New Developments in Psoriatic Disease Research

Musculoskeletal Ultrasound Increases Specificity for Diagnosing Psoriatic Arthritis

According to a study published in Rheumatology, musculoskeletal ultrasound (MSUS) used by dermatologists as a screening instrument for psoriatic arthritis (PsA) leads to a more precise diagnosis and fewer referrals to rheumatologists.

Researchers evaluated the value of MSUS use by dermatologists previously trained on a novel handheld, chip-based ultrasound device to screen for early PsA in a prospective doubleblind study. A total of 12 dermatologists participated in the study. Between October 1, 2020, and May 26, 2021, a total of 140 patients with arthralgia were screened based on medical history, clinical examination, and the GEPARD questionnaire paired with an MSUS examination of up to 3 painful joints and then referred to rheumatologists who determined the final diagnosis. MSUS screening effect was assessed according to the sensitivity and specificity before and after application.

PsA was diagnosed in 13.6% of the participants. Before applying MSUS, dermatologists’ screening sensitivity was 88.2% and specificity was 54.4%. After applying MSUS, the sensitivity was 70.6% and specifi city was 90.4%. PsA was no longer suspected in 45 cases. “This study was able to demonstrate that PsA screening using MSUS by previously trained dermatologists can lead to more precise PsA detection and potentially decreased rheumatologist referral rates,” concluded the study authors.

Reference
Grobelski J, Wilsmann-Theis D, Karakostas P, Behning C, Brossart P, Schäfer VS. Prospective double-blind study on the value of musculoskeletal ultrasound by dermatologists as a screening instrument for psoriatic arthritis. Rheumatology (Oxford). Published online December 20, 2022. doi:10.1093/rheumatology/keac702

Deep Learning Model Discriminates Between Scalp Psoriasis and Seborrheic Dermatitis

A new deep learning-based approach shows promising results in differentiating between scalp psoriasis and seborrheic dermatitis from dermoscopic images, according to a study published in Frontiers in Medicine.

Researchers aimed to develop a deep learning approach for differentiating scalp psoriasis and seborrheic dermatitis from dermoscopic images that would achieve a higher accuracy than dermatologists trained with dermoscopy. A total of 617 patients with pathologic and diagnostic confirmed skin diseases were used to collect 1358 pictures. The pictures were randomly divided into training, validation, and testing datasets in the study.

The deep learning model showed 96.1% sensitivity, 88.2% specificity, and 0.922% area under curve. It outperformed all dermatologists in diagnosing scalp psoriasis and seborrheic dermatitis. It also helped a dermatology graduate study and general practitioners improve their diagnostic performance.

“The developed [deep learning] model has favorable performance in discriminating 2 skin diseases and can improve the diagnosis, clinical decision-making, and treatment of dermatologists in primary hospitals,” concluded the study authors.

Reference
Yu Z, Kaizhi S, Jianwen H, Guanyu Y, Yonggang W. A deep learning-based approach toward differentiating scalp psoriasis and seborrheic dermatitis from dermoscopic images. Front Med (Lausanne). Published online November 3, 2022. doi:10.3389/ fmed.2022.965423

Increased Pregnancy Complication Risk in Women With PsA and Ankylosing Spondylitis

According to a study published in BMC Pregnancy Childbirth, women with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) who are pregnant typically have normal pregnancies, but are at a higher risk for premature birth, oligohydramnios, and caesarean delivery.

Researchers aimed to evaluate maternal IL-17A and disease activity impact on pregnancy outcomes in women with PsA and AS in a prospective cohort research study. A total of 48 pregnant women with PsA and AS and 30 healthy pregnant women attending the inpatient and outpatient clinics of the rheumatology and rehabilitation and obstetrics and gynecology departments at Zagazig University Hospitals in Egypt between January 1, 2018, and December 31, 2019, were included in the study.

Women with PsA and AS had a higher risk of preterm labor (32 to 36 weeks’ gestation) (aRR [absolute risk reduction] 1.80; 95% CI: 0.79–4.17), oligohydramnios (aRR 3.15; 95% CI: 1.26–8.42), caesarean delivery (aRR 1.57; 95% CI: 1.41–2.68), and delivering infants small for gestational age (aRR 7.04; 95% CI: 2.36–12.42). The level of IL-17A between the 2 groups was significantly different.

“In conclusion, the majority of [women] with PsA and AS had an uneventful pregnancy with regard to deleterious effects; however, in comparison to normal pregnancies with high levels of IL-17A in [the third] trimester, we found an elevated risk of premature birth, oligohydramnios, and caesarean delivery,” wrote the study authors.

Reference
Girbash EF, Abdelwahab SM, Atef RM, et al. Maternal interleukin-17 and disease activity influence pregnancy outcomes in women with psoriatic arthritis and ankylosing spondylitis. BMC Pregnancy Childbirth. 2023;23(1):35. doi:10.1186/ s12884-023-05364-4

Patients With Psoriasis at Risk for Advanced Liver Fibrosis

A recent systematic review and meta-analysis published in Frontiers in Medicine showed that patients with psoriasis have a high prevalence of advanced liver fibrosis and present the need for liver fibrosis screening.

Researchers performed a systematic review and meta-analysis to determine liver fibrosis prevalence and risk factors for developing liver fibrosis in patients with psoriasis. Searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from their inception until May 2022. Observational studies that described liver fibrosis prevalence and/or risk factors in patients with psoriasis were included in the review.

The pooled prevalence in patients with psoriasis at high risk for advanced liver fibrosis was 9.66% [95% CI: 6.92–12.75%; I2 = 76.34%] and at low risk, 77.79% (95% CI: 73.23–82.05%; I2 = 85.72%). The prevalence of advanced liver fibrosis in methotrexate-naïve patients was 4.44 (95% CI: 1.17–9.22%; I2 = 59.34%) compared with 12.25 (95% CI: 6.02–20.08%; I2 = 82.34%) for methotrexate-user patients. The pooled odds ratio for age > 50 years was 2.20 (95% CI: 1.42–3.40; I2 = 0%); body mass index > 30, 3.67 (95% CI: 2.37–5.68; I2 = 48.8%); diabetes mellitus, 6.23 (95% CI: 4.39–8.84; I2 = 42.4%); hypertension, 2.82 (95% CI: 1.68–4.74; I2 = 0%); dyslipidemia, 3.08 (95% CI: 1.90–4.98, I2 = 0%); and metabolic syndrome, 5.98 (95% CI: 3.63–9.83; I2 = 17%).

“Approximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk,” concluded the study authors. “Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring,” they added.

Reference
Yongpisarn T, Namasondhi A, Iamsumang W, Rattanakaemakorn P, Suchonwanit P. Liver fi brosis prevalence and risk factors in patients with psoriasis: a systematic review and meta-analysis. Front Med (Lausanne). Published online December 15, 2022. doi:10.3389/fmed.2022.1068157