Two Cases of Pachydermodactyly Presenting as Polyarthritis

Pachydermodactyly is characterized by asymptomatic, progressive swelling of the lateral aspects of the 2nd to 4th finger along the proximal interphalangeal (PIP) joint without involving the joint itself. We present 2 interesting cases of patients with periarticular swelling who were initially diagnosed and treated as juvenile idiopathic arthritis (JIA) with subsequent clinical and pathology confirmation of pachydermodactyly. These cases emphasize the importance of considering pachydermodactyly in young patients with development of periarticular swelling and no joint involvement

The Self-Administered Psoriasis and Arthritis Screening Questionnaire (PASQ): A Sensitive and Specific Tool for the Diagnosis of Early and Established Psoriatic Arthritis

Background Psoriatic arthritis is a serious chronic inflammatory arthritis that can lead to significant joint damage and often is associated with comorbidities. Early detection and effective management of psoriatic arthritis may prevent the development of such complications. Most patients develop psoriatic arthritis years after onset of psoriasis, and most patients with psoriasis alone are managed by dermatologists or general practitioners. These clinicians are thus in an excellent position to screen for psoriatic arthritis early in the disease course. Objective The objective of this study was to evaluate the sensitivity and specificity of the Psoriasis and Arthritis Screening Questionnaire (PASQ) in detecting patients with psoriatic arthritis. Methods Two groups of patients were screened: patients with established disease and patients referred for evaluation of possible (i.e., early) psoriatic arthritis. Results In patients with established disease, analysis of the PASQ score yielded an optimal cutoff point of 9 with 86.27% sensitivity and 88.89% specificity. In patients with early disease, the PASQ indicated an optimal score of 7 with 92.86% sensitivity and 75% specificity. Conclusion The PASQ is an effective screening tool in psoriatic arthritis patients with a long history of disease as well as in those with short disease duration. </jats:sec

Sunscreens: Past, Present, and Future

Sunscreens form an important modality for cutaneous photoprotection. Sunscreen formulations incorporate many features that provide protection from ultraviolet (UV)-induced carcinogenesis, immunosuppression, and accelerated photoaging. Since the 1920s, when the link between skin cancer and UV radiation was first observed, sunscreen use has become part of our daily routine. Chemical and physical modifications are continuously made to formulations so that they may be more appealing to the general population, especially to those with fair skin. The demand for a formula that is effective in its UV protection while at the same time is adoptable in its application and exposure characteristics is an important consideration in the development of sunscreens. Because of continued development, technological advances, and substantive gains in knowledge on UV-induced photodamage, at present, we are able to produce effective formulations, and although these formulations do not provide total spectrum protection, they are considerably better than sunscreens of the past. </jats:p

The Electronic Psoriasis and Arthritis Screening Questionnaire (ePASQ): A Sensitive and Specific Tool to Diagnose Psoriatic Arthritis Patients

Background: We report on an electronic version of the Psoriatic Arthritis Screening Questionnaire (ePASQ), a sensitive and specific tool for diagnosis of psoriatic arthritis (PsA) in patients with plaque psoriasis. Objective: To validate the ePASQ against the original paper version. Method: The ePASQ scores 15 points on 10 weighted questions and a 68-joint diagram. Data were collected from a prospective cohort of 42 patients with early PsA meeting the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria and from 12 plaque psoriasis patients without PsA. Results: The receiver operating characteristic curves for the ePASQ group yielded an optimal 97.62% sensitivity and 75.00% specificity, for a cutoff score of 7. A cutoff point of 8 yielded 88.10% sensitivity and 75.00% specificity. Concordance of the paper and electronic scores was very high. Conclusion: The ePASQ is a sensitive and specific tool to screen for PsA. The simple electronic administration and automatic scoring minimize clinician involvement and increase the potential for wider distribution. </jats:sec

Two Cases of Pachydermodactyly Presenting as Polyarthritis

Pachydermodactyly is characterized by asymptomatic, progressive swelling of the lateral aspects of the 2nd to 4th finger along the proximal interphalangeal (PIP) joint without involving the joint itself. We present 2 interesting cases of patients with periarticular swelling who were initially diagnosed and treated as juvenile idiopathic arthritis (JIA) with subsequent clinical and pathology confirmation of pachydermodactyly. These cases emphasize the importance of considering pachydermodactyly in young patients with development of periarticular swelling and no joint involvement

Clinical Experience with Alefacept in Canadian Patients with Psoriasis: The Amevive Wisdom Acquired from Real-world Evidence (AWARE) Study

Background Alefacept was the first biologic therapy approved for the treatment of chronic plaque psoriasis in Canada. Objective The AWARE study was an observational phase IV study whose main goal was to describe the outcomes of alefacept treatment in a broad population of Canadian psoriasis patients. Methods A total of 426 patients with chronic plaque psoriasis were enrolled from 37 clinics across Canada. Patients were treated with up to two courses of alefacept and followed for up to 60 weeks. Results The majority of patients had a moderate to marked response to alefacept treatment. Treatment with concomitant systemic therapy was discontinued or reduced in up to a third of subjects. Forty percent completed the entire follow-up period without receiving a second course of alefacept. Conclusion In routine clinical settings in Canada, alefacept is an effective and safe option for the treatment of a wide range of patients with psoriasis. </jats:sec

Hidradenitis Suppurativa: A Novel Model of Care and an Integrative Strategy to Adopt an Orphan Disease

Unnecessary investigations, inappropriate treatment, worsening disease, and frustration for both patients and health care professionals are the hallmarks of hidradenitis suppurativa (HS) management. In light of a new treatment algorithm and biologic therapies made available to patients, an HS model of care is outlined in this article. The recommendations and management strategy presented here have been developed to help address the currently unmet needs of this patient population. The patient-centred model of care and disease management strategies were developed through the guidance and recommendations of HS medical experts in Newfoundland and Labrador. This article lays the foundation for the resources and steps required to change the status of this orphan disease and firmly embed patients with HS within a coordinated and integrative system of care. </jats:p

Patterns of Combination Therapy with Alefacept for the Treatment of Psoriasis in Canada in the AWARE Study

Background: Evidence from clinical trials supports the use of alefacept for the treatment of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept. Methods: Patients with chronic plaque psoriasis were treated with at least one course of alefacept treatment followed by a period of at least 12 weeks off-treatment. The use of combination therapy with alefacept in a real-world population of psoriasis patients is presented here, including the types of psoriasis therapies received by patients at the time of enrolment, reasons for initiating alefacept, and discontinuation or dosage reduction of concomitant therapy. Results: The majority of patients were receiving other antipsoriatic therapies at the time of enrolment into the AWARE study, most commonly topical therapy, systemic agents, or phototherapy. Most patients were receiving monotherapy prior to the initiation of alefacept. There was little change in the use of topical therapies with alefacept at 24 weeks, whereas a substantial proportion of patients were able to reduce or discontinue concomitant systemic therapies and/or phototherapy. The use of combination therapy regimens was relatively consistent across the country and by age groups, although younger patients were prescribed systemic agents more often than older patients. Conclusion: Alefacept is commonly added to other antipsoriatic therapies in a broad population of real-world chronic plaque psoriasis patients in Canada and may allow for dosage reduction or discontinuation of concomitant systemic agents or phototherapy. </jats:sec