Evaluation of Psoriasis Area and Severity Index Thresholds as Proxies for Systemic Inflammation on an Individual Patient Level

Dermatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Jochen H.O. Hoffmann ◽  
Alexander H. Enk
Keyword(s):  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Disease Severity ◽  
Systemic Inflammation ◽  
Systemic Treatment ◽  
Severity Index ◽  
Individual Patient Level ◽  
Lymphocyte Ratio ◽  
Patient Level ◽  
Psoriasis Severity

<b><i>Background:</i></b> Psoriasis is a chronic and systemic inflammatory disease with a loss of up to 5 life years, which is thought to be reduced by biologic treatment. Disease severity and eligibility for systemic treatment are often based on the cutaneous psoriasis area and severity index (PASI) with a cut-off of 10 in several European countries. However, it is unclear how well this cut-off reflects systemic inflammation and, consequently, the risk for the development of comorbidity. <b><i>Objectives:</i></b> (1) To assess whether specific PASI thresholds, in particular PASI 10, predict elevated biomarkers of systemic inflammation and cardiovascular risk on an individual patient level. (2) To assess the association of PASI and psoriatic arthritis with biomarkers of systemic inflammation and cardiovascular risk. <b><i>Methods:</i></b> Retrospective cross-sectional study of 72 psoriasis patients without systemic treatment. <b><i>Results:</i></b> Overall, 68, 42, and 50% of patients had cardiovascular risk level neutrophil-to-lymphocyte ratio (NLR), C-reactive protein, and elevated platelet-to-lymphocyte ratio (PLR) values, respectively. The respective positive predictive values of PASI 10 were 70, 45, and 70. The performance of the optimal PASI cut-offs according to the Youden index was similarly weak. Subgrouping of patients with a PASI below 10 did not result in a considerably improved reflection of systemic inflammation. PLR was significantly higher in patients with moderate-to-severe compared to mild psoriasis and significantly correlated with PASI in patients with a PASI above 2 (<i>r</i><sub>s</sub> = 0.266, <i>n</i> = 64). NLR was significantly higher in patients with psoriatic arthritis. <b><i>Conclusion:</i></b> Specific PASI thresholds were not well suited to predict elevated biomarkers of systemic inflammation and cardiovascular risk on an individual patient level. Therefore, PASI, and possibly other purely cutaneous measures, may not be ideal as stand-alone parameters to define disease severity and eligibility for systemic treatment. Our results are relevant for the ongoing discussion on the definition of psoriasis severity and eligibility for systemic treatment. Further research addressing the added value of a set of biomarkers of systemic inflammation in the assessment of psoriasis severity would be desirable.

scholarly journals PGA×BSA: A Measure of Psoriasis Severity Tested in Patients with Active Psoriatic Arthritis and Treated with Certolizumab Pegol

2018 ◽  
Vol 45 (7) ◽  
pp. 922-928 ◽  
Author(s):  
Jessica A. Walsh ◽  
Terri Arledge ◽  
Tommi Nurminen ◽  
Luke Peterson ◽  
Jeffrey Stark
Keyword(s):  
Psoriatic Arthritis ◽  
Dermatology Life Quality Index ◽  
Certolizumab Pegol ◽  
Life Quality ◽  
Severity Index ◽  
Strong Correlations ◽  
Double Blind ◽  
Percentage Improvement ◽  
High Concordance ◽  
Psoriasis Severity

Objective.The product of physician’s global assessment and body surface area (PGA×BSA) to assess psoriasis severity has previously been investigated in patients with psoriasis, with the aim of assessing PGA×BSA as an alternative to the time-consuming Psoriasis Area and Severity Index (PASI). Here, we investigate PGA×BSA as an alternative to PASI in patients with psoriatic arthritis (PsA).Methods.Analyses used data from the double-blind, placebo-controlled, RAPID-PsA trial (NCT01087788) that investigated the efficacy of certolizumab pegol (CZP) in patients with PsA. Outcomes assessed whether the PGA×BSA and PASI results were comparable, and whether these outcomes correlated with one another or with the Dermatology Life Quality Index (DLQI).Results.For CZP-treated patients, both PGA×BSA and PASI demonstrated similar sensitivities to treatment between baseline and Week 24, with mean improvements of 77.4% and 69.0%, respectively. Similar improvements were also seen with placebo (PGA×BSA: 3.2%, PASI: 6.1%). Achievement of 75% response criterion in PGA×BSA and PASI was attained by similar proportions of patients with CZP (PGA×BSA75: 59.0%, PASI75: 61.4%) and placebo (PGA × BSA75: 15.1%, PASI75: 15.1%). Cross tabulations showed high concordance between achievement of response outcomes in PGA×BSA and PASI (79.6–95.2%). Spearman correlations revealed strong correlations between PGA×BSA and PASI at baseline (r = 0.78; n = 225) and percentage improvement to Week 24 (r = 0.85; n = 186). Both outcomes were only moderately correlated with DLQI (r = 0.41–0.50; n = 179–249).Conclusion.PGA×BSA is sensitive to changes in skin manifestations in patients with PsA treated with CZP. Further, PGA×BSA correlates strongly with PASI, and achievement of 75% improvement was similar for PGA×BSA and PASI.

scholarly journals IL-17A in the Psoriatic Patients’ Serum and Plaque Scales as Potential Marker of the Diseases Severity and Obesity

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Anna Michalak-Stoma ◽  
Joanna Bartosińska ◽  
Małgorzata Kowal ◽  
Dorota Raczkiewicz ◽  
Dorota Krasowska ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Disease Severity ◽  
Body Mass ◽  
Severity Index ◽  
Control Group ◽  
Clinical Activity ◽  
Physician Global Assessment ◽  
Elisa Kit ◽  
Potential Marker ◽  
Psoriasis Severity

The aim of the study was to evaluate concentrations of IL-17 in the serum and plaque scales of psoriatic patients. We analyzed their association with the clinical activity of the disease and with body mass index (BMI). Demographic data, medical history, serum, and scale from psoriatic plaques for assessment of IL-17 were collected from all the participants. The disease severity was assessed with PASI (Psoriasis Area and Severity Index), BSA (Body Surface Area), PGA (Physician Global Assessment), NAPSI (Nail Psoriasis Severity Index), and DLQI (Dermatology Quality of Life Index) scores. Obesity was diagnosed by calculating body mass index. Serum and scale concentration of IL-17 was determined with Human IL-17A High Sensitivity ELISA kit and Human IL-17 ELISA kit. In the psoriatic patients, BMI was statistically significantly higher than in the control group. Most of the patients presented BMI higher than normal. Our study confirms that overweight is a problem among psoriatic patients. A significant positive correlation between the IL-17 serum and scale concentrations and psoriasis severity indicates that IL-17 can be used as the marker of disease severity. More data from human studies can be crucial for understanding that relationship between IL-17, psoriasis, and obesity.

The association between etanercept serum concentration and psoriasis severity is highly age-dependent

2017 ◽  
Vol 131 (11) ◽  
pp. 1179-1189 ◽  
Author(s):  
Iris Detrez ◽  
Kristel Van Steen ◽  
Siegfried Segaert ◽  
Ann Gils
Keyword(s):  
Serum Concentration ◽  
Disease Severity ◽  
Severity Index ◽  
Physician Global Assessment ◽  
Age Group ◽  
Opposite Trend ◽  
Dependent Relation ◽  
Age Dependent ◽  
Consecutive Time ◽  
Psoriasis Severity

The association between etanercept serum concentration and psoriasis disease severity is poorly investigated, and currently etanercept serum concentration monitoring that is aiming to optimize the psoriasis treatment lacks evidence. In this prospective study, we investigated the relation between etanercept exposure and disease severity via measuring etanercept concentrations at five consecutive time points in 56 psoriasis patients. Disease severity assessments included the Psoriasis Area and Severity Index (PASI), body surface area (BSA) and Physician Global Assessment (PGA), and etanercept and anti-etanercept antibody concentrations were determined every 3 months for a period of 1 year. The present study demonstrated that the association between etanercept concentration and psoriasis severity is age-dependent: when patients were stratified into three groups, patients in the youngest age group (–50 years) showed a lower PASI at a higher etanercept concentration (β = –0.26), whereas patients in the oldest age group (+59 years) showed the opposite trend (β =0.22). Similar age effects were observed in the relation of etanercept concentration with BSA (P=0.02) and PGA (P=0.02). The influence of age and length of time in therapy on the etanercept concentration–disease severity relation was unaffected by body mass index (BMI) or any other possible confounder. Incidence of anti-etanercept antibodies was low (2%). The age-dependent relation between etanercept serum concentrations is both unexpected and intriguing and needs further investigation.

scholarly journals Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and other hematological parameters in psoriasis patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wen-Ming Wang ◽  
Chao Wu ◽  
Yi-Meng Gao ◽  
Feng Li ◽  
Xiao-Ling Yu ◽  
...  
Keyword(s):  
Blood Cell ◽  
Systemic Inflammation ◽  
Hematological Parameters ◽  
Severity Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Control Group ◽  
Platelet To Lymphocyte Ratio ◽  
Psoriasis Area Severity Index ◽  
Lymphocyte Ratio ◽  
Healthy Control

Abstract Background Psoriasis is a chronic immune‐mediated skin disorder. Systemic inflammation plays an important role in the pathogenesis of psoriasis. Methods A total of 477 patients with psoriasis vulgaris (PsV, n = 347), generalized pustular psoriasis (GPP, n = 37), erythrodermic psoriasis (PsE, n = 45), arthritic psoriasis (PsA, n = 25) and mixed psoriasis (n = 23), and 954 healthy control subjects were included in the study. Demographic, clinical, and laboratory information were collected and compared between subgroups. Results Compared with the healthy control group, patients with psoriasis had higher total white blood cell (WBC), neutrophil, platelet counts, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR), but lower hemoglobin (Hb) levels, lymphocyte and red blood cell (RBC) counts. NLR values in the PsV group were significantly lower than those in the GPP, PsE, and PsA groups, with GPP group being the highest. PLR values in the PsV group were significantly lower than those in the GPP, PsE, and PsA groups. There was no significant correlation between the psoriasis area severity index (PASI) score and either the NLR or PLR in the PsV group. Conclusions Elevated NLR and PLR were associated with psoriasis and differed between subtypes, suggesting that they could be used as markers of systemic inflammation in psoriasis patients.

Psoriasis and Psoriatic Arthritis Video Project: An Update from the GRAPPA 2011 Annual Meeting

2012 ◽  
Vol 39 (11) ◽  
pp. 2198-2200 ◽  
Author(s):  
KRISTINA CALLIS DUFFIN ◽  
APRIL W. ARMSTRONG ◽  
PHILIP J. MEASE
Keyword(s):  
Psoriatic Arthritis ◽  
Severity Index ◽  
Additional Patient ◽  
Multimedia Presentations ◽  
Axial Disease ◽  
Evaluation Module ◽  
Ongoing Development ◽  
Improved Accuracy ◽  
Training Modules ◽  
Psoriasis Severity

Numerous physical examination instruments are used to assess and measure severity of psoriasis and psoriatic arthritis (PsA) in practice and in clinical trials. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has developed several online training modules used by GRAPPA members and investigators participating in psoriasis and PsA research. At the 2011 GRAPPA meeting, attendees were updated on the ongoing development of the training modules. Several Internet-based multimedia presentations for psoriasis and PsA assessments have been completed. Available psoriasis modules include the Psoriasis Area and Severity Index (PASI) and Body Surface Area, one 5-point and two 6-point Physician Global Assessments, the original and modified Nail Psoriasis Severity Index, the Palmar-Plantar Pustular Psoriasis Area and Severity Index, the Psoriasis Scalp Severity Index, and the Total Plaque Severity Score. Rheumatology modules that demonstrate evaluation of swollen and tender joints, enthesitis, and dactylitis are now available, and an axial disease evaluation module is near completion. Each video includes the background and rationale for each measure, demonstration videos of select examinations, diagrams, and photographs to emphasize teaching points, and for most dermatology modules, an optional test to assess competence. Preliminary data generated by a pilot study of pre- and post-education PASI scoring by experienced and naive physicians and patient assessors were presented, revealing improved accuracy of scoring after viewing the PASI video. Attendees agreed that additional patient examples with more diverse skin types and psoriasis phenotypes, translation to languages other than English, and further validation studies are needed.

scholarly journals The relationship between the nail and systemic enthesitis in psoriatic arthritis

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Ashley Elliott ◽  
Adrian Pendleton ◽  
Gary Wright ◽  
Madeleine Rooney
Keyword(s):  
Power Doppler ◽  
Severity Index ◽  
Moderate Correlation ◽  
Patient Level ◽  
Close Relationship ◽  
Severity Index Score ◽  
Psoriatic Nail Disease ◽  
The Relationship ◽  
Nail Disease ◽  
Psoriasis Severity

Abstract Objective Psoriatic nail disease is more common in PsA than in isolated skin psoriasis (PsO). The nail is closely integrated to the DIP joint entheses. US data have shown that those patients with nail disease in PsO are more likely to have systemic enthesitis. We examined whether there was a relationship between nail disease, DIP enthesitis and systemic enthesitis in established PsA. Methods Forty-six PsA participants with nail disease underwent US scanning of the nail unit and the DIP entheses along with peripheral entheseal sites according to the Madrid sonographic enthesitis index (MASEI). Results At the finger level, there was a mild to moderate correlation between nail US changes and both clinical nail disease and DIP enthesis changes (DIP US) [Spearman correlation (rS) = 0.30, P &lt; 0.001 and rS = 0.16, P &lt; 0.001, respectively]. At the patient level, there was a moderate correlation between the nail US score and nail psoriasis severity index score and DIP US (rS = 0.33, P = 0.024 and rS = 0.43, P = 0.003, respectively). At the patient level, there was also a positive correlation between a higher nail US score and the active peripheral enthesitis score (MASEI-active) (rS = 0.35, P = 0.018). When power Doppler was part of nail US score, similar results were demonstrated at both the finger and patient levels. Conclusion This study has demonstrated the utility of nail US imaging and the close relationship, on scanning, between the DIP entheses and the nail unit. In PsA, we have seen a correlation between active US changes at the nail and peripheral enthesitis, which requires further analysis. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT03955861.

scholarly journals Correlates and assessment of excess cardiovascular risk in bronchiectasis

2017 ◽  
Vol 50 (5) ◽  
pp. 1701127 ◽  
Author(s):  
Aarash D. Saleh ◽  
Bessie Kwok ◽  
Jeremy S. Brown ◽  
John R. Hurst
Keyword(s):  
Cardiovascular Risk ◽  
Systemic Inflammation ◽  
Aortic Stiffness ◽  
Demographic Data ◽  
Elevated Serum ◽  
Severity Index ◽  
Forced Expiratory Volume ◽  
Cardiac Biomarkers ◽  
Exacerbation Frequency ◽  
Increased Risk

Patients with bronchiectasis are at increased risk of cardiovascular disease. We aimed to identify factors associated with elevated cardiovascular risk in bronchiectasis, measured using aortic stiffness and cardiac biomarkers. In addition, we sought to compare these direct measures against calculated QRISK2 scores.Aortic stiffness, cardiac biomarkers and systemic inflammation were measured in 101 adults with stable bronchiectasis. In addition, clinical and demographic data were collected to allow calculation of QRISK2 score and the bronchiectasis severity index (BSI) for each patient.The BSI score correlated with measured cardiovascular risk assessments, partly due to greater exacerbation frequency and lower forced expiratory volume in 1 s. Pulse-wave velocity was significantly higher in frequent exacerbators (≥3 events·year-1) than infrequent exacerbators (<3 events·year-1; 10.5 versus 9.2 m·s−1, p=0.01). In addition, frequent exacerbators had elevated serum C-reactive protein concentration, suggesting increased systemic inflammation (4.8 versus 2.2 mg·L−1, p=0.005). QRISK2 systematically underestimated cardiovascular risk in this population (median change in relative risk 1.29). Underestimation was associated with frequent exacerbations and male sex.Patients with bronchiectasis have greater cardiovascular risk than published reference populations. Excess cardiovascular risk is associated with exacerbation frequency and impaired lung function. Cardiovascular risk assessment in bronchiectasis should be individualised, as calculation tools are likely to underestimate the risk in this population.

scholarly journals The Role of Chemokines in Psoriasis—An Overview

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 754
Author(s):  
Natalia Zdanowska ◽  
Marta Kasprowicz-Furmańczyk ◽  
Waldemar Placek ◽  
Agnieszka Owczarczyk-Saczonek
Keyword(s):  
Psoriatic Arthritis ◽  
T Lymphocytes ◽  
Adhesion Molecules ◽  
Disease Severity ◽  
Biological Markers ◽  
Inflammatory Process ◽  
Systemic Treatment ◽  
Therapeutic Targets ◽  
Disease Process

By participating in both the recruitment and activation of T lymphocytes, macrophages and neutrophils at the site of psoriatic inflammation, chemokines play an important role in the pathogenesis of psoriasis and, crucially, may be one indicator of the response to the systemic treatment of the disease. As a result of their major involvement in both physiological and pathological processes, both chemokines and their receptors have been identified as possible therapeutic targets. Due to their presence in the inflammatory process, they play a role in the pathogenesis of diseases that often coexist with psoriasis, such as atherosclerosis and psoriatic arthritis. Chemokines, cytokines and adhesion molecules may be biological markers of disease severity in psoriasis. However, the mechanism of inflammation in psoriasis is too complex to select only one marker to monitor the disease process and improvement after treatment. The aim of this review was to summarize previous reports on the role of chemokines in the pathogenesis of psoriasis, its treatment and comorbidities.

Sign in / Sign up

Export Citation Format

Share Document