Association between biological immunotherapy for psoriasis and time to incident inflammatory arthritis: a retrospective cohort study

Summary

Background

Targeted biological immunotherapies have been highly effective in controlling skin disease in patients with psoriasis, but whether therapy delays progression to inflammatory arthritis is unclear. The aim of this study was to compare the time to incident inflammatory arthritis among patients newly receiving biological therapies for psoriasis.

Methods

In this retrospective cohort study, we obtained data on a national sample of patients in the USA from the electronic health records database of the US-based TriNetX network. We included adult patients (aged ≥18 years) with two diagnostic codes for psoriasis (>30 days apart; International Classification of Diseases [ICD] codes) who had been newly prescribed a biologic (inhibitors of tumour necrosis factor [TNF], interleukin [IL]-17, IL-23, or IL-12/23, first prescribed on or after the date of receiving a first psoriasis diagnosis code). The time to incident inflammatory arthritis, defined by first occurrence of a diagnostic code for psoriatic arthritis or other inflammatory arthritis after initiation of biological therapy, was graphed with use of the Kaplan-Meier estimate. Time-dependent risk for inflammatory arthritis was calculated with weighted Cox proportional hazards regression with anti-TNF exposure as the reference, adjusted for demographic and clinical covariables. Sensitivity analyses were used to evaluate incident cases of psoriasis, increased exclusion periods for prevalent cases of inflammatory arthritis, drug switching, and more stringent disease and outcome definitions.

Findings

Between Jan 1, 2014, and June 1, 2022, we identified 15 501 patients with psoriasis (mean age 50·2 years [SD 15·0]; 8399 [54·2%] women and 7102 [45·8%] men; 11 175 [72·1%] White). 976 (6·3%) of the 15 501 patients developed inflammatory arthritis, with a cumulative incidence of 2·6 cases per 100 person-years. In multivariable regression analyses, the risk of developing inflammatory arthritis was significantly lower in patients prescribed IL-12/23 inhibitors (adjusted HR 0·58, 95% CI 0·43–0·76) or IL-23 inhibitors (0·41, 0·17–0·95) than in patients prescribed TNF inhibitors. We found no significant difference for IL-17 inhibitors (0·86, 0·54–1·38) compared with TNF inhibitors. For IL-12/23 inhibitors, the results persisted in all sensitivity analyses. For IL-23 inhibitors, the results persisted in three of six sensitivity analyses, when a higher diagnostic threshold for incident arthritis was used and when excluding patients who developed arthritis within 3 or 6 months after first biologic prescription.

Interpretation

In this large cohort study of patients with psoriasis, treatment with IL-12/23 inhibitors or IL-23 inhibitors was associated with reduced risk of progression to inflammatory arthritis compared with TNF inhibitors. Prospective observational cohorts with disease activity measures and pooled analyses of previous randomised trials are required to confirm these findings.

Funding

None.

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Article info

Publication history

Published: March 06, 2023

Identification

DOI: https://doi.org/10.1016/S2665-9913(23)00034-6

Copyright

© 2023 Elsevier Ltd. All rights reserved.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Children onychomycosis, a neglected dermatophytosis: A retrospective study of epidemiology and treatment - Song - 2023 - Mycoses - Wiley Online Library

https://onlinelibrary.wiley.com/doi/abs/10.1111/myc.13571?campaign=woletoc

Children onychomycosis, a neglected dermatophytosis: A retrospective study of epidemiology and treatment

Weida Liu

Background

Onychomycosis was an ignored disease in children, and the prevalence was still unknown worldwide.

Objectives

This study was conducted to investigate the prevalence and treatment regimens of onychomycosis in children younger than 18 years old.

Methods

We systemically reviewed all publications by searching the key terms to reveal the onychomycosis in children from 1990 to 2022.

Results

A total of 44 articles including 2,382 children with onychomycosis were enrolled in this study. The male to female ratio was 1.29:1. The youngest child was 35 days old and the average age was 9.8 years old. The duration of disease usually ranged from 7 days to 4 years. Onychomycosis in children was more prevalent in toenails compared to fingernails (77.6% vs. 18.4%), and 4% patients had both. A total of 527 children (22.12%) had concomitant tinea pedis infection, and in 267 patients (11.21%), their family members had onychomycosis or tinea pedis. The most common clinical type of onychomycosis was DLSO (67.74%) and the predominant isolates were T. rubrum (66.13%), followed by C. albicans (9.08%) and T. mentagrophytes complex (5.34%). There were 419 children (74.03%) receiving systematic treatment only, 74 patients (13.07%) receiving topical treatment only, and 73 patients (12.90%) receiving both systematic and topical treatment. Twelve patients (2.12%) had mild drug-related side effects. During the follow-up, 71.25% children were cured, 17.50% symptoms improved and 4.17% failed.

Conclusions

Onychomycosis was underestimated in children and the diagnosis of onychomycosis should be properly considered in children with nail disorders. For mild patients, topical treatment can be a good choice, and oral antifungal drugs could be added to severe individuals under monitoring.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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What’s the effect of probiotics on skin photoaging ?

In a systematic review and meta-analysis published in Photodermatology, Photoimmunology & Photomedicine, the authors aimed to assess the effects of probiotics on skin photoaging. This study included 13 articles examining the effects of probiotics on skin photoaging in humans and mice. The administration of probiotics in mice reduced the matrix metalloproteinase levels and reversed the UV-induced increase in epidermal thickness, UV-induced trans-epidermal water loss, and UV-induced skin dehydration. The authors propose that oral probiotics seem to have anti-inflammatory and skin barrier-restoring properties, although they discuss the limitations of murine experiments and the lack of standardized concentration, dosing, and timing for the probiotic.

Photodermatology, Photoimmunology & Photomedicine

Volume 39, Issue 2 p. 122-131

ORIGINAL ARTICLE

Effects of probiotics supplementation on skin photoaging and skin barrier function: A systematic review and meta-analysis

Jhen-Yu Jwo, Ya-Ting Chang, Yu-Chen Huang

First published: 30 December 2022

https://doi.org/10.1111/phpp.12861

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Dietary strategies for chronic spontaneous urticaria: an evidence-based review

Dietary strategies for chronic spontaneous urticaria: an evidence-based review

Saurabh Jaiswal MD

Although the relationship between diet and chronic spontaneous urticaria (CSU) remains elusive, several patients seek dietary modifications as they are easy and cost-effective. Adequate patient education and counseling are crucial as modified diets may be beneficial for a subset of antihistamine refractory CSU patients, and no modality currently exists to identify these patients. Elimination of food items based exclusively on patient history may lead to unnecessary restrictions in most cases resulting in nutritional deficiencies and impaired quality of life. Several dietary strategies have been tried till date with varying rates of success and evidence. This review highlights the various dietary strategies along with their levels of evidence, which may help the treating dermatologists and physicians to counsel CSU patients and make evidence-based treatment decisions. There is grade A recommendation for the elimination of food additives (artificial pseudoallergens), personalized diets, vitamin D supplementation, Diamine oxidase supplementation and probiotics (in children), grade B recommendation for dietary elimination of red meat, fish and their products, natural pseudoallergens (fruits, vegetables, and spices), and low-histamine diet, while dietary elimination of gluten (with concomitant celiac disease) has grade C recommendation. Notably, elimination diets should be continued for at least 3 consecutive weeks to assess their effectiveness.

International Journal of Dermatology

Volume 62, Issue 2 p. 143-153

Review

Dietary strategies for chronic spontaneous urticaria: an evidence-based review

Indrashis Podder MD, DNB, Saurabh Jaiswal MD, Anupam Das MD

First published: 26 November 2021

https://doi.org/10.1111/ijd.15988

Citations: 2

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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a mobile device.