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Chandran V.,University of Toronto | Chandran V.,Center for Prognosis Studies in the Rheumatic Diseases
Clinical Reviews in Allergy and Immunology | Year: 2013

Genetic epidemiological studies have demonstrated a significant genetic basis to both psoriasis and psoriatic arthritis (PsA). Although candidate gene association studies had identified genes for disease susceptibility, recent genome-wide association studies have demonstrated robust associations both within and outside the major histocompatibility region on chromosome 6p. The susceptibility genes identified include HLA-C, IL13, IL4, TNFAIP3, IL23A, IL23R, IL28RA, REL, IFIH1, ERAP, TRAF3IP2, NFKBIA, TYK2, ZNF313, NOS2, FBXL19 and NFKBIA in subjects of European ethnicity and HLA-C, IL12B, LCE3D, ERAP1, TNIP1, PTTG1, CSMD1, GJB2, SERPINB8 and ZNF816A in subjects of Chinese ethnicity. These associations provide us with a model for the pathogenesis of psoriasis involving skin barrier function, innate and adaptive immunity. Gene-gene and gene-environmental interaction effects have also been demonstrated. However, loci identified to date do not fully account for the high heritability of psoriasis and PsA, and therefore many genetic as well as environmental factors and interaction effects remain to be determined. This article reviews the current status of genetic studies in psoriasis and PsA. © 2012 Springer Science+Business Media, LLC. Source

Garg A.,Boston University | Gladman D.,Center for Prognosis Studies in the Rheumatic Diseases
Journal of the American Academy of Dermatology | Year: 2010

Dermatologists care for patients with psoriasis in whom there exists an inherent risk of psoriatic arthritis, a condition with potential for causing joint damage and subsequent disability. Most patients have psoriasis for years before the development of psoriatic arthritis, and there may be a significant proportion of psoriasis patients with joint involvement that are cared for by the dermatologist. With the absence of a diagnostic measure, the criterion standard for recognizing or monitoring psoriatic arthritis remains the clinical assessment. Recognition of psoriatic arthritis in the psoriasis patient - and the dermatologist's ability to differentiate it from other types of arthritis - provide an opportunity to improve patient outcomes through early recognition and facilitation of intervention in collaboration with a rheumatologist. Learning objectives: After completing this learning activity, participants should be able to recognize the presence of psoriatic arthritis among patients with psoriasis; distinguish psoriatic arthritis from reactive arthritis, osteoarthritis, gout, rheumatoid arthritis, and ankylosing spondylitis; and use appropriate laboratory and imaging tests in the evaluation of patients with psoriasis and musculoskeletal complaints. © 2009 by the American Academy of Dermatology, Inc. Source

Steiman A.J.,University of Toronto | Gladman D.D.,University of Toronto | Ibanez D.,Center for Prognosis Studies in the Rheumatic Diseases | Urowitz M.B.,University of Toronto
Arthritis Care and Research | Year: 2012

Objective. Serologically active clinically quiescent (SACQ) systemic lupus erythematosus (SLE) patients' discordance presents a clinical dilemma. Does active serology alone warrant treatment? We explore outcomes in patients with and without a prolonged SACQ period, comparing the rate of damage accrual by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and incidences of renal damage and coronary artery disease (CAD) over a decade. Methods. SACQ was defined as a ≥2-year sustained period without clinical activity, with persistent serologic activity (increased anti-double-stranded DNA and/or hypocomplementemia). Antimalarials were permissible and corticosteroids/immunosuppressives were not. The SACQ patients were matched for relevant variables with SLE controls. Change in the SDI and incidences of CAD and renal damage were compared. Descriptive statistics were used; comparisons were made using t-tests and McNemar's tests. Results. Fifty-five SACQ patients and 110 controls were identified. The mean ± SD SDI score at 3 years from the start of the SACQ period was 0.70 ± 1.27 in the SACQ patients versus 1.13 ± 1.54 in controls (P < 0.0001), and by 10 years was 1.26 ± 1.68 versus 2.26 ± 2.23 (P = 0.001); the intergroup difference in damage significantly increased over 10 years. Initially, 2 (3.6%) of the SACQ patients had CAD versus 7 (6.4%) of the controls (P = 0.32), with 1 (1.8%) new case in SACQ patients versus 8 (7.3%) new cases in controls over 10 years (P = 0.06). Baseline serum creatinine level did not differ between the groups. By definition, the SACQ patients had no baseline proteinuria versus 13 (12.3%) of the controls (P < 0.0001). By year 10, 2 (3.6%) SACQ patients versus 26 (23.6%) controls had renal damage (P < 0.0001). Conclusion. Patients with a prolonged SACQ period accrued less damage over a decade compared to matched controls, supporting management with active surveillance without treatment during an SACQ period. © 2012, American College of Rheumatology. Source

Eder L.,Center for Prognosis Studies in the Rheumatic Diseases | Tillett W.,Royal National Hospital for Rheumatic Diseases | Ritchlin C.T.,University of Rochester
Journal of Rheumatology | Year: 2015

The seventh trainees symposium was held at the 2014 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in New York, New York, USA. A total of 26 rheumatology and dermatology trainees engaged in psoriasis or psoriatic arthritis research presented their work to meeting attendees. This article briefly reviews the 4 oral presentations and 22 posters presented at the meeting. Copyright © 2015. All rights reserved. Source

Gladman D.D.,University of Toronto | Gladman D.D.,Center for Prognosis Studies in the Rheumatic Diseases | Ziouzina O.,University of Calgary | Thavaneswaran A.,University of Western Ontario | Chandran V.,Center for Prognosis Studies in the Rheumatic Diseases
Journal of Rheumatology | Year: 2013

Objective. To determine the prevalence of acute dactylitis in patients with psoriatic arthritis (PsA) and to compare the response of new acute dactylitis to treatment with traditional disease-modifying antirheumatic drug (DMARD) and anti-tumor necrosis factor-α (anti-TNF) agents in a longitudinal PsA cohort. Methods. Patients with PsA followed at 6 months according to a standard protocol from January 2000 to January 2010 were included in our study. Acute dactylitis was defined as the presence of painful swelling of an entire digit. Response was defined as either complete resolution of dactylitis or > 50% improvement in the number of dactylitic digits. A multivariate generalized estimating equations analysis using a negative binomial model to account for repeated measures was conducted to determine predictors for response to treatment of dactylitis. Results. Of the 752 patients seen in the clinic during this period, 294 had dactylitis in at least 1 visit, giving a prevalence of 39%. Patients with acute dactylitis and data available for response at 6 and 12 months (n = 252; 34% women, mean age 47 yrs, PsA duration 11 yrs) were included in the study on predictors of response to treatment. Multivariate analysis showed that treatment with anti-TNF agents was a significant predictor of improvement in dactylitis at 12 months (relative risk 0.528, 95% CI 0.283-0.985, p = 0.045). Conclusion. The prevalence of dactylitis on at least 1 visit was 39%. Treatment was associated with improvement of dactylitis. Patients treated with biologics had better response to treatment compared with those treated with nonbiologic DMARD alone. Copyright © The Journal of Rheumatology 2013. Source

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