Browsing by Subject "Psoriasis"

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    Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021.
    (Nature reviews. Rheumatology, 2022-08) Coates, Laura C; Soriano, Enrique R; Corp, Nadia; Bertheussen, Heidi; Callis Duffin, Kristina; Campanholo, Cristiano B; Chau, Jeffrey; Eder, Lihi; Fernández-Ávila, Daniel G; FitzGerald, Oliver; Garg, Amit; Gladman, Dafna D; Goel, Niti; Helliwell, Philip S; Husni, M Elaine; Jadon, Deepak R; Katz, Arnon; Laheru, Dhruvkumar; Latella, John; Leung, Ying-Ying; Lindsay, Christine; Lubrano, Ennio; Mazzuoccolo, Luis Daniel; Mease, Philip J; O'Sullivan, Denis; Ogdie, Alexis; Olsder, Wendy; Palominos, Penelope Esther; Schick, Lori; Steinkoenig, Ingrid; de Wit, Maarten; van der Windt, DA; Kavanaugh, Arthur; GRAPPA Treatment Recommendations domain subcommittees
    Since the second version of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations were published in 2015, therapeutic options for psoriatic arthritis (PsA) have advanced considerably. This work reviews the literature since the previous recommendations (data published 2013-2020, including conference presentations between 2017 and 2020) and reports high-quality, evidence-based, domain-focused recommendations for medication selection in PsA developed by GRAPPA clinicians and patient research partners. The overarching principles for the management of adults with PsA were updated by consensus. Principles considering biosimilars and tapering of therapy were added, and the research agenda was revised. Literature searches covered treatments for the key domains of PsA: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail psoriasis; additional searches were performed for PsA-related conditions (uveitis and inflammatory bowel disease) and comorbidities. Individual subcommittees used a GRADE-informed approach, taking into account the quality of evidence for therapies, to generate recommendations for each of these domains, which were incorporated into an overall schema. Choice of therapy for an individual should ideally address all disease domains active in that patient, supporting shared decision-making. As safety issues often affect potential therapeutic choices, additional consideration was given to relevant comorbidities. These GRAPPA treatment recommendations provide up-to-date, evidence-based guidance on PsA management for clinicians and people with PsA.
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    Miliary tuberculosis in a paediatric patient with psoriasis.
    (BMJ case reports, 2021-03) Kilgore, Jacob; Pelletier, Jonathon; Becken, Bradford; Kenny, Stephen; Das, Samrat; Parnell, Lisa
    We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.