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Dafna D. Gladman - One of the best experts on this subject based on the ideXlab platform.
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Oxford textbook of Psoriatic Arthritis.
2019Co-Authors: O. Fitzgerald, Dafna D. GladmanAbstract:Oxford textbook of Psoriatic Arthritis. , Oxford textbook of Psoriatic Arthritis. , فهرست آنلاین کتابخانه های دانشگاه علوم پزشکی و خدمات بهداشتی درمانی مشهد
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Historical Perspectives on Psoriatic Arthritis
Psoriatic Arthritis and Psoriasis, 2016Co-Authors: Dafna D. GladmanAbstract:Psoriatic Arthritis is defined as an inflammatory musculoskeletal disease associated with psoriasis. First described in the nineteenth century, it was recognized as a unique entity in 1964, following detailed descriptions of the condition by Wright and Moll. Over that past several decades advances in the recognition, prognosis and outcome of Psoriatic Arthritis have been made, as well as therapeutic interventions which have improved the lives of individuals with this condition.
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Early Psoriatic Arthritis.
Rheumatic diseases clinics of North America, 2012Co-Authors: Dafna D. GladmanAbstract:Psoriatic Arthritis is an inflammatory musculoskeletal disease associated with psoriasis that is usually seronegative for rheumatoid factor. Psoriatic Arthritis affects men and women equally, usually during the fourth decade, although it may affect children and octogenarians. Psoriatic Arthritis may lead to deformities, joint damage, reduced quality of life and function. Early detection and treatment may prevent untoward outcomes.
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Etanercept for Psoriatic Arthritis
BMJ (Clinical research ed.), 2010Co-Authors: Dafna D. GladmanAbstract:Patients who do not respond to standard doses are unlikely to benefit from a higher one In the linked randomised controlled trial (doi:10.1136/bmj.c147) Sterry and colleagues compared the effectiveness of two different etanercept regimens (50 mg once a week or twice a week) in treating the skin manifestations of psoriasis in people who also had Psoriatic Arthritis over 12 weeks.1 Psoriatic Arthritis is an inflammatory Arthritis that affects about 30% of patients with psoriasis. Over the past few decades it has become clear that the disease is more common and more severe than previously thought. Studies in the 1940s indicated that the frequency of Psoriatic Arthritis in patients with psoriasis was 7%, but more recent studies suggest a frequency of 30%.2 Psoriatic Arthritis may cause joint destruction, disability, and reduced quality of life. Patients with the disease have more disability and a worse quality of life than those with psoriasis alone.3 Although disease modifying antirheumatic drugs have been used to treat Psoriatic Arthritis, they have not altered the disease course or prevented the progression of joint damage.4 Since the advent …
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Recognizing Psoriatic Arthritis in the dermatology clinic
Journal of the American Academy of Dermatology, 2010Co-Authors: Amit Garg, Dafna D. GladmanAbstract:Dermatologists care for patients with psoriasis in whom there exists an inherent risk of Psoriatic Arthritis, a condition with potential for causing joint damage and subsequent disability. Most patients have psoriasis for years before the development of Psoriatic Arthritis, and there may be a significant proportion of psoriasis patients with joint involvement that are cared for by the dermatologist. With the absence of a diagnostic measure, the criterion standard for recognizing or monitoring Psoriatic Arthritis remains the clinical assessment. Recognition of Psoriatic Arthritis in the psoriasis patient—and the dermatologist's ability to differentiate it from other types of Arthritis—provide an opportunity to improve patient outcomes through early recognition and facilitation of intervention in collaboration with a rheumatologist. Learning objectives After completing this learning activity, participants should be able to recognize the presence of Psoriatic Arthritis among patients with psoriasis; distinguish Psoriatic Arthritis from reactive Arthritis, osteoArthritis, gout, rheumatoid Arthritis, and ankylosing spondylitis; and use appropriate laboratory and imaging tests in the evaluation of patients with psoriasis and musculoskeletal complaints.
Philip J. Mease - One of the best experts on this subject based on the ideXlab platform.
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Psoriatic Arthritis therapy advances.
Current opinion in rheumatology, 2005Co-Authors: Philip J. MeaseAbstract:Purpose of review This paper will review the data published in 2004 on the treatment of Psoriatic Arthritis, which Arthritis affects 6 to 39% of all patients with psoriasis. Recent findings New data from placebo-controlled trials of anti-tumor necrosis factor agents, etanercept, infliximab, and adalimumab continue to show sustained effectiveness of these therapies in their ability to control the symptoms and signs of both Arthritis and psoriasis, improve quality of life and function, and inhibit disease progression as measured by radiologic changes. Medications that inhibit T cells have been approved for the treatment of psoriasis and have been studied in Psoriatic Arthritis. The effectiveness of one of these agents, efalizumab, did not achieve statistical significance in the treatment of Psoriatic Arthritis. The results of a trial with a second agent, alefacept are pending public review. Summary There has been a persistent increased focus on the diagnosis and treatment of Psoriatic Arthritis as newer and more effective drugs than traditional disease-modifying agents have become available.
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Diagnosis and treatment of Psoriatic Arthritis
Journal of the American Academy of Dermatology, 2005Co-Authors: Philip J. Mease, Bernard S GoffeAbstract:Psoriatic Arthritis is a chronic, heterogeneous disease whose pathogenesis is unknown, although genetic, environmental, and immunologic factors play major roles. Psoriatic Arthritis can follow an aggressive clinical course, and differentiating it from other arthropathies is sometimes difficult. Diagnosis of Psoriatic Arthritis is based on history, physical examination, the usual absence of rheumatoid factor, and characteristic radiographic features. At least 40% of patients with Psoriatic Arthritis develop radiographically detectable joint destruction; therefore, proper diagnosis and early treatment can have a significant impact on disease course and outcome. Understanding the pathogenesis of Psoriatic disease has led to the use of several biologic agents that work by modulating T-cell signaling or by inhibiting key cytokines involved in inflammation, such as tumor necrosis factor (TNF). TNF inhibitors have demonstrated excellent efficacy in resolving skin and joint disease in patients with Psoriatic Arthritis and have been shown to be safe agents in various inflammatory disorders. This article reviews the diagnostic and treatment challenges of Psoriatic Arthritis as they relate to pathogenesis and burden of disease. Learning objective At the conclusion of this learning activity, participants should have acquired a more comprehensive knowledge of our current understanding of the classification, clinical presentation, etiology, pathophysiology, differential diagnosis, and treatment of Psoriatic Arthritis.
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Epidemiology of Psoriatic Arthritis in the population of the United States.
Journal of the American Academy of Dermatology, 2005Co-Authors: Joel M. Gelfand, Dafna D. Gladman, Philip J. Mease, Nana Smith, David J. Margolis, Tamar Nijsten, Robert S. Stern, Steven R. Feldman, Tara RolstadAbstract:Background Estimates of the prevalence of Psoriatic Arthritis vary widely and are usually not determined by population-based studies. Objectives We sought to determine the prevalence of Psoriatic Arthritis and the impact of the disease on quality of life in the US population. Methods Patients were selected randomly from the US population and were interviewed by telephone. Cases were defined as patients who reported a physician diagnosis of psoriasis and Psoriatic Arthritis. Results Interviews of 27,220 persons were conducted; 601 of the interviewees had psoriasis and 71 had psoriasis and Psoriatic Arthritis. The prevalence of Psoriatic Arthritis was 0.25% (95% confidence interval [CI]: 0.18%, 0.31%). The prevalence of Psoriatic Arthritis among patients with psoriasis was 11% (95% CI: 9%, 14%) and varied substantially based on self-reporting of the extent of skin involvement with psoriasis. Thirty-nine percent of patients with Psoriatic Arthritis indicated that it was a large problem in everyday life. Limitations Psoriatic Arthritis was classified on the basis of the patient's self-report. Conclusion Psoriatic Arthritis affects an estimated 520,000 patients in the US population, and many rate it as a large problem in everyday life. The prevalence varies widely based on the extent of skin involvement, which demonstrates the importance of performing broadly representative studies to measure the prevalence of Psoriatic Arthritis.
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Recent advances in the management of Psoriatic Arthritis
Current opinion in rheumatology, 2004Co-Authors: Philip J. MeaseAbstract:Purpose of reviewThe incidence of Psoriatic Arthritis is currently estimated at 7 to 42% of the population with active psoriasis, considered to affect 2 to 3% of the general population. Unmanaged Psoriatic Arthritis may result in progressive radiologic erosion, severe physical limitations, and disab
Philip S. Helliwell - One of the best experts on this subject based on the ideXlab platform.
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classification and diagnostic criteria for Psoriatic Arthritis
Annals of the Rheumatic Diseases, 2005Co-Authors: Philip S. Helliwell, William J. TaylorAbstract:Background: The study of Psoriatic Arthritis is difficult and has lagged behind the study of other arthropathies in that there are no universally agreed or properly validated case definitions. Method: This paper examined the validity and practicality of the original Moll and Wright criteria and subsequent criteria sets. Key features discriminating between Psoriatic and other arthropathies were reviewed. A comparative study involving patients with Psoriatic Arthritis and rheumatoid Arthritis was used to contrast the different classification methods. Results: Although the Moll and Wright criteria continue to be widely used, they have been shown to discriminate poorly between Psoriatic and rheumatoid Arthritis. In comparison, the most sensitive criteria were those of Vasey and Espinoza, McGonagle et al, and Gladman et al (99%), whereas the others were significantly less sensitive (between 56% and 94%). The specificity of all methods was high and statistically similar (between 93% and 99%). Models that had reasonably good accuracy even without such key variables as psoriasis or rheumatoid factor were developed. Spinal involvement continues to be a key feature of Psoriatic Arthritis, but dissimilarities with classic ankylosing spondylitis have been highlighted. Conclusions: Further work is required to produce classification criteria for Psoriatic Arthritis. A prospective study collecting clinical, radiological, human leucocyte antigen (HLA) and immunological data from both Psoriatic and non-Psoriatic cases should provide agreed criteria for use in Psoriatic Arthritis studies in the future.
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Relationship of Psoriatic Arthritis with the other spondyloarthropathies.
Current Opinion in Rheumatology, 2004Co-Authors: Philip S. HelliwellAbstract:PURPOSE OF REVIEW: The seronegative spondyloarthropathies are a group of disorders sharing common clinical features, the hallmark of which is sacroiliitis. Despite the 40 years since Psoriatic Arthritis was recognized, controversy still exists about which patients to include within this disease group and the relation of Psoriatic Arthritis with the other spondyloarthropathies. RECENT FINDINGS: Early disease can present difficulties because it is inappropriate to use criteria developed on established cases in early Arthritis, in which many cases may be initially undifferentiated. The taxonomy of juvenile spondyloarthropathy remains a contentious issue, and further modifications of the Durban criteria have been suggested. The predictive value of the European Spondyloarthropathy Study Group criteria for spondyloarthropathy varies with the prevalence of the disease in the population under consideration, as has been demonstrated in ambulatory practice in France and Spain. It appears that physicians differ in their interpretation of the individual features, particularly of such clinical items as asymmetry and predominantly lower limb involvement. The combination of dactylitis of a toe, heel pain, and oligoArthritis appears to be strongly suggestive of Psoriatic Arthritis. However, solitary heel pain can be problematic, and ultrasonographic entheseal erosion at the calcaneum has been shown equally in rheumatoid Arthritis and Psoriatic Arthritis. MRI may be more sensitive and quantitatively discriminative in Psoriatic Arthritis. Spinal involvement in Psoriatic Arthritis can be asymptomatic, as in classical ankylosing spondylitis. Importantly, Psoriatic spondylitis has been observed in the absence of sacroiliitis. SUMMARY: Clinicians generally agree that Psoriatic Arthritis constitutes a discreet subset within the spondyloarthropathy group, but the demarcation continues to be the subject of clinical research. The matter is confounded by the lack of agreed classification criteria for Psoriatic Arthritis; although in both adult and juvenile disease criteria for spondyloarthropathy exist, the place of Psoriatic Arthritis within this larger group requires further definition.
D D Gladman - One of the best experts on this subject based on the ideXlab platform.
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Psoriatic Arthritis.
Expert opinion on investigational drugs, 2000Co-Authors: D D Gladman, J BrockbankAbstract:Psoriatic Arthritis occurs in 5 - 42% of patients with psoriasis. It is an inflammatory Arthritis distinct from rheumatoid, being usually sero-negative, asymmetrical and often affecting the spine, sacro-iliac and distal interphalangeal joints. It runs a very variable course, from a mild non-destructive disease to a severe rapidly progressive erosive arthropathy, producing an 'Arthritis mutilans' with a combination of bone lysis and joint ankylosis. Its pathogenesis is not as well understood as rheumatoid Arthritis, but is thought to be similarly immune driven, with a qualitatively similar immunomodulatory cascade and cytokine profile. Quantitatively, however, there are distinct differences in cell ratios and cytokine levels that may well impact on therapeutic strategies. Current therapies, such as methotrexate and sulphasalazine, have yet to be shown to be significantly more effective than placebo in delaying damage and produce only marginal improvements in symptoms. The newer specific biological agents, such as the anticytokine antibodies, interleukins and more specific anti-T-cell therapies, are starting to be studied in Psoriatic Arthritis. The rationale for their use comes mostly from extrapolation of their efficacy in rheumatoid Arthritis. It has yet to be seen whether they will be efficacious in treating the osteolysis, fibrosis and new bone formation particular to Psoriatic Arthritis. Any treatment for the Arthritis must also help the skin. Greater understanding of Psoriatic Arthritis, its pathogenesis and natural history is required if we are to target these exciting but expensive therapies effectively.
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Juvenile Psoriatic Arthritis andHLA antigens
1990Co-Authors: M L Hamilton, D D Gladman, A Shore, R M Laxer, E D SilvermanAbstract:The clinical, laboratory, andradiological features, including histocompatibility typing, of28patients withjuvenile Psoriatic Arthritis arereported. Themostcommon presentation was thatofpsoriasis preceding or occurring simultaneously withArthritis. The most common courseofjuvenile Psoriatic Arthritis was tostart as an oligoArthritis andprogress, usuallyto polyArthritis. No patients with juvenile Psoriatic Arthritis haduveitis. Overall, mostpatients hada goodoutcome(93%in functional class IandII), though 8/28(29%) didrequire disease modifying drugs over a mean period of8-8yearsoffollow up. The clinical features ofthesepatients were very similar to thoseofa group of158adult patients withPsoriatic Arthritis withthesame disease duration followed up intheclinic. Although there was an increased prevalence ofB17inbothjuvenile andadult Psoriatic Arthritis, juvenile Psoriatic Arthritis showed increased prevalence ofA2,whereas adult Psoriatic Arthritis showed increased prevalence ofB27,Bw39, andCw6.ThisHLAassociation differed fromthatreported inother formsof juvenile Arthritis.
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Psoriatic Arthritis.
Current opinion in rheumatology, 1990Co-Authors: D D GladmanAbstract:Psoriatic Arthritis is a common form of Arthritis. It is recognized that there is a subset of patients who have a severe, disabling form of the disease, and that patients need to be treated earlier if a good outcome is to occur. The pathogenesis of Psoriatic Arthritis is still unclear, but the "experiment of nature" provided by the HIV infection may help further outline the causative mechanisms. Newer modalities of therapy are being investigated.
E D Silverman - One of the best experts on this subject based on the ideXlab platform.
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Juvenile Psoriatic Arthritis and HLA antigens.
Annals of the rheumatic diseases, 1990Co-Authors: M L Hamilton, Dafna D. Gladman, A Shore, R M Laxer, E D SilvermanAbstract:The clinical, laboratory, and radiological features, including histocompatibility typing, of 28 patients with juvenile Psoriatic Arthritis are reported. The most common presentation was that of psoriasis preceding or occurring simultaneously with Arthritis. The most common course of juvenile Psoriatic Arthritis was to start as an oligoArthritis and progress, usually to polyArthritis. No patients with juvenile Psoriatic Arthritis had uveitis. Overall, most patients had a good outcome (93% in functional class I and II), though 8/28 (29%) did require disease modifying drugs over a mean period of 8.8 years of follow up. The clinical features of these patients were very similar to those of a group of 158 adult patients with Psoriatic Arthritis with the same disease duration followed up in the clinic. Although there was an increased prevalence of B17 in both juvenile and adult Psoriatic Arthritis, juvenile Psoriatic Arthritis showed increased prevalence of A2, whereas adult Psoriatic Arthritis showed increased prevalence of B27, Bw39, and Cw6. This HLA association differed from that reported in other forms of juvenile Arthritis.
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Juvenile Psoriatic Arthritis andHLA antigens
1990Co-Authors: M L Hamilton, D D Gladman, A Shore, R M Laxer, E D SilvermanAbstract:The clinical, laboratory, andradiological features, including histocompatibility typing, of28patients withjuvenile Psoriatic Arthritis arereported. Themostcommon presentation was thatofpsoriasis preceding or occurring simultaneously withArthritis. The most common courseofjuvenile Psoriatic Arthritis was tostart as an oligoArthritis andprogress, usuallyto polyArthritis. No patients with juvenile Psoriatic Arthritis haduveitis. Overall, mostpatients hada goodoutcome(93%in functional class IandII), though 8/28(29%) didrequire disease modifying drugs over a mean period of8-8yearsoffollow up. The clinical features ofthesepatients were very similar to thoseofa group of158adult patients withPsoriatic Arthritis withthesame disease duration followed up intheclinic. Although there was an increased prevalence ofB17inbothjuvenile andadult Psoriatic Arthritis, juvenile Psoriatic Arthritis showed increased prevalence ofA2,whereas adult Psoriatic Arthritis showed increased prevalence ofB27,Bw39, andCw6.ThisHLAassociation differed fromthatreported inother formsof juvenile Arthritis.
