Aim: Most of the patients with Psoriatic Arthritis (PsA) develop arthritis following the onset of psoriasis. The aim of the project is to identify genetic and environmental risk factors for PsA among psoriasis patients. Methods: PsA and psoriasis patients from two prospective cohorts were analyzed. The incidence of PsA among a prospective cohort of psoriasis patients was assessed. The distribution of Human Leukocyte Antigen (HLA) alleles and Killer Cell Immunoglobulin like Receptors (KIRs) and their combinations was compared between PsA, psoriasis and healthy controls. In addition, the association between a wide range of environmental exposures and PsA was evaluated by comparing the frequencies of exposed individuals among patients with recent onset PsA and psoriasis. The association between smoking and PsA was further investigated. The prevalence of smoking was in PsA, psoriasis and the general population. The interaction between HLA-C*06 and smoking was also tested. Results: The genetic analysis revealed several HLA-B alleles and HLA haplotypes that are associated with PsA compared to psoriasis and can potentially serve as independent markers for PsA. Furthermore, several combinations of KIR genes and their respective HLA ligands were also found to be associated with PsA compared to psoriasis. The incidence of PsA among psoriasis patients was found to be higher than previously reported and its rate was constant over time. HLA-C*06 was associated with increased interval between psoriasis onset and PsA. Several environmental factors including occupational exposures, infections, injuries and smoking were associated with development of PsA. The prevalence of smoking was decreased among PsA patients compared to psoriasis. The interaction between HLA-C*06 and smoking was found to be significant. Conclusions: Genetic and environmental factors are associated with the development of PsA in patients with psoriasis. These factors may serve as specific markers to identify psoriasis patients at increased risk for PsA.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 7 uppsatser.

Licentiatavhandling (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 2 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2009. / Härtill 4 uppsatser.

Thèse (M.Sc.)--Université Laval, 2007. / Bibliogr.: f. 82-89. Publié aussi en version électronique dans la Collection Mémoires et thèses électroniques.

Includes bibliographical references.

Background: Psoriasis is a heterogeneous disease with several clinical manifestations; the symptoms are characterized by redness, scaliness and thickness of the skin. There are several treatment options available for psoriasis and patients with moderate to severe psoriasis generally need systemic agents. In 2004 biologics were introduced for patients with moderate to severe psoriasis in Sweden. Methods: The Swedish Health Care Registers and the Swedish registry for systemic treatment of psoriasis PsoReg, were used to; estimate the incidence of psoriasis cases in the Swedish specialist care, to examine the treatment allocation and important factors related to the initiation of especially biologic treatment. Results: On average 9000 new psoriasis patients entered specialist care in Sweden each year under study, corresponding to an incidence of 98 patients per 100,000 person-years. In the treatment allocation analysis of the incident psoriasis cases in the Swedish specialist care Patients living in a Metropolitan Area and with a University degree were more likely to initiate a biologic treatment. By analysing biologic-naïve patients enrolled in PsoReg, PASI (the physician’s assessment of the psoriasis severity) and Psoriasis Arthropathy were shown to be two important factors associated with the initiation of biologic treatment while sex was not. Furthermore, it was also shown that the decision to initiate biological treatment was more strongly associated with PASI than with DLQI (the patients’ assessment of the disease impact Quality of Life). Conclusion: These studies indicate that there are inequalities in the assignments of systemic psoriasis treatments (especially in biologic treatment). Since the allocation of treatments should not depend on sex, education or residency in a Metropolitan Area but rather the need of care, it is important that future studies continue analysing possible factors that could influence the initiation of treatment in clinical practice.

No description available.

Resumo: Psoríase é doença inflamatória da derme e epiderme. Avaliação clínica é parâmetro essencial na indicação e avaliação de resultados terapêuticos. Alteração clínica é tradução macromorfológica de achados micromorfológicos. Investigar a correlação entre índices de gravidade clínica e histopatologia, antes e depois de tratamento sistêmico de pacientes com psoríase em placa. Avaliação clínica padronizada: PASI; "PASI" de região topográfica da lesão alvo; índice de inflamação total e índice de inflamação da região topográfica", expurgados da extensão comprometida e, correlação histopatológica. Nos momentos pré e pós-tratamento sistêmico. Os escores clínicos e histopatológicos foram capazes de detectar melhora significativa entre o pré e pós-tratamento. Não houve correlação, pré-tratamento, entre os escores de gravidades dos índices clínicos utilizados e os escores histopatológicos. No pós-tratamento houve correlação entre índice de "inflamação total" e "inflamação da região topográfica da lesão alvo" e achados histopatológicos nos pacientes com PASI <12. Não houve correlação entre índices clínicos e histopatológicos em nenhum momento nos pacientes com PASI ≥ 12. Os índices clínicos utilizados e a análise histopatológica captaram a intensidade de melhoria clínica dos pacientes. Porém, em pacientes com doença moderada e grave os índices de gravidade clínica não se correlacionaram com as alterações histopatológicas. Palavras-chave: histopatologia, PASI, psoríase, tratamento. / Abstract: Psoriasis is a chronic inflammatory disease of the skin. Clinical appraisal is essential to decide the treatment indication and results evaluation. Clinical aspects are the macro morphologic consequence of the histopathological changes. To investigate the correlation between clinical severity index and histopathological alterations observed before and after systemic treatment plaque psoriasis patients. Structured clinical evaluation of psoriasis area and severity index (PASI), local "PASI", "total inflammatory index" and "inflammatory index of a target lesion", these ones without compromised area, and correlated with histopathological changes, both, before and after treatment. The clinical and histopathological scores were able of detecting significant improvement after treatment. There were no agreement among all clinical indexes and the histopathological appraisal. Considering the post-treatment evaluation, correlation was observed among "total inflammatory index" and "inflammatory index of a target lesion" and histopathological scores from patients with PASI < 12.There was no correlation between clinical indexes and histopathological scores in any moment considering patients with PASI ≥12. The clinical indexes and the histopathological analysis were able to detect the degree of patients' improvement. However, among patients with moderated and severe disease the clinical indexes showed no correlation with the observed histopathological changes. / Orientador: Sílvio Alencar Marques / Coorientador: Mariângela E. A. Marques / Banca: Maria Rita Parise Fortes / Banca: Luciane Donida Bartoli Miot / Banca: Artur Antonio Duarte / Banca: Ricardo Romiti / Doutor

Made available in DSpace on 2014-10-09T12:54:18Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:09:21Z (GMT). No. of bitstreams: 1 12722.pdf: 558008 bytes, checksum: 01284590d84b5a596a55c0b0b7177695 (MD5) / Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia) / IPEN/D-MPLO / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo