Enthesitis in Psoriatic Disease

McGonagle, Dennis; Helliwell, Philip S.; Veale, Douglas J.

doi:10.1159/000341536

Cited by 41 publications

(36 citation statements)

References 122 publications

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“…70 Enthesitis is generally more often found in the lower extremities with the Achilles and plantar aponeurosis the most commonly involved sites. 71 Unfortunately, examination of the entheses is often subjective, there is low interrater realibility even when standardized examination techniques are used, and tenderness on exam is often discordant with findings of inflammation on ultrasound or other imaging techniques.…”

Section: Methodsmentioning

confidence: 99%

The Epidemiology of Psoriatic Arthritis

Ogdie

Weiss

2015

Rheumatic Disease Clinics of North America

415

256

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Section: Methodsmentioning

confidence: 99%

The Epidemiology of Psoriatic Arthritis

Ogdie

Weiss

2015

Rheumatic Disease Clinics of North America

415

256

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“…Indeed MRI is able both to quantify the extent of the inflammatory process within the affected joints and to detect enthesitis even in apparently unaffected joints and in the absence of clinical symptoms. Enthesitis is considered the primary event in the pathogenesis of the disease [7]. Moreover MRI and scintigraphy can be used for an early detection of sacroiliitis and axial disease.…”

Section: Introductionmentioning

confidence: 99%

Gene Expression Profiling in Peripheral Blood Cells and Synovial Membranes of Patients with Psoriatic Arthritis

et al. 2015

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BackgroundPsoriatic arthritis (PsA) is an inflammatory arthritis whose pathogenesis is poorly understood; it is characterized by bone erosions and new bone formation. The diagnosis of PsA is mainly clinical and diagnostic biomarkers are not yet available. The aim of this work was to clarify some aspects of the disease pathogenesis and to identify specific gene signatures in paired peripheral blood cells (PBC) and synovial biopsies of patients with PsA. Moreover, we tried to identify biomarkers that can be used in clinical practice.MethodsPBC and synovial biopsies of 10 patients with PsA were used to study gene expression using Affymetrix arrays. The expression values were validated by Q-PCR, FACS analysis and by the detection of soluble mediators.ResultsSynovial biopsies of patients showed a modulation of approximately 200 genes when compared to the biopsies of healthy donors. Among the differentially expressed genes we observed the upregulation of Th17 related genes and of type I interferon (IFN) inducible genes. FACS analysis confirmed the Th17 polarization. Moreover, the synovial trascriptome shows gene clusters (bone remodeling, angiogenesis and inflammation) involved in the pathogenesis of PsA. Interestingly 90 genes are modulated in both compartments (PBC and synovium) suggesting that signature pathways in PBC mirror those of the inflamed synovium. Finally the osteoactivin gene was upregulared in both PBC and synovial biopsies and this finding was confirmed by the detection of high levels of osteoactivin in PsA sera but not in other inflammatory arthritides.ConclusionsWe describe the first analysis of the trancriptome in paired synovial tissue and PBC of patients with PsA. This study strengthens the hypothesis that PsA is of autoimmune origin since the coactivity of IFN and Th17 pathways is typical of autoimmunity. Finally these findings have allowed the identification of a possible disease biomarker, osteoactivin, easily detectable in PsA serum.

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“…It may be that a common mechanism lies at the root of psoriasis and clubbing. The nail is a complex system, functionally linked to the distal interphalangeal joint, to the muscoskeletal system and anchored to tendons, ligaments and periosteum [7]. The complex anatomy of the distal interphalangeal joints gave rise to the term "enthesis organ", highlighting the fact that inflammatory reaction intrinsic to enthesitis involves not only the enthesis itself, but neighbouring tissues as well [8].…”

Section: Discussionmentioning

confidence: 99%

Clubbing/Pseudoclubbing only in Fingernails Previously Affected by Psoriasis

Antonucci¹,

Tengattini²

2012

J Clin Exp Ophthalmol

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We report a case of fingernails clubbing in a 55-year-old man suffered since the age of 40 from cutaneous psoriasis. The patient had no clubbing before and had no familial cases of clubbing. Cardiological and pneumological visits revealed no abnormalities. All laboratory tests were within normal limits and X-rays excluded the presence of pachyodermoperiostosis. We made the diagnosis of atypical clubbing exclusively in the fingernails previously affected by psoriasis. It may be that a common mechanism lies at the root of these two phenomena.The patient had no enlargement of the distal phalanx before (unfortunately we don't have photo) and had no familial cases of clubbing. Cardiological and pneumological visits revealed no abnormalities. All laboratory tests were within normal limits. The patient underwent X-rays that excluded the presence of pachyodermoperiostosis. Capillaroscopy of the fingers with the enlargement of the distal phalanx showed alterations in the capillarity pattern like splayed and arborized loops and plexus. We made the diagnosis of clubbing/pseudoclubbing exclusively in the fingernails previously affected by psoriasis. Till now the ACH has been treated with acitretina 25 mg daily with good results but the enlargement of the distal phalanx persists at the 6 months follow-up visit. DiscussionThe mechanism for the development of clubbing is not clear, and several hypotheses have been proposed. Brouwers et al. hypothesized

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Enthesitis in Psoriatic Disease

Cited by 41 publications

References 122 publications

The Epidemiology of Psoriatic Arthritis

The Epidemiology of Psoriatic Arthritis

Gene Expression Profiling in Peripheral Blood Cells and Synovial Membranes of Patients with Psoriatic Arthritis

Clubbing/Pseudoclubbing only in Fingernails Previously Affected by Psoriasis

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