Search for predictors of psoriatic arthritis in patients with psoriasis

Background. Psoriatic arthritis is a chronic inflammatory disease of the joints, spine and entheses that can occur in patients with psoriasis. The prevalence of psoriatic arthritis is 19.7%. In 70% of cases, psoriasis precedes the development of arthritis. It has been proven that a delay in the diagnosis of psoriatic arthritis even by 6 months is associated with a deterioration in long-term radiological and functional results, leading to disability. The problem of early diagnosis of joint damage can be solved by identifying predictors of the risk of developing psoriatic arthritis in patients with psoriasis. Aims. To determine possible predictors for the development of psoriatic arthritis in patients with psoriasis. Methods. The open, uncontrolled, prospective study enrolled 250 patients. The main group consisted of 190 patients diagnosed with plaque psoriasis. The control group consisted of 60 patients with psoriatic arthritis. In order to identify associations of clinical and genetic (HLA-B27 carriage) parameters with the development of psoriatic arthritis, we compared the frequency of occurrence of these parameters in patients with psoriatic arthritis and without. Results. Among 190 patients with plaque psoriasis 128 (67.4%) men, 62 (32.6%) women, aged 18 to 84 years (40.30 ± 15.56), the average duration of psoriasis was 10.09 ± 11.08 years (0–57). Among 60 patients with psoriatic arthritis 39 (65%) men, 21 (35%) women aged 18 to 86 years (44.43 ± 14.15), the average duration of psoriasis was 20.47 ± 13.22 years (2–57), the average duration of psoriatic arthritis was 7.97 ± 9.95 years (0–47). Сlinical predictors for the development of psoriatic arthritis in patients with psoriasis: nail psoriasis (OR = 2.244 [95% CI: 1.245–4.045]); severe psoriasis (PASI ≥ 20) (OR = 2.148 [95% CI: 1.161–3.975]); arterial hypertension (OR = 1.982 [95% CI: 1.031–3.812]); duration of psoriasis over 25 years (OR = 3.365 [95% CI: 1.676–6.756]), р 0,05. Conclusions. The joint consideration of informative predictors will allow us to develop an original multi-parameter mathematical model for calculating the risk of developing psoriatic arthritis in patients with psoriasis

Narrow-band UVB phototherapy in patients with atopic dermatitis: analysis of the factors determining treatment efficacy

Background. Efficacy the narrow-band UVB phototherapy in patients with atopic dermatitis varies greatly. An important condition for achieving optimal therapeutic effect is the identification of factors that can impact on the efficacy of therapy and considering their influence when prescribing treatment. Aims. The present study aimed to identify the factors which affect the efficacy of narrow-band phototherapy in patients with atopic dermatitis Methods. A prospective, open-label trial was conducted to evaluate the efficacy and safety of narrow-band UVB phototherapy for patients with moderate-to-severe atopic dermatitis. All patients were treated with narrow-band UVB phototherapy four times weekly for 5 weeks. Disease severity was evaluated by SCORing of the Atopic Dermatitis Index (SCORAD) and Eczema Area and Severity Index (EASI). Distribution of patients by the severity of therapeutic effect was evaluated. To compare the efficacy of therapy depending on initial atopic dermatitis severity, initial and cumulative irradiation doses, skin phototype, and smoking status patients were divided into subgroups. Results. 40 patients with moderate-to-severe atopic dermatitis received course of narrow-band UVB phototherapy. After NB-UVB therapy SCORAD and EASI scores reduced from 45.6 ± 11.4 at baseline to 22.6 ± 12.4 (p 0,05) and from 14.4 ± 7.2 at baseline to 4.1 ± 3.9 (p 0,05) respectively demonstrating the efficacy of narrow-band UVB phototherapy in patients with atopic dermatitis. Our investigation showed that tobacco smokers had definitely lower efficacy of NB-UVB phototherapy in comparison with non-smokers. Narrow-band UVB phototherapy had definitely higher efficacy when it is started with an initial dose 0.2–0.3 J/cm2 chosen in compliance with results of MED determing in comparison with an initial dose 0.05–0.15 J/cm2 selected according to skin phototype. Conclusions. Factors that impact on the efficacy of narrow-band UVB phototherapy in patients with atopic dermatitis were identified. It was determined that using higher initial dose is associated with higher efficacy of therapy. The obtained data suggest the opportunity of decrease in efficacy of therapy in smokers with atopic dermatitis

Case report of leprosy in the Russian Federation

A clinical case of leprosy diagnosis in a citizen of the Republic of Chad (lepra-endemic region), а 24 year old male, student is presented. In 2019 the patient received permission to stay in the Russian Federation for educational purposes, entered one of the federal universities, and studied in Moscow, living in a hostel. During these years, he applied to various clinics, complaining of skin rashes and other symptoms characteristic of leprosy, without the effect of the prescribed treatment. In 2023, after contacting the clinic of skin diseases of the I.M. Sechenov First Moscow State Medical University (Sechenov University), was first sent to the The Federal State Research Center of Dermatovenereology and Cosmetology of the Ministry of Health of Russia with suspicion of leprosy. The results of clinical and laboratory studies including bacterioscopic examination of skin scarifications and pathohistological study of the skin confirmed the diagnosis: A30.5 Leprosy, multibacterial form, lepromatous type, active stage. This case presentation testifies to the lack of alertness regarding leprosy, especially among doctors conducting medical examinations of foreign citizens in order to obtain permission to stay in the Russian Federation, which may cause the spread of dangerous infectious diseases on the territory of the Russian Federation

Cutaneous lichen amyloidosis within scratched areas

It is considered that pruritus might be either a predisposing factor of development of cutaneous lichen amyloidosis or its symptom. In this case report we try to elucidate this issue. Case of 27-years old patient of Asian origin with cutaneous lichen amyloidosis is presented. Sites of lesions closely matched the scratched areas. Within the affected area there was a melanocytic nevus, which the patient avoided to touch. The area around the nevus was free from amyloidosis lesions. It proves the role of pruritus followed by scratching in the development of cutaneous lichen amyloidosis patches

The effect of apremilast therapy on skin cytokine levels in patients with psoriasis

Objective — Assessment of phosphodiesterase-4 inhibitor (apremilast) therapy’s influence on skin cytokine levels in patients with moderate-to-severe and severe psoriasis. Material and Methods — An open, uncontrolled study was conducted. 16 patients with plaque psoriasis (13 men, 3 women; mean ± standard deviation (SD) age 35.1±9.7 years, range 21-60) were enrolled. The mean Psoriasis Area and Severity Index (PASI) was 20.7±8.93 (range 10-47). All patients were prescribed apremilast 30 milligrams (mg) per os (PO) Bis In Die (BID). The efficacy of therapy was evaluated by PASI at 14 and 26 weeks of therapy. Lesional skin samples were collected at baseline and weeks 14 and 26. Levels of interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL -33, interferon (INF)-γ, Soluble CD40-ligand (sCD40L), tumor necrosis factor (TNF)-α were measured by microsphere-based suspension array technology (Luminex® xMAP™ system). Results — Levels of cytokines (except IL-4 and IL-33) in lesional skin samples were found to have decreased at week 14 compared with those at baseline. Similar decreases were seen for IL-23, IL-25, IL-31, sCD40L at week 26. In contrast, the levels of other cytokines increased again at week 26, in comparison with baseline. Levels of IL-4 and IL-33 rose throughout the follow-up period. Cytokine levels in lesional skin samples were compared with those of healthy controls both at baseline and during therapy. Conclusion — The results of our study show that administering apremilast therapy to patients with psoriasis can bring the levels of cytokines involved in the IL-23/IL-17 axis in the lesional skin to the level of cytokine in non-lesional skin and to the levels in the skin of healthy individuals

Apremilast Pharmacogenomics in Russian Patients with Moderate-to-Severe and Severe Psoriasis

One of the target drugs for plaque psoriasis treatment is apremilast, which is a selective phosphodiesterase 4 (PDE4) inhibitor. In this study, 34 moderate-to-severe and severe plaque psoriasis patients from Russia were treated with apremilast for 26 weeks. This allowed us to observe the effectiveness of splitting patient cohorts based on clinical outcomes, which were assessed using the Psoriasis Area Severity Index (PASI). In total, 14 patients (41%) indicated having an advanced outcome with delta PASI 75 after treatment; 20 patients indicated having moderate or no effects. Genome variability was investigated using the Illumina Infinium Global Screening Array. Genome-wide analysis revealed apremilast therapy clinical outcome associations at three compact genome regions with undefined functions situated on chromosomes 2, 4, and 5, as well as on a single single-nucleotide polymorphism (SNP) on chromosome 23. Pre-selected SNP sets were associated with psoriasis vulgaris analysis, which was used to identify four SNP-associated targeted therapy efficiencies: IL1β (rs1143633), IL4 (IL13) (rs20541), IL23R (rs2201841), and TNFα (rs1800629) genes. Moreover, we showed that the use of the global polygenic risk score allowed for the prediction of onset psoriasis in Russians. Therefore, these results can serve as a starting point for creating a predictive model of apremilast therapy response in the targeted therapy of patients with psoriasis vulgaris