Laboratory Findings in Psoriatic Arthritis

Punzi, Leonardo; Podswiadek, Marta; Oliviero, Francesca; Lonigro, Andrew J.; Modesti, Valentina; Ramonda, Roberta; Todesco, S

doi:10.4081/reumatismo.2007.1s.52

Cited by 37 publications

(52 citation statements)

References 30 publications

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“…In PsA, the most common inflammatory indicators (ESR and CRP) used for the evaluation of disease activity in rheumatoid arthritis are within normal levels in half of the patients [27]. However, when these two markers are increased, their utility is undeniable [27].…”

Section: Discussionmentioning

confidence: 99%

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Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study

Queiró

Cañete

Montilla³

et al. 2017

Arthritis Res Ther

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BackgroundPatients with psoriatic arthritis (PsA) experience functional impairment and reduced quality of life, and thus patient global assessment in PsA is explained mainly by the physical, but also by the psychological, aspect of the disease. To assess the prevalence of minimal disease activity (MDA) in Spanish patients with PsA, we examined their characteristics and the association between MDA and the impact of the disease as assessed by the PsA Impact of Disease (PsAID) questionnaire.MethodsA cross-sectional multicenter study was carried out in patients who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least 1 year of disease duration, and who were treated with biological or conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) according to routine clinical practice in Spain. Patients were considered in MDA if they met at least 5/7 of the MDA criteria. The association between MDA and the recently developed PsAID questionnaire was also recorded.ResultsOf 227 patients included, 133 (58.6%) were in the MDA state (52% with antitumor necrosis factor (anti-TNF)α monotherapy, 24% with csDMARD monotherapy, and 24% with anti-TNFα in combination with csDMARD). Using multivariate logistic regression analysis, male gender (odds ratio (OR) 2.74, p = 0.001), a sedentary lifestyle (OR 3.13, p = 0.002), familial history of PsA (OR 0.38, p = 0.036), C-reactive protein (CRP) level (OR 0.92, p = 0.010), and use of corticoids (OR 0.33, p = 0.007) were considered features related to MDA. MDA patients had a significantly lower impact of the disease according to PsAID (mean total score (SD): MDA 3.3 (3.1) vs. non-MDA 7.1 (5.2); p < 0.001).ConclusionsNearly 60% of Spanish PsA patients achieve MDA in routine clinical practice. MDA remains one of the most useful therapeutic targets for PsA since patients who reached this state also had a significantly lower impact of disease according to PsAID.

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Section: Discussionmentioning

confidence: 99%

“…However, when these two markers are increased, their utility is undeniable [27]. Baseline high CRP and ESR are predictors for MDA [6].…”

Section: Discussionmentioning

confidence: 99%

Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study

Queiró

Cañete

Montilla³

et al. 2017

Arthritis Res Ther

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“…Hallmark clinical features differentiating PsA from other, similar arthropathies include the presence of psoriatic skin involvement in nearly all cases, nail dystrophy and dactylitis. Diagnostic laboratory markers for PsA are lacking, and those used to date have typically helped differentiate PsA from other conditions rather than specifically diagnosing PsA [98]. Evaluation of the erythrocyte sedimentation rate and C-reactive protein level has limited utility in diagnosis of PsA, as these markers have been shown to be elevated in only about half of the patients with PsA; however, in PsA patients who do have an elevated erythrocyte sedimentation rate and elevated C-reactive protein levels, they are useful to assess disease activity and thus worthwhile to assess in patients who are suspected to have PsA.…”

Section: Patient Assessment Staging and Treatment Planmentioning

confidence: 99%

Managing Patients with Psoriatic Disease: The Diagnosis and Pharmacologic Treatment of Psoriatic Arthritis in Patients with Psoriasis

Mease

Armstrong

2014

Drugs

230

208

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Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. Up to 40 % of patients with psoriasis will go on to develop PsA, usually within 5–10 years of cutaneous disease onset. Both conditions share common pathogenic mechanisms involving genetic and environmental factors. Because psoriasis is typically present for years before PsA-related joint symptoms emerge, dermatologists are in a unique position to detect PsA earlier in the disease process through regular, routine screening of psoriasis patients. Distinguishing clinical features of PsA include co-occurrence of psoriatic skin lesions and nail dystrophy, as well as dactylitis and enthesitis. Patients with PsA are usually seronegative for rheumatoid factor, and radiographs may reveal unique features such as juxta-articular new bone formation and pencil-in-cup deformity. Early treatment of PsA with disease-modifying anti-rheumatic drugs has the potential to slow disease progression and maintain patient quality of life. Optimally, a single therapeutic agent will control both the skin and joint psoriatic symptoms. A number of traditional treatments used to manage psoriasis, such as methotrexate and cyclosporine, are also effective for PsA, but these agents are often inadequately effective, temporary in benefit and associated with significant safety concerns. Biologic anti-tumour necrosis factor agents, such as etanercept, infliximab and adalimumab, are effective for treating patients who have both psoriasis and PsA. However, a substantial number of patients may lose efficacy, have adverse effects or find intravenous or subcutaneous administration inconvenient. Emerging oral treatments, including phosphodiesterase 4 inhibitors, such as apremilast, and new biologics targeting interleukin-17, such as secukinumab, brodalumab and ixekizumab, have shown encouraging clinical results in the treatment of psoriasis and/or PsA. Active and regular collaboration of dermatologists with rheumatologists in managing patients who have psoriasis and PsA is likely to yield more optimal control of psoriatic dermal and joint symptoms, and improve long-term patient outcomes.

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“…Laboratory evaluation of erythrocyte sedimentation rate and C-reactive protein (CRP), which are elevated in about 50% of PsA patients, may be used for prognostic reasoning and to monitor disease activity, but are nonspecific for PsA and generally do not contribute to choice of medical therapy nor to determination of disease severity. 24,47 MANAGEMENT GOALS Improving joint pain and soreness, mobility, patient QOL, and emotional health are major goals for PsA patients, ideally through management by both a dermatologist and rheumatologist. Treatment of cutaneous disease alone is insufficient and has little effect on joint symptoms of PsA.…”

Section: Patient Evaluationmentioning

confidence: 99%