Psoriatic arthritis - ScienceDirect

Baillière's Clinical Rheumatology

Volume 9, Issue 2, May 1995, Pages 319-329

Baillière's Clinical Rheumatology

https://doi.org/10.1016/S0950-3579(05)80193-1 Get rights and content

Summary

Despite the fact that psoriatic arthritis has been recognized as an entity for almost five decades, there are still no valid criteria for either its diagnosis or classification. Several sets of criteria have been proposed but none was studied. None the less, investigators have been able to study the condition and describe its unique features and its natural course and prognosis. However, in order to facilitate further studies, it would be worthwhile to develop an internationally accepted and validated set of criteria, both for the diagnosis and classification of the disease, as well as for the assessment of damage. These criteria would help set up appropriate therapeutic trials in this condition as well.

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Cited by (64)

The Cost of Psoriasis and Psoriatic Arthritis in 5 European Countries: A Systematic Review
2016, Actas Dermo-Sifiliograficas
La introducción de las terapias biológicas ha mejorado la calidad de vida de los pacientes con psoriasis y artritis psoriásica, aunque podría haber incrementado su carga económica.
Objetivo: Revisar los estudios de costes del manejo de la psoriasis y artritis psoriásica en cinco países de Europa (Alemania, España, Francia, Italia y Reino Unido).
Revisión sistemática de la literatura en Medline y Embase hasta mayo 2015. La calidad metodológica de las publicaciones se evaluó mediante las recomendaciones de la Consolidated Health Economics Reporting Standard (CHEERS). Se consideraron costes directos (sanitarios y no sanitarios) e indirectos, actualizados por la inflación de cada país y ajustados a dólares internacionales 2015 mediante la Paridad de Capacidad Adquisitiva (USD-PPP).
Se identificaron 775 publicaciones, 68,3% de psoriasis y 31,7% de artritis psoriásica. El coste total anual por paciente osciló entre 2.077-13.132 USD-PPP y 10.924-17.050 USD-PPP en psoriasis y artritis psoriásica, respectivamente. En ambas patologías, la partida con mayor contribución al coste total fue la relacionada con costes directos. Estadios más graves de la enfermedad se asociaron con un aumento de costes. La introducción de terapias biológicas conllevó un incremento de 3 a 5 veces de los costes directos, que repercutió en los costes totales.
Esta revisión pone de manifiesto el impacto económico que supone el tratamiento y manejo de la psoriasis y artritis psoriásica, el cual aumenta en función de la gravedad del paciente y de la inclusión de terapias biológicas.
While the introduction of biologics has improved the quality of life of patients with psoriasis and psoriatic arthritis, it may have increased the economic burden of these diseases.
To perform a systematic review of studies on the costs associated with managing and treating psoriasis and psoriatic arthritis in 5 European countries: Germany, Spain, France, Italy, and the United Kingdom.
We undertook a systematic review of the literature (up to May 2015) using the MEDLINE and EMBASE databases. The methodological quality of the studies identified was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. We considered both direct costs (medical and nonmedical) and indirect costs, adjusted for country-specific inflation and converted to international dollars using purchasing power parity exchange rates for 2015 ($US PPP).
The search retrieved 775 studies; 68.3% analyzed psoriasis and 31.7% analyzed psoriatic arthritis. The total annual cost per patient ranged from US $2,077 to US $13,132 PPP for psoriasis and from US $10,924 to US $17,050 PPP for psoriatic arthritis. Direct costs were the largest component of total expenditure in both diseases. The severity of these diseases was associated with higher costs. The introduction of biologics led to a 3-fold to 5-fold increase in direct costs, and consequently to an increase in total costs.
We have analyzed the economic burden of psoriasis and psoriatic arthritis and shown that costs increase with the treatment and management of more severe disease and the use of biologics.
Psoriatic spondylitis
2014, Spine Journal
Consensus statement of the Spanish Society of Rheumatology on the management of biologic therapies in psoriatic arthritis
2011, Reumatologia Clinica
Dada la gran cantidad de información actual sobre el uso de terapias biológicas (TB) en la artritis psoriásica (APs), y la variabilidad de la misma en cuanto a su calidad, desde la Sociedad Española de Reumatología (SER) se ha impulsado la generación de recomendaciones basadas en la mejor evidencia posible. Éstas deben de servir de referencia para reumatólogos e implicados en el tratamiento de APs que vayan a utilizar o consideren la utilización de TB.
Las recomendaciones se emitieron siguiendo la metodología de grupos nominales y basadas en revisiones sistemáticas. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por técnica Delphi.
Se realizan recomendaciones sobre el uso de las TB disponibles en la actualidad en nuestro país para el tratamiento de la APs. Estas recomendaciones incluyen la evaluación de la enfermedad, objetivos del tratamiento, esquema terapéutico y cambios en el mismo.
Se presentan las actualizaciones a las recomendaciones SER para el uso de TB en pacientes con APs.
Due to the amount and quality variability regarding the use of biologic therapy (BT) in psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology (SER) has promoted the generation of recommendations based on the best evidence available. These recommendations should serve as reference to rheumatologists and those involved in the treatment of patients with PsA, who are using, or about to use BT.
Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation was classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique.
We have produced recommendations for the use of TB currently available for PsA in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching.
We present an update on the SER recommendations for the use of BT in patients with PsA.
Sustained Clinical Response in Psoriatic Arthritis Patients Treated with Anti-TNF Agents: A 5-year Open-Label Observational Cohort Study
2011, Seminars in Arthritis and Rheumatism
To investigate the efficacy, toxicity, and drug discontinuation in patients with psoriatic arthritis treated with anti-tumor necrosis factor agents.
Sixty-five patients with active disease were included in this open-label study. They had tender or swollen joint count ≥5, Psoriatic Arthritis Severity Index (PASI) score ≥10, and erythrocyte sedimentation rate ≥28 mm Hg/1st hour and/or C-reactive protein ≥10 mg/L. All were refractory to at least 2 disease-modifying antirheumatic drugs. Thirty were treated with infliximab, 25 with etanercept, and 10 with adalimumab. Infliximab (5 mg/kg body weight) was given intravenously at weeks 0, 2, 6, and every 8 weeks thereafter; etanercept was given subcutaneously (25 mg twice a week), while adalimumab was given subcutaneously (40 mg every other week) for a period of 5 years. Data concerning anti-tumor necrosis factor efficacy tolerability, adverse events, and drug discontinuation were recorded. The percentage of patients who achieved the Psoriatic Arthritis Response Criteria (PSARC), the improvement of PASI, the improvement according to the American College of Rheumatology (ACR) criteria, and the disease activity for 28 joint indices score (DAS-28) were recorded.
After 5 years, PSARC was 60%, PASI 70 was 66.7%, PASI 90 was 63.3%, while ACR 50 was 56.7% for the patients treated with infliximab. Moreover, PsARC was 64%, PASI 70 and PASI 90 were 68%, while ACR 50 was 56% for those treated with etanercept. Furthermore, in the adalimumab group PsARC was 56%, PASI 70 and PASI 90 were 58% and 50%, respectively, while ACR 50 was 50%. Additionally, DAS-28 scores were significantly improved. Thirteen patients treated with infliximab, 6 with etanercept, and 5 patients with adalimumab were withdrawn. At the end of treatment, the survival of infliximab was 56.7%, for etanercept 76%, and for adalimumab 50%.
All drugs were effective, safe, and well-tolerated. The clinical improvement was maintained through the 5 years with satisfying infliximab and adalimumab survival and high etanercept survival.
Recognizing psoriatic arthritis in the dermatology clinic
2010, Journal of the American Academy of Dermatology
Citation Excerpt :
Key points PsA has a worldwide prevalence among psoriasis patients ranging from 6% to 42%.15-23 Population heterogeneity and varying methods of disease classification and data acquisition contribute to the difficulty in establishing its true prevalence.
Dermatologists care for patients with psoriasis in whom there exists an inherent risk of psoriatic arthritis, a condition with potential for causing joint damage and subsequent disability. Most patients have psoriasis for years before the development of psoriatic arthritis, and there may be a significant proportion of psoriasis patients with joint involvement that are cared for by the dermatologist. With the absence of a diagnostic measure, the criterion standard for recognizing or monitoring psoriatic arthritis remains the clinical assessment. Recognition of psoriatic arthritis in the psoriasis patient—and the dermatologist's ability to differentiate it from other types of arthritis—provide an opportunity to improve patient outcomes through early recognition and facilitation of intervention in collaboration with a rheumatologist.
After completing this learning activity, participants should be able to recognize the presence of psoriatic arthritis among patients with psoriasis; distinguish psoriatic arthritis from reactive arthritis, osteoarthritis, gout, rheumatoid arthritis, and ankylosing spondylitis; and use appropriate laboratory and imaging tests in the evaluation of patients with psoriasis and musculoskeletal complaints.
Classification of psoriatic arthritis
2009, Seminarios de la Fundacion Espanola de Reumatologia
La artritis psoriásica es un reumatismo inflamatorio incluido en el grupo de las espondiloartropatías. Se define como una artropatía que se manifiesta en pacientes con psoriasis y se caracteriza por la ausencia de factor reumatoide. En 1960 se reconoció como una entidad clínica independiente y diferente de la artritis reumatoide. A lo largo de la historia de la reumatología se ha clasificado de muchas maneras diversas. Es una entidad clínicamente heterogénea y en muchas ocasiones su clasificación es dificultosa. Varios autores se han esforzado en consensuar criterios comunes de clasificación de la enfermedad, aunque no existe consenso al respecto puesto que la adecuada clasificación de los diferentes subtipos sigue siendo un tema polémico y controvertido. De entre los criterios que se han propuesto destacan los de Moll y Wright, que por su sencillez han sido los más utilizados. Asimismo cabe mencionar, por su enorme sensibilidad y especificidad, los novedosos y actuales criterios de clasificación CASPAR.
Psoriatic arthritis is an inflammatory joint disease, included within the group of spondyloarthropathies. The diagnosis of psoriatic arthritis is made when a patient with psoriasis shows inflammatory arthritis and rheumatoid factor is usually negative. In 1960, psoriatic arthritis was recognized as a distinct entity from rheumatoid arthritis. Throughout the history of rheumatology, classifications of this disease have varied. Classification of this disease is hampered by its clinical heterogeneity. Several authors have attempted to define common classification criteria for psoriatic arthritis but consensus is still lacking, since appropriate classification of the distinct subtypes continues to be controversial. Notable among the criteria proposed are those of Moll and Wright, which, because of their simplicity, have become the most widely used. The latest classification, the CASPAR criteria, is also worth mentioning because of its high sensitivity and specificity.

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Copyright © 1995 Published by Elsevier Ltd.