Pubmed #26807494.

ABSTRACT: The management of psoriatic arthritis (PsA) and psoriasis has undergone major advancements over the last decade. This has been made possible, in part, due to the introduction of new therapies for their management, as well as global collaboration in the development of outcome measures and "treat- to- target" paradigms. In this review article, we discuss how disease activity is measured and the outcome measures that have been recently developed for the management of PsA. The importance of assessing the individual domains as well as global assessments both from the physician and patient perspective, and the development of composite measures are discussed. The newer PsA specific measures are expected to be more commonly used in clinical trials as well as clinical practice.

15 Review Clinical Features and Diagnostic Considerations in Psoriatic Arthritis. 2015

Gladman, Dafna D. ·Toronto Western Hospital, University of Toronto, University Health Network, 399 Bathurst Street, 1E-410B, Toronto, Ontario M5T 2S8, Canada. Electronic address: dafna.gladman@utoronto.ca. ·Rheum Dis Clin North Am · Pubmed #26476219.

ABSTRACT: Psoriatic arthritis is an inflammatory musculoskeletal disease affecting almost a third of patients with psoriasis. Clinical presentations are complex and varied and include peripheral arthritis, axial disease, dactylitis, and enthesitis, as well as skin and nail manifestations. We lack diagnostic biomarkers, but specific clinical and imaging features distinguish psoriatic arthritis from other forms of arthritis such as rheumatoid arthritis, gout, osteoarthritis, and other forms of spondyloarthritis.

16 Review Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review. 2015

Haddad, Amir / Johnson, Sindhu R / Somaily, Mansour / Fazelzad, Rouhi / Kron, Amie T / Chau, Cathy / Chandran, Vinod. ·From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto. ·J Rheumatol · Pubmed #26077409.

ABSTRACT: OBJECTIVE: Research on psoriatic arthritis mutilans (PAM), the most severe form of psoriatic arthritis, is impeded by the lack of an accepted classification criteria. We performed a systematic review of the literature to identify and synthesize clinical and radiographic features associated with the definition of PAM. METHODS: A systematic literature search limited to human studies was conducted without language restriction. Abstracts were independently screened by 2 investigators and studies that reported information on patients with PAM were included. A standardized form was used to independently collect clinical and radiographic items defining PAM, patient's demographics, disease characteristics, and outcomes. RESULTS: There were 8570 citations searched to identify 112 articles for full review and 58 articles for data abstraction. We identified 8 definitions of PAM that were used in 283 subjects with a mean age ± SD at diagnosis of PsA of 33.9 ± 8.2 years. Disease manifestations (prevalence) included dactylitis (29-64%), enthesitis (29-32%), axial disease (14-27%), and nail lesions (47%). PAM definitions include 1 (n = 2 studies) or more (n = 14 studies) joints involving interphalangeal, metacarpophalangeal, or metatarsophalangeal joints. The most prevalent PAM clinical features were digital telescoping (34%), digital shortening (33%), and flail joints (22%). The most prevalent PAM radiographic items were bone resorption (41%), pencil-in-cup change (16%), total joint erosions (14%), ankylosis (21%), and subluxation (7%). CONCLUSION: We have identified 8 definitions of PAM, and synthesized the clinical and radiographic items that are important for the classification of PAM. We have established the groundwork for future development classification criteria for PAM.

17 Review Enhanced Patient Involvement and the Need to Revise the Core Set - Report from the Psoriatic Arthritis Working Group at OMERACT 2014. 2015

Tillett, William / Eder, Lihi / Goel, Niti / De Wit, Maarten / Gladman, Dafna D / FitzGerald, Oliver / Campbell, Willemina / Helliwell, Philip S / Gossec, Laure / Orbai, Ana-Maria / Ogdie, Alexis / Strand, Vibeke / McHugh, Neil J / Mease, Philip J. ·From the Royal National Hospital for Rheumatic Diseases, Bath, UK; Toronto Western Hospital; Psoriatic Arthritis Program, University Health Network, Toronto Western Research Institute, Toronto, Ontario, Canada; St. Vincent's University Hospital, Dublin, Ireland; Quintiles; Duke University School of Medicine; Durham, North Carolina, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; Chapel Allerton Hospital, Leeds, UK; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6 (UPMC Univ Paris 6), Institut Pierre Louis d'Epidémiologie et de Santé Publique; AP-HP, Pitié Salpêtrière Hospital, Department of Rheumatology, Paris, France; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland; Division of Immunology/Rheumatology, Stanford University School of Medicine, Portola Valley, California, USA; University of Bath, Bath, UK; Swedish Medical Center, University of Washington, Seattle, Washington; Hospital of the University of Pennsylvania (HUP), Philadelphia, Pennsylvania, USA.W. Tillett, MB, ChB, BSc, MRCP, PhD, Research Fellow, Royal National Hospital for Rheumatic Diseases; L. Eder, MD, PhD, Postdoctoral Research Fellow, Toronto Western Hospital; M. de Wit, PhD, OMERACT Patient Research Partner, The Netherlands; D.D. Gladman, MD, FRCPC, Director, Psoriatic Arthritis Program, University Health Network, Senior Scientist, Toronto Western Research Institute; O. FitzGerald, MD, FRCPI, FRCP( UK), Consultant Rheumatologist and Newman Clinical Research Professor, St. Vincent's University Hospital; N. Goel, MD, OMERACT Patient Research Partner, Quintiles, and Duke University School of Medicine; W. Campbell, BEd, LLB, OMERACT Patient Research Partner; P.S. Helliwell, DM, PhD, FRCP, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital; L. Gossec, MD, PhD, Sorbonne Universités, UPMC Univ Paris 6, Institut Pierre Louis d'Epidémiologie et de Sant ·J Rheumatol · Pubmed #25934828.

ABSTRACT: OBJECTIVE: To discuss the need for revision of the "core set" of domains to be included for assessment in psoriatic arthritis (PsA) randomized controlled trials and longitudinal observational studies, review work undertaken since the 2012 meeting of Outcome Measures for Rheumatology 11 (OMERACT 11) to include patient perspectives in this revision, and reassess proposed composite measures in the context of new research data and the OMERACT Filter 2.0 framework. METHODS: The OMERACT 12 (2014) PsA working group presented work completed over the last 2 years to incorporate patient involvement in PsA outcomes research, review the endorsed PsA core set based on the patient perspective as well as new research findings, and further develop PsA responder indices. Breakout groups then discussed 2 topics: (1) the need to revise the PsA core set, and opportunities to add, move, or merge existing domains to improve existing redundancy; and (2) how to incorporate the core set in a composite index. Breakout groups fed back to the working group before participant voting. RESULTS: Meeting participants endorsed the need to revise the PsA core set according to the OMERACT Filter 2.0 framework (100%), and the inclusion of disease impact (94%) and fatigue (72%) in the inner circle. Breakout group feedback suggested the core set revision was an opportunity to consolidate pathophysiologic aspects such as arthritis, enthesitis, dactylitis, spondylitis as "inflammatory musculoskeletal disease," and nail and skin psoriasis as "psoriasis activity." CONCLUSION: Future work will focus on updating the PsA core set and development of responder indices with ongoing, meaningful involvement of patient research partners.

18 Review What have we learned about genetic susceptibility in psoriasis and psoriatic arthritis? 2015

Eder, Lihi / Chandran, Vinod / Gladman, Dafna D. ·Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. ·Curr Opin Rheumatol · Pubmed #25415529.

ABSTRACT: PURPOSE OF REVIEW: To review recent evidence for genetic susceptibility in psoriasis and psoriatic arthritis. RECENT FINDINGS: Psoriasis and psoriatic arthritis (PsA) have substantive genetic determinants as indicated by their high family aggregation. Psoriasis and PsA share several susceptibility genes; however, other genes, mostly within the major histocompatibility complex (MHC) region, confer an independent risk for PsA. The human leukocyte antigen-C0602 allele confers the highest risk for psoriasis whereas several human leukocyte antigen-B alleles were identified as 'PsA-specific' genes. Fine mapping of the MHC suggests that glutamine at position 45 is an important susceptibility factor for PsA. Additional genes outside of the MHC region were identified as psoriasis susceptibility genes. These genes belong to several proinflammatory pathways and skin barrier mechanisms that play a role in the pathogenesis of psoriatic disease. SUMMARY: The MHC remains the major susceptibility locus for psoriatic disease. Future studies using next-generation sequencing technologies may reveal novel rare susceptibility genes for this disease.

19 Review Unusual cause of limited elbow movement in a patient with psoriatic arthritis. 2014

Maharaj, Ajesh B / Chandran, Vinod. ·Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands, and Prince Mshiyeni Memorial Hospital, Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa; maharaja30@ukzn.ac.za. · Division of Rheumatology, University of Toronto, Staff Physician, Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada. ·J Rheumatol · Pubmed #25452180.

ABSTRACT: -- No abstract --

20 Review Recognition of preclinical and early disease in axial spondyloarthritis. 2014

Wallis, Dinny / Inman, Robert D. ·Department of Rheumatology, Royal Hampshire County Hospital, Romsey Road, Winchester 50300PP, UK. · Division of Rheumatology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto M5T 2S8, Ontario, Canada. Electronic address: robert.inman@uhnresearch.ca. ·Rheum Dis Clin North Am · Pubmed #25437285.

ABSTRACT: In recent years the early identification of axial spondyloarthritis has become a high priority area of research. Evidence that therapy may slow radiographic progression of disease has heightened the importance of recognition of early disease. However, the concept of early axial spondyloarthritis and natural history of early disease are not fully understood. Future strategies to detect early and preclinical disease may incorporate clinical information, radiographic, serologic, and genetic testing. The risks and benefits of screening and early identification of disease need careful consideration.

21 Review Comprehensive treatment of psoriatic arthritis: managing comorbidities and extraarticular manifestations. 2014

Ogdie, Alexis / Schwartzman, Sergio / Eder, Lihi / Maharaj, Ajesh B / Zisman, Devy / Raychaudhuri, Siba P / Reddy, Soumya M / Husni, Elaine. ·From the University of Pennsylvania, Philadelphia, Pennsylvania; Hospital for Special Surgery, New York, New York, USA; Toronto Western Hospital, Toronto, Ontario, Canada; Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Carmel Medical Center, Faculty of Medicine, Technion, Haifa, Israel; Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis, Davis, California; Division of Rheumatology, New York University School of Medicine, New York, New York; and the Cleveland Clinic, Cleveland, Ohio, USA.A. Ogdie, MD, MSCE, University of Pennsylvania; S. Schwartzman, MD, Hospital for Special Surgery; L. Eder, MD, PhD, Toronto Western Hospital; A.B. Maharaj, MB, BS, HDipIntMed(SA), FCP(SA), Nelson R. Mandela School of Medicine, University of KwaZulu Natal and Academic Medical Center, University of Amsterdam; D. Zisman, MD, Carmel Medical Center, Faculty of Medicine, Technion; S.P. Raychaudhuri, MD, Rheumatology, VA Sacramento Medical Center; Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, UC Davis; S.M. Reddy, MD, Division of Rheumatology, New York University School of Medicine; E. Husni, MD, MPH, Cleveland Clinic. ·J Rheumatol · Pubmed #25362717.

ABSTRACT: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that can lead to decreased health-related quality of life and permanent joint damage leading to functional decline. In addition to joint and skin manifestations, both psoriasis and PsA are associated with numerous comorbidities and extraarticular/cutaneous manifestations, which may influence the physician's choice of therapy. The objectives of this review are (1) to identify comorbidities in patients with PsA based on the available evidence; (2) to examine the effects of these comorbidities or extraarticular/cutaneous manifestation on the management of patients with PsA as well as the selection of therapy; and (3) to highlight research needs around comorbidities and treatment paradigms. This review is part of a treatment recommendations update initiated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

22 Review Updated guidelines for the management of axial disease in psoriatic arthritis. 2014

Nash, Peter / Lubrano, Ennio / Cauli, Alberto / Taylor, William J / Olivieri, Ignazio / Gladman, Dafna D. ·From the Department of Medicine, University of Queensland, Australia; Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy; Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy; and University of Toronto and Toronto Western Research Institute, Toronto, Ontario, Canada.P. Nash, MBBS (Hons), FRACP, Department of Medicine, University of Queensland; E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; W.J. Taylor, MBChB, PhD, FRACP, Rehabilitation Teaching and Research Unit, University of Otago; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Toronto Western Research Institute. ·J Rheumatol · Pubmed #25362712.

ABSTRACT: Axial involvement in patients with psoriatic arthritis (PsA) remains common and can be defined in terms of spinal disease alone or in combination with peripheral manifestations. Diagnosis is based upon inflammatory spinal symptoms or the presence of radiological sacroiliitis and other radiographic signs of spondylitis, or by criteria for axial spondyloarthritis (SpA) defined by ASAS (Assessment of SpondyloArthritis International Society). Although recent data are scarce for efficacy of traditional therapies for axial disease (e.g., nonsteroidal antiinflammatory drugs, methotrexate, etc.), limited data are available for targeted biologics and novel agents. We identify and evaluate the efficacy of therapeutic interventions for treatment of axial disease in PsA. This review is an update of the axial PsA section of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

23 Review Investigational drugs for treating psoriatic arthritis. 2014

Sheane, Barry J / Chandran, Vinod. ·University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital , 1E 416, 399 Bathurst Street, Toronto, Ontario, M5T 2S8 , Canada +1 416 603 5192 ; +1 416 603 9387 ; vchandra@uhnresearch.ca. ·Expert Opin Investig Drugs · Pubmed #24758276.

ABSTRACT: INTRODUCTION: Psoriatic arthritis (PsA) is an inflammatory arthritis occurring in up to 30% of patients with psoriasis and can lead to progressive joint damage and disability. The emergence of 'biological' treatments, typified by the TNF inhibitors, has significantly advanced treatment of psoriatic disease over the last two decades and has led to an expanding field of drugs designed to target specific pathways identified in the pathogenesis of the disease. AREAS COVERED: This review article describes current knowledge pertaining to genetic susceptibility and that gleaned from animal models. It discusses putative drug targets and drugs in development, up to Phase II, while acknowledging that many of these drugs are being investigated in rheumatoid arthritis and psoriasis rather than PsA alone. EXPERT OPINION: Ongoing trials of some of these drugs, such as the JAK inhibitors, appear particularly promising, while the evolution of dual-targeting therapies affords the aspiration of enhanced efficacy, safety and remission. Paramount to the future of drug discovery and development is the affordability of these agents to the healthcare purchaser as well as their accessibility to the patient.

24 Review Predictors for clinical outcome in psoriatic arthritis - what have we learned from cohort studies? 2014

Eder, Lihi / Gladman, Dafna D. ·Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. ·Expert Rev Clin Immunol · Pubmed #24702706.

ABSTRACT: Psoriatic Arthritis (PsA) is a heterogeneous disease that ranges from a mild form of oligoarthritis to destructive polyarthritis. The burden of disease can be severe and comparable to that of rheumatoid arthritis. Identifying predictors of worse outcome may improve the understanding of the underlying mechanisms of the disease and may guide therapeutic management at the individual level. Longitudinal cohort studies identified predictors of long-term outcomes such as joint damage, physical function and work disability in PsA. In general, male gender and lower burden of inflammation at presentation predict better outcome while a delay in diagnosis, disability and joint damage are associated with worse long term outcomes. Several HLA alleles also identify patients who are likely to sustain joint damage.

25 Review Development of a disease activity and responder index for psoriatic arthritis--report of the Psoriatic Arthritis Module at OMERACT 11. 2014

Coates, Laura C / FitzGerald, Oliver / Mease, Philip J / Gladman, Dafna D / Strand, Vibeke / Goel, Niti / Campbell, Ina / Krueger, Gerald / McHugh, Neil J / Helliwell, Philip S. ·From the Division of Rheumatic and Musculoskeletal Disease, University of Leeds, UK; Department of Rheumatology, St. Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland; Seattle Rheumatology Associates, Swedish Medical Center, University of Washington School of Medicine, Seattle, Washington, USA; Division of Rheumatology, Department of Medicine, University of Toronto, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Immunology/Rheumatology, Stanford University, Palo Alto, California; Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, and General Medicine Therapeutic Delivery Unit, Quintiles, Morrisville, North Carolina; Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; Royal National Hospital for Rheumatic Diseases and University of Bath, Bath, UK. ·J Rheumatol · Pubmed #24488420.

ABSTRACT: This module reflected work within the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) to develop and validate composite disease activity measures in psoriatic arthritis (PsA). At the Outcome Measures in Rheumatology (OMERACT) 8 Meeting, a core set of domains to be assessed in randomized controlled trials (RCT) and longitudinal observational studies of PsA was agreed upon. At OMERACT 10, 5 proposed composite responder definitions for PsA were reviewed and discussed, including new data from the GRACE (GRAppa Composite Exercise) study. At OMERACT 11, ongoing retrospective analyses of RCT data using the 3 proposed measures (Composite Psoriatic Disease Activity Index, Psoriatic Arthritis Disease Activity Score, and Arithmetic Mean of the Desirability Function) were discussed in detail. There was agreement that developing composite outcome measures for use in RCT and longitudinal observational studies in PsA was important. Concerns were expressed regarding development of a single measure that encompassed diverse domains, such as joint counts, quality of life (QOL), and disability measures. It was emphasized that the use of any composite measure should include the ability to differentiate between activity in individual domains, such as enthesitis or psoriasis, such that the effect of each could be assessed independently. It was also agreed that patients would be systematically involved in further development and refinement of composite measures. Future plans include qualitative work with patients to explore their experience of disease activity and statistical modeling to explore how each of the proposed measures will perform in different disease subgroups.

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