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Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis
P3305
P3307
Improvement of psoriatic onychodystrophy by a water-soluble nail lacquer based on hydroxypropyl-chitosan Franca Cantoresi, MD, Dermatology Department, Universita` La Sapienza, Rome, Italy; Annalisa Arcese, MD, Dermatology Department, Universita` La Sapienza, Rome, Italy; Federico Mailland, MD, Polichem SA, Lugano-Pazzallo, Lugano, Switzerland; Paola Sorgi, MD, Dermatology Department, Universita` La Sapienza, Rome, Italy
Adiponectin is associated with disease activity of psoriasis Hazel H. Oon, MD, MMSc, National Skin Centre, Singapore; C.F. Liew, MBBS, Division of Endocrinology, Department of Medicine, National University Hospital, Singapore; Colin CT Theng, MBBS, National Skin Centre, Singapore; M. SL. Ho, MBChB, National Skin Centre, Singapore
Background: There is a strong need for effective products that are simple to use and safe for chronic use in the management of nail psoriasis. A medical device became recently available, based on water-soluble nail lacquer, containing hydroxypropylchitosan (HPCH), horsetail extract (E arvense) and methylsulphonyl-methane (DMSO2). This product was effective in strengthening the nails and reducing fragility and roughness in brittle nails. A clinical trial was performed to verify whether this product was able to improve nail psoriatic signs and appearance. Methods: Thirty adult patients affected by mild to moderate nail psoriasis of the matrix and/or of the nail bed in at least one fingernail were recruited. Clinical signs included pitting, onycholysis, and/or leuchonychia. The extent and severity of nail psoriasis was assessed every 4 weeks on a target fingernail. The patients were excluded if they had psoriasis for less than 6 months or if they had any positive mycology findings in their fingernails. The nail lacquer was applied once daily on the affected fingernails of the left hand for 24 consecutive weeks. The right hand was used as control. Results: Clinical characteristics at the inclusion visit: presence of pitting in 15 patients (50%); onycholysis in nine (30%); and leuchonychia in six (20%). Twentyeight patients were included in the efficacy analysis. Mean NaPSI score was 2.83 6 SD 0.99 at baseline and 1.0 6 1.22 at the end. Significant improvement of the nail abnormalities was evident in 14 patients (50%) at week 12. At the end of treatment, the improvement was significant (‘‘very satisfying’’ or ‘‘good’’) in 22 patients (78.6%). There was no change of the onychodystrophy in the nails of the untreated hand. The acceptability of the treatment was excellent in all patients both for the easiness and for the cosmetic characteristics of the product, and 21 (75%) of them decided to continue the application after the end of the study. The product was safe and no adverse reactions were reported.
Background: Adiponectin is an adipocyte-derived cytokine with insulin sensitizing and antiinflammatory properties. Circulating adiponectin levels are decreased in diabetes and obesity. Paradoxically, adiponectin is increased in chronic inflammatory disorders such as systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease. The relationship between adiponectin and psoriasis is not well studied. Epidemiologic data suggest that psoriasis is associated with diabetes and obesity. We sought to determine the relationship between psoriasis severity and adiponectin. Methods: Psoriasis patients were recruited from the National Skin Centre psoriasis clinic from October 2007 to March 2008. Serum adiponectin, Psoriasis Area and Severity Index (PASI) score, body mass index (BMI), and fasting glucose were measured. Nondiabetic patients and diabetics on diet therapy were subjected to a 2-hour oral glucose challenge. Result: One hundred ten patients, comprising 74 Chinese, 14 Malays, and 22 Indians were studied. Mean adiponectin was 2.80 6 1.31 ng/mL. Adiponectin levels were correlated with severity of psoriasis, measured by PASI (r ¼ 0.222; P ¼ .02) and negatively correlated with BMI (r ¼ -0.335; P \.001). Multiple linear regression showed that adiponectin was positively correlated with PASI (t ¼ 2.656; P ¼ .009) and inversely correlated with BMI (t ¼ -2.503; P ¼.014) after adjusting for age, sex, ethnicity, and glucose tolerance (regression model R2 ¼ 0.193; P ¼ .001). Conclusions: Our findings indicate that disease activity of psoriasis is associated with raised adiponectin levels. This is consistent with the observation that adiponectin is elevated in various chronic inflammatory conditions and adds to our current knowledge on the role of the adipocytokines in psoriasis. Commercial support: None identified.
Conclusions: Nail psoriasis is a chronic condition that does not respond definitely to a therapeutic treatment. In our experience, the new water-soluble nail lacquer proved to be effective in improving the nail structure in psoriatic patients affected by onychodystrophy. The effect was particularly evident on pitting and on nail fragility. The product was very well accepted by the patients. Commercial support: Printing sponsored by Polichem SA.
P3306 Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis Hong Liang Tey, National Skin Centre, Singapore; Hock Leong Ee, MBBS, National Skin Centre, Singapore; Soon Long Tan, MPH, MBBS, Health Promotion Board, Singapore; Thiam Seng Theng, MBBS, National Skin Centre, Singapore Background: Psoriatic arthritis may be severe and disabling in certain patients, and early identification of psoriatic arthritis will enable these patients to be treated early and aggressively. Aside from psoriatic nail changes, other risk factors of joint disease in psoriasis patients have not been well studied and there is conflicting evidence as to whether severe cutaneous psoriasis is associated with psoriatic arthritis. Aim: This study aims to determine if the following characteristics are associated with the presence of psoriatic arthritis in a sample of psoriasis patients seen at the Psoriasis and Photomedicine clinic in the National Skin Centre: race, family history of psoriasis and psoriatic arthritis, age of onset of psoriasis, smoking, alcohol consumption, and the maximum body surface area (BSA) of involvement in psoriasis. Methods: This is a case control study involving 400 psoriasis patients who were seen at the Psoriasis and Photomedicine clinic, National Skin Centre, over a 1-year period. Cases are defined as psoriasis patients with psoriatic arthritis, while the control group is defined as psoriasis patients who do not have psoriatic arthritis. Recruited patients completed a self-administered standardized questionnaire that included questions on sociodemographic data, family history of psoriasis and psoriatic arthritis in the first- and second-degree relatives, age of onset of psoriasis, and current smoking and drinking status. The participants were assessed by dermatologists to verify the diagnoses of psoriasis and the range of body surface involvement were determined by referring to the participants’ case notes. The diagnoses of psoriatic arthritis were made by rheumatologists.
P3308 Successful treatment of acrodermatitis continua of Hallopeau with methotrexate and etanercept Aline Aar~ao, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Bruna Duque-Estrada, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Carla Tamler, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Deborah Brazuna, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Jo~ao Avelleira, MD, PhD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil
Results: Bivariate analyses showed that psoriatic arthritis was not significantly associated with gender, race, age of onset of psoriasis, family history of psoriasis, smoking, alcohol consumption, and plaque versus nonplaque type of psoriasis, but was significantly associated with family history of psoriatic arthritis (P \.001) and maximum body surface involvement (P ¼ .05). The multivariate logistic regression model showed that the presence of psoriatic arthritis was significantly associated with family history of psoriatic arthritis (odds ratio [OR], 20.5; 95% confidence interval [CI], 2.49-169.10) after adjusting for maximum BSA and ethnicity. Those with the most severe cutaneous psoriasis were significantly more likely than the least severe psoriasis patients to have psoriatic arthritis (OR, 2.52 times; 95% CI, 1.33-4.75). Indians were significantly more likely to have psoriatic arthritis compared to Chinese (OR, 2.11; 95% CI, 1.08-4.15). Conclusions: A family history of psoriatic arthritis and a greater maximum surface area of psoriasis are associated with having psoriatic arthritis in this study population of psoriasis patients. Gender, race, smoking, alcohol consumption, and family history of psoriasis are not associated with psoriatic arthritis. Psoriasis patients with a family history of psoriatic arthritis and/or extensive skin disease, in addition to nail psoriasis, should be educated and monitored so that progressive arthritis can be promptly detected and treated.
Introduction: Acrodermatitis continua of Hallopeau (ACH) is a chronic, recurrent pustular acral eruption involving the distal phalanges of the hands and feet. Atrophic skin changes, onychodystrophy, and osteolysis are frequently present, causing painful and disabling lesions. The etiology of ACH is still unknown. Because of its histologic features, most authors consider ACH as a variant of pustular palmoplantar psoriasis which, in contrast to other forms, is recalcitrant to most antipsoriatic drugs. This cyclic disease causes important psychological and physical morbidity. The quality of life for patients is greatly impaired because the fragility and tenderness of the skin on the hands limits activities of daily living. We report a case of successful treatment of ACH with methotrexate and etanercept. Case report: An 80-year-old female presented with an 8-month history of persistent confluent pustules on her right thumbnail. Within weeks, paronychial and subungual involvement occurred on all fingers and led to nail dystrophy and involvement of the plantar regions. Psoriasiform lesions were also observed on hair scalp and elbows. Microbiologic examination of pustular lesions was negative to infection. Histologic features of psoriasis were found in biopsy specimens. Therapeutic regimens, such as topical coal tar, calcipotriol, and oral acitretin demonstrated poor response. Because of the progression which led to severe disability and the minor response to previous treatments, we decided to use methotrexate 10 mg weekly. After 8 weeks without satisfactory response, etanercept was associated at 50 mg/week. Pustule formation cleared completely after 6 weeks. In contrast to previous treatment, the effect of the methotrexate associated with etanercept persisted under continuing therapy. No adverse events or a relapse were observed under the 4-month therapy. Discussion: The treatment of ACH is known to be difficult. Because of the known immunologic background of psoriasis and the histopathologic similarity of ACH with pustular psoriasis, methotrexate and etanercept have been used in our patient. The various presentations of psoriasis may all have a common immune alteration and, because no large-scale, controlled studies exist on therapeutic approaches, the trends of such reports bring to the forefront possibilities and a hopeful light for our patients. Furthermore, such reports will encourage new approaches to therapy and ideally be groundwork for larger controlled study.
Commercial support: None identified.
Commercial support: Printing costs are sponsored by Wyeth.
MARCH 2009
J AM ACAD DERMATOL
AB163
P3307
Improvement of psoriatic onychodystrophy by a water-soluble nail lacquer based on hydroxypropyl-chitosan Franca Cantoresi, MD, Dermatology Department, Universita` La Sapienza, Rome, Italy; Annalisa Arcese, MD, Dermatology Department, Universita` La Sapienza, Rome, Italy; Federico Mailland, MD, Polichem SA, Lugano-Pazzallo, Lugano, Switzerland; Paola Sorgi, MD, Dermatology Department, Universita` La Sapienza, Rome, Italy
Adiponectin is associated with disease activity of psoriasis Hazel H. Oon, MD, MMSc, National Skin Centre, Singapore; C.F. Liew, MBBS, Division of Endocrinology, Department of Medicine, National University Hospital, Singapore; Colin CT Theng, MBBS, National Skin Centre, Singapore; M. SL. Ho, MBChB, National Skin Centre, Singapore
Background: There is a strong need for effective products that are simple to use and safe for chronic use in the management of nail psoriasis. A medical device became recently available, based on water-soluble nail lacquer, containing hydroxypropylchitosan (HPCH), horsetail extract (E arvense) and methylsulphonyl-methane (DMSO2). This product was effective in strengthening the nails and reducing fragility and roughness in brittle nails. A clinical trial was performed to verify whether this product was able to improve nail psoriatic signs and appearance. Methods: Thirty adult patients affected by mild to moderate nail psoriasis of the matrix and/or of the nail bed in at least one fingernail were recruited. Clinical signs included pitting, onycholysis, and/or leuchonychia. The extent and severity of nail psoriasis was assessed every 4 weeks on a target fingernail. The patients were excluded if they had psoriasis for less than 6 months or if they had any positive mycology findings in their fingernails. The nail lacquer was applied once daily on the affected fingernails of the left hand for 24 consecutive weeks. The right hand was used as control. Results: Clinical characteristics at the inclusion visit: presence of pitting in 15 patients (50%); onycholysis in nine (30%); and leuchonychia in six (20%). Twentyeight patients were included in the efficacy analysis. Mean NaPSI score was 2.83 6 SD 0.99 at baseline and 1.0 6 1.22 at the end. Significant improvement of the nail abnormalities was evident in 14 patients (50%) at week 12. At the end of treatment, the improvement was significant (‘‘very satisfying’’ or ‘‘good’’) in 22 patients (78.6%). There was no change of the onychodystrophy in the nails of the untreated hand. The acceptability of the treatment was excellent in all patients both for the easiness and for the cosmetic characteristics of the product, and 21 (75%) of them decided to continue the application after the end of the study. The product was safe and no adverse reactions were reported.
Background: Adiponectin is an adipocyte-derived cytokine with insulin sensitizing and antiinflammatory properties. Circulating adiponectin levels are decreased in diabetes and obesity. Paradoxically, adiponectin is increased in chronic inflammatory disorders such as systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease. The relationship between adiponectin and psoriasis is not well studied. Epidemiologic data suggest that psoriasis is associated with diabetes and obesity. We sought to determine the relationship between psoriasis severity and adiponectin. Methods: Psoriasis patients were recruited from the National Skin Centre psoriasis clinic from October 2007 to March 2008. Serum adiponectin, Psoriasis Area and Severity Index (PASI) score, body mass index (BMI), and fasting glucose were measured. Nondiabetic patients and diabetics on diet therapy were subjected to a 2-hour oral glucose challenge. Result: One hundred ten patients, comprising 74 Chinese, 14 Malays, and 22 Indians were studied. Mean adiponectin was 2.80 6 1.31 ng/mL. Adiponectin levels were correlated with severity of psoriasis, measured by PASI (r ¼ 0.222; P ¼ .02) and negatively correlated with BMI (r ¼ -0.335; P \.001). Multiple linear regression showed that adiponectin was positively correlated with PASI (t ¼ 2.656; P ¼ .009) and inversely correlated with BMI (t ¼ -2.503; P ¼.014) after adjusting for age, sex, ethnicity, and glucose tolerance (regression model R2 ¼ 0.193; P ¼ .001). Conclusions: Our findings indicate that disease activity of psoriasis is associated with raised adiponectin levels. This is consistent with the observation that adiponectin is elevated in various chronic inflammatory conditions and adds to our current knowledge on the role of the adipocytokines in psoriasis. Commercial support: None identified.
Conclusions: Nail psoriasis is a chronic condition that does not respond definitely to a therapeutic treatment. In our experience, the new water-soluble nail lacquer proved to be effective in improving the nail structure in psoriatic patients affected by onychodystrophy. The effect was particularly evident on pitting and on nail fragility. The product was very well accepted by the patients. Commercial support: Printing sponsored by Polichem SA.
P3306 Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis Hong Liang Tey, National Skin Centre, Singapore; Hock Leong Ee, MBBS, National Skin Centre, Singapore; Soon Long Tan, MPH, MBBS, Health Promotion Board, Singapore; Thiam Seng Theng, MBBS, National Skin Centre, Singapore Background: Psoriatic arthritis may be severe and disabling in certain patients, and early identification of psoriatic arthritis will enable these patients to be treated early and aggressively. Aside from psoriatic nail changes, other risk factors of joint disease in psoriasis patients have not been well studied and there is conflicting evidence as to whether severe cutaneous psoriasis is associated with psoriatic arthritis. Aim: This study aims to determine if the following characteristics are associated with the presence of psoriatic arthritis in a sample of psoriasis patients seen at the Psoriasis and Photomedicine clinic in the National Skin Centre: race, family history of psoriasis and psoriatic arthritis, age of onset of psoriasis, smoking, alcohol consumption, and the maximum body surface area (BSA) of involvement in psoriasis. Methods: This is a case control study involving 400 psoriasis patients who were seen at the Psoriasis and Photomedicine clinic, National Skin Centre, over a 1-year period. Cases are defined as psoriasis patients with psoriatic arthritis, while the control group is defined as psoriasis patients who do not have psoriatic arthritis. Recruited patients completed a self-administered standardized questionnaire that included questions on sociodemographic data, family history of psoriasis and psoriatic arthritis in the first- and second-degree relatives, age of onset of psoriasis, and current smoking and drinking status. The participants were assessed by dermatologists to verify the diagnoses of psoriasis and the range of body surface involvement were determined by referring to the participants’ case notes. The diagnoses of psoriatic arthritis were made by rheumatologists.
P3308 Successful treatment of acrodermatitis continua of Hallopeau with methotrexate and etanercept Aline Aar~ao, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Bruna Duque-Estrada, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Carla Tamler, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Deborah Brazuna, MD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil; Jo~ao Avelleira, MD, PhD, Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil
Results: Bivariate analyses showed that psoriatic arthritis was not significantly associated with gender, race, age of onset of psoriasis, family history of psoriasis, smoking, alcohol consumption, and plaque versus nonplaque type of psoriasis, but was significantly associated with family history of psoriatic arthritis (P \.001) and maximum body surface involvement (P ¼ .05). The multivariate logistic regression model showed that the presence of psoriatic arthritis was significantly associated with family history of psoriatic arthritis (odds ratio [OR], 20.5; 95% confidence interval [CI], 2.49-169.10) after adjusting for maximum BSA and ethnicity. Those with the most severe cutaneous psoriasis were significantly more likely than the least severe psoriasis patients to have psoriatic arthritis (OR, 2.52 times; 95% CI, 1.33-4.75). Indians were significantly more likely to have psoriatic arthritis compared to Chinese (OR, 2.11; 95% CI, 1.08-4.15). Conclusions: A family history of psoriatic arthritis and a greater maximum surface area of psoriasis are associated with having psoriatic arthritis in this study population of psoriasis patients. Gender, race, smoking, alcohol consumption, and family history of psoriasis are not associated with psoriatic arthritis. Psoriasis patients with a family history of psoriatic arthritis and/or extensive skin disease, in addition to nail psoriasis, should be educated and monitored so that progressive arthritis can be promptly detected and treated.
Introduction: Acrodermatitis continua of Hallopeau (ACH) is a chronic, recurrent pustular acral eruption involving the distal phalanges of the hands and feet. Atrophic skin changes, onychodystrophy, and osteolysis are frequently present, causing painful and disabling lesions. The etiology of ACH is still unknown. Because of its histologic features, most authors consider ACH as a variant of pustular palmoplantar psoriasis which, in contrast to other forms, is recalcitrant to most antipsoriatic drugs. This cyclic disease causes important psychological and physical morbidity. The quality of life for patients is greatly impaired because the fragility and tenderness of the skin on the hands limits activities of daily living. We report a case of successful treatment of ACH with methotrexate and etanercept. Case report: An 80-year-old female presented with an 8-month history of persistent confluent pustules on her right thumbnail. Within weeks, paronychial and subungual involvement occurred on all fingers and led to nail dystrophy and involvement of the plantar regions. Psoriasiform lesions were also observed on hair scalp and elbows. Microbiologic examination of pustular lesions was negative to infection. Histologic features of psoriasis were found in biopsy specimens. Therapeutic regimens, such as topical coal tar, calcipotriol, and oral acitretin demonstrated poor response. Because of the progression which led to severe disability and the minor response to previous treatments, we decided to use methotrexate 10 mg weekly. After 8 weeks without satisfactory response, etanercept was associated at 50 mg/week. Pustule formation cleared completely after 6 weeks. In contrast to previous treatment, the effect of the methotrexate associated with etanercept persisted under continuing therapy. No adverse events or a relapse were observed under the 4-month therapy. Discussion: The treatment of ACH is known to be difficult. Because of the known immunologic background of psoriasis and the histopathologic similarity of ACH with pustular psoriasis, methotrexate and etanercept have been used in our patient. The various presentations of psoriasis may all have a common immune alteration and, because no large-scale, controlled studies exist on therapeutic approaches, the trends of such reports bring to the forefront possibilities and a hopeful light for our patients. Furthermore, such reports will encourage new approaches to therapy and ideally be groundwork for larger controlled study.
Commercial support: None identified.
Commercial support: Printing costs are sponsored by Wyeth.
MARCH 2009
J AM ACAD DERMATOL
AB163