Hagit Matz

Prevalence of TNF-α Blocker Immunogenicity in Psoriatic Arthritis

Objective. The longterm use of tumor necrosis factor (TNF)-α blockers is limited by the formation of neutralizing antibodies. To the best of our knowledge, immunogenicity in psoriatic arthritis (PsA) has not been investigated in depth. Our objective was to evaluate the prevalence and significance of TNF-α blocker immunogenicity in PsA. Methods. Consecutive patients with PsA treated with either infliximab (IFX), adalimumab (ADA), or etanercept (ETN) > 3 months participated in our cross-sectional study. Their demographic and clinical characteristics, skin and joint disease activity, and records of use of methotrexate (MTX) and other medications were collected. Drug levels (ELISA) and antidrug antibodies (ADAb; Bridging ELISA) were evaluated before the next injection or infusion. Results. A total of 93 patients with PsA were recruited (48 receiving ADA, 24 IFX, and 21 ETN), with a mean age of 53 years (range 21–83 yrs), composed of 53% women. One-fourth of the patients were concomitantly treated with MTX. Altogether, 77% of the patients demonstrated therapeutic drug levels. High levels of ADAb were found in 29% of patients taking ADA, 21% taking IFX, and 0% taking ETN. ADAb significantly correlated with lower drug levels, higher 28-joint Disease Activity Scores, and higher global assessments. MTX use correlated significantly with a lower prevalence of ADAb. Conclusion. Significant levels of ADAb were present in up to 29% of patients with PsA treated with ADA or IFX. ADAb clearly correlated with low therapeutic drug levels and higher disease activity variables. The use of MTX significantly decreased ADAb prevalence, and its use should be strongly considered in combination with TNF-α blocker antibodies in patients with PsA.

Computerized system to enhance the clinical diagnosis of pigmented cutaneous malignancies

Background  An increase in the incidence of cutaneous malignant melanoma in recent years has not been accompanied by satisfactory progress in diagnostic methods. This study was carried out to evaluate a specially designed computerized image analysis system, called Derma Vision, to aid in the differentiation between malignant and benign cutaneous pigmented lesions.

The Effect of the Presence of Fibromyalgia on Common Clinical Disease Activity Indices in Patients with Psoriatic Arthritis: A Cross-sectional Study

Objective. To study the effect of the presence of fibromyalgia (FM) on common clinical disease activity indices in patients with psoriatic arthritis (PsA). Methods. Seventy-three consecutive outpatients with PsA (mean age 51.7 yrs; 42 females, 57.5%) were enrolled in a prospective cross-sectional study. FM was determined according to American College of Rheumatism criteria (2010 and 1990). All patients underwent clinical evaluation of disease activity and completed the Health Assessment Questionnaire (HAQ), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Dermatology Life Quality Index, and the Leeds Enthesitis Index (LEI). Disease activity was evaluated using the Composite Psoriatic Disease Activity Index (CPDAI), minimal disease activity (MDA), and the Disease Activity Index for Psoriatic Arthritis (DAPSA) scores. Results. The overall prevalence of FM was 17.8% (13 patients), and all but 1 were women (12 patients, 92.3%, p = 0.005). CPDAI and DAPSA scores were significantly higher in patients with coexisting PsA and FM (9.23 ± 1.92 and 27.53 ± 19.23, respectively) than in patients with PsA only (4.25 ± 3.14 and 12.82 ± 12.71, respectively; p < 0.001 and p = 0.003). None of the patients with FM + PsA met the criteria for MDA, whereas 26 PsA-only patients did (43.3%, p = 0.003). HAQ, BASDAI, and LEI scores were significantly worse in patients with PsA and associated FM. Conclusion. Coexisting FM is related to worse scores on all tested measures in patients with PsA. Its influence should be taken into consideration in the treatment algorithm to avoid unnecessary upgrading of treatment.

Phototherapy for psoriasis: what to choose and how to use: facts and controversies

In dermatologic practice, phototherapy is restricted mainly to the use of ultraviolet radiation. When used in combination with a photosensitizing chemical, it becomes photochemotherapy. Discussion of these therapeutic modalities includes mode of use, indications, and unwanted effects.

Normal levels and function of endothelial progenitor cells in patients with psoriatic arthritis

Endothelial progenitor cells (EPCs) are a population of bone marrow derived cells which have been attributed with the ability to migrate into areas of tissue ischemia and to posses reparative qualities. EPCs have been shown to be decreased in level and function in various inflammatory disorders. Psoriasis and psoriatic arthritis are associated with an increase in cardiovascular morbidity. The aim of the study was to investigate the number of EPCs among patients suffering from psoriasis and psoriatic arthritis. Patients suffering from active psoriasis and psoriatic arthritis were recruited as well as healthy controls. Disease activity was assessed with the DAS-28, BASDAI and PASI scores. Peripheral blood mononuclear cells were isolated and EPC numbers evaluated by FACS analysis using the CD34/133 and CD34/KDR. No significant difference was found between numbers of EPCs between healthy controls, patients with psoriasis and psoriatic arthritis. A significant correlation was found between levels of VGEF and the BASDAI score. The results of the current study do not support a significant role for EPCs in the pathogenesis of psoriasis and psoriatic arthritis.

IGFBP7 as a potential therapeutic target in Psoriasis.

A letter to the editor is presented regarding the potential therapeutic use of insulin-like growth factor-binding protein 7 (IGFBP7) in psoriasis.

Bilharziasis cutanea tarda: a rare presentation of schistosomiasis.

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NB-UVB phototherapy for generalized granuloma annulare.

Granuloma annulare (GA) is a benign, usually self‐limited, granulomatous skin disease of unknown etiology. The generalized form of the disease shows a more chronic, relapsing course, rare spontaneous resolution, and poorer response to therapy. Psoralen plus UVA phototherapy has been reported to be effective for GA. However, little is known regarding the efficacy of narrowband UVB phototherapy. Our goal was to determine the efficacy of NB‐UVB phototherapy in generalized GA. We carried out a retrospective study of patients with generalized GA treated with NB‐UVB phototherapy over a period of 3 years. On completion of treatment, outcome was assessed as complete response (complete clearance of the lesions), partial response (>50% clearance of the lesions), and poor response (<50% clinical response). Therapy was stopped if no improvement was seen after 20 treatments. Thirteen patients were included in the study. 54% of patients treated with NB‐UVB had a complete/partial response by the end of the treatment period. NB‐UVB phototherapy was well‐tolerated, with no serious adverse effects. NB‐UVB phototherapy is effective in a substantial portion of patients with generalized GA. To determine the true efficacy of this therapeutic modality, a prospective study comparing it to PUVA is warranted.

“More is missed by not looking than by not knowing”[Thomas McCrae, 1870–1935]

Case 1  A 19‐year‐old woman presented with a black crust on one part of the tattoo on her right leg ( Fig. 1 ) which appeared after laser‐assisted hair removal by an alexandrite laser (755 nm).

Tumbu larvae do not have abdominal hooklets and can be easily extracted

A 31-year-old male presented with five inflamed, painful, erythematous nodules on his left chest (two lesions) (Fig. 1), the left belt area, left forearm, and right leg. The patient is an Israeli, who has been residing and working for the past year in Angola. He reported feeling something stirring under the site of the lesions. The diagnosis was clearcut as the patient brought with him the corpus delicti (two larvae that had spontaneously emerged alive and wriggling from the lesions of his leg and arm) with him. He reported that he usually hangs his washed clothes on a line outdoors and does not iron them routinely before he puts them on, so the source of infection was obvious as well. We extracted three additional larvae by simply squeezing the skin surrounding them out after applying a local anesthesia, in a similar way one would treat a giant comedo (Fig. 2). The extracted larvae (Fig. 3) were identified as Cordylobia anthropophaga.