The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients

It is well established that several inflammatory-type conditions, such as arthritis, diabetes, cardiovascular disease, and irritable bowel disease exist comorbidly and at an increased incidence in patients with psoriasis. Psoriasis and other associated diseases are thought to share common inflammatory pathways. Conditions such as these, with similar pathogenic mechanisms involving cytokine dysregulation, are referred to as immune-mediated inflammatory diseases (IMIDs). Considerable evidence for the genetic basis of cormobidities in psoriasis exists. The WHO has reported that the occurrence of chronic diseases, including IMIDs, are a rising global burden. In addition, conditions linked with psoriasis have been associated with increasing rates of considerable morbidity and mortality. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions. For example, methotrexate is contraindicated in hepatic impairment, while patients on ciclosporin should be monitored for kidney function. In addition, some agents, such as beta blockers, lithium, synthetic antimalarial drugs, NSAIDs and tetracycline antibiotics, have been implicated in the initiation or exacerbation of psoriasis. Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions

ANATOLIAN JOURNAL OF CARDIOLOGY

Objective: To investigate the effects of tumor necrosis factor (INF)-alpha antagonism with etanercept (ENC) on endothelial functions in patients with active rheumatoid arthritis (RA). Methods: A total of 21 patients with RA were enrolled in this prospective study. Eleven of them (8 women, 3 men mean age 47.0 +/- 10.1 years) with high disease activity despite the conventional treatment were assigned to Group 1 and were given ENC treatment twice a week (25 mg SC injection) for 12 weeks. Ten patients with RA (8 women, 2 men mean age 55.0 +/- 6.4 years) under conventional methotrexate and prednisone therapy were assigned as Control group (Group 2). Endothelium-dependent and -independent vasodilator responses of the brachial artery were assessed by high-resolution ultrasound. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at baseline and at the post treatment period. Mann-Whitney U and Wilcoxon tests were used to compare the data and correlation analysis was performed using Pearson correlation test. Results: Endothelium-dependent vasodilatation improved from 5.2 +/- 0.8% to 7.9 +/- 1.3% (p=0.04) in ENC group, while no significant change was observed in the control group (from 6.6 +/- 1.1% to 7.0 +/- 1.8% p=0.67). No significant changes were found in endothelium-independent vasodilatation and baseline brachial artery diameters in both groups. A significant reduction in ESR and CRP were observed in patients receiving ENC (from 16.2 +/- 6.8 to 9.2 +/- 5.1 mm/h, p=0.003 and from 14.68 +/- 3.4 to 9.25 +/- 3.7 mg/L, p=0.003, respectively). Conclusion: Treatment with ENC for 12 weeks significantly improved endothelial function in patients with active RA compared to those under conventional therapy. The findings of the present study support the hypothesis that the use of TNF-alpha blockers in patients with active RA may reduce the high incidence of cardiovascular complications. (Anadolu Kardiyol Derg 2010; 10: 98-103

INTERNATIONAL JOURNAL OF CARDIOLOGY

Background: Previous studies have reported controversial results regarding the clinical and angiographic factors involved in the left ventricular aneurysm (LVA) formation after myocardial infarction (MI). Objective: This study was performed to determine the clinical and angiographic factors that are priori predictors of LVA following anterior myocardial infarction and so to provide a paradigm which may identify patients who were candidates for aneurysm formation. Methods: Of the patients who underwent coronary angiography during the interval between 1995 and 2000 in our clinic, 809 were found to have anterior MI and LVA (aneurysm group) (677 men, 132 women, mean age 53.3 +/- 11.4 years). The clinical and the angiographic data of these patients were compared with those of 446 patients (399 men, 47 women, mean age 55.2 +/- 10.5 years) with previous anterior MI and without LVA (control group). Results: LVA was found to occur more frequently in females (16.3% in women and 10.4%, in men, P = 0.03) and in patients without previous angina (23.5 vs. 8.2%. P < 0.0001). Major cardiovascular risk factors, previous anti-anginal medication and thrombolytic therapy did not show a significant difference between the two groups. Angiographic examination revealed that single-vessel disease, proximal left anterior descending artery (LAD) stenosis, total LAD occlusion, mean stenosis in LAD artery, end-diastolic pressure and left ventricular score were all higher in the aneurysm group compared to control group. After adjustment for other clinical and angiographic variables, single-vessel disease [odds ratio (OR) 5.89, 95% confidence interval (CI) = 3.68-9.28, P < 0.0001), absence of previous angina (OR) = 4.21. 95% CI = 2.1-7.48, P = 0.0003), total LAD occlusion (OR = 2.63, 95% CI = 1.97-3.53, P < 0.0017) and female gender (OR = 1.60, 95% CI = 1.20-2.28, P = 0.043) remained the independent determinants of LVA formation after anterior MI. Conclusion: In patients with LVA, logistic regression analysis revealed that (1) single-vessel disease, (2) absence of previous angina, (3) total LAD occlusion and (4) female gender were independent determinants in the formation of LVA after anterior MI. Coronary collateral status and risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, smoking and family history of CAD were not found to be important determinants in the aneurysm formation. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

ANGIOLOGY

This study was performed to evaluate whether coexistent diabetes mellitus has any adverse effect on the outcomes of thrombolytic therapy in patients with acute myocardial infarction. Although the early reperfusion rates were similar between the two groups of patients who had acute myocardial infarction with and without diabetes mellitus (42% vs 45.4%, p > 0.05), the results of late angiographic examination showed a significantly lower rate of patency in infarct-related coronary artery (defined as TIMI 3 flow) in diabetics compared to nondiabetics (28.9% vs 41.3%, p < 0.001). The global left ventricular function was also poorer in diabetics (left ventricular wall motion score was 18.6 +/- 73 in diabetics and 14.1 +/- 4.6 in nondiabetics, p < 0.01)

The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis [Romatoid artrit'li hastalarda etanercept ile yapilan anti-tümör nekroz faktör (TNF)-alfa tedavisinin endotel fonksiyonlari üzerine etkisi]

PubMed ID: 20382605Objective: To investigate the effects of tumor necrosis factor (TNF)-< antagonism with etanercept (ENC) on endothelial functions in patients with active rheumatoid arthritis (RA). Methods: A total of 21 patients with RA were enrolled in this prospective study. Eleven of them (8 women, 3 men mean age 47.0±10.1 years) with high disease activity despite the conventional treatment were assigned to Group 1 and were given ENC treatment twice a week (25 mg SC injection) for 12 weeks. Ten patients with RA (8 women, 2 men mean age 55.0±6.4 years) under conventional methotrexate and prednisone therapy were assigned as Control group (Group 2). Endothelium-dependent and -independent vasodilator responses of the brachial artery were assessed by high-resolution ultrasound. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at baseline and at the post treatment period. Mann-Whitney U and Wilcoxon tests were used to compare the data and correlation analysis was performed using Pearson correlation test. Results: Endothelium-dependent vasodilatation improved from 5.2±0.8% to 7.9±1.3% (p=0.04) in ENC group, while no significant change was observed in the control group (from 6.6±1.1% to 7.0±1.8% p=0.67). No significant changes were found in endothelium-independent vasodilatation and baseline brachial artery diameters in both groups. A significant reduction in ESR and CRP were observed in patients receiving ENC (from 16.2±6.8 to 9.2± 5.1 mm/h, p=0.003 and from 14.68±3.4 to 9.25± 3.7 mg/L, p=0.003, respectively). Conclusion: Treatment with ENC for 12 weeks significantly improved endothelial function in patients with active RA compared to those under conventional therapy. The findings of the present study support the hypothesis that the use of TNF-< blockers in patients with active RA may reduce the high incidence of cardiovascular complications. (Anadolu Kardiyol Derg 2010; 10: 98-103) © Copyright 2010 by AVES Yayincilik Ltd

Effects of aerobic plus explosive power exercises on bone remodeling and bone mineral density in young men

Objectives: This study aims to examine effects of aerobic jogging and explosive power exercises on body composition, maximal oxygen consumption (MaxVO2), bone mineral density (BMD) and bone turn-over markers: serum bone alkaline phosphatase (BAP), C terminal telopeptide (CTx), Procollagen type I N-terminal propeptide (PINP), in men aged between 20 and 40. Materials and methods: Thirty seven healthy males were divided into exercise group (EG, n = 19) and control group (CG, n = 18). EG completed 10 weeks of outdoor aerobic (jogging at 60-70% maximal heart rate reserve starting from 20 min steadily increasing up to 28 min) and explosive power exercises (in 2-3 sets, with maximum repetitions lasting 15 s), 3 times per week. All measurements were taken before and after the exercise program. BMD was measured via dual energy X-ray absorptiometry (DEXA). Results: Body mass index (p &lt; 0.001) significantly decreased; MaxVO2 (p &lt; 0.001), femur neck (p = 0.036) and total score BMD significantly increased in EG (p = 0.034). BAP and vitamin D increased in both groups (p &lt; 0.001). Conclusion: Performing our outdoor exercise program in spring months might have an important role in the significant increase (9 vs. 22 ng/mL) in mean vitamin D level, which reached above the fracture risk level of 20 ng/mL. © 2018 Turkish Biochemistry Society. All rights reserved