Psoriasis

Efforts underway to tailor psoriatic arthritis treatments to the various tissues involved in the pathogenesis of the disease could optimize therapeutic approaches, Dr. Iain McInnes said at the annual Perspectives in Rheumatic Diseases held by Global Academy for Medical Education.

“Psoriatic arthritis [PsA] is a disease whose treatment is evolving quickly, ” added Dr. McInnes, professor of medicine and director of the Institute of Infection, Immunity, and Inflammation at the University of Glasgow (Scotland). “We have new ideas about pathogenesis, emerging studies that inform the best strategic approach to disease management, including potential value in a treat-to-target approach, and new therapeutics that offer a range of options to allow us to optimize treatment.”

He pointed to recent evidence for a diverse pathogenesis of PsA subtypes. Synovial membranes in PsA have high levels of tumor necrosis factor (TNF)-alpha, while resident populations of interleukin (IL)-23 receptor–positive T cells are found in entheses and IL-17 is abundant in psoriatic lesions. Genome-wide association studies have underscored the role of the IL-23 and IL-17 cytokine axis, while other work has implicated Th17 cytokines in mesenchymal tissue changes.

Although drug development efforts have typically viewed rheumatoid arthritis and PsA as homogeneous, “we can appreciate the extent of articular, entheseal, and cutaneous involvement, and look to tailor therapies accordingly,” Dr. McInnes said.

So what will the next decade look like for PsA? Therapy will center around TNF-alpha inhibitors, new cytokine pathways, and small-molecule inhibitors, according to Dr. McInnes. While anti-TNF agents are not universally tolerated or effective, their “well-established safety profile” and positive effects on American College of Rheumatology response criteria and radiographic endpoints generally outweigh risks of infection and problems with decreasing long-term drug survival, he said. These agents also can improve disease activity, skin symptoms, physical function, fatigue, overall quality of life, enthesitis, and dactylitis, he noted.

Other recent additions to the PsA arsenal include the IL-12/IL-23 inhibitor ustekinumab (Stelara), which in the PSUMMIT 1 and 2 trials was associated with decreased rates of radiographic progression and dose-dependent improvements in enthesitis, Dr. McInnes said. The phosphodiesterase-4 inhibitor apremilast (Otezla) was associated with significantly better ACR 20 response at week 16 and significantly greater improvements in Maastricht Ankylosing Spondylitis Enthesis Score and measures of dactylitis at week 24 of the PALACE trials. Most recently, in the FUTURE1 and FUTURE2 trials, the IL-17A inhibitor secukinumab (Cosentyx) beat placebo in terms of ACR 20, ACR 50, ACR 70, resolution of dactylitis and enthesitis, and radiographic measures of disease progression.

The availability of effective biologics raises the possibility of a treat-to-target approach geared toward clinical remission or low disease activity, Dr. McInnes concluded. “Targets for low disease activity in PsA are now available. Composite measures of disease activity, such as minimal disease activity (MDA), encompass all clinically important aspects of PsA,” he emphasized. While studies still need to pinpoint the best therapeutic pathways for disease subtypes, the first treat-to-target study of PsA found that tailoring therapy based on remission or minimal disease activity led to significantly better ACR 20, ACR 50, and ACR 70 responses at week 48, compared with standard care, he noted.

Dr. McInnes reported receiving research funding or honoraria from Novartis, Janssen, AbbVie, UCB, Pfizer, and MSD Pharmaceuticals, all of which make medications for rheumatic diseases. Global Academy for Medical Education and this news organization are owned by the same parent company.

Efforts underway to tailor psoriatic arthritis treatments to the various tissues involved in the pathogenesis of the disease could optimize therapeutic approaches, Dr. Iain McInnes said at the annual Perspectives in Rheumatic Diseases held by Global Academy for Medical Education.

“Psoriatic arthritis [PsA] is a disease whose treatment is evolving quickly, ” added Dr. McInnes, professor of medicine and director of the Institute of Infection, Immunity, and Inflammation at the University of Glasgow (Scotland). “We have new ideas about pathogenesis, emerging studies that inform the best strategic approach to disease management, including potential value in a treat-to-target approach, and new therapeutics that offer a range of options to allow us to optimize treatment.”

He pointed to recent evidence for a diverse pathogenesis of PsA subtypes. Synovial membranes in PsA have high levels of tumor necrosis factor (TNF)-alpha, while resident populations of interleukin (IL)-23 receptor–positive T cells are found in entheses and IL-17 is abundant in psoriatic lesions. Genome-wide association studies have underscored the role of the IL-23 and IL-17 cytokine axis, while other work has implicated Th17 cytokines in mesenchymal tissue changes.

Although drug development efforts have typically viewed rheumatoid arthritis and PsA as homogeneous, “we can appreciate the extent of articular, entheseal, and cutaneous involvement, and look to tailor therapies accordingly,” Dr. McInnes said.

So what will the next decade look like for PsA? Therapy will center around TNF-alpha inhibitors, new cytokine pathways, and small-molecule inhibitors, according to Dr. McInnes. While anti-TNF agents are not universally tolerated or effective, their “well-established safety profile” and positive effects on American College of Rheumatology response criteria and radiographic endpoints generally outweigh risks of infection and problems with decreasing long-term drug survival, he said. These agents also can improve disease activity, skin symptoms, physical function, fatigue, overall quality of life, enthesitis, and dactylitis, he noted.

Other recent additions to the PsA arsenal include the IL-12/IL-23 inhibitor ustekinumab (Stelara), which in the PSUMMIT 1 and 2 trials was associated with decreased rates of radiographic progression and dose-dependent improvements in enthesitis, Dr. McInnes said. The phosphodiesterase-4 inhibitor apremilast (Otezla) was associated with significantly better ACR 20 response at week 16 and significantly greater improvements in Maastricht Ankylosing Spondylitis Enthesis Score and measures of dactylitis at week 24 of the PALACE trials. Most recently, in the FUTURE1 and FUTURE2 trials, the IL-17A inhibitor secukinumab (Cosentyx) beat placebo in terms of ACR 20, ACR 50, ACR 70, resolution of dactylitis and enthesitis, and radiographic measures of disease progression.

The availability of effective biologics raises the possibility of a treat-to-target approach geared toward clinical remission or low disease activity, Dr. McInnes concluded. “Targets for low disease activity in PsA are now available. Composite measures of disease activity, such as minimal disease activity (MDA), encompass all clinically important aspects of PsA,” he emphasized. While studies still need to pinpoint the best therapeutic pathways for disease subtypes, the first treat-to-target study of PsA found that tailoring therapy based on remission or minimal disease activity led to significantly better ACR 20, ACR 50, and ACR 70 responses at week 48, compared with standard care, he noted.

Dr. McInnes reported receiving research funding or honoraria from Novartis, Janssen, AbbVie, UCB, Pfizer, and MSD Pharmaceuticals, all of which make medications for rheumatic diseases. Global Academy for Medical Education and this news organization are owned by the same parent company.

Efforts underway to tailor psoriatic arthritis treatments to the various tissues involved in the pathogenesis of the disease could optimize therapeutic approaches, Dr. Iain McInnes said at the annual Perspectives in Rheumatic Diseases held by Global Academy for Medical Education.

“Psoriatic arthritis [PsA] is a disease whose treatment is evolving quickly, ” added Dr. McInnes, professor of medicine and director of the Institute of Infection, Immunity, and Inflammation at the University of Glasgow (Scotland). “We have new ideas about pathogenesis, emerging studies that inform the best strategic approach to disease management, including potential value in a treat-to-target approach, and new therapeutics that offer a range of options to allow us to optimize treatment.”

He pointed to recent evidence for a diverse pathogenesis of PsA subtypes. Synovial membranes in PsA have high levels of tumor necrosis factor (TNF)-alpha, while resident populations of interleukin (IL)-23 receptor–positive T cells are found in entheses and IL-17 is abundant in psoriatic lesions. Genome-wide association studies have underscored the role of the IL-23 and IL-17 cytokine axis, while other work has implicated Th17 cytokines in mesenchymal tissue changes.

Although drug development efforts have typically viewed rheumatoid arthritis and PsA as homogeneous, “we can appreciate the extent of articular, entheseal, and cutaneous involvement, and look to tailor therapies accordingly,” Dr. McInnes said.

So what will the next decade look like for PsA? Therapy will center around TNF-alpha inhibitors, new cytokine pathways, and small-molecule inhibitors, according to Dr. McInnes. While anti-TNF agents are not universally tolerated or effective, their “well-established safety profile” and positive effects on American College of Rheumatology response criteria and radiographic endpoints generally outweigh risks of infection and problems with decreasing long-term drug survival, he said. These agents also can improve disease activity, skin symptoms, physical function, fatigue, overall quality of life, enthesitis, and dactylitis, he noted.

Other recent additions to the PsA arsenal include the IL-12/IL-23 inhibitor ustekinumab (Stelara), which in the PSUMMIT 1 and 2 trials was associated with decreased rates of radiographic progression and dose-dependent improvements in enthesitis, Dr. McInnes said. The phosphodiesterase-4 inhibitor apremilast (Otezla) was associated with significantly better ACR 20 response at week 16 and significantly greater improvements in Maastricht Ankylosing Spondylitis Enthesis Score and measures of dactylitis at week 24 of the PALACE trials. Most recently, in the FUTURE1 and FUTURE2 trials, the IL-17A inhibitor secukinumab (Cosentyx) beat placebo in terms of ACR 20, ACR 50, ACR 70, resolution of dactylitis and enthesitis, and radiographic measures of disease progression.

The availability of effective biologics raises the possibility of a treat-to-target approach geared toward clinical remission or low disease activity, Dr. McInnes concluded. “Targets for low disease activity in PsA are now available. Composite measures of disease activity, such as minimal disease activity (MDA), encompass all clinically important aspects of PsA,” he emphasized. While studies still need to pinpoint the best therapeutic pathways for disease subtypes, the first treat-to-target study of PsA found that tailoring therapy based on remission or minimal disease activity led to significantly better ACR 20, ACR 50, and ACR 70 responses at week 48, compared with standard care, he noted.

Dr. McInnes reported receiving research funding or honoraria from Novartis, Janssen, AbbVie, UCB, Pfizer, and MSD Pharmaceuticals, all of which make medications for rheumatic diseases. Global Academy for Medical Education and this news organization are owned by the same parent company.

Methotrexate use more than doubled the risk of liver enzyme abnormalities but was not tied to serious hepatic outcomes among patients with rheumatic diseases, according to a meta-analysis of 32 randomized, controlled trials.

“Serious liver events were rare, with a suggestion of a trend towards fewer poor liver outcomes,” wrote Dr. Richard Conway of Galway (Ireland) University Hospitals. “The short duration of the included studies and the lack of liver biopsies are limitations, but the available data provide robust evidence for short-term safety” of methotrexate, wrote Dr. Conway and his associates.

Methotrexate is a first-line RA therapy with efficacy in several other inflammatory diseases, but concerns about toxicity have limited its use, the researchers noted. Clinicians have particularly debated its hepatic effects, in part because it can be “exceedingly difficult” to determine if liver disease is preexisting, methotrexate related, or caused by other medications or comorbidities, they said. To better assess the issue, they searched PubMed and the Cochrane Central Register of Controlled Trials for relevant double-blind, randomized, controlled trials published between 1990 and 2014. They found 32 such trials that included 13,177 patients with rheumatoid arthritis, psoriasis, psoriatic arthritis or inflammatory bowel disease (Semin Arthritis Rheum. 2015;45:156-62). Methotrexate use approximately doubled the risk of any adverse hepatic event (relative risk, 2.19; 95% confidence interval, 1.73-2.77) and of major and minor liver enzyme abnormalities (RR, 2.16; 95% CI, 1.67-2.79), but did not increase the risk of liver failure, cirrhosis, or liver-related mortality (RR, 0.12; 95% CI, 0.01-1.09), the investigators reported. “Clinical trials have inherent limitations, including short duration, selection bias, failure to collect information or reports that are not part of a prespecified protocol, and limited power to evaluate rare or unusual reports,” they cautioned. “While meta-analyses help overcome the last of these, the others raise some concern.”

But several other reports align with their results, the researchers noted. In an analysis of methotrexate studies lasting at least 2 years, about 10% of patients developed at least one minor liver enzyme abnormality, but less than 4% stopped methotrexate because of liver toxicity. Other controlled studies did not link methotrexate to severe fibrosis or cirrhosis – even after 4 years of treatment, they added. “It appears likely that serious liver-related complications due to methotrexate may take many years of treatment to manifest,” the investigators concluded.

The researchers reported no funding sources or conflicts of interest.

Methotrexate use more than doubled the risk of liver enzyme abnormalities but was not tied to serious hepatic outcomes among patients with rheumatic diseases, according to a meta-analysis of 32 randomized, controlled trials.

“Serious liver events were rare, with a suggestion of a trend towards fewer poor liver outcomes,” wrote Dr. Richard Conway of Galway (Ireland) University Hospitals. “The short duration of the included studies and the lack of liver biopsies are limitations, but the available data provide robust evidence for short-term safety” of methotrexate, wrote Dr. Conway and his associates.

Methotrexate is a first-line RA therapy with efficacy in several other inflammatory diseases, but concerns about toxicity have limited its use, the researchers noted. Clinicians have particularly debated its hepatic effects, in part because it can be “exceedingly difficult” to determine if liver disease is preexisting, methotrexate related, or caused by other medications or comorbidities, they said. To better assess the issue, they searched PubMed and the Cochrane Central Register of Controlled Trials for relevant double-blind, randomized, controlled trials published between 1990 and 2014. They found 32 such trials that included 13,177 patients with rheumatoid arthritis, psoriasis, psoriatic arthritis or inflammatory bowel disease (Semin Arthritis Rheum. 2015;45:156-62). Methotrexate use approximately doubled the risk of any adverse hepatic event (relative risk, 2.19; 95% confidence interval, 1.73-2.77) and of major and minor liver enzyme abnormalities (RR, 2.16; 95% CI, 1.67-2.79), but did not increase the risk of liver failure, cirrhosis, or liver-related mortality (RR, 0.12; 95% CI, 0.01-1.09), the investigators reported. “Clinical trials have inherent limitations, including short duration, selection bias, failure to collect information or reports that are not part of a prespecified protocol, and limited power to evaluate rare or unusual reports,” they cautioned. “While meta-analyses help overcome the last of these, the others raise some concern.”

But several other reports align with their results, the researchers noted. In an analysis of methotrexate studies lasting at least 2 years, about 10% of patients developed at least one minor liver enzyme abnormality, but less than 4% stopped methotrexate because of liver toxicity. Other controlled studies did not link methotrexate to severe fibrosis or cirrhosis – even after 4 years of treatment, they added. “It appears likely that serious liver-related complications due to methotrexate may take many years of treatment to manifest,” the investigators concluded.

The researchers reported no funding sources or conflicts of interest.

Methotrexate use more than doubled the risk of liver enzyme abnormalities but was not tied to serious hepatic outcomes among patients with rheumatic diseases, according to a meta-analysis of 32 randomized, controlled trials.

“Serious liver events were rare, with a suggestion of a trend towards fewer poor liver outcomes,” wrote Dr. Richard Conway of Galway (Ireland) University Hospitals. “The short duration of the included studies and the lack of liver biopsies are limitations, but the available data provide robust evidence for short-term safety” of methotrexate, wrote Dr. Conway and his associates.

Methotrexate is a first-line RA therapy with efficacy in several other inflammatory diseases, but concerns about toxicity have limited its use, the researchers noted. Clinicians have particularly debated its hepatic effects, in part because it can be “exceedingly difficult” to determine if liver disease is preexisting, methotrexate related, or caused by other medications or comorbidities, they said. To better assess the issue, they searched PubMed and the Cochrane Central Register of Controlled Trials for relevant double-blind, randomized, controlled trials published between 1990 and 2014. They found 32 such trials that included 13,177 patients with rheumatoid arthritis, psoriasis, psoriatic arthritis or inflammatory bowel disease (Semin Arthritis Rheum. 2015;45:156-62). Methotrexate use approximately doubled the risk of any adverse hepatic event (relative risk, 2.19; 95% confidence interval, 1.73-2.77) and of major and minor liver enzyme abnormalities (RR, 2.16; 95% CI, 1.67-2.79), but did not increase the risk of liver failure, cirrhosis, or liver-related mortality (RR, 0.12; 95% CI, 0.01-1.09), the investigators reported. “Clinical trials have inherent limitations, including short duration, selection bias, failure to collect information or reports that are not part of a prespecified protocol, and limited power to evaluate rare or unusual reports,” they cautioned. “While meta-analyses help overcome the last of these, the others raise some concern.”

But several other reports align with their results, the researchers noted. In an analysis of methotrexate studies lasting at least 2 years, about 10% of patients developed at least one minor liver enzyme abnormality, but less than 4% stopped methotrexate because of liver toxicity. Other controlled studies did not link methotrexate to severe fibrosis or cirrhosis – even after 4 years of treatment, they added. “It appears likely that serious liver-related complications due to methotrexate may take many years of treatment to manifest,” the investigators concluded.

The researchers reported no funding sources or conflicts of interest.

VANCOUVER – Tumor necrosis factor inhibitor–induced psoriasiform dermatitis can occur in pediatric patients after any length of treatment, with documented cases emerging after the very first dose and as late as 63 months into anti-TNF therapy, Dr. Amy S. Paller said at the World Congress of Dermatology.

Histopathologically, this medication-induced condition is psoriasis. But it tends to follow a distinctive pattern, favoring the scalp, dorsal hands and feet, nails, and periorificial skin. Palmoplantar pustulosis is not uncommon. The lesions are often secondarily infected with Staphylococcus aureus, according to Dr. Paller, professor and chair of the department of dermatology and professor of pediatrics at Northwestern University in Chicago.

Bruce Jancin/Frontline Medical News

The phenomenon was first described in adults. But in the past several years, as the use of tumor necrosis factor (TNF) antagonists has gained increasing traction for treatment of pediatric inflammatory bowel disease and rheumatologic diseases, the dermatologic disorder has become better characterized in youths. In a retrospective study at McMaster Children’s Hospital in Hamilton, Ont., 17 of 172 (10%) infliximab-treated patients with Crohn’s disease developed new-onset psoriasis and another (0.6%) experienced worsening of preexisting psoriasis after anywhere from 1 to 25 infusions. Most patients responded well to topical steroids; however, three discontinued the biologic because of this complication (J Pediatr Gastroenterol Nutr. 2013 May;56[5]:512-8).

It’s now clear that the emergence of TNF inhibitor–induced psoriasis does not adversely affect the response of a patient’s inflammatory bowel disease or juvenile arthritis to the biologic. Also, the risk of recurrent psoriatic eruption is not reduced by concurrent methotrexate.

Researchers find TNF inhibitor–induced psoriasis to be an intriguing puzzle because of its paradoxical nature. After all, the TNF inhibitors are a highly effective treatment for moderate to severe plaque psoriasis. The leading theory as to the underlying basis for TNF inhibitor–induced psoriasis is that it may have a genetic basis, Dr. Paller noted.

The McMaster group found that their pediatric Crohn’s disease patients who developed psoriasis in conjunction with infliximab (Remicade) therapy were more likely than disease-matched controls to be homozygous for one of several specific polymorphisms in the interleukin-23R gene. And investigators at the University of Helsinki have reported that children with inflammatory bowel disease who developed psoriasiform dermatitis while on infliximab only rarely possessed the HLA-Cw*0602 genotype, which is commonly associated with psoriasis (Inflamm Bowel Dis. 2014 Aug;20[8]:1309-15).

The possibility of streptococcal or staphylococcal infection serving as a trigger for TNF inhibitor–induced psoriasis is also being explored, according to Dr. Paller.

She has received research funding from LEO Pharma and Amgen and serves as a consultant to AbbVie.

[email protected]

VANCOUVER – Tumor necrosis factor inhibitor–induced psoriasiform dermatitis can occur in pediatric patients after any length of treatment, with documented cases emerging after the very first dose and as late as 63 months into anti-TNF therapy, Dr. Amy S. Paller said at the World Congress of Dermatology.

Histopathologically, this medication-induced condition is psoriasis. But it tends to follow a distinctive pattern, favoring the scalp, dorsal hands and feet, nails, and periorificial skin. Palmoplantar pustulosis is not uncommon. The lesions are often secondarily infected with Staphylococcus aureus, according to Dr. Paller, professor and chair of the department of dermatology and professor of pediatrics at Northwestern University in Chicago.

Bruce Jancin/Frontline Medical News

The phenomenon was first described in adults. But in the past several years, as the use of tumor necrosis factor (TNF) antagonists has gained increasing traction for treatment of pediatric inflammatory bowel disease and rheumatologic diseases, the dermatologic disorder has become better characterized in youths. In a retrospective study at McMaster Children’s Hospital in Hamilton, Ont., 17 of 172 (10%) infliximab-treated patients with Crohn’s disease developed new-onset psoriasis and another (0.6%) experienced worsening of preexisting psoriasis after anywhere from 1 to 25 infusions. Most patients responded well to topical steroids; however, three discontinued the biologic because of this complication (J Pediatr Gastroenterol Nutr. 2013 May;56[5]:512-8).

It’s now clear that the emergence of TNF inhibitor–induced psoriasis does not adversely affect the response of a patient’s inflammatory bowel disease or juvenile arthritis to the biologic. Also, the risk of recurrent psoriatic eruption is not reduced by concurrent methotrexate.

Researchers find TNF inhibitor–induced psoriasis to be an intriguing puzzle because of its paradoxical nature. After all, the TNF inhibitors are a highly effective treatment for moderate to severe plaque psoriasis. The leading theory as to the underlying basis for TNF inhibitor–induced psoriasis is that it may have a genetic basis, Dr. Paller noted.

The McMaster group found that their pediatric Crohn’s disease patients who developed psoriasis in conjunction with infliximab (Remicade) therapy were more likely than disease-matched controls to be homozygous for one of several specific polymorphisms in the interleukin-23R gene. And investigators at the University of Helsinki have reported that children with inflammatory bowel disease who developed psoriasiform dermatitis while on infliximab only rarely possessed the HLA-Cw*0602 genotype, which is commonly associated with psoriasis (Inflamm Bowel Dis. 2014 Aug;20[8]:1309-15).

The possibility of streptococcal or staphylococcal infection serving as a trigger for TNF inhibitor–induced psoriasis is also being explored, according to Dr. Paller.

She has received research funding from LEO Pharma and Amgen and serves as a consultant to AbbVie.

[email protected]

VANCOUVER – Tumor necrosis factor inhibitor–induced psoriasiform dermatitis can occur in pediatric patients after any length of treatment, with documented cases emerging after the very first dose and as late as 63 months into anti-TNF therapy, Dr. Amy S. Paller said at the World Congress of Dermatology.

Histopathologically, this medication-induced condition is psoriasis. But it tends to follow a distinctive pattern, favoring the scalp, dorsal hands and feet, nails, and periorificial skin. Palmoplantar pustulosis is not uncommon. The lesions are often secondarily infected with Staphylococcus aureus, according to Dr. Paller, professor and chair of the department of dermatology and professor of pediatrics at Northwestern University in Chicago.

Bruce Jancin/Frontline Medical News

The phenomenon was first described in adults. But in the past several years, as the use of tumor necrosis factor (TNF) antagonists has gained increasing traction for treatment of pediatric inflammatory bowel disease and rheumatologic diseases, the dermatologic disorder has become better characterized in youths. In a retrospective study at McMaster Children’s Hospital in Hamilton, Ont., 17 of 172 (10%) infliximab-treated patients with Crohn’s disease developed new-onset psoriasis and another (0.6%) experienced worsening of preexisting psoriasis after anywhere from 1 to 25 infusions. Most patients responded well to topical steroids; however, three discontinued the biologic because of this complication (J Pediatr Gastroenterol Nutr. 2013 May;56[5]:512-8).

It’s now clear that the emergence of TNF inhibitor–induced psoriasis does not adversely affect the response of a patient’s inflammatory bowel disease or juvenile arthritis to the biologic. Also, the risk of recurrent psoriatic eruption is not reduced by concurrent methotrexate.

Researchers find TNF inhibitor–induced psoriasis to be an intriguing puzzle because of its paradoxical nature. After all, the TNF inhibitors are a highly effective treatment for moderate to severe plaque psoriasis. The leading theory as to the underlying basis for TNF inhibitor–induced psoriasis is that it may have a genetic basis, Dr. Paller noted.

The McMaster group found that their pediatric Crohn’s disease patients who developed psoriasis in conjunction with infliximab (Remicade) therapy were more likely than disease-matched controls to be homozygous for one of several specific polymorphisms in the interleukin-23R gene. And investigators at the University of Helsinki have reported that children with inflammatory bowel disease who developed psoriasiform dermatitis while on infliximab only rarely possessed the HLA-Cw*0602 genotype, which is commonly associated with psoriasis (Inflamm Bowel Dis. 2014 Aug;20[8]:1309-15).

The possibility of streptococcal or staphylococcal infection serving as a trigger for TNF inhibitor–induced psoriasis is also being explored, according to Dr. Paller.

She has received research funding from LEO Pharma and Amgen and serves as a consultant to AbbVie.

[email protected]

Interviewing patients who live with psoriasis can reveal important information not included in psoriasis severity measures, according to Dr. David Pariser of Eastern Virginia Medical School, Norfolk, and his associates.

More than 90% of 101 patients with moderate to severe plaque psoriasis, with and without psoriatic arthritis, reported emotional and social impacts to their lives. Social impacts included avoiding/changing activities, relationships, or trying new things. Emotional impacts included a sense of anger, frustration, embarrassment, and self-consciousness; a lowered sense of self-esteem was common. Patients reported impacts in family, professional, social, and educational areas.

Patients with psoriasis and psoriatic arthritis tended to report both symptoms and well-being complications more often, with 77% reporting physical impacts and 34% reporting educational impacts, compared with 38% and 17%, respectively, for those with psoriasis only.

The study data “provide practitioners with deep insight into how patients with moderate to severe psoriasis are suffering, regardless of whether the concerns are elucidated during patient visits. The burdens in patients’ lives support the use of effective treatment; indeed, patients expressed how they value physicians who are knowledgeable about psoriasis and who will try various therapies,” the investigators concluded.

Find the full study in the Journal of Dermatological Treatment (doi: 10.3109/09546634.2015.1044492).

[email protected]

Interviewing patients who live with psoriasis can reveal important information not included in psoriasis severity measures, according to Dr. David Pariser of Eastern Virginia Medical School, Norfolk, and his associates.

More than 90% of 101 patients with moderate to severe plaque psoriasis, with and without psoriatic arthritis, reported emotional and social impacts to their lives. Social impacts included avoiding/changing activities, relationships, or trying new things. Emotional impacts included a sense of anger, frustration, embarrassment, and self-consciousness; a lowered sense of self-esteem was common. Patients reported impacts in family, professional, social, and educational areas.

Patients with psoriasis and psoriatic arthritis tended to report both symptoms and well-being complications more often, with 77% reporting physical impacts and 34% reporting educational impacts, compared with 38% and 17%, respectively, for those with psoriasis only.

The study data “provide practitioners with deep insight into how patients with moderate to severe psoriasis are suffering, regardless of whether the concerns are elucidated during patient visits. The burdens in patients’ lives support the use of effective treatment; indeed, patients expressed how they value physicians who are knowledgeable about psoriasis and who will try various therapies,” the investigators concluded.

Find the full study in the Journal of Dermatological Treatment (doi: 10.3109/09546634.2015.1044492).

[email protected]

Interviewing patients who live with psoriasis can reveal important information not included in psoriasis severity measures, according to Dr. David Pariser of Eastern Virginia Medical School, Norfolk, and his associates.

More than 90% of 101 patients with moderate to severe plaque psoriasis, with and without psoriatic arthritis, reported emotional and social impacts to their lives. Social impacts included avoiding/changing activities, relationships, or trying new things. Emotional impacts included a sense of anger, frustration, embarrassment, and self-consciousness; a lowered sense of self-esteem was common. Patients reported impacts in family, professional, social, and educational areas.

Patients with psoriasis and psoriatic arthritis tended to report both symptoms and well-being complications more often, with 77% reporting physical impacts and 34% reporting educational impacts, compared with 38% and 17%, respectively, for those with psoriasis only.

The study data “provide practitioners with deep insight into how patients with moderate to severe psoriasis are suffering, regardless of whether the concerns are elucidated during patient visits. The burdens in patients’ lives support the use of effective treatment; indeed, patients expressed how they value physicians who are knowledgeable about psoriasis and who will try various therapies,” the investigators concluded.

Find the full study in the Journal of Dermatological Treatment (doi: 10.3109/09546634.2015.1044492).

[email protected]

Attitudes toward psoriasis and herpes are significantly more stigmatizing than are perceptions of other dermatologic conditions, reported Dr. Jessica M. Donigan and her associates from Massachusetts General Hospital in Boston.

In a survey of 56 adults without any skin conditions aside from typical teenage acne, investigators used an image-based questionnaire to assess attitudes toward psoriasis, compared with other skin conditions such as atopic dermatitis, acne, vitiligo, rosacea, herpes labialis, warts, and tinea versicolor. At least 48% of respondents reported feeling upset by images of psoriasis, although significantly more were upset by images of herpes. Additionally, about 61% believed psoriasis had an infectious cause, with 41% of participants thinking psoriasis lesions looked contagious because of scale, color, and size, the authors reported.

Courtesy of the Centers for Disease Control and Prevention (CDC)

A total of 39% of respondents thought herpes was the most-bothersome skin disease, compared with 30% for psoriasis, although this difference was not significant (P = .42). As many as 86% said they would feel pity if they saw a person with psoriasis, which was significantly greater for any of the other dermatologic conditions except acne, the investigators said.

The findings suggest that “misconceptions of infection and contagion, and feelings of pity cause psoriasis to be as bothersome as herpes labialis,” Dr. Donigan and her colleagues said.

Additionally, despite participants perceiving the two conditions as similarly bothersome, psoriasis may “have a greater overall impact on quality of life because of its continuity and chronicity,” they said. “Because of its potential lifelong impact, it is important to familiarize the public with psoriasis to aid in destigmatization.”

Read the full report in the Journal of the American Academy of Dermatology.

Attitudes toward psoriasis and herpes are significantly more stigmatizing than are perceptions of other dermatologic conditions, reported Dr. Jessica M. Donigan and her associates from Massachusetts General Hospital in Boston.

In a survey of 56 adults without any skin conditions aside from typical teenage acne, investigators used an image-based questionnaire to assess attitudes toward psoriasis, compared with other skin conditions such as atopic dermatitis, acne, vitiligo, rosacea, herpes labialis, warts, and tinea versicolor. At least 48% of respondents reported feeling upset by images of psoriasis, although significantly more were upset by images of herpes. Additionally, about 61% believed psoriasis had an infectious cause, with 41% of participants thinking psoriasis lesions looked contagious because of scale, color, and size, the authors reported.

Courtesy of the Centers for Disease Control and Prevention (CDC)

A total of 39% of respondents thought herpes was the most-bothersome skin disease, compared with 30% for psoriasis, although this difference was not significant (P = .42). As many as 86% said they would feel pity if they saw a person with psoriasis, which was significantly greater for any of the other dermatologic conditions except acne, the investigators said.

The findings suggest that “misconceptions of infection and contagion, and feelings of pity cause psoriasis to be as bothersome as herpes labialis,” Dr. Donigan and her colleagues said.

Additionally, despite participants perceiving the two conditions as similarly bothersome, psoriasis may “have a greater overall impact on quality of life because of its continuity and chronicity,” they said. “Because of its potential lifelong impact, it is important to familiarize the public with psoriasis to aid in destigmatization.”

Read the full report in the Journal of the American Academy of Dermatology.

Attitudes toward psoriasis and herpes are significantly more stigmatizing than are perceptions of other dermatologic conditions, reported Dr. Jessica M. Donigan and her associates from Massachusetts General Hospital in Boston.

In a survey of 56 adults without any skin conditions aside from typical teenage acne, investigators used an image-based questionnaire to assess attitudes toward psoriasis, compared with other skin conditions such as atopic dermatitis, acne, vitiligo, rosacea, herpes labialis, warts, and tinea versicolor. At least 48% of respondents reported feeling upset by images of psoriasis, although significantly more were upset by images of herpes. Additionally, about 61% believed psoriasis had an infectious cause, with 41% of participants thinking psoriasis lesions looked contagious because of scale, color, and size, the authors reported.

Courtesy of the Centers for Disease Control and Prevention (CDC)

A total of 39% of respondents thought herpes was the most-bothersome skin disease, compared with 30% for psoriasis, although this difference was not significant (P = .42). As many as 86% said they would feel pity if they saw a person with psoriasis, which was significantly greater for any of the other dermatologic conditions except acne, the investigators said.

The findings suggest that “misconceptions of infection and contagion, and feelings of pity cause psoriasis to be as bothersome as herpes labialis,” Dr. Donigan and her colleagues said.

Additionally, despite participants perceiving the two conditions as similarly bothersome, psoriasis may “have a greater overall impact on quality of life because of its continuity and chronicity,” they said. “Because of its potential lifelong impact, it is important to familiarize the public with psoriasis to aid in destigmatization.”

Read the full report in the Journal of the American Academy of Dermatology.

Patients with psoriasis are at increased risk of arrhythmia, with the risk even greater for younger patients and those with psoriatic arthritis, according to a population-based cohort study conducted in Taiwan.

Dr. Hsien-Yi Chiu of National Taiwan University and Wei-Lun Chang of National Yang-Ming University, both in Taipei, and their colleagues, looked at records from 40,637 patients diagnosed with psoriasis and 162,548 age- and sex-matched controls without psoriasis, over a mean follow-up of about 6 years, for the incidence of arrhythmias over a mean of 6 years.

© Schlegelfotos/iStockphoto

In an article published in the September issue of the Journal of the American Academy of Dermatology, the investigators reported that those patients with psoriasis were at a significantly higher risk of developing arrhythmia, independent of traditional cardiovascular risk factors (adjusted hazard ratio, 1.34; 95% confidence interval, 1.29-1.39). Increased risk for patients with mild disease (aHR,1.35; 95% CI, 1.30-1.41) was comparable to that of patients with severe disease (aHR, 1.25; 95% CI 1.12-1.39) and more pronounced in the subgroup of patients with psoriatic arthritis (aHR, 1.46; 95% CI, 1.22-1.74). Younger patients, between aged 20 and 39 years, were at a higher risk (aHR, 1.39; 95% CI, 1.26-1.54) than older patients in the cohort (J Am Acad Dermatol. 2015 Sep;73:429-38).

Although previous studies have shown severe psoriasis to be associated with a nearly 60% increase in cardiovascular morbidity and mortality beyond traditional risk factors, less is known about arrhythmias specifically. “Inflammation may contribute to the alteration of cardiomyocyte electrophysiology, such as dysregulation of ion channel function, leading to increased risk of arrhythmia,” the investigators wrote.

The authors noted that limitations of their study were the potential surveillance bias for psoriasis patients due to increased hospital visits, and the fact that alcohol and tobacco use was not captured in the patient data. Treatment with systemic therapies may lower cardiovascular risk in psoriasis patients, they added, which may have explained why the arrhythmia risk among patients with severe disease was similar to those with mild disease.

The findings indicate “that psoriasis can be added to future risk-stratification scores for arrhythmia,” the investigators wrote, adding that patients with psoriasis, “especially young patients and those with PsA [psoriatic arthritis] , should be more closely screened for various types of arrhythmia,” with the hope of earlier intervention leading to reduction of cardiovascular morbidity and mortality.

Patients with psoriasis are at increased risk of arrhythmia, with the risk even greater for younger patients and those with psoriatic arthritis, according to a population-based cohort study conducted in Taiwan.

Dr. Hsien-Yi Chiu of National Taiwan University and Wei-Lun Chang of National Yang-Ming University, both in Taipei, and their colleagues, looked at records from 40,637 patients diagnosed with psoriasis and 162,548 age- and sex-matched controls without psoriasis, over a mean follow-up of about 6 years, for the incidence of arrhythmias over a mean of 6 years.

© Schlegelfotos/iStockphoto

In an article published in the September issue of the Journal of the American Academy of Dermatology, the investigators reported that those patients with psoriasis were at a significantly higher risk of developing arrhythmia, independent of traditional cardiovascular risk factors (adjusted hazard ratio, 1.34; 95% confidence interval, 1.29-1.39). Increased risk for patients with mild disease (aHR,1.35; 95% CI, 1.30-1.41) was comparable to that of patients with severe disease (aHR, 1.25; 95% CI 1.12-1.39) and more pronounced in the subgroup of patients with psoriatic arthritis (aHR, 1.46; 95% CI, 1.22-1.74). Younger patients, between aged 20 and 39 years, were at a higher risk (aHR, 1.39; 95% CI, 1.26-1.54) than older patients in the cohort (J Am Acad Dermatol. 2015 Sep;73:429-38).

Although previous studies have shown severe psoriasis to be associated with a nearly 60% increase in cardiovascular morbidity and mortality beyond traditional risk factors, less is known about arrhythmias specifically. “Inflammation may contribute to the alteration of cardiomyocyte electrophysiology, such as dysregulation of ion channel function, leading to increased risk of arrhythmia,” the investigators wrote.

The authors noted that limitations of their study were the potential surveillance bias for psoriasis patients due to increased hospital visits, and the fact that alcohol and tobacco use was not captured in the patient data. Treatment with systemic therapies may lower cardiovascular risk in psoriasis patients, they added, which may have explained why the arrhythmia risk among patients with severe disease was similar to those with mild disease.

The findings indicate “that psoriasis can be added to future risk-stratification scores for arrhythmia,” the investigators wrote, adding that patients with psoriasis, “especially young patients and those with PsA [psoriatic arthritis] , should be more closely screened for various types of arrhythmia,” with the hope of earlier intervention leading to reduction of cardiovascular morbidity and mortality.

Patients with psoriasis are at increased risk of arrhythmia, with the risk even greater for younger patients and those with psoriatic arthritis, according to a population-based cohort study conducted in Taiwan.

Dr. Hsien-Yi Chiu of National Taiwan University and Wei-Lun Chang of National Yang-Ming University, both in Taipei, and their colleagues, looked at records from 40,637 patients diagnosed with psoriasis and 162,548 age- and sex-matched controls without psoriasis, over a mean follow-up of about 6 years, for the incidence of arrhythmias over a mean of 6 years.

© Schlegelfotos/iStockphoto

In an article published in the September issue of the Journal of the American Academy of Dermatology, the investigators reported that those patients with psoriasis were at a significantly higher risk of developing arrhythmia, independent of traditional cardiovascular risk factors (adjusted hazard ratio, 1.34; 95% confidence interval, 1.29-1.39). Increased risk for patients with mild disease (aHR,1.35; 95% CI, 1.30-1.41) was comparable to that of patients with severe disease (aHR, 1.25; 95% CI 1.12-1.39) and more pronounced in the subgroup of patients with psoriatic arthritis (aHR, 1.46; 95% CI, 1.22-1.74). Younger patients, between aged 20 and 39 years, were at a higher risk (aHR, 1.39; 95% CI, 1.26-1.54) than older patients in the cohort (J Am Acad Dermatol. 2015 Sep;73:429-38).

Although previous studies have shown severe psoriasis to be associated with a nearly 60% increase in cardiovascular morbidity and mortality beyond traditional risk factors, less is known about arrhythmias specifically. “Inflammation may contribute to the alteration of cardiomyocyte electrophysiology, such as dysregulation of ion channel function, leading to increased risk of arrhythmia,” the investigators wrote.

The authors noted that limitations of their study were the potential surveillance bias for psoriasis patients due to increased hospital visits, and the fact that alcohol and tobacco use was not captured in the patient data. Treatment with systemic therapies may lower cardiovascular risk in psoriasis patients, they added, which may have explained why the arrhythmia risk among patients with severe disease was similar to those with mild disease.

The findings indicate “that psoriasis can be added to future risk-stratification scores for arrhythmia,” the investigators wrote, adding that patients with psoriasis, “especially young patients and those with PsA [psoriatic arthritis] , should be more closely screened for various types of arrhythmia,” with the hope of earlier intervention leading to reduction of cardiovascular morbidity and mortality.