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Simple clinical indicators for early psoriatic arthritis detection. Caso Francesco,Costa Luisa,Atteno Mariangela,Del Puente Antonio,Cantarini Luca,Lubrano Ennio,Scarpa Raffaele SpringerPlus BACKGROUND:Diagnosis of psoriatic arthritis (PsA), in a period of 12 months from the onset of the first articular episode, permits of identifying the early form defined as "early PsA". The recognition of the disease in this phase leads to better outcome. The aim of this study was to identify peculiar clinical and/or laboratory findings that could be useful for the diagnosis of "early PsA". FINDINGS:Thirty-five patients with early onset of arthritis were observed. The following data were collected for each patient: family and personal history, physical examination, tender and swollen joint counts (TJC, SJC), tender entheseal count, presence of dactylitis and low back pain (LBP), and laboratory tests. Among the 35 total patients, 24 showed skin and/or nail psoriasis or a family history of psoriasis. The remaining 11 patients showed absence of concomitant or previous psoriasis and/or familiarity for psoriasis. The comparison between the two groups showed that patients with psoriasis had a significant presence of LBP, dactylitis and enthesitis than patients with psoriasis. CONCLUSIONS:The study confirms that the distinctive clinical findings of PsA is psoriasis, but also LBP, dactylitis and enthesitis have a relevant role in early identification. A low number of SJC and TJC are frequently observed in early phases of PsA than in other forms of early arthritis. These aspects could be mostly helpful when psoriasis is not detected or can follow arthritis in absence of familiar positivity, making difficult PsA diagnosis. In conclusion, careful medical history, clinical examination and first-level laboratory investigations are useful to characterize early phases of PsA. 10.1186/2193-1801-3-759
Clinical Features and Diagnostic Considerations in Psoriatic Arthritis. Gladman Dafna D Rheumatic diseases clinics of North America Psoriatic arthritis is an inflammatory musculoskeletal disease affecting almost a third of patients with psoriasis. Clinical presentations are complex and varied and include peripheral arthritis, axial disease, dactylitis, and enthesitis, as well as skin and nail manifestations. We lack diagnostic biomarkers, but specific clinical and imaging features distinguish psoriatic arthritis from other forms of arthritis such as rheumatoid arthritis, gout, osteoarthritis, and other forms of spondyloarthritis. 10.1016/j.rdc.2015.07.003
Synovial Fluid and Serum Concentrations of Inflammatory Markers in Rheumatoid Arthritis, Psoriatic Arthritis and Osteoarthitis: A Systematic Review. Altobelli Emma,Angeletti Paolo Matteo,Piccolo Domenico,De Angelis Rossella Current rheumatology reviews BACKGROUND:The aim of this review is to investigate systematically the presence of the most extensively studied Synovial Fluid (SF) and/or serum markers in patients with Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Osteoarthritis (OA), and their associations and correlations with laboratory and clinical data, with a view to providing insights for future research. OBJECTIVE:Papers were selected using the PRISMA flow-chart. Search of the electronic databases according to the above criteria found a total of 55 papers. Examination led to the exclusion of 39 papers. Finally, 16 studies met the inclusion criteria and are reviewed. As regards to interleukins we found: Higher TNF-α levels in patients with early RA and PsA than in those with osteoarthritis (p<0.05); higher IL-6 levels in patients with inflammatory arthritis (RA and PsA) than in those with OA (p=0.032) and higher IL-17 levels in SF from PsA patients than RA patients (p=0.04) and a significant difference in serum levels between PsA patients and healthy controls (p=0.013) and higher IL-22 SF levels in PsA than OA patients (p<0.001) and in RA compared with OA patients (p<0.01). As regards chemokine, CCL-22 was higher in SF from RA and PsA patients than in OA patients (p<0.01). METHOD:Considering the sample size of the studies reviewed here, their findings need confirmation in larger samples, while the potential prognostic value of SF and/or serum biomarkers requires prospective investigation. CONCLUSION:The limitations of the biological SF assays and the problems encountered in the attempted use of cytokine assays for diagnostic purposes must be addressed. 10.2174/1573397113666170427125918