Perspectives of patients and health professionals on the experience of living with psoriatic arthritis-related foot problems:A qualitative investigation

Objective: The aim of the study was to explore how foot problems impact on the lives of people with psoriatic arthritis by interviewing patients and health professionals. Method: Participants were recruited from outpatient rheumatology clinics in Sydney, Australia, and in Auckland, New Zealand, using a convenience sampling strategy. People with psoriatic arthritis were asked questions in semi-structured interviews about their foot problems and the impact they have on daily living until qualitative data saturation. Focus groups were undertaken with health professionals to explore their understanding of the patient experience of psoriatic arthritis-related foot problems. All interviews were audio-recorded and transcribed verbatim. Constant comparative analysis was used to identify emerging themes from the data. Results: Twenty-one people with psoriatic arthritis-related foot problems and 17 health professionals participated. Three overarching key themes were derived from patients and health professionals: (1) structural and functional foot manifestations, (2) impact on daily life leading to social withdrawal and reduced work productivity and (3) mediating factors influencing the severity of impact from foot problems on their lives such as social support, self-management strategies and experiences of health care. Conclusion: Foot problems caused functional disability and altered self-concept, which lead to a cascade of social, economic and psychological consequences. People with foot problems contend with profound disruption to their functioning and life roles. Whilst health professionals recognised the functional and visual impact that foot problems have on daily life, the emotional burden may be under-appreciated. Future work to determine the scale and types of foot problems in psoriatic arthritis is required.</p

Human leukocyte Antigen Class I-restricted activation of CD8+ T Cells provides the immunogenetic basis of a systemic drug hypersensitivity

The basis for strong immunogenetic associations between particular human leukocyte antigen (HLA) class I allotypes and inflammatory conditions like Behçet's disease (HLA-B51) and ankylosing spondylitis (HLA-B27) remain mysterious. Recently, however, even stronger HLA associations are reported in drug hypersensitivities to the reverse-transcriptase inhibitor abacavir (HLA-B57), the gout prophylactic allopurinol (HLA-B58), and the antiepileptic carbamazepine (HLA-B∗1502), providing a defined disease trigger and suggesting a general mechanism for these associations. We show that systemic reactions to abacavir were driven by drug-specific activation of cytokine-producing, cytotoxic CD8+ T cells. Recognition of abacavir required the transporter associated with antigen presentation and tapasin, was fixation sensitive, and was uniquely restricted by HLA-B∗5701 and not closely related HLA allotypes with polymorphisms in the antigen-binding cleft. Hence, the strong association of HLA-B∗5701 with abacavir hypersensitivity reflects specificity through creation of a unique ligand as well as HLA-restricted antigen presentation, suggesting a basis for the strong HLA class I-association with certain inflammatory disorders

The immunogenetic diversity of the HLA system in Mexico correlates with underlying population genetic structure

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