<p>Psoriasis är en kronisk inflammatorisk hudsjukdom som drabbar tre procent av Sveriges befolkning. Sjukdomen är en kombination av abnorm och snabb celldelning och en överreaktion i immunsystemet. Psoriasis kan variera i svårighetsgrad från lätt psoriasis till svår psoriasis men är ingen livshotande sjukdom. Sjukdomen kan dock påverka livskvaliteten kraftigt. Om man får psoriasis så har man fått psoriasis livet ut. Idag finns det ingen behandling som helt kan bota psoriasis, däremot finns det behandlingar som är symtomlindrande. Psoriasisbehandling blir därför alltid en långtidsbehandling. Eftersom huden är kroppens största organ kan det dagliga livet påverkas av tidskrävande och framförallt dyra behandlingar. Syftet med denna studie var att undersöka vilken av de olika tillgängliga biologiska behandlingarna mot psoriasis som har bäst effekt på kort respektive lång sikt. Metoden som användes var en litteraturstudie där inkluderade artiklar hämtades från PubMed. Sammanlagt baseras studien på fyra monoterapistudier och en meta-analys. Samtliga monoterapistudier av de biologiska preparaten adalimumab, efalizumab, etanercept och infliximab visade på en effektiv och säker långtidsbehandling hos patienter med måttlig till svår psoriasis. Den femte studien som var en meta-analys baserad på korttidsbehandlingar med biologiska läkemedel (alefacept, efalizumab, etanercept och infliximab) tyder på att infliximab har bäst effekt jämfört med de andra biologiska läkemedlen. Även om infliximab har bäst effekt vid korttidsbehandling är detta inte nödvändigtvis fallet vid långtidsbehandling. Alla de olika biologiska läkemedlen förefaller ge ungefär samma effekt vid långtidsbehandling. Jämförande studier som direkt undersöker vilket av de biologiska läkemedlen som är effektivast och som tolereras bäst av patienter med måttlig till svår plackpsoriasis är önskvärda i framtiden.</p> / <p>Psoriasis is a chronic inflammatory skin disease that affects three percent of Sweden's population. The disease is a combination of abnormal and fast cell division and over-reaction of the immune system. Psoriasis varies from moderate to severe and it is not a critical disease, but it can affect the quality of life considerably. If you have psoriasis you have it for life.Today, there is no treatment that can cure psoriasis completely but there are treatments that can relieve the symptoms. Therefore, psoriasis requires long-term therapy. Since the skin is the body's largest organ, the daily life is influenced by time-consuming and above all costly treatments. The aim of this study was to examine which of the available biological agents that has the best effect in the treatment of psoriasis, with a focus on long-term treatment. The method used was a literature study with articles acquired from PubMed. The study is based on four mono-therapy-studies and one meta-analysis. The mono-therapy-studies investigated the following biological agents, adalimumab, efalizumab, etanercept and infliximab which were all shown to be effective and safe for long-term treatment of patients with moderate to severe psoriasis. The fifth study, which was based on short-term treatments with biological agents (alefacept, efalizumab, etanercept and infliximab), indicated that infliximab has the best efficacy. Although infliximab may have the best effect in short-term treatments this may not be the case for long-term treatments. All biological agents had approximately the same effect in the long-term treatments.There is still a need for direct comparative studies examining which of the biological agents that is most effective and best tolerated for patients with moderate to severe plaque psoriasis.</p>

published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

The specific anti-T lymphocyte immunosuppressive drugs cyclosporine A (CsA), FK-506 (FK) and rapamycin (RPM) have revolutionized the field of allograft transplantation and have recently been evaluated for use in autoimmune diseases. Effects of immunosuppressive drugs on adhesion molecule expression in the putative autoimmune conditions psoriasis, through the use of keratinocyte (KC) cell culture techniques, and alopecia areata were investigated. In the Dundee Experiment Bald Rat, a model of alopecia areata, hair regrowth was only apparent with CsA therapy and FK had a high toxicity profile. <I>In vivo</I> the observed cutaneous reduction of ICAM-1 and LFA-1 expression particularly around the hair bulbs was due to the effects of CsA and FK on the inflammatory cell infiltrate, especially since the associated cutaneous lymphocyte populations were reduced with drug. This is corroborated by the results obtained from <I>in vitro</I> culture of human KC, since cytokine-induced expression and release of ICAM-1 by KC was unaffected by CsA, RPM or FK treatment. CsA and RPM, but not FK, however, had an observable cytostatic effect on unstimulated and more especially, cytokine-stimulated KC proliferation and may, therefore, clinically inhibit KC hyperplasia, which is characteristic of psoriasis. This study shows that CsA, FK and RPM may inhibit either directly but more likely in an indirect manner, cellular adhesion molecule expression during immune reactions. This effect will lower the possible number of cellular interactions and furthermore, reduce intracellular co-signalling events necessary for cellular activation which accounts for the overall inhibition of cell-mediated immune responses by these novel immunosuppressive drugs.

Ten patients with severe intractable psoriasis were treated with cyclosporin (CyA) at an average dose of 3 mg/kg/day for a period of 12 weeks. At the end of the study, 5 patients had a greater than 90% reduction in their PASI (psoriasis area severity index) score, 3 an 80%, one a 69% and one a 52% reduction. In a long term study, 13 patients with severe psoriasis were treated with CyA for an average duration of 2.5 years. The average dose of CyA was 3 mg/kg/day, with a range of 1 - 5 mg/kg/day. The average reduction in mean PASI score throughout the study was 70 - 80%. Seven of the 13 patients developed a rise in blood pressure, 3 of whom required antihypertensive therapy. Studies on possible nephrotoxicity showed that 4 of the 13 had a greater than 30% rise in their serum creatinine compared to their baseline value. 6 of the 13 patients had a low glomerular filtration rate (GFR) at the end of the study, but this rose in all 6 when CyA was discontinued, and to normal levels in 5 patients. In the sixth, a renal biopsy was performed which showed no structural damage due to CyA. In a further 11 patients, the mean GFR was shown to fall significantly after 9 weeks of CyA. Thus, CyA causes impairment of renal function with a dose of 3 mg/kg/day, but this impairment appears to be reversible when CyA is stopped. Six patients with plaque psoriasis were treated with topical CyA, and a further 10 with intralesional CyA. Topical CyA was ineffective, but intralesional CyA was effective in clearing psoriasis, implying that failure of topical preparations is probably due to lack of penetration. T cell and dendritic cell subsets in psoriasis were studied during oral CyA, and at the end of intralesional CyA treatment. After oral CyA, total CD4 and CD8, and DR+CD8 cells were decreased in the epidermis and dermis. However, DR+CD4 cells were decreased in the dermis but not the epidermis. After intralesional CyA, total and DR+CD4 and CD8 cells were decreased in both dermis and epidermis. The most significant effect of both intralesional and oral CyA on the dendritic cells was the decrease of the DR+CD1-subset.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Proefschrift Universiteit van Amsterdam. / Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Thesis (M. Nursing)--Montana State University--Bozeman, 2005. / Typescript. Chairperson, Graduate Committee: Madine Parker. Includes bibliographical references (leaves 35-37).

Proefschrift Maastricht. / Met lit. opg. - Met een samenvatting in het Nederlands.

Data from studies looking at the use of systemic vitamin D and omega-3 fatty acids independently in the treatment of psoriasis has shown that both these supplements have at least a modest effect when taken in above average doses. Recent advances in the understanding of the pathophysiology of psoriasis as well as the immunomodulatory and anti-inflammatory properties of these supplements suggest that they could have an additive effect in treating this life-long disease. The proposed study is a randomized placebo-controlled trial that aims to explore this supposition by supplying demographically diverse subjects, who have varying levels of psoriasis severity, with 4g of Omacor® fish oil (1.8g EPA + 1.5g DHA) and 4000IU of vitamin D3 (cholecalciferol) or placebo pills on top of their existing treatment regimen. The subjects will have a baseline evaluation and the trial will run for 1 year with 12 week follow up intervals. Every 12 weeks the subjects will have a clinician calculate their current PASI score and have blood drawn to measure vitamin D levels. Investigators will analyze the overall percent reduction of an individual’s PASI score as well as the mean final PASI scores of the intervention and control groups. The data from this study will provide information that could add another safe, inexpensive, and effective treatment modality to the dermatologist’s arsenal.

No description available.