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Psoriasis Arthritis

Psoriatic arthritis

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Summary

This article presents an overview of psoriatic arthritis, including the origin, genetic influence and immunologic factors involved in its evolution. The clinical features of psoriatic arthritis are also reviewed in this article, and a discussion of the diagnosis and treatment is included. We have highlighted the current psoriasis treatments, new biological therapies, and their use in practice. This paper reviews the efficacy of these agents, and the importance of their early appliance. The available published data on the efficacy of antimalarials, sulfasalazine, methotrexate, azathioprine and ciclosporin are described, as well as new data on leflunomide and other novel agents.

Zusammenfassung

Dieser Artikel gibt einen Überblick über Psoriasis Arthritis, in dem die Ätiologie, der genetische Einfluss aber auch die immunologisch beeinflussenden Faktoren dieser Erkrankung beschrieben werden. Sowohl klinische Parameter als auch diagnostische Maßnahmen werden in diesem Artikel zusammengefasst. Es werden aktuelle Therapien diskutiert, ebenso werden neue biologische Therapien und ihr Einsatz in der täglichen Routine beschrieben. Zusätzlich wird die unterschiedliche Effektivität der verschiedenen krankheitsmodifizierenden antirheumatischen Therapien und die Wichtigkeit eines raschen Einsatzes überprüft. Die publizierten Ergebnisse über den Einsatz und die Wirksamkeit von Antimalariamittel, Sulfosalazin, Methotrexat, Azathioprin, und Cyclosporin ebenso wie Leflunomid und anderen neuen Wirkstoffen werden beschrieben.

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Literatur

  • Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE (2000)The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982–1991. J Rheumatol 27(5): 1247–1250

    CAS  PubMed  Google Scholar 

  • Leonard DG, O'Duffy JD, Rogers RS (1978) Prospective analysis of psoriatic arthritis in patients hospitalized for psoriasis. Mayo Clin Proc 53(8): 511–518

    CAS  PubMed  Google Scholar 

  • Gladman D (2004) Psoriatic Arthritis. In Isenberg DA, et al (eds). Oxford Textbook of Rheumatology, 3rd edition. UK Oxford University Press, Oxford

    Google Scholar 

  • Veale D, Yanni G, Rogers S, Barnes L, Bresnihan B, Fitzgerald O (1993) Reduced synovial membrane macrophage numbers, ELAM-1 expression, and lining layer hyperplasia in psoriatic arthritis as compared with rheumatoid arthritis. Arthritis Rheum 36(7): 893–900

    CAS  PubMed  Google Scholar 

  • Buskila D, Langevitz P, Gladman DD, Urowitz S, Smythe HA (1992) Patients with rheumatoid arthritis are more tender than those with psoriatic arthritis. J Rheumatol 19(7): 1115–1119

    CAS  PubMed  Google Scholar 

  • Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK (1987) Psoriatic arthritis (PSA) – an analysis of 220 patients. Q J Med 62(238): 127–141

    CAS  PubMed  Google Scholar 

  • Rahman P, Nguyen E, Cheung C, Schentag CT, Gladman DD (2001) Comparison of radiological severity in psoriatic arthritis and rheumatoid arthritis. J Rheumatol 28(5): 1041–1044

    CAS  PubMed  Google Scholar 

  • Bowcock AM, Cookson WO (2004) The genetics of psoriasis, psoriatic arthritis and atopic dermatitis. Hum Mol Genet 13 Spec No 1: R43–R55

    Google Scholar 

  • Moll JM, Wright V (2001) Familial occurrence of psoriatic arthritis. Ann Rheum Dis 1973(32): 181–201

    Google Scholar 

  • Hohler T, Marker-Hermann E (2002) Psoriatic arthritis: clinical aspects, genetics, and the role of T cells. Curr Opin Rheumatol 13(4): 273–279

    Article  Google Scholar 

  • Barton AC, Bruce IN, Silman AJ (2001) Genetic studies of psoriatic arthritis:dissecting joints and skin. J Rheumatol 28: 3–5

    CAS  PubMed  Google Scholar 

  • Tay GK, Hui J, Gaudieri S et al (2000) PERB11(MIC): a polymorphic MHC gene is expressed in skin and single nucleotide polymorphisms are associated with psoriasis. Clin Exp Immunol 119: 553–558

    Article  CAS  PubMed  Google Scholar 

  • Groh V, Braham S, Bauer S, Hermann A, Beauchamp M, Spies T (1996) Cell stress regulated human MHC class I gene expressed in gastrointestinal epithelium. Proc Natl Acad Sci USA 93: 12445–12450

    Article  CAS  PubMed  Google Scholar 

  • Bauer S, Groh V, Wu J, Steinle A, Phillips JH, Lanier LL, Spies T (1999) Activation of NK cells and T cells by NKG2D, a receptor for stress-inducible MICA. Science 285: 727–729

    Article  CAS  PubMed  Google Scholar 

  • Gonzalez S, Martinez-Borra J, Lopez-Vazquez A, Garcia-Fernandez S, Torre-Alonso JC, Lopez-Larrea C (2002) MICA rather than MICB, TNFA, or HLA-DRB1 is associated with susceptibility to psoriatic arthritis. J Rheumatol 29(5): 973–978

    CAS  PubMed  Google Scholar 

  • Karvonen J, Lassus A, Sievers U, Tiilikainen A (1974) HLAantigens in psoriatic arthritis. Ann Clin Res 6(5): 304–307

    CAS  PubMed  Google Scholar 

  • McKendry RJ, Sengar DP, DesGroseilliers JP, Dunne JV (1984) Frequency of HLA antigens in patients with psoriasis or psoriatic arthritis. Can Med Assoc J 15, 130(4): 411–415

    Google Scholar 

  • Fearon U, Veale D (2001) Pathogenesis of psoriatic arthritis. Clin Exp Dermatol 26: 333–337

    Article  CAS  PubMed  Google Scholar 

  • Costello PJ, Winchester RJ, Curran SA, Peterson KS, Kane DJ, Bresnihan B (2001) Psoriatic arthritis joint fluids are characterized by CD8 and CD4 T cell clonal expansions appear antigen driven. J Immunol 166: 2878–2886

    CAS  PubMed  Google Scholar 

  • Tassiulas I, Duncan SR, Centola M, Theofilopoulos AN, Boumpas DT (1999) Clonal characteristics of T cell infiltrates in skin and synovium of patients with psoriatic arthritis. Human Immunol 60: 479–491

    Article  CAS  Google Scholar 

  • Weisenseel P, Laumbacher B, Besgen P, Ludolph-Hauser D, Herzinger T, Roecken M, Wank R, Prinz JC (2002) Streptococcal infection distinguishes different types of psoriasis. Journal of Medical Genetics 39: 767–768

    Article  CAS  PubMed  Google Scholar 

  • Prinz JC (2001) Psoriasis vulgaris – a sterile antibacterial skin reaction mediated by cross-reactive T cells? An immunological view of the pathophysiology of psoriasis. Clin Exp Dermatol 26(4): 326–332

    Article  CAS  PubMed  Google Scholar 

  • Rantakokko K, Rimpilainen M, Uksila J, Jansen C, Luukkainen R, Toivanen P (1997) Antibodies to streptococcal cell wall in psoriatic arthritis and cutaneous psoriasis. Clin Exp Rheumatol 15(4): 399–404

    CAS  PubMed  Google Scholar 

  • Vasey FB, Deitz C, Fenske NA, Germain BF, Espinoza LR (1982) Possible involvement of group A streptococci in the pathogenesis of psoriatic arthritis. J Rheumatol 9(5): 719–722

    CAS  PubMed  Google Scholar 

  • Wang Q, Vasey FB, Mahfood JP, Valeriano J, Kanik KS, Anderson BE, Bridgeford PH (1999) V2 regions of 16S ribosomal RNA used as a molecular marker for the species identification of streptococci in peripheral blood and synovial fluid from patients with psoriatic arthritis. Arthritis Rheum 42(10): 2055–2059

    Article  CAS  PubMed  Google Scholar 

  • Danning CL, Illei GG, Hitchon C, Greer MR, Boumpas DT, McInnes IB (2000) Makrophage-derived cytokine and nuclear factor κB p65 expression in synovial membrane and skin of patients with psoriatic arthritis. Arthritis Rheum 43: 1244–1256

    Article  CAS  PubMed  Google Scholar 

  • Ritchlin C, Haas-Smith SA, Hicks D, Cappuccio J, Osterland CK, Looney RJ (1998) Patterns of cytokine production in psoriatic synovium. J Rhematol 25: 1544–1552

    CAS  Google Scholar 

  • Nishibu A, Han GW, Iwatsuki K, Matsui T, Inoue M, Akiba H, Kaneko F (1999) Overexpression of monocytederived cytokines in active psoriasis: a relation to coexistent arthropathy. J Dermatol Sci 21: 63–70

    Article  CAS  PubMed  Google Scholar 

  • Partsch G, Steiner G, Leeb BF, Dunky A, Bröll H, Smolen JS (1997) Highly increased levels of tumor necrosis factor and other proinflammatory cytokines in psoriatic arthritis synovial fluid. J Rhematol 24: 518–523

    CAS  Google Scholar 

  • Elkayam O, Yaro I, Shirazi I, Yaron M, Caspi D (2000) Serum levels of IL-10, IL-6, IL-1ra and sIL-2R in patients with psoriatic arthritis. Rheumatol Int 19: 101–105

    Article  CAS  PubMed  Google Scholar 

  • Partsch G, Wagner E, Leeb BF, Dunky A, Steiner G, Smolen J (1998) Upregulation of cytokine receptors TNF-R55, sTNF-R75, and sIL-2R in psoriatic arthritis synovial fluid. J Rheumatol 25: 105–110

    CAS  PubMed  Google Scholar 

  • Dunky A, Neumuller J, Menzel J (1997) Interactions of lymphocytes from patients with psoriatic arthritis or healthy controls and cultured endothelial cells. Clin Immunol Immunopathol 85(3): 297–314

    Article  CAS  PubMed  Google Scholar 

  • Moreland LW (1999) Inhibitors of tumor necrosis factor: new treatment options for rheumatoid arthritis. Cleve Clin J Med 66: 367–374

    CAS  PubMed  Google Scholar 

  • Goldenberg MM (1999) Etanercept: anovel drug for the treatment of patients with severe, active rheumatoid arthritis. Clin Ther 21: 75–87

    Article  CAS  PubMed  Google Scholar 

  • Keystone EC (1999) The role of tumor necrosis factor antagonism in clinical practice. J Rhematol 26(S57): 22–28

    Google Scholar 

  • Bonifati C, Carducci M, Cordiali Fei P, Tento E, Sacerdoti G, Fazio M (1994) Correlated increase of tumor necrosis factor-alpha, interleukin-6 and granulocyte monocyte-colony stimulating factor levels in suction blister fluids and sera of psoriatic patients-relationships with disease severity. Clin Exp Dermatol 19: 383–387

    Article  CAS  PubMed  Google Scholar 

  • Moll JM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3(1): 55–78

    Article  CAS  PubMed  Google Scholar 

  • Gladman DD (1998) Clinical aspects of the spondylarthropathies. Am J Med Sci 316: 234–238

    Article  CAS  PubMed  Google Scholar 

  • Black RL, O'Brien WM, Vanscott EJ, Auerbach R, Eisen AZ, Bunim JJ (1964) Methotrexate therapy in psoriatic arthritis; double blind study on 21 patients. Jama 189: 743–747

    CAS  PubMed  Google Scholar 

  • Willkens RF, Williams HJ, Ward JR, Egger MJ, Reading JC, Clements PJ (1984) Randomized, double-blind, placebo controlled trial of low-dose pulse methotrexate in psoriatic arthritis. Arthritis Rheum 27(4): 376–381

    CAS  PubMed  Google Scholar 

  • Jones G, Crotty M, Brooks P (2000) Interventions for psoriatic arthritis. Cochrane Database Syst Rev (3):CD000212

  • Farr M, Kitas GD, Waterhouse L, Jubb R, Felix-Davies D, Bacon P (1988) Treatment of psoriatic arthritis with sulphasalazine: a one year open study. Clin Rheumatol 7(3): 372–377

    Article  CAS  PubMed  Google Scholar 

  • Salvarani C, Macchioni P, Olivieri I, Marchesoni A, Cutolo M, Ferraccioli G et al (2001) A comparison of cyclosporine, sulfasalazine, and symptomatic therapy in the treatment of psoriatic arthritis. J Rheumatol 28(10): 2274–2282

    CAS  PubMed  Google Scholar 

  • Gupta AK, Grober JS, Hamilton TA, Ellis CN, Siegel MT, Voorhees JJ et al (1995) Sulfasalazine therapy for psoriatic arthritis: a double blind, placebo controlled trial. J Rheumatol 22(5): 894–898

    CAS  PubMed  Google Scholar 

  • Spadaro A, Taccari E, Mohtadi B, Riccieri V, Sensi F, Zoppini A (1997) Life-table analysis of cyclosporin A treatment in psoriatic arthritis: comparison with other disease-modifying antirheumatic drugs. Clin Exp Rheumatol 15(6): 609–614

    CAS  PubMed  Google Scholar 

  • Cuchacovich M, Soto L (2002) Leflunomide decreases joint erosions and induces reparative changes in a patient with psoriatic arthritis. Ann Rheum Dis 61: 942–943

    Article  CAS  PubMed  Google Scholar 

  • Scali JJ, Visentini S, Salomon G, Castelli G, Barcena P, Morales E (2000) Treatment of psoriatic arthritis:open prospective study comparing efficacy and safety profile between leflunomide vs methotrexate. Ann Rheum Dis 59: POS-566

    Google Scholar 

  • Kaltwasser JP, Nash P, Gladman D, Mease (2004) Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: a multinational, double-blind, randomized, placebo-controlled clinical trial. Arthritis Rheum 50: 1939–1950

    Article  CAS  PubMed  Google Scholar 

  • Dechant C, Antoni C, Wendler J (2000) One year outcome of patients with severe psoriatic arthritis treated with infliximab. Arthritis Rheum 43: 212

    Google Scholar 

  • Van den Bosch F, Kruithof E, Beaten D, De Keyser F, Mielants H, Veys EM (2000) Effects of loading dose regimen of three infusions of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) in spondyloarthropathy: an open pilot study. Ann Rheum Dis 59: 428–433

    Article  CAS  PubMed  Google Scholar 

  • Cauza E, Spak M, Cauza K, Hanusch-Enserer U, Dunky A, Wagner E (2002) Treatment of psoriatic arthritis and psoriasis vulgaris with the tumor necrosis factor inhibitor infliximab. Rheumatol Int 22: 227–232

    Article  CAS  PubMed  Google Scholar 

  • Ogilvie AL, Antoni C, Dechant C, Manger B, Kalden JR, Schuler G, Luftl M (2001) Treatment of psoriatic arthritis with anti tumor necrosis factor-alpha antibody clears skin lesions of psoriasis resistant to treatment with methotrexat. Br J Dermatol 144: 587–589

    Article  CAS  PubMed  Google Scholar 

  • Oh CJ, Das KM, Gottlieb AB (2000) Treatment with anti tumor necrosis factor alpha (TNFα) monoclonal antibody dramatically decreases the clinical activity of psoriasis lesions. J Am Acad Dermatol 42: 829–830

    Article  CAS  PubMed  Google Scholar 

  • Antoni C, Dechant B, Hanns-Martin Lorenz PD, Wendler J, Ogilvie A, Lueftl M et al (2002) Open-label study on infliximab treatment for psoriatic arthritis: clinical and magnetic resonance imaging measurements of reduction of inflammation. Arthritis Rheum 47(5): 506–512

    Article  CAS  PubMed  Google Scholar 

  • Antoni C, Kavanaugh A, Kirkham B (2005) The infliximab multinational psoriatic arthritis controlled trial substantial efficacy on synovitis and psoriatic lesions with or without concomitant DMARD therapy. (Impact): Arthritis Rheum in press

  • Kavanaugh A, Krueger G, De Vlam K et al (2004) Infliximab significantly improves joint and skin involvement in psoriatic arthritis to a substantial extend and irrespective of baseline joint involvement or MTX use: analysis of clinical response from the Impact 2 trial. Arthritis Rheum 50 (Suppl 9): 617

    Google Scholar 

  • Mease PJ, Goffe BS, Metz J, VanderStoep A, Finck B, Burge DJ (2000) Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet 356: 385–390

    Article  CAS  PubMed  Google Scholar 

  • Iyer S, Yamauchi P, Lowe NJ (2002) Etanercept for severe psoriasis and psoriatic arthritis: observations on combination therapy. Br J Dermatol 146: 118–121

    Article  CAS  PubMed  Google Scholar 

  • Mease P, Gladman DD, Ritchlin C et al (2004) Adalimumab therapy in patients with psoriatic arthritis: 24 week result of a phase III study. Arthritis Rheum 50: 4097

    Article  Google Scholar 

  • Nikas SN, Drosos AA (2003) Onercept. Serono. Curr Opin Investig Drugs 4(11): 1369–1376

    CAS  PubMed  Google Scholar 

  • Papp K, Mease P, Garovoy M et al (2004) Efalizumab in patients with psoriatic arthritis: results of a phase II randomized double-blind placebo controlled study. Presented at International Psoriasis Symposium, Toronto

  • Da Silva AJ, Brickelmaier M, Majeau GR, Li Z, Su L, Hsu YM, Hochman PS (2002) Alefacept, an immunomodulatory recombinant LFA-3/IgG1 fusion protein, induces CD16 signaling and CD2/CD16-dependent apoptosis of CD2(+) cells. J Immunol 168: 4462–4471

    CAS  PubMed  Google Scholar 

  • Cooper JC, Morgan G, Harding S, Subramanyam M, Majeau GR, Moulder K, Alexander DR (2003) Alefacept selectively promotes NK cell-mediated deletion of CD45R0+ human T cells. Eur J Immunol 33: 666–675

    Article  CAS  PubMed  Google Scholar 

  • Lebwohl M, Christophers E, Langley R, Ortonne JP, Roberts J, Griffiths CE (2003) An international, randomized, double-blind, placebo-controlled phase 3 trial of intramuscular alefacept in patients with chronic plaque psoriasis. Arch Dermatol 139: 719–727

    Article  CAS  PubMed  Google Scholar 

  • Kremer JM, Westhovens R, Leon M, Di Giorgio E, Alten R, Steinfeld S et al (2003) Treatment of rheumatoid arthritis by selective inhibition of T-cell activation with fusion protein CTLA4Ig. N Engl J Med 13, 349(20): 1907–1915

    Google Scholar 

  • McInnes IB, Gracie JA (2004) Interleukin-15: a new cytokine target for the treatment of inflammatory diseases. Curr Opin Pharmacol 4(4): 392–397

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Edmund Cauza.

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Cauza, E., Dunky, A. Psoriasis Arthritis. Wien Med Wochenschr 156, 587–595 (2006). https://doi.org/10.1007/s10354-006-0276-7

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  • DOI: https://doi.org/10.1007/s10354-006-0276-7

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