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Eder L.,Womens College Hospital | Abji F.,Center for Prognosis Studies in the Rheumatic Diseases | Rosen C.F.,University of Waterloo | Chandran V.,Womens College Hospital | And 2 more authors.
Journal of Rheumatology | Year: 2016

Objective. To investigate the association between HLA susceptibility and disease severity markers and the extent of atherosclerosis in patients with psoriatic disease. Methods.White patients with psoriatic arthritis (PsA) and psoriasis without PsA (PsC) were recruited. An ultrasound of the carotid arteries was performed and the size of each atherosclerotic plaque was measured. The resulting score, the total plaque area (TPA), represented the extent of atherosclerosis. HLA genotyping was performed using sequence-specific oligonucleotide probes. The association between 10 HLA susceptibility and severity markers of PsC and PsA and the severity of atherosclerosis was assessed by ordinal logistic regression models adjusted for age, sex, and cardiovascular (CV) risk factors. Results. The study involved 411 patients (273 PsA, 138 PsC). Of them, 61.8% had at least 1 atherosclerotic plaque. HLA-B-13:02 and HLA-C-06:02 were associated with more severe atherosclerosis (age-and sex-Adjusted OR 2.31, 95% CI 1.23-4.32 and OR 1.68, 95% CI 1.12-2.52, respectively). HLA-B-38:01 was associated with less severe atherosclerosis (OR 0.49, 95% CI 0.28-0.86). These associations remained statistically significant after adjusting for CV risk factors. Higher levels of erythrocyte sedimentation rate (ESR) were associated with more severe atherosclerosis (age-and sex-Adjusted OR 1.33, p = 0.02). HLA-B-13:02-positive (p = 0.01) as well as HLA-C-06:02-positive (p = 0.008) patients had higher levels of ESR over time. Conclusion. HLA-C∗06:02 and B∗13:02 alleles are associated with a higher burden of atherosclerosis in patients with psoriatic disease. This association may be mediated by a higher level of systemic inflammation. © Copyright 2016. All rights reserved.


Gladman D.D.,University of Toronto | Gladman D.D.,Western Research Institute | Gladman D.D.,Center for Prognosis Studies in the Rheumatic Diseases | Gladman D.D.,University of Western Ontario
Journal of Rheumatology | Year: 2012

Major advances have taken place in the study of psoriatic arthritis (PsA) in the past several decades. Future trends in research will likely be based on these advances and will span a wide spectrum of activities including further refinement of disease definition and particularly disease pattern. More precise definitions for axial and peripheral disease and in particular arthritis mutilans will be necessary for further genetic and biomarker studies. Early definition of PsA is crucial. Future research will concentrate on identifying genetic and other biomarkers for early diagnosis, disease expression, disease progression, and comorbidities. Newer therapies will be developed as well. The Journal of Rheumatology Copyright © 2012. All rights reserved.


Ding J.Y.C.,University of Toronto | Ding J.Y.C.,Hoffmann-La Roche | Ding J.Y.C.,University of Toronto | Ibanez D.,University of Toronto | And 5 more authors.
Journal of Rheumatology | Year: 2015

Objective. To identify patients presenting with isolated hematuria and/or pyuria in the absence of other systemic lupus erythematosus (SLE) disease activity, describe their demographics, and determine whether they present with evidence of SLE flare in a period adjacent to the presentation. Methods. We studied patients followed at the University of Toronto Lupus Clinic between 1970 and 2012. An episode of isolated hematuria (> 5 red blood cells per high power field) and/or pyuria (> 5 white blood cells per high power field) was defined as 2 consecutive visits with these findings in the absence of other concurrent SLE manifestations such as proteinuria, casts, or azotemia. We then excluded patients whose findings might be explained by urinary tract infections, menstruation, urolithiasis, and/or anticoagulation. Only patients presenting with no other SLE disease activity were included. Results. Isolated hematuria and/or pyuria were identified in 49 patients, of whom 17 were excluded according to the criteria above, leaving 32. Twenty-four patients had another renal manifestation 1 year before and/or after the occurrence; 27 had a non-renal manifestation 1 year before and/or after the occurrence; 3 patients had a biopsy in the same time frame, all with evidence of active lupus nephritis. Therefore the majority of patients with an occurrence of isolated hematuria and/or pyuria had evidence of renal or other non-renal SLE disease activity at a time adjacent to this presentation. Conclusion. Although not proven, our results suggest that these manifestations were associated with SLE activity, either before or after the episode, and therefore may represent a phase of active disease. The Journal of Rheumatology Copyright © 2015. All rights reserved.

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