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      Enthesitis and Dactylitis in Psoriatic Disease: A Guide for Dermatologists

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      Author(s): 1 , , 2
      Publication date (Electronic):
      Journal: American Journal of Clinical Dermatology
      Publisher: Springer International Publishing

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          Abstract

          Psoriatic arthritis (PsA) is an inflammatory arthritis that is estimated to affect approximately 30% of patients with psoriasis. Enthesitis and dactylitis, two hallmarks of PsA, are associated with radiographic peripheral/axial joint damage and severe disease. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation, whereas dactylitis is recognized by swelling of an entire digit that is different from adjacent digits. Both ultrasound and magnetic resonance imaging can be used to diagnose enthesitis and dactylitis, especially in patients in whom symptoms may be difficult to discern. Delayed treatment of PsA can result in irreversible joint damage and reduced quality of life. Thus, it is recommended that dermatologists monitor patients with psoriasis for these two early and important manifestations of PsA.

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          Psoriatic arthritis: epidemiology, clinical features, course, and outcome.

          D D Gladman, C Antoni, P. Mease … (2005)
          Psoriatic arthritis (PsA) has been defined as a unique inflammatory arthritis associated with psoriasis. Its exact prevalence is unknown, but estimates vary from 0.3% to 1% of the population. The clinical features described initially are recognised by most experienced clinicians, although they are most distinct in early disease. Initially, PsA typically presents as an oligoarticular and mild disease. However, with time PsA becomes polyarticular, and it is a severe disease in at least 20% of patients. Patients with PsA who present with polyarticular disease are at risk for disease progression. In addition to progression of clinical and radiological damage, health related quality of life is reduced among patients with PsA. It important to note that patients included in recent drug trials resemble patients followed prospectively in a clinic.
          Article 0 comments Cited 344 times – based on 0 reviews     Review now
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            Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis.

            Laura Coates, Arthur Kavanaugh, Philip J. Mease … (2016)
            To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA).
            Article 0 comments Cited 293 times – based on 0 reviews     Review now
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              Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial.

              Philip J. Mease, Dafna D. Gladman, Christopher Ritchlin … (2005)
              Adalimumab, a fully human, anti-tumor necrosis factor monoclonal antibody, was evaluated for its safety and efficacy compared with placebo in the treatment of active psoriatic arthritis (PsA). Patients with moderately to severely active PsA and a history of inadequate response to nonsteroidal antiinflammatory drugs were randomized to receive 40 mg adalimumab or placebo subcutaneously every other week for 24 weeks. Study visits were at baseline, weeks 2 and 4, and every 4 weeks thereafter. The primary efficacy end points were the American College of Rheumatology 20% improvement (ACR20) response at week 12 and the change in the modified total Sharp score of structural damage at week 24. Secondary end points were measures of joint disease, disability, and quality of life in all patients, as well as the severity of skin disease in those patients with psoriasis involving at least 3% of body surface area. At week 12, 58% of the adalimumab-treated patients (87 of 151) achieved an ACR20 response, compared with 14% of the placebo-treated patients (23 of 162) (P < 0.001). At week 24, similar ACR20 response rates were maintained and the mean change in the modified total Sharp score was -0.2 in patients receiving adalimumab and 1.0 in those receiving placebo (P < 0.001). Among the 69 adalimumab-treated patients evaluated with the Psoriasis Area and Severity Index (PASI), 59% achieved a 75% PASI improvement response at 24 weeks, compared with 1% of the 69 placebo-treated patients evaluated (P < 0.001). Disability and quality of life measures were also significantly improved with adalimumab treatment compared with placebo. Adalimumab was generally safe and well-tolerated. Adalimumab significantly improved joint and skin manifestations, inhibited structural changes on radiographs, lessened disability due to joint damage, and improved quality of life in patients with moderately to severely active PsA.
              Article 0 comments Cited 215 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jerry Bagel: (609) 529-7442 , dreamacres1@aol.com
                Journal
                Journal ID (nlm-ta): Am J Clin Dermatol
                Journal ID (iso-abbrev): Am J Clin Dermatol
                Title: American Journal of Clinical Dermatology
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 1175-0561
                ISSN (Electronic): 1179-1888
                Publication date (Electronic): 16 August 2018
                Publication date PMC-release: 16 August 2018
                Publication date (Print): 2018
                Volume: 19
                Issue: 6
                Pages: 839-852
                Affiliations
                [1 ]GRID grid.478094.6, Psoriasis Treatment Center of Central New Jersey, ; 59 One Mile Road Ext. Suite G, East Windsor, NJ 08520 USA
                [2 ]ISNI 0000 0001 2285 8823, GRID grid.239915.5, Hospital for Special Surgery, ; New York, NY USA
                Article
                Publisher ID: 377
                DOI: 10.1007/s40257-018-0377-2
                PMC ID: 6267546
                PubMed ID: 30117018
                SO-VID: 3a208507-948f-4e6f-bf70-6f0ad0a8e77e
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                issue-copyright-statement © Springer Nature Switzerland AG 2018

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