Autonomic dysfunction in psoriatic arthritis

Syngle, Ashit; Ic, Verma; Garg, Nidhi; Krishan, Pawan

doi:10.1007/s10067-013-2239-x

Cited by 28 publications

(25 citation statements)

References 19 publications

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“…This suggests that these may predict the occurrence of neuropathy and response to treatment. Earlier study on autonomic neuropathy in PsA patients has shown a positive correlation between biomarkers of inflammation (ESR and CRP) and parasympathetic dysfunction [Syngle et al 2013]. In another spondyloarthropathy disease, AS, there is a positive correlation between parasympathetic dysfunction and disease activity (BASDAI) and biomarkers of inflammation (ESR and CRP) [Toussirot et al 1999].…”

Section: Discussionmentioning

confidence: 97%

Disease-modifying antirheumatic drugs improve cardiovascular autonomic neuropathy in psoriatic arthritis

Syngle¹,

Krishan

et al. 2016

Therapeutic Advances in Musculoskeletal

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Background: Cardiovascular autonomic neuropathy (CAN) is a significant risk predictor for sudden cardiac death in autoimmune rheumatic diseases. As yet, there is no therapeutic treatment of CAN in psoriatic arthritis (PsA). Even now, the impact of the most commonly employed disease-modifying antirheumatic drug (DMARD) therapy on CAN in PsA is not known. Hence, we investigated the impact of DMARDs on CAN in PsA. Methods: In this prospective, cross-sectional study, 20 patients of PsA and 20 ageand sex-matched healthy controls were recruited. CAN was diagnosed by applying the five cardiovascular reflex tests according to Ewing. Parasympathetic dysfunction was established by performing three tests: heart-rate response to deep breathing, standing, and Valsalva tests. Sympathetic dysfunction was examined by applying two tests: blood pressure response to standing, and handgrip tests. Disease severity was assessed by the 28-joint-count disease activity score (DAS-28) and the disease activity score in psoriatic arthritis (DAPSA). Results: Cardiovascular reflex tests were impaired significantly among the PsA patients compared with well-matched healthy subjects (p < 0.05). Parasympathetic dysfunction was more prominent than sympathetic dysfunction. After 12 weeks treatment, parasympathetic dysfunction (heart rate response to deep breath and standing) significantly (p < 0.05) improved in patients with PsA, while there was no significant improvement in sympathetic function. Conclusion: These study results suggests parasympathetic autonomic dysfunction is more prominent than sympathetic dysfunction in PsA. Synthetic DMARDs improved parasympathetic dysfunction in PsA.

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Section: Discussionmentioning

confidence: 97%

Disease-modifying antirheumatic drugs improve cardiovascular autonomic neuropathy in psoriatic arthritis

Syngle¹,

Krishan

et al. 2016

Therapeutic Advances in Musculoskeletal

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“…Baseline N=52 Background: Evaluating psoriatic arthritis (PsA)-related enthesitis is diagnostically and therapeutically essential, but may be very complex because of the wide range of signs and symptoms that partly overlap or co-exist with the clinical features of fibromyalgia (FM) [1,2]. Objectives: The primary aim was to compare the prevalence of clinical and ultrasonographic signs of enthesitis in patients with PsA, FM, or both.…”

Section: Variablementioning

confidence: 99%

Fri0433 effects of Disease Modifying Drugs on Bone Mineral Density, Fracture Incidence, Back Pain and Physical Activity in Patients With Psoriasis and Psoriatic Arthritis

Freier

Wiebe

Zeiner

et al. 2019

Psoriatic Arthritis

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BackgroundReports on the prevalence of osteoporosis, osteoporotic fractures and risk factors for osteoporosis in patients with psoriasis (PSO) or psoriatic arthritis (PSOA) are scarce, and the published results on this are, at least in part, contradictory. [1] Despite the fact that IL-17 is involved in bone homeostasis under both physiologic and pathologic conditions, there is no detailed knowledge of the direct and indirect impact an IL-17 antagonist like secukinumab (SEC) has on bone mineral density (BMD).ObjectivesRh-GIOP (ClinicalTrials.gov Identifier NCT02719314) is an ongoing prospective study monitoring glucocorticoid (GC)-induced osteoporosis of rheumatic patients, established in 2015 at the Charité University Hospital. For this analysis, clinical data and bone mineral density data measured by dual x-ray absorptiometry (DXA) of 936 patients with inflammatory rheumatic diseases provided the basis. The main objective of this cross-sectional analysis was to evaluate the prevalence of osteoporosis and the frequency of fractures in patients with PSO or PSOA. Additionally, patients treated with secukinumab were compared to those with methotrexate (MTX) with regard to BMD, fracture incidence, physical activity, and back painMethodsWe analyzed the initial visit of 103 patients with PSO (n= 31, 74% female) or PSOA (n=72, 64% female). Descriptive analyses were performed, and values are displayed as means and standard deviations. For subgroup analyses non-parametric tests were used.ResultsThe prevalence of osteoporosis in our patient group (mean age: 62±10 years; 67% female; mean disease duration: 17±13 years) was 19%. The prevalence of osteopenia was 26%, 34% (n=35) reported peripheral fragility fractures, and 11% (n=11) had vertebral fractures in history. Regular physical activity was reported by 41% (n=42), while 53% (n=55) suffered from movement restrictions. Back pain was present in 68% (n=70) of patients with a mean numeric rating scale of 5 (NRS; 0-10). SEC was used by 18% (n=19), and MTX by 42% (n=43, 25% sc, 13% oral, 4% unknown), respectively. Eight percent had a combination therapy of MTX and SEC. Twenty-seven percent used GC and/or other biologics/conventional disease modifying antirheumatic drugs (DMARDs). Mean glucocorticoid cumulative dose (GCCD) was 12.8±22.0g. Patients with SEC showed a significantly longer disease duration (median: 24 years vs. 13 years) compared to MTX, but showed no other differences in baseline-characteristics or risk factors. T-Scores of both femora were significantly higher in the MTX versus the SEC group. We could not find significant differences between these groups with regard to physical activity, back pain, movement restriction, fracture rates or GCCD. Twenty-five percent of the MTX users and 27% of the patients in the SEC group additionally had GC while; in contrast to no patient in the combination group.ConclusionThe prevalence of osteoporosis in patients with PSO or PSOA was found to be as high as in the normal population. However, there was a high frequency of peripher...

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“…The disease can have a diverse clinical course but usually, manifests as oligoarthritis [1]. Peripheral sympathetic autonomic dysfunction in psoriatic arthritis is known [2]. Secukinumab is an IgG1k fully monoclonal antibody selectively targeting interleukin-17A.…”

Section: Introductionmentioning

confidence: 99%

Interleukin-17inhibition With Secukinumab Improves Sudomotor Dysfunction in Psoriatic Arthritis

Syngle

Kaur³

et al. 2018

Int J Pharm Pharm Sci

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Psoriatic arthritis (PsA) is a relapsing inflammatory disease, most commonly a seronegative oligoarthritis found in patients with psoriasis, characterized by the absence of rheumatoid factor in serum, with differentiating features of distal joint involvement and in extreme cases of arthritis mutilans (which is a destructive form of PsA). Cardiovascular autonomic and peripheral sympathetic neuropathy occurs in PsA. However, there is no specific treatment recommendation for autonomic neuropathy (AN) in psoriatic diseases. Secukinumab, a recently approved therapeutic advancement for psoriasis and psoriatic arthritis, is an immunoglobulin G (IgG) 1k fully monoclonal antibody that selectively inhibits the effector function of interleukin (IL)-17A. Its effect on sudomotor dysfunction in PsA has not yet been reported. This is the first reported observation of improvement in peripheral sympathetic autonomic neuropathy with secukinumab in PsA. We report a case of a 52-year-old male with PsA on methotrexate 15 mg/week with severe disease activity treated with the addition of subcutaneous secukinumab 150 mg once a week for 5 w followed by once a month dose. We found significant improvement in sudomotor dysfunction after 4 and 8 w of treatment.

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Autonomic dysfunction in psoriatic arthritis

Cited by 28 publications

References 19 publications

Disease-modifying antirheumatic drugs improve cardiovascular autonomic neuropathy in psoriatic arthritis

Disease-modifying antirheumatic drugs improve cardiovascular autonomic neuropathy in psoriatic arthritis

Fri0433 effects of Disease Modifying Drugs on Bone Mineral Density, Fracture Incidence, Back Pain and Physical Activity in Patients With Psoriasis and Psoriatic Arthritis

Interleukin-17inhibition With Secukinumab Improves Sudomotor Dysfunction in Psoriatic Arthritis

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