Psoriatic arthritis is a chronic inflammatory arthritis that affects about 5-25% of patients with psoriasis. The prevalence varies from 20-420 per 100,000 population across the world except in Japan where it is 1 per 100,000. Psoriatic arthritis affects both genders equally and in more than half it follows long-standing psoriasis. Psoriatic arthritis has been grouped into five subtypes: distal interphalangeal (DIP) predominant, symmetrical polyarthritis, asymmetrical oligoarthritis and monoarthritis, predominant spondylitis, and arthritis mutilans. Oligoarthritis occurs in nearly 60% during early disease but later polyarticular disease predominates mainly due to evolution of oligoarthritis to polyarthritis. In 50-60% polyarthritis is symmetrical. Dactylitis and enthesopathy are other major features seen in nearly one third of patients. The diagnosis of psoriatic arthritis is easy in the presence of typical skin lesions, however it can also be made in absence of skin lesions using Classification of Psoriatic Arthritis criteria. Though 30-40% of patients develop joint deformities at a follow-up of 5-10 years but most retain good functional status. Clinical damage has a strong relationship with number of swollen joints, erythrocyte sedimentation rate, and duration of arthritis. Radiological damage occurs early and erosions are present in nearly 50% at 10 years of disease. Spinal disease also has good outcome with maintained spinal mobility in majority of the patients. Screening of patients with psoriasis using questionnaire can help in early diagnosis. Nail dystrophy, scalp lesions, and intergluteal/perianal psoriasis are associated with higher chance of development of psoriatic arthritis. Early diagnosis will lead to early treatment and better outcome especially with advent of new drugs.
PMID: 22294201 [PubMed - as supplied by publisher]
Psoriatic arthritis (PsA), a chronic inflammatory arthritis associated with psoriasis, is often associated with significant inflammation and joint damage leading to a decrease in quality of life measures. Plain radiographs have traditionally been used to detect and estimate the extent of joint damage. Newer imaging modalities such as ultrasound and MRI however, have provided the ability to detect joint damage earlier and measure the extent of joint damage more accurately, than with radiographs. These imaging modalities also provide a sensitive means of assessing for the presence of and quantifying the amount of inflammation. Furthermore, these imaging modalities can help with the identification of enthesitis, tendonitis, and dactylitis, features that can help make a diagnosis of PsA. Additionally, MRI and scintigraphy can help in the early detection and assessment of sacroiliitis and axial disease. In addition to benefits with diagnosis and prognosis, recent advances in imaging techniques have led to their increased use in the assessment of efficacy of novel therapies for psoriatic arthritis. Imaging modalities therefore allow for early detection, assessment of joint inflammation and joint damage as well as in the estimation of disease activity of PsA and thereby enable the clinician to treat PsA early, adequately, and safely.
PMID: 22294202 [PubMed - as supplied by publisher]
Allergic and Immunologic Reactions to Food Additives.
Clin Rev Allergy Immunol. 2012 Jan 27;
Authors: Gultekin F, Doguc DK
Abstract
For centuries, food additives have been used for flavouring, colouring and extension of the useful shelf life of food, as well as the promotion of food safety. During the last 20 years, the studies implicating the additives contained in foods and medicine as a causative factor of allergic reactions have been proliferated considerably. In this review, we aimed to overview all of the food additives which were approved to consume in EU and find out how common and serious allergic reactions come into existence following the consuming of food additives.
PMID: 22278172 [PubMed - as supplied by publisher]
Clinical and Histologic Diagnostic Guidelines for Psoriasis: A Critical Review.
Clin Rev Allergy Immunol. 2012 Jan 27;
Authors: Johnson MA, Armstrong AW
Abstract
Psoriasis is a common inflammatory skin disease that is associated with joint, psychiatric, and cardiovascular comorbidities. Diagnosis of plaque psoriasis is dependent primarily on characteristic physical findings and history. Given the varied clinical presentations of psoriasis and its mimicry to other papulosquamous skin diseases, it may be difficult for nondermatologists to diagnose psoriasis. Currently, no diagnostic criteria for plaque psoriasis have been validated in clinical studies. In this paper, we provide diagnostic guidelines for the nondermatologist to aid them in recognizing psoriasis.
PMID: 22278173 [PubMed - as supplied by publisher]
The Genetics of Psoriasis and Psoriatic Arthritis.
Clin Rev Allergy Immunol. 2012 Jan 25;
Authors: Chandran V
Abstract
Genetic epidemiological studies have demonstrated a significant genetic basis to both psoriasis and psoriatic arthritis (PsA). Although candidate gene association studies had identified genes for disease susceptibility, recent genome-wide association studies have demonstrated robust associations both within and outside the major histocompatibility region on chromosome 6p. The susceptibility genes identified include HLA-C, IL13, IL4, TNFAIP3, IL23A, IL23R, IL28RA, REL, IFIH1, ERAP, TRAF3IP2, NFKBIA, TYK2, ZNF313, NOS2, FBXL19 and NFKBIA in subjects of European ethnicity and HLA-C, IL12B, LCE3D, ERAP1, TNIP1, PTTG1, CSMD1, GJB2, SERPINB8 and ZNF816A in subjects of Chinese ethnicity. These associations provide us with a model for the pathogenesis of psoriasis involving skin barrier function, innate and adaptive immunity. Gene-gene and gene-environmental interaction effects have also been demonstrated. However, loci identified to date do not fully account for the high heritability of psoriasis and PsA, and therefore many genetic as well as environmental factors and interaction effects remain to be determined. This article reviews the current status of genetic studies in psoriasis and PsA.
PMID: 22274791 [PubMed - as supplied by publisher]
Type I Interferons: Beneficial in Th1 and Detrimental in Th17 Autoimmunity.
Clin Rev Allergy Immunol. 2012 Jan 10;
Authors: Axtell RC, Raman C, Steinman L
Abstract
In relapsing remitting multiple sclerosis (RRMS), type I interferon (IFN) is considered immuno-modulatory, and recombinant forms of IFN-β are the most prescribed treatment for this disease. However, within the RRMS population, 30-50% of MS patients are nonresponsive to this treatment, and it consistently worsens neuromyelitis optica (NMO), a disease once considered to be a form of RRMS. In contrast to RRMS, type I IFNs have been shown to have properties that drive the inflammatory pathologies in many other autoimmune diseases. These diseases include Sjögren’s syndrome, system lupus erythematosus (SLE), neuromyelitis optica (NMO), rheumatoid arthritis (RA) and psoriasis. Historically, autoimmune diseases were thought to be driven by a TH1 response to auto-antigens. However, since the discovery of the TH17 in experimental autoimmune encephalomyelitis (EAE), it is now generally thought that TH17 plays an important role in MS and all other autoimmune diseases. In this article, we will discuss recent clinical and basic research advances in the field of autoimmunity and argue that IFN-β and other type I IFNs are immuno-modulatory in diseases driven predominantly by TH1 but in contrast are inflammatory in diseases that have a predominant Th17 response.
PMID: 22231516 [PubMed - as supplied by publisher]
The Practical Understanding and Treatment of Asthma.
Clin Rev Allergy Immunol. 2012 Jan 11;
Authors: Gershwin ME, Albertson TE
Abstract
Asthma is a syndrome which is seen by physicians in nearly every specialty and affects millions of people throughout the world. Although the geoepidemiology with respect to prevalence and incidence of asthma does vary, even under the most mild of circumstance, asthma is among the leading causes of school absenteeism, work loss, and physician visits. In the past, it was considered primarily a disorder of childhood. Hence, the adage that children outgrow their asthma. We now realize that children really only outgrow their pediatrician and the genetic predisposition to asthma and bronchial hyperactivity persists throughout life. This issue is devoted to key papers that focus on important clinical problems in allergies and asthma. This issue is dedicated to helping the many sufferers of asthma with the hope that this topic will eventually become a medical anachronism.
PMID: 22234874 [PubMed - as supplied by publisher]
There have been enormous strides in our understanding of autoimmunity. These strides have come under the umbrellas of epidemiology, immunological phenotype and function, disease definitions and classification and especially new therapeutic reagents. However, while these advances have been herculean, there remains enormous voids. Some of these voids include genetic susceptibility and the interaction of genes and environment. The voids include induction of tolerance in preclinical disease and definitions of host susceptibility and responses to the expensive biologic agents. The voids include the so-called clustering of human autoimmune diseases and the issues of whether the incidence is rising in our western society. Other voids include the relationships between microbiology, vaccination, gut flora, overzealous use of antibiotics, and the role of nanoparticles and environmental pollution in either the induction or the natural history of disease. One cannot even begin to address even a fraction of these issues. However, in this special issue, we are attempting to discuss clinical issues in autoimmunity that are not usually found in generic reviews. The goal is to bring to the readership provocative articles that ultimately will lead to improvement in patient care.
PMID: 22203433 [PubMed - as supplied by publisher]
Current Concepts in Multiple Sclerosis: Autoimmunity Versus Oligodendrogliopathy.
Clin Rev Allergy Immunol. 2011 Dec 22;
Authors: Nakahara J, Maeda M, Aiso S, Suzuki N
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system that affects millions of patients worldwide. The current disease-modifying therapies (DMTs) that are widely used to treat MS only show modest effects. Because MS is a chronic disease, it is important to develop treatments that have better long-term efficacy. Recently, several new-generation DMTs have been developed, most of which target specific immune molecules based on the assumption that MS is an autoimmune disease. These DMTs are designed to inhibit inflammation that is thought to directly cause demyelination. Preliminary studies suggest that these new therapies are likely to show a greater effect in reducing relapses in early MS patients, although their long-term efficacy is still unknown. In contrast, it was recently reported that the initial course of MS does not significantly influence long-term disability and that disability increases approximately at the same rate despite variable relapse frequencies. Furthermore, new neuropathological evidence now argues against the autoimmune hypothesis and suggests that MS is a primary oligodendrogliopathy disease in which the inflammatory response may be a mere epiphenomenon. So can we be optimistic about the unproven long-term outcomes of new DMTs or should we reconsider the pathogenesis of MS when developing more disease-specific treatments?
PMID: 22189514 [PubMed - as supplied by publisher]
Asthma in Children and Adolescents: A Comprehensive Approach to Diagnosis and Management.
Clin Rev Allergy Immunol. 2011 Mar 29;
Authors: Chang C
Abstract
Asthma is a chronic disease that has a significant impact on quality of life and is particularly important in children and adolescents, in part due to the higher incidence of allergies in children. The incidence of asthma has increased dramatically during this time period, with the highest increases in the urban areas of developed countries. It seems that the incidence in developing countries may follow this trend as well. While our knowledge of the pathophysiology of asthma and the available of newer, safer medication have both improved, the mortality of the disease has undergone an overall increase in the past 30 years. Asthma treatment goals in children include decreasing mortality and improving quality of life. Specific treatment goals include but are not limited to decreasing inflammation, improving lung function, decreasing clinical symptoms, reducing hospital stays and emergency department visits, reducing work or school absences, and reducing the need for rescue medications. Non-pharmacological management strategies include allergen avoidance, environmental evaluation for allergens and irritants, patient education, allergy testing, regular monitoring of lung function, and the use of asthma management plans, asthma control tests, peak flow meters, and asthma diaries. Achieving asthma treatment goals reduces direct and indirect costs of asthma and is economically cost-effective. Treatment in children presents unique challenges in diagnosis and management. Challenges in diagnosis include consideration of other diseases such as viral respiratory illnesses or vocal cord dysfunction. Challenges in management include evaluation of the child’s ability to use inhalers and peak flow meters and the management of exercise-induced asthma.
PMID: 22187333 [PubMed - as supplied by publisher]
PubMed requires this notice of disclaimer is present.
