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The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology,...
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The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 May 2021) | Viewed by 37332

Special Issue Editor

Dr. Alen Zabotti

E-Mail Website
Guest Editor
Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
Interests: psoriatic arthritis; psoriasis; rheumatoid arthritis; ultrasonography
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Psoriasis (PsO) is one of the most common inflammatory skin diseases and predisposes to developing psoriatic arthritis (PsA). Up to one-third of PsO patients develop PsA in their lifetime. Early diagnosis and early treatment are two cornerstones to reach clinical remission and to stop articular damage. In patients with poor prognostic factors, such as polyarthritis, dactylitis, and joint damage, rapid initiation of conventional or biological disease-modifying antirheumatic drugs is strongly recommended. Currently, integrated rheumatological–dermatological clinical evaluation could be crucial for early referral of PsO patients with articular symptoms, for tailored therapies that could work for skin and joints, and for highlighting minimal psoriasis in early seronegative arthritis. PsA is a clinically heterogeneous condition of skin, joint, enthesis, and bone, usually associated with systemic comorbidities that contribute to the worsening of pain and quality of life. In this setting, imaging, particularly ultrasonography and MRI, could assist clinicians in differentiating between symptoms related to PsA and symptoms related to comorbidities or mimickers diseases (e.g., osteoarthritis and fibromyalgia).

Dr. Alen Zabotti
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Psoriatic Arthritis 
  • Psoriasis 
  • Imaging 
  • Ultrasonography 
  • Rheuma-Derma 
  • Early diagnosis 
  • Spondyloarthritis 
  • Patient Reported Outcomes 
  • Coneventional and Biological DMARDs

Published Papers (7 papers)

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Research

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19 pages, 1373 KiB  
Article
Comparison of Psoriatic Arthritis and Rheumatoid Arthritis Patients across Body Mass Index Categories in Switzerland
by Enriqueta Vallejo-Yagüe, Theresa Burkard, Burkhard Möller, Axel Finckh and Andrea M. Burden
J. Clin. Med. 2021, 10(14), 3194; https://doi.org/10.3390/jcm10143194 - 20 Jul 2021
Cited by 7 | Viewed by 3578
Abstract
Abnormal body mass index (BMI) was associated with worse rheumatic markers in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Aiming to describe PsA and RA patients stratified by BMI, we performed a descriptive study in PsA and RA patients (two distinct cohorts) in [...] Read more.
Abnormal body mass index (BMI) was associated with worse rheumatic markers in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Aiming to describe PsA and RA patients stratified by BMI, we performed a descriptive study in PsA and RA patients (two distinct cohorts) in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry. New users of biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were stratified by BMI at the start of their treatment (underweight, normal weight, overweight, obese). The PsA underweight and normal weight categories were merged. Age at disease onset and further characteristics at the start of the first b/tsDMARD treatment were compared across BMI categories vs. the corresponding normal weight group. The study included 819 PsA (36.5% overweight, 23.8% obese) and 3217 RA patients (4.4% underweight, 31.8% overweight, 17.0% obese). Compared to the corresponding normal weight group, PsA and RA obese patients had significantly (p < 0.05) higher C-reactive protein, worse disease activity, and lower quality of life (QoL). Obese PsA patients had significantly worse skin manifestation and pain, while obese RA patients had significantly higher erythrocyte sedimentation rate and tender joint counts, as well as lower seropositive prevalence. To conclude, obese PsA and RA patients presented worse disease activity and poorer QoL than those with normal weight. Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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12 pages, 1734 KiB  
Article
In Patients with Early Peripheral Psoriatic Arthritis Baseline C-Reactive Protein, Pain and Ultrasound-Detected Synovitis Predict Subsequent Treatment with ts/bDMARDs. A Retrospective Analysis
by Garifallia Sakellariou, Silvana Quaglini, Serena Bugatti, Francesca Bobbio-Pallavicini, Vittorio Gabba and Carlomaurizio Montecucco
J. Clin. Med. 2021, 10(13), 2834; https://doi.org/10.3390/jcm10132834 - 27 Jun 2021
Cited by 2 | Viewed by 1739
Abstract
With the availability of effective treatment with targeted synthetic and biologic disease-modifying anti-rheumatic drugs (ts/bDMARDs) for psoriatic arthritis (PsA), it is crucial to identify predictors of access to this treatment since disease onset. We retrospectively enrolled patients with peripheral PsA, assessed in an [...] Read more.
With the availability of effective treatment with targeted synthetic and biologic disease-modifying anti-rheumatic drugs (ts/bDMARDs) for psoriatic arthritis (PsA), it is crucial to identify predictors of access to this treatment since disease onset. We retrospectively enrolled patients with peripheral PsA, assessed in an early arthritis clinic from 2005 to 2020. The main baseline demographic, clinical and ultrasonographic (assessment of bilateral wrist and metacarpophalangeal joints) features were evaluated through descriptive statistics and tested as predictors by univariate and multivariate Cox models. The outcome of interest was the indication for ts/bDMARDs within 2 years from diagnosis. We included 238 patients with PsA, with a mean (sd) age of 51.04 (13.98) years; 90 (37.8%) were male, and the median (IQR) symptom duration was 6.12 (3.29–12.25) months. In univariate analyses, C-reactive protein (RR, 95% CI 1.204 (1.065,1.362)), Visual Analogue Scale (VAS) pain (1.027 (1.005,1.048)), the number of tender joints on 28 joints (1.087 (1.025, 1.153)), and a synovial power Doppler (PD) score > 1 (3.63 (1.307, 10.08)) emerged as significant predictors. C-reactive protein, VAS pain and PD confirmed their predictive value also in multivariate models. These results provide preliminary evidence on the features that might characterize patients with early peripheral PsA requiring more intensive monitoring and treatment escalation. Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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11 pages, 1199 KiB  
Article
Musculoskeletal Ultrasound in Monitoring Clinical Response to Treatment in Acute Symptomatic Psoriatic Dactylitis: Results from a Multicentre Prospective Observational Study
by Nicolò Girolimetto, Pierluigi Macchioni, Niccolò Possemato, Ilaria Tinazzi, Vittoria Bascherini, Giorgia Citriniti, Rebecca McConnell, Antonio Marchetta, Rosario Peluso, Vincenzo Sabbatino, Carlo Salvarani, Raffaele Scarpa, Luisa Costa and Francesco Caso
J. Clin. Med. 2020, 9(10), 3127; https://doi.org/10.3390/jcm9103127 - 27 Sep 2020
Cited by 6 | Viewed by 2361
Abstract
This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis [...] Read more.
This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis Index-basic (LDI-b) score and the visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). High-frequency ultrasound with grey scale (GS) and power Doppler (PD) assessed flexor tenosynovitis (FT), soft tissue oedema (STO), extensor tendon paratenonitis, and joint synovitis. There was a statistically significant correlation between the clinical parameters (VAS-p, VAS-FI, and LDI-b) and FT and STO at T1 and T3. We found statistically significant improvement in FT and STO for the cases with clinically meaningful treatment responses (p < 0.001). After a multiple conditional logistic regression analysis, the only variables that correlated with a T1 clinical response were the resolutions of PD FT (OR 15.66) and PD STO (OR 6.23), while the resolution of PD FT (OR 27.77) and of GS STO (OR 7.29) correlated with a T3 clinical response. The clinical improvements of active dactylitis are linked to the regression of sonographic evidence of extracapsular inflammation (particularly FT and STO). Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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11 pages, 871 KiB  
Article
Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography
by Ummugulsum Gazel, Dilek Solmaz, Gizem Ayan, Catherine Ivory, Jacob Karsh and Sibel Zehra Aydin
J. Clin. Med. 2020, 9(9), 2929; https://doi.org/10.3390/jcm9092929 - 10 Sep 2020
Cited by 4 | Viewed by 2203
Abstract
We aimed to explore the accuracy of physical examination (PE) to detect the synovial and extra-synovial pathologies in psoriatic arthritis (PsA) in comparison to ultrasonography (US). Twenty-nine PsA patients with hand pain were included in the study. A detailed PE of the hands [...] Read more.
We aimed to explore the accuracy of physical examination (PE) to detect the synovial and extra-synovial pathologies in psoriatic arthritis (PsA) in comparison to ultrasonography (US). Twenty-nine PsA patients with hand pain were included in the study. A detailed PE of the hands was performed and US scans were performed for the joints, extensor and flexor tendons, and entheses of the second to fifth fingers of both hands. The agreement between PE and US findings was calculated. The strongest agreement for the joints was between “swollen joints” and power Doppler (PD) signals in the metacarpophalangeal (MCP) joints and grey scale synovitis in the proximal interphalangeal (PIP) joints. The agreement of tender entheses on PE and inflammation on US (hypoechogenicity, thickening, and/or PD signals) was poor for both extensor (Kappa = −0.027, Prevalence Adjusted and Bias Adjusted Kappa (PABAK) = 0.344) and flexor compartments (Kappa = 0.039, PABAK = 0.569). Similar to enthesitis, comparison of any PE and US findings showed a poor agreement at the extensor and flexor tendon regions (extensor: Kappa = 0.123, PABAK = 0.448, and flexor: Kappa = 0.171, PABAK = 0.431). Our study showed that there was a poor to fair agreement of PE and US findings of hands. US can add value when determining the source of pain in PsA in the small joints. Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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Review

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12 pages, 1719 KiB  
Review
Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging
by Nicolò Girolimetto, Ivan Giovannini, Gloria Crepaldi, Gabriele De Marco, Ilaria Tinazzi, Niccolò Possemato, Pierluigi Macchioni, Rebecca McConnell, Dennis McGonagle, Annamaria Iagnocco and Alen Zabotti
J. Clin. Med. 2021, 10(12), 2604; https://doi.org/10.3390/jcm10122604 - 12 Jun 2021
Cited by 11 | Viewed by 4591
Abstract
Dactylitis, one of the most typical features of psoriatic arthritis (PsA), is the diffuse swelling of the digits and is determined by the involvement of different anatomic structures, including: the subcutaneous fibrous tissue “accessory pulley” system; flexor tendons, with their related structures; the [...] Read more.
Dactylitis, one of the most typical features of psoriatic arthritis (PsA), is the diffuse swelling of the digits and is determined by the involvement of different anatomic structures, including: the subcutaneous fibrous tissue “accessory pulley” system; flexor tendons, with their related structures; the articular synovium; the small enthesis of the hands. Dactylitis is currently considered both a marker of disease activity and severe prognosis and its importance in PsA is emphasized by the inclusion in the classification criteria of PsA. This review focuses on the role of imaging in the management of PsA patients with dactylitis in clinical practice and in a research setting. Furthermore, imaging could be a valuable tool to assist in unravelling some of the underlying mechanisms of the onset and chronicization of dactylitis in PsA patients. Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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14 pages, 2754 KiB  
Review
Topographic Differential Diagnosis of Chronic Plaque Psoriasis: Challenges and Tricks
by Paolo Gisondi, Francesco Bellinato and Giampiero Girolomoni
J. Clin. Med. 2020, 9(11), 3594; https://doi.org/10.3390/jcm9113594 - 08 Nov 2020
Cited by 13 | Viewed by 16968
Abstract
Background: Psoriasis is an inflammatory skin disease presenting with erythematous and desquamative plaques with sharply demarcated margins, usually localized on extensor surface areas. Objective: To describe the common differential diagnosis of plaque psoriasis classified according to its topography in the scalp, trunk, extremities, [...] Read more.
Background: Psoriasis is an inflammatory skin disease presenting with erythematous and desquamative plaques with sharply demarcated margins, usually localized on extensor surface areas. Objective: To describe the common differential diagnosis of plaque psoriasis classified according to its topography in the scalp, trunk, extremities, folds (i.e., inverse), genital, palmoplantar, nail, and erythrodermic psoriasis. Methods: A narrative review based on an electronic database was performed including reviews and original articles published until 1 September 2020, assessing the clinical presentations and differential diagnosis for psoriasis. Results: Several differential diagnoses could be considered with other inflammatory, infectious, and/or neoplastic disorders. Topographical differential diagnosis may include seborrheic dermatitis, tinea capitis, lichen planopilaris in the scalp; lupus erythematosus, dermatomyositis, cutaneous T-cell lymphomas, atopic dermatitis, syphilis, tinea corporis, pityriasis rubra pilaris in the trunk and arms; infectious intertrigo in the inguinal and intergluteal folds and eczema and palmoplantar keratoderma in the palms and soles. Conclusions: Diagnosis of psoriasis is usually straightforward but may at times be difficult and challenging. Skin cultures for dermatophytes and/or skin biopsy for histological examination could be required for diagnostic confirmation of plaque psoriasis. Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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14 pages, 1468 KiB  
Review
Defining Pre-Clinical Psoriatic Arthritis in an Integrated Dermato-Rheumatology Environment
by Laura Savage, Ilaria Tinazzi, Alen Zabotti, Philip M. Laws, Miriam Wittmann and Dennis McGonagle
J. Clin. Med. 2020, 9(10), 3262; https://doi.org/10.3390/jcm9103262 - 12 Oct 2020
Cited by 20 | Viewed by 4717
Abstract
In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging [...] Read more.
In excess of three quarters of patients with psoriatic arthritis (PsA) have preceding psoriasis (PsO), which offers a clinical biomarker for the recognition of early PsA. Numerous surveys have shown a remarkably high frequency of clinically occult musculoskeletal symptoms in psoriasis patients. Imaging studies, particularly ultrasound, show a high prevalence of subclinical enthesitis and other inflammatory changes in psoriasis subjects. Since a serum biomarker, such as the case of anti-citrullinated protein antibodies (ACPA) in rheumatoid arthritis, neither exists nor seems biologically plausible at this point, this article explores how integration of rheumatological and dermatological assessment can be facilitated for the early recognition of potential PsA. Given that scalp disease is a PsA predictor, but may be managed in the community, then a particular need to access this group is needed. An integrated approach between rheumatology and dermatology can involve joint clinics, parallel clinics with discussion of relevant cases or virtual contact between specialties. Early therapy evaluation and integrated strategies have considerable implications for minimizing suffering and joint damage in PsA. Full article
(This article belongs to the Special Issue The Management of Psoriatic Arthritis: Interface between Rheumatology and Dermatology, Early Diagnosis and Monitoring of Disease Activity)
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