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Autoři uvádí případ 74leté ženy se změnami nehtů rukou i nohou trvajícími 30 let. Histopatologické vyšetření prokázalo psoriázu nehtů. Diskutována je problematika izolovaného postižení nehtů, diferenciální diagnózy, hodnocení závažnosti postižení nehtů, souvislost s psoriatickou artritidou, a současné možnosti léčby.

The authors present the case of a 74-year-old woman with changes in her fingernails and toenails lasting 30 years. Histopathological examination showed nail psoriasis. The issue of isolated nail involvement, differential diagnosis, evaluation of the severity of nail involvement, context with psoriatic arthritis, and current treatment options are discussed.

MeSH
kvalita života MeSH
lidé MeSH
nemoci nehtů * diagnóza farmakoterapie MeSH
psoriatická artritida MeSH
psoriáza * diagnóza farmakoterapie komplikace MeSH
senioři MeSH
Check Tag
lidé MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
kazuistiky MeSH

Článek

Comparing DAPSA, DAPSA28, and DAS28-CRP in Patients With Psoriatic Arthritis Initiating a First Tumor Necrosis Factor Inhibitor Across Nine European Countries

Arthritis care & research. 2024 ; 76 (11) : 1558-1565. [pub] 20240819

Arthritis Care Res (Hoboken)
ISSN 2151-4658
Medvik
Zdroj

OBJECTIVE: Because 66/68 joint counts are not always performed in routine care, we aimed to determine which of the modified 28-joint disease activity index for psoriatic arthritis (DAPSA28) or 28-joint disease activity score with C-reactive protein (DAS28-CRP) should be preferred for monitoring disease activity in psoriatic arthritis (PsA) when the original DAPSA (66/68 joints) is not available. METHODS: Prospectively collected real-world data of European bionaive patients with PsA initiating a first tumor necrosis factor inhibitor were pooled. Remission and response status were evaluated at 6 months by remission (DAPSA ≤ 4, DAPSA28 ≤ 4, and DAS28-CRP < 2.6), response (75% improvement for DAPSA and DAPSA28), and combined EULAR good/moderate responses for DAS28-CRP. Logistic regression analyses on multiple imputed data were used to identify baseline predictors. RESULTS: Remission and response cohorts included 3,159 and 1,866 patients, respectively. The 6-month proportions achieving remission/response were DAPSA (27%/44%), DAPSA28 (28%/44%), and DAS28-CRP (59%/80%). Of 14 possible baseline predictors, 11 predicted both DAPSA and DAPSA28 remission (8 of which also predicted their response, indicated by "*"): longer disease duration*, male sex*, and higher CRP* were positive, whereas older age*, higher body mass index*, patient fatigue*, and global, physician global, health assessment questionnaire score*, and tender and swollen* joint counts were negative predictors. Eight and five of these predicted DAS28-CRP remission and response, respectively. CONCLUSION: In patients with PsA, DAPSA28 should be preferred over DAS28-CRP as a substitute for DAPSA when 66/68 joint counts are not available because of the large overlap in remission and response status and in predictors between DAPSA and DAPSA28.

MeSH
antirevmatika terapeutické užití MeSH
biologické markery krev MeSH
C-reaktivní protein * analýza MeSH
dospělí MeSH
indukce remise * MeSH
inhibitory TNF terapeutické užití MeSH
lidé středního věku MeSH
lidé MeSH
prospektivní studie MeSH
psoriatická artritida * farmakoterapie krev MeSH
senioři MeSH
stupeň závažnosti nemoci * MeSH
TNF-alfa antagonisté a inhibitory MeSH
výsledek terapie MeSH
Check Tag
dospělí MeSH
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
multicentrická studie MeSH
srovnávací studie MeSH
Geografické názvy
Evropa MeSH

Článek

Bimekizumab - účinná moderní léčba psoriázy

Rob, Filip
Autor Autorita Dermatovenerologická klinika 2. LF UK a FN Bulovka, Praha

Svět praktické medicíny. 2024 ; 2024 (2) : 39-43.

ISSN 2694-8516
Medvik
Zdroj

Článek

Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis

Annals of the rheumatic diseases. 2024 ; 83 (8) : 1060-1071. [pub] 20240715

Ann Rheum Dis
ISSN 1468-2060
Medvik
Zdroj

OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.