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Background and aims: Patients with psoriatic arthritis (PsA) have high prevalence of cardiovascular risk factors (CVRF), and they also show higher rates of cardiovascular disease (CVD). We aimed to corroborate these findings and identify factors associated with these events in our clinical setting. Methods: This cross‐sectional study included 340 consecutive patients seen in a tertiary care hospital. The prevalence of CVRF was compared to that of 600 outpatients without inflammatory conditions. To analyze CVD‐associated factors, odds ratio (OR) values were calculated by conditional logistic regression analysis. Significant variables in the univariate analysis were then introduced in a multivariate analysis with a backward stepwise approach. Results: Patients with psoriatic arthritis had higher frequencies of hypertension (36% vs 23%, OR 2.4, 95%CI: 1.6‐2.7, P < 0.0001), diabetes (13.8% vs 5%, OR 2.8, 95%CI: 1.7‐4.3, P < 0.0001), obesity (35% vs 22%, OR 2.1, 95%CI: 1.5‐2.8, P < 0.0001) and tobacco use (26% vs 21%, OR 1.4, 95%CI: 1.0‐1.8, P < 0.05). More PsA patients had CVD compared to non‐inflammatory patients (9.4% vs 5.8%, OR 1.68, 95%CI: 1.02‐2.76, P < 0.05). Independent CVD‐associated factors were: an age of onset of psoriasis >40 years (OR 3.4, 95%CI: 1.1‐10.0, P < 0.05), a high number of swollen joints during evolution (OR 2.9, 95%CI: 1.1‐8.0, P < 0.05), hypertension (OR 5.3, 95%CI: 1.6‐17.6, P < 0.01) and dyslipidemia (OR 2.6, 95%CI: 1.0‐7.2, P < 0.05). Conclusions: Cardiovascular risk should be carefully evaluated in patients with PsA whose disease presents a high inflammatory burden and in those with late‐onset psoriasis. [ABSTRACT FROM AUTHOR]

With the aim of clarifying the role of several polymorphisms around the HLA-C locus in the clinical expression of PsA, the distribution of several polymorphic markers and genes located around the HLA-C locus was analyzed in a well-established cohort of 110 patients with PsA, 50 patients with psoriasis alone, and 110 healthy controls. The frequency of these genes was also analyzed by PsA articular models, based on three main subgroups: oligoarthritis, polyarthritis, and spondylitis. Distal interphalangeal joint (DIP) involvement was associated with the presence of MICB-CA20 (OR 6.0, 95% CI: 1.58-22.69, P = 0.005). HLA-DRB"07 was associated with oligoarticular forms of PsA (OR 4.1, 95% CI: 1.8-9.3, P = 0.0007). The spondylitic forms overexpressed the antigen HLA-B'27 (OR 5.7, 95% CI: 2.4-13.6, P = 0.0001). MICA-A5.1 showed association with polyarthritis (OR 3.7, 95% CI: 1.5-8.8, P = 0.006). Genes telomeric to HLA-C were overexpressed in psoriasis but not in PsA subphenotypes. This study shows that the region centromeric to HLA-C is a key region that expresses not only disease risk genes but also genes that help explain the phenotypic variability of PsA. [ABSTRACT FROM AUTHOR]

Background/aims: Ustekinumab (UST) is a fully human immunoglobulin G1 monoclonal antibody approved for treating moderate to severe psoriasis and, more recently, psoriatic arthritis (PsA) as well. However, information regarding its clinical usefulness in a real-world setting is scarce. We aimed to evaluate the effectiveness and safety of UST in a real-world clinical setting., Methods: This single-center observational study included PsA outpatients (n = 50) treated with UST from March 2015 to March 2017. Only patients who used at least 3 doses of UST were analyzed. The percentage of patients who achieved a minimal disease activity (MDA) response was collected. The impact of the disease was also evaluated according to the recently developed Psoriatic Arthritis Impact of Disease (PsAID) questionnaire. A binary logistic regression multivariate model was performed to look for variables predicting MDA., Results: Twenty-seven patients (54%) reached an MDA state. Mean PsAID in MDA group was 3.5 ± 2.9 versus 6.8 ± 5.1 in non-MDA patients (p < 0.001). Among the patients who achieved MDA, 19 (70.4%) had a patient-acceptable symptom state according to the PsAID, whereas only 5 (21.7%) of the 23 patients who did not reach an MDA achieved a patient-acceptable symptom state (p < 0.001). Higher basal Psoriasis Area and Severity Index decreased the odds of achieving MDA (odds ratio [OR], 0.80; 95% CI, 0.65-0.99; p = 0.038), whereas a longer use of UST (OR, 1.52; 95% CI, 1.13-2.06; p = 0.015) and a previous failure to 1 anti-tumor necrosis factor α (OR, 18; 95% CI, 2.52-128.63; p = 0.004) increased this odds. We found no major safety problems., Conclusions: Ustekinumab was effective and safe in this PsA population. Minimal disease activity and PsAID may be useful tools in the evaluation of PsA therapeutic interventions in routine clinical practice.

Objectives: We aimed to determine which disease features could be associated to the risk of cardiovascular (CV) events in a PsA cohort from a tertiary care institution., Methods: We conducted an age- and sex-matched case-control study in which the cases were all PsA patients who developed cardiovascular (CV) events during the study period (2010-14). The control group was free of CV events during the same period. Univariate analysis was performed to examine unadjusted associations of potential risk factors. Significant variables in the univariate analysis were then introduced in a multivariate analysis with a backward stepwise approach., Results: Of the 206 patients enrolled, 17 (8.3%) patients developed a total of 25 CV events (10 stroke, 9 acute coronary events and 6 ischaemic peripheral vascular events). In univariate analysis these patients showed more pustular psoriasis (OR 5.5, p=0.02), polyarticular onset (OR 3.2, p=0.03), polyarthritis during follow-up (OR 2.9, p=0.04), arthritis onset after 40 yr (OR 3.7, p=0.02), high lipid levels (OR 2.8, p=0.04), hypertension (OR 6.4, p=0.0008), diabetes (OR 12.1, p<0.0001) and lower educational level (OR 3.2, p=0.05). After controlling for age and other confounders, a polyarticular onset of PsA (OR 3.7, p=0.043) and diabetes (OR 8.1, p=0.001) remained as independently related to the risk of CV events., Conclusions: Traditional CV risk factors as well as factors related to the inflammatory nature of the disease were the main predictors of CV complications in this PsA population.

There are still numerous incompatibilities in the definitions of basic dermatological terms. In Spain, the problem is aggravated by the coexistence and conflict between two different semantic models, imported from other countries (France and the USA). These two models really have different "units": one model can be called "essentialist" and the other "nominalist". These models are not original to Spain; rather, each one shows the predominance or influence of an outside culture. Through a historical and evolutional study, we were able to verify that the origin of these semantic models goes back to Joseph Plenck and Robert Willan (essentialist model) and to Ferdinand Hebra (nominalist model), respectively. An analysis of these models from a historical perspective may help in understanding the origin of the current conflicts in the everyday use of Spanish dermatological semiology, and may therefore help resolve them.

The development of flat angiomas in the form of a "port-wine stain" is an infrequent event in adults. We describe two cases of acquired flat angioma in the form of a "port-wine stain", which began in the second decade of life and grew slowly and steadily until reaching a large size. In the first case, it affected the front and back of the trunk, and in the second patient, the neck and left shoulder. Histopathology showed ectatic vessels in the papillary and reticular dermis, with no proliferation of endothelial cells.

Scleromyxedema is a type of mucinosis that presents with some well defined clinical and histopathological characteristics. We describe the findings observed with transmission electron microscopy in a case that we recently studied. The patient was a 56-year-old female with a localized eruption of lichenoid papules on the face, upper trunk and limbs. It was accompanied by IgG lambda gammopathy. Optical microscopy showed the findings typical of scleromyxedema. Electron microscopy revealed the existence of a large number of fibroblasts with high activity levels in the synthesis and release of collagen fibers and a mucoid substance.