MRI changes in psoriatic dactylitisextent of pathology, relationship to tenderness and correlation with clinical indices

Objectives. To quantify the extent of inflammation in psoriatic dactylitis and to examine the relationship between clinical and magnetic resonance imaging (MRI) data in both tender and non-tender dactylitis. Methods. Seventeen patients with psoriatic dactylitis underwent clinical assessment for 6 months after change of treatment, usually to methotrexate. Measures of dactylitis included the Leeds Dactylitis Index, the assessment tool used in the Infliximab in Psoriatic Arthritis Clinical Trial (IMPACT), a simple count of tender dactlylitic digits and a count of all dactylitic digits, both tender and non-tender. MRI scans of the affected hand or foot were performed before and after treatment using a 1.5T Siemens scanner pre- and post-contrast. Results. All patients improved clinically, as did their respective dactylitis scores and MRI images. The findings on MRI in both dactylitic and non-dactylitic digits were profound and widespread. The difference between tender and non-tender dactylitis was quantitative rather than qualitative. Synovitis and soft-tissue oedema were the most frequent abnormalities being present in 69 of tender dactylitic digits but bone oedema and flexor tenosynovitis were also frequently seen. Soft-tissue oedema was circumferential and enhancing and not limited to association with the flexor or extensor tendons. None of the clinical indices of dactylitis showed a close relationship to the extent of MRI abnormalities. Conclusions. MRI images demonstrate widespread abnormalities in digits of people with psoriatic arthritis. Tender dactylitic digits have more abnormalities than other digits but the relationship between clinical and MRI scores is not strong

Arthritis and disability

Executive summary: Arthritis Australia commissioned the Social Policy Research Centre (SPRC) at UNSW Australia to carry out research on the lived experience of people with arthritis related conditions. This report outlines the methods, findings and implications of the research. Arthritis is the second leading cause of disability and the most common cause of chronic pain in Australia; it is the most prevalent long-term health condition, affecting 3 million people or about 15 per cent of the population. Studies are available on the health costs and loss of productivity associated with arthritis, but not as much is understood about the extent to which arthritis is associated with disability–who is affected, how people are affected, what helps people cope with their condition day to day, and how support services can be improved. Improving understanding of the disability impact of arthritis is particularly important given the transition in Australia to the National Disability Insurance Scheme and the impact this may have on service availability and delivery

BSR Spondyloarthritis Course, 27 February 2020. Spondyloarthritis: pathogenesis, diagnosis and management

High-quality continuous medical education is essential to maintain excellence in health-care delivery, upskilling professionals and improving patient outcomes. This is particularly relevant when addressing rare disease groups, such as the spondyloarthritides, a group of heterogeneous inflammatory conditions that affect joints and other organs, such as the skin, bowel and eye. Professional bodies, such as the British Society for Rheumatology (BSR), are well placed to deliver this type of education. In 2020, the BSR ran a dedicated SpA course aimed at rheumatology health-care professionals wishing to update their basic knowledge of SpA with a review of the latest advances in the field. Here, we summarize the proceedings of the meeting and discuss the value of such an initiative

Psoriasis, psoriatic arthritis, and rheumatoid arthritis: Is all inflammation the same?

AbstractObjectivesTo review the pathophysiology, co-morbidities, and therapeutic options for psoriasis, psoriatic arthritis and rheumatoid arthritis in order to further understand the similarities and differences in treatment paradigms in the management of each disease. New targets for individualized therapeutic decisions are also identified with the aim of improving therapeutic outcome and reducing toxicity.Search strategyUsing the PubMed database, we searched literature published from 2000 to 2015 using combinations of the key words “psoriasis,” “psoriatic arthritis,” “rheumatoid arthritis,” “pathogenesis,” “immunomodulation,” and “treatment.”Inclusion and exclusion criteriaThis was a non-systematic review and there were no formal inclusion and exclusion criteria.Data extractionAbstracts identified in the search were screened for relevance and articles considered appropriate evaluated further. References within these selected articles were also screened. Information was extracted from 198 articles for inclusion in this report.Data synthesisThere was no formal data synthesis. Articles were reviewed and summarized according to disease area (psoriasis, psoriatic arthritis, and rheumatoid arthritis).Headline resultsThe pathophysiology of psoriasis, psoriatic arthritis, and rheumatoid arthritis involves chronic inflammation mediated by pro-inflammatory cytokines. Dysfunction in integrated signaling pathways affecting different constituents of the immune system result in varying clinical features in the three diseases. Co-morbidities, including cardiovascular disease, malignancies, and non-alcoholic fatty liver disease are increased. Increased understanding of the immunopathogenesis allowed development of targeted treatments; however, despite a variety of potentially predictive genetic, protein and cellular biomarkers, there is still significant unmet need in these three inflammatory disorders

Depression in patients with spondyloarthritis:prevalence, incidence, risk factors, mechanisms and management

Depression is a major neuropsychiatric disorder common in patients with rheumatological conditions including spondyloarthritis (SpA). It is associated with higher disease activity, functional impairment, poor treatment response and quality of life in patients with musculoskeletal disorders. Using ankylosing spondylitis (AS) and psoriatic arthritis (PsA) as examples, we have reviewed the evidence regarding the burden, risk factors, potential mechanisms and clinical management of depression in spondyloarthritis. The prevalence of depression is higher in patients with AS and PsA compared with the general population, with evidence of moderate/severe depression in about 15% of patients with AS or PsA. Mild depression is even more common and estimated to be present in about 40% of patients with AS. In addition to conventional risk factors such as stressful life events and socioeconomic deprivation, increased risk of depression in SpA may be associated with disease-related factors, such as disease activity, poor quality of life, fatigue, and sleep disturbances. Emerging evidence implicates inflammation in the aetiology of depression, which could also be a shared mechanism for depression and chronic inflammatory conditions such as AS and PsA. It is imperative for clinicians to actively assess and treat depression in SpA, as this could improve treatment adherence, quality of life, and overall long-term clinical and occupational outcomes. The use of validated tools can aid recognition and management of depression in rheumatology clinics. Management of depression in SpA, especially when to refer to specialist mental health services, are discussed

Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management

Funder: MQ: Transforming Mental Health; FundRef: https://doi.org/10.13039/501100008162; Grant(s): MQDS17/40Funder: cambridge trust; FundRef: https://doi.org/10.13039/501100003343Depression is a major neuropsychiatric disorder common in patients with rheumatological conditions including spondyloarthritis (SpA). It is associated with higher disease activity, functional impairment, poor treatment response and quality of life in patients with musculoskeletal disorders. Using ankylosing spondylitis (AS) and psoriatic arthritis (PsA) as examples, we have reviewed the evidence regarding the burden, risk factors, potential mechanisms and clinical management of depression in spondyloarthritis. The prevalence of depression is higher in patients with AS and PsA compared with the general population, with evidence of moderate/severe depression in about 15% of patients with AS or PsA. Mild depression is even more common and estimated to be present in about 40% of patients with AS. In addition to conventional risk factors such as stressful life events and socioeconomic deprivation, increased risk of depression in SpA may be associated with disease-related factors, such as disease activity, poor quality of life, fatigue, and sleep disturbances. Emerging evidence implicates inflammation in the aetiology of depression, which could also be a shared mechanism for depression and chronic inflammatory conditions such as AS and PsA. It is imperative for clinicians to actively assess and treat depression in SpA, as this could improve treatment adherence, quality of life, and overall long-term clinical and occupational outcomes. The use of validated tools can aid recognition and management of depression in rheumatology clinics. Management of depression in SpA, especially when to refer to specialist mental health services, are discussed

Foot involvement among people with psoriatic arthritis

Despite recognition that hallmark features of psoriatic arthritis (PsA) are predominant and persistent in the foot and ankle, limited foot-specific research exists and there are no validated outcome measures to comprehensively assess the impact of foot involvement from the perspective of people living with PsA. Previous research has shown merit in linking to the International Classification of Functioning, Disability and Health (ICF) in order to better define and understand the impact of global disease associated with PsA, but little is known about the impact of localised disease in the foot. Current understanding of foot involvement in PsA is based on a limited number of studies with relatively small sample sizes of predominantly discrete sub-populations of PsA, which fail to adequately incorporate the perspective of those living with PsA. Therefore, foot involvement in PsA remains under-researched and poorly understood with a lack of large-scale data to provide the basis for targeted disease-specific assessments and interventions. This thesis aimed to investigate foot involvement in PsA from the patient perspective, and to develop a national Australasian-based survey in order to comprehensively describe the nature, extent and location of foot problems and their impact on the daily life of people with PsA. Findings highlight the importance of involving those with PsA to generate survey items, which resulted in relevant concepts being included in the survey that were not considered to be important by health professionals. This programme of work provides a comprehensive view of the wide-reaching impact of PsA foot-specific involvement from the patient perspective, which will inform the future research priorities on targeted strategies towards improving foot health and the patient experience in PsA

Evaluation of the Economic Burden of Psoriatic Arthritis and the Relationship Between Functional Status and Healthcare Costs

Doce imágenes de un liposarcoma metastatizado situado en el cerebro de un paciente de 44 años.Twelve pictures of a metastasized liposarcoma located in the brain of a 44-year-old male patient