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The Arthritis Impact Measurement Scales (AIMS) consists of 9 scales that measure physical function, pain and psychosocial function. It has been validated for use in various forms of arthritis, but not in psoriatic arthritis (PsA). The AIMS was administered to 145 patients attending our PsA clinic. We carried out simultaneous assessment of clinical measures of function, measures of disease activity, and measures of disease severity. Most scales of physical function were moderately to highly correlated with clinical measures of function (r = 0.33-0.57; p = 0.0001), measures of disease activity (r = 0.24-0.53, p = 0.003-0.0001), and measures of disease severity (r = 0.23-0.6; p = 0.02-0.0001). The pain scale was highly correlated with clinical measures of function and measures of disease activity (r = 0.38-0.58; p = 0.0001) but not with measures of disease severity. Of the psychosocial scales, the depression scale was moderately correlated with clinical measures of function (r = 0.27-0.3; p = 0.001-0.0001). Our data suggest that the physical function and pain scales are good indicators of overall function and disease activity and are valid for use in PsA.
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PMID:The utility of the arthritis impact measurement scales for patients with psoriatic arthritis. 149 91

The microhysteroscope, which affords direct in vivo observation of otherwise inaccessible surfaces, can be used to great advantage in arthroscopy. Although conventional arthroscopy can distinguish between 'inflammatory' and 'reactive' (post-traumatic) synovial changes, the microendoscope offers the possibility of more precise differentiation. Synovial membranes, joint cartilage, and menisci were studied at four different magnifications, including microscopic observation of vitally stained cells. Frankly pathological synovia (e.g., rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) were compared and distinguished from examples of less florid synovial changes. The fibrocartilaginous structure of the menisci and secondary undulations and tertiary depression of joint cartilage become visible in vivo with the microendoscope; these may well point to early damage to these structures. The authors believe that the three dimensional images at the magnifications provided by this microendoscope go some way towards bridging the gap between the conventional arthroscope, the light microscope, and the scanning electron microscope. This report presents preliminary findings with this new technique.
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PMID:New methods in arthroscopy: preliminary investigations. 374 Sep 79

Mitogen response of peripheral blood lymphocytes with phytohemagglutinin (PHA), conconavalin A (Con A), pokeweed mitogen (PWM), and purified protein derivative (PPD) was studied in 32 patients with psoriatic arthritis (PsA). Results were compared with those obtained from a control group with rheumatoid arthritis (RA) and another group of normal subjects. The PHA, Con A, and PWM responses were depressed in the PsA group. The degree of depression of the mitogen response was comparable to that observed in the group of patients with active RA. Sequential studies done in a small group of PsA patients revealed that the mitogen response paralleled disease activity. Improvement of disease activity was followed by increased mitogen response.
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PMID:Cell-mediated immunity in psoriatic arthritis. 696 33

The need for a global assessment of the health state of patients affected by psoriatic arthritis (APs) which takes into account not only bio-clinical aspects but also other relevant results such as physical, mental and social wealth, was the main reason for the development of an original questionnaire capable of assessing the social and psychological impact of both the affections [psoriasis (Ps) and APs] considered individually and in their summing up of effects. Our study assessed 56 consecutive patients affected by APs under treatment in the Medical and Skin Disease Departments of the "Santa Maria" Perugia University Hospital of Terni, within a time span of 14 months. A questionnaire divided in five parts (a general part and four special parts, assessing, psychological, social, rheumatological and social, economic and therapeutic issues) was proposed to each patient under observation. The questionnaire can be self-filled in by the patient more than once and has been statistically validated for internal consistency, reproduciability and comparability with control groups. The patients with APs consider "bad" their diseases (50%) and develop depression (50%); the social life are troubled by Ps (49%) alone, in comparison with APs (22%); 70% of patients agrees with therapy and is willing to sustain an extra-expense of 500 euro per year.
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PMID:[A proposal of questionnaire for evaluation of the quality of life in patients with psoriatic arthritis]. 1294 99

Cytokines influence multiple psychiatric and medical conditions. Proinflammatory cytokines are associated with depression. The novel treatment of autoimmune diseases with anticytokines presents a unique strategy to understand the role of cytokines in affective disorders. Specifically, because antidepressants can be associated with cycling into manic states, and antidepressants can be associated with resolution of cytokine-induced depression, then, hypothetically, the treatment of a vulnerable patient who has an affective disorder with an anticytokine could also result in cycling. The development of a manic episode is described in a patient with psoriatic arthritis who was treated with etanercept, a tumour necrosis factor-alpha antagonist.
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PMID:Etanercept, anticytokines and mania. 1593 86

Psoriasis and psoriatic arthritis are inflammatory immune-mediated skin and joint conditions with major impacts on patients' health-related quality of life (HRQOL). Physical manifestations include unsightly, scaly, pruritic plaques and inflamed joints for patients with psoriatic arthritis. These symptoms can severely impair physical functioning and occupational capability and negatively affect psychosocial domains. Consequently, patients often experience feelings of embarrassment, helplessness, and depression. Recent therapies, including the biologics, have been shown to improve not only the physical signs and symptoms of these conditions, but also patients' HRQOL. To accurately assess these improvements, standardized and validated instruments are needed. However, there are currently a limited number of feasible and validated tools available in dermatology for measuring HRQOL and function. Valuable insights can be acquired from the rheumatology field, and refinement of existing outcome measures through a cooperative and consensus building process between dermatologists and rheumatologists will lead to standardization of assessment tools in the years ahead.
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PMID:Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective. 1654 93

Folic acid is a vitamin B essential for the integrity and function of DNA. Relative deficiency of folic acid may occur in conditions such as pregnancy and hyperproliferative or chronic inflammatory disorders. Folic acid supplementation has been proven to be beneficial in the prevention of neural tube defects and in limiting methotrexate side effects, and may reduce the risk of colorectal cancer. Folate is a critical vitamin in determining plasma homocysteine levels, which in turn is a major risk factor for cardiovascular diseases. The results of large clinical trials with dietary supplementation of folic acid, vitamin B12 and vitamin B6 have shown that this homocysteine-lowering therapy is effective in the secondary prevention of non-fatal strokes, but had no effect in the prevention of fatal cardiovascular diseases. Hyperhomocysteinemia has also been reported in age-related neurological conditions with cognitive impairment (e.g. dementia), and psychiatric disorders such as depression. Elevated homocysteine levels are frequent in patients with chronic immune-mediated disorders including rheumatoid arthritis, systemic lupus erythematosus, chronic plaque psoriasis and psoriatic arthritis, which have in common a tendency to an accelerated atherosclerosis leading to increased deaths from cardiovascular events. Folic acid supplementation appears as a reasonable therapeutic option in patients affected by chronic inflammatory skin diseases, such as moderate to severe psoriasis; in particular, those with concomitant hyperhomocysteinemia, low plasma folate and additional cardiovascular risk factors.
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PMID:Folic acid in general medicine and dermatology. 1753 1

Epidemiologic data document not only a higher prevalence of joint involvement among psoriasis patients than previously thought, but also an association with numerous other diseases, including depression, smoking, alcoholism, Crohn's disease, and metabolic syndrome. The resulting increased cardiovascular mortality is of particular clinical importance, and its pathogenetic link as a complication of the psoriatic inflammation is well recognized. Thus, we need to re-invent the management of psoriasis: Dermatologists are not only the sentinel regarding the early diagnosis of psoriatic arthritis, but also of metabolic complications such as dyslipidemia or diabetes. Moreover, they need to keep in mind interactions between (systemic) anti-psoriatic drugs and the co-medication of their patients as well as possible consequences of these co-medications on the course of psoriasis. To successfully accomplish this mission, a comprehensive management concept and ground-breaking research are urgently needed.
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PMID:[Co-morbidities in psoriasis vulgaris]. 1915 62

Psoriasis is a disease mediated by Th1 and Th17 cytokines that has different phenotypes (plaque, guttate, pustular, and erythrodermic type). Aside from the well known psoriatic arthritis, associated disorders may occur more frequently than expected, including Crohn's disease, anxiety/depression, and metabolic syndrome. This is based on a constellation of different factors, including abdominal obesity, atherogenic dyslipidemia, hypertension, and glucose intolerance, and is a strong predictor of type 2 diabetes, cardiovascular disease, and stroke. People with moderate to severe psoriasis have more risk for cardiac disease, presumably due to the inflammatory nature of psoriasis, causing inflammatory changes in coronary arteries. The strong association between psoriasis and obesity potentially makes psoriasis an important healthcare issue. Since cardiovascular risk factors are higher in psoriatic patients, dermatologists treating moderate to severe psoriasis should screen for their presence, thus approaching psoriasis as a potential multisystem disorder.
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PMID:Clinical aspects and comorbidities of psoriasis. 1966 31

Psoriasis is a chronic inflammatory disease affecting 2% to 3% of the population in Western countries. Psoriasis is associated with limited quality of life, cardiovascular disease, and depression. The approval of injectable biological agents has revolutionized the management of moderate to severe psoriasis. Adalimumab is a human monoclonal antibody against tumor necrosis factor (TNF) alpha approved for moderate-to-severe plaque-type psoriasis and psoriatic arthritis (PsA). This systematic review summarizes the evidence concerning the efficacy, clinical effectiveness, safety, and cost-effectiveness of adalimumab in the treatment of psoriasis. Five randomized controlled trials demonstrated the efficacy of adalimumab in moderate-to-severe plaque-type psoriasis and PsA with PASI-75 response rates of 53% to 80% and ACR-20 response rates of 39% to 58% after 12 to 16 weeks of treatment. In clinical practice patients who have not responded to one TNF antagonist may respond to another TNF antagonist. Adalimumab has similar or better cost-effectiveness than other biologics, but is less efficient than methotrexate and cyclosporine. Adalimumab is generally well tolerated. Patients should be evaluated for active/latent tuberculosis, serious infections, and other contraindications prior to initiation of adalimumab therapy. Future studies should investigate the comparative efficacy of adalimumab and other biologic and prebiologic agents. Recently established registries will yield additional data on the effectiveness and long-term safety of adalimumab.
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PMID:Targeted treatment of psoriasis with adalimumab: a critical appraisal based on a systematic review of the literature. 1970 17


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