Idera Pharmaceuticals, Inc. (NASDAQ: IDRA) today announced the receipt of verbal notification from the Food and Drug Administration (FDA) that the company may proceed with a Phase 2 clinical trial of IMO-3100 in patients with psoriasis based on a trial protocol submitted by the company in October 2011. IMO-3100 is a dual antagonist of Toll-like receptor (TLR) 7 and TLR9 and is in clinical development as a potential therapy for autoimmune and inflammatory diseases.

“We are pleased to have the FDA’s notification that we can proceed with a Phase 2 clinical trial of IMO-3100 in patients with psoriasis,” said Sudhir Agrawal, D.Phil., Chairman and Chief Executive Officer of Idera. “We are now preparing for this Phase 2 trial of our novel dual-TLR antagonist for the treatment of autoimmune diseases and expect to initiate the study in the first half of 2012.”

Idera has selected psoriasis as the initial indication for the first clinical evaluation of IMO-3100 in patients with autoimmune disease. In July 2011, the company submitted a Phase 2 protocol to evaluate IMO-3100 in patients with psoriasis over a 12-week treatment period. As previously announced, this protocol was put on clinical hold by the FDA. In October 2011, the company submitted a new Phase 2 protocol to evaluate IMO-3100 in patients with psoriasis over a 4-week treatment period, for which the company has received notification of FDA authorization to proceed.

About IMO-3100
IMO-3100, an antagonist of TLR7 and TLR9, is a lead clinical candidate in development to treat autoimmune and inflammatory diseases. IMO-3100 is designed to block production of multiple cytokines induced through TLR7 and TLR9. In contrast, many current autoimmune disease treatments aim to block the activity of individual cytokines. IMO-3100 has demonstrated potent activity in reducing pathologic and immunologic manifestations in preclinical mouse models of diseases such as lupus, arthritis, psoriasis and hyperlipidemia. Phase 1 clinical trials of IMO-3100, including an escalating single-dose study and a multiple-dose study, have been completed in healthy subjects.

Source: iderapharma.com

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You have had psoriasis for a number of years and have tried all the prescribed treatments, you have tried all the over the counter drugs, you have tried a diet and life style change, you even fell for the con artist out there and parted with your hard earned cash trying to be rid of psoriasis.

One day you wake up with an idea buzzing around your head that you think could work. After all these years you hadn’t noticed that the cure for psoriasis was staring you in the face! You go about collecting the things you need to mix up a potion and after a few failed attempts; you think you have finally got it right.

OK let’s not get too carried away with it all. You have to try it first before telling anyone. So you start using your potion in small doses as well as keeping a diary of the trials. This goes on for about a year and you haven’t said a word to anyone.
So your potion works. After 2 months you were completely clear and had stopped taking the potion. You can’t believe it yourself so you share your potion with a trusted friend who also gets clear in two months.

You both remain clear and for around 5 years and decide you must share this with the world. But where to start? Should you form a company, should you get a patent, should you even try Dragons Den? Damn all this worry is enough to bring on a flare up. But it doesn’t, you are both still clear.

The cure that everyone has been looking for exists and you and your friend have it. You want to share it with the world for free, it’s easy to make at home and anyone with your instructions could make it. Your friend however wants to sell it and make lots of money; after all it’s got to be worth anyone with psoriasis paying €100 to be clear for the rest of their life.
Luckily you and your friend still get on very well and you both decide to sit down and discuss it. After a few days your friend tells you he has contacted four of the big drug manufacturers to ask if they would be interested in a psoriasis cure. You are livid; you wanted it to be free to the world and just wanted to see everyone cured of psoriasis. 

Within a few days you have offers from the big four drug companies, they are all interested but they all want it removed from the market. They have sent you and your friend an offer of One Hundred Million to remove it from the market, destroy any notes, and never talk about it again. If you break the contract they will take you to court for Two Hundred Million.

So what do you do? Would you say no to One Hundred Million, if you did could you trust your friend? Or would you just give it to the whole world for free and watch the big four drug manufacturers run it into the ground with false allegations about how your potion can kill people!

P.S No I haven’t developed a potion. If I had do you think I would be sitting here typing this with my stiff flaky fingers?

T Cells are like Soldiers in your body and their job is to protect you from Viruses, Infections and Foreign Substances.

Cell and Function
B-cell: Production of antibodies
Helper T cell: Helps B-cells in their function
Helper Th2: Helps B-cells
Helper Th1: Helps Cytotoxic T cells
Cytotoxic T cell: Kills and damages the antigens

The dutiful soldiers get into action the moment any foreign substance or agent enters our body. Thereby the immune system is activated. The end result is the elimination of the substance or agent from our bodies.

Usually your Soldiers will just go about their business without you knowing about it, but should you have psoriasis then things go wrong with your army.

Private T cell thinks he knows best and gets a bit carried away with his job. Somehow he gets in your skin, which is not his job. He spots a skin injury and off he goes! He stimulates B cells and other white blood cells into attack mode.
Also amongst his weapons he can stimulate the production of powerful immune factors called cytokines. In small amounts, cytokines are very important for healing. However, a high level of cytokines causes your skin cells to reproduce at a faster rate. This in turn creates a pile of dead skin that Private T Cell thinks are more enemies, and so the cycle begins.

Normally private T cell is very well regimented and obeys his orders, but you and me have inherited in our genetics, some rouge soldiers that have been waiting around for us to have a slight injury, emotional stress, or an infection so he can come out and go wild with his weapons.

Someone throw that soldier in the Cooler!

Hey everyone, been to see my parent's for a couple of weeks but glad to be back home.
Hope everyone is ok, I have had to endure numerous John Wayne films from my aged Father, so I have been bored stupid, but it is still nice to see them, and also nice to be home again.
Regards to all,
Micky.

A new study in Sweden shows high risk of pulmonary embolism in people with psoriasis and other autoimmune disorders.

Background:
Some autoimmune disorders have been linked to venous thromboembolism. We examined whether there is an association between autoimmune disorders and risk of pulmonary embolism.

Methods:
We followed up all individuals in Sweden without previous hospital admission for venous thromboembolism and with a primary or secondary diagnosis of an autoimmune disorder between Jan 1, 1964, and Dec 31, 2008, for hospital admission for pulmonary embolism. We obtained data from the MigMed2 database, which has individual-level information about all registered residents of Sweden. The reference population was the total population of Sweden. We calculated standardised incidence ratios (SIRs) for pulmonary embolism, adjusted for individual variables, including age and sex.

Findings:
535 538 individuals were admitted to hospital because of an autoimmune disorder. Overall risk of pulmonary embolism during the first year after admission for an autoimmune disorder was 6·38 (95% CI 6·19—6·57). All the 33 autoimmune disorders were associated with a significantly increased risk of pulmonary embolism during the first year after admission. However, some had a particularly high risk—eg, immune thrombocytopenic purpura (10·79, 95% CI 7·98—14·28), polyarteritis nodosa (13·26, 9·33—18·29), polymyositis or dermatomyositis (16·44, 11·57—22·69), and systemic lupus erythematosus (10·23, 8·31—12·45). Overall risk decreased over time, from 1·53 (1·48—1·57) at 1—5 years, to 1·15 (1·11—1·20) at 5—10 years, and 1·04 (1·00—1·07) at 10 years and later. The risk was increased for both sexes and all age groups.

Interpretation:
Autoimmune disorders are associated with a high risk of pulmonary embolism in the first year after hospital admission. Our findings suggest that these disorders in general should be regarded as hypercoagulable disorders.

Source: thelancet.com

In the dumps at the moment.I cannot believe this has happened to me in my 70s.i could cheerfully cut my head off.My scalp is giving me so much trouble.The Xamiol the Dr prescribed has made my head worse i have short fair hair and you would think i had been scalded.So now i have decided to stop all the treatment and see what happens.Also stopped the Dovobet on my body.The horrible red patches are sprouting up like mushrooms in the dark.Oh woe is me what a winge i am in fact family are calling me grumpy gertie

In its collaboration with Abbott, Biotest AG is pursuing an innovative therapeutic strategy to treat the autoimmune disorders Rheumatoid Arthritis and Chronic Plaque Psoriasis using the monoclonal antibody Tregalizumab (BT-061).

A phase IIa clinical trial with repeated doses has been completed in which Tregalizumab was tested for the treatment of chronic plaque psoriasis.

This trial was a placebo-controlled, double-blind, multicentre, multinational, multiple dose, dose-escalation study to evaluate the safety and efficacy of BT-061 in different doses and mode of administrations. Patients were treated subcutaneously or intravenously weekly for eight consecutive weeks in six different escalating dose groups. The primary endpoint of the study was PASI 75 (PASI : Psoriasis Area and Severity Index) response at Week 9, with PASI 50 and PASI 90 responses at Week 9 as secondary endpoints.

49 patients with Chronic Plaque Psoriasis were enrolled. Patients received Tregalizumab as monotherapy at doses between 25-100 mg as subcutaneous injections or 0.5 and 2 mg as intravenous infusions. Tregalizumab was administered once weekly for 8 weeks. In each treatment group, six patients received active treatment and two patients received placebo. After the treatment period, the patients were observed for further 12 weeks without Tregalizumab treatment (follow-up period).

Highest clinical response measured by the PASI score was achieved in the 100 mg dose-group. 71.4% of patients experienced at least a 50% improvement in psoriasis signs and symptoms as measured by PASI (PASI 50) at week 9, compared with 37.5% of those who received placebo. At the same time, in this dose-group, 42.9% of patients receiving active drug had an improvement of at least 75% (PASI 75) vs 12.5% for placebo.

In analogy to the results of the previous Phase I/II trial Study 967 (single dose administration), also in study 973 in the relevant active dose-groups, the PASI score generally further improved after the end of the 8 week treatment period. Further improvement of up to 90% (PASI 90) was observed in several patients during the treatment and follow-up period. The evaluation of response within the treatment and follow-up period (best response) showed a PASI 50 improvement in 71.4%, a PASI 75 in 57.1% and a PASI 90 in 14.3% of patients in the 100 mg SC dose-group. The respective numbers in the corresponding placebo group were 37.5%, 25.0%, and 0.0% (PASI 50, PASI 75, and PASI 90).

The good tolerability of Tregalizumab, which was expected based on the data from previous trials, has also been confirmed in the concluded phase IIa trial.

Further studies in Psoriasis in larger patient groups with a less frequent dosing schedule and a longer treatment period for Tregalizumab will only be started after finalisation of phase IIb trials in Rheumatoid Arthritis.

Source: pipelinereview.com

The LEO Pharma Research Foundation’s Gold and Silver awards 2011 go to Claus Johansen and Charlotte Menné Bonefeld – young researchers with exceptional achievements in dermatology.

The awards will be presented on 23 November at the Panum Institute in Copenhagen by Professor Povl Krogsgaard-Larsen, world-leading medicinal chemist and Chairman of the Board of the Carlsberg Foundation.

“This year’s award winners have made outstanding contributions to dermatology, despite their young age. Ultimately their research can lead to better care for patients with skin disorders. We hope that the awards can support their accomplishments in the future,” says Tore Duvold, chairman of LEO Pharma Research Foundation’s award selection committee.

Gold award:
The DKK 1,000,000 award goes to 38-year-old Danish dermatological researcher Claus Johansen. His research over the years has focused on the complex network of intra-cellular signals controlling inflammatory skin disorders, particularly in relation to psoriasis. The results have furthered understanding of the inflammatory process in psoriasis – key knowledge for the future development of new therapies.

Silver award:
The 36-year-old immunologist Charlotte Menné Bonefeld receives the DKK 500,000 award for her research achievements in dermatology. Her research includes new promising results, which show that the immune system weakens – in other words develops tolerance – when someone is repeatedly exposed to strong allergens such as those found in hair dyes. The results offer new insight into treatment possibilities and the reasons why people develop allergies.

Source: leo-pharma.com

Amgen announced today that a new U.S patent had been granted that could protect its big-selling drug Enbrel from generic competition for 17 more years.

Enbrel was one of several biotechnology drugs that were expected to face competition in the next few years from copycat versions, eventually saving the health care system billions of dollars a year.

The 2010 health care law established a way for such biologic drugs, which can cost tens of thousands of dollars a year, to face competition from near generic versions, which are often called biosimilars. A new law was needed because biologic drugs, which are made in living cells, were not covered by the 1984 law governing most pharmaceutical competition.

The main patent on Enbrel was to expire in October of next year. But the new patent could stave off such biosimilar competition until Nov. 22, 2028. By that time, Enbrel will have been on the market 30 years, far longer than the 20 years of protection expected in patent law.

Source: Amgen

LEO Pharma and Aarhus University have cloned the world’s first transgenic mini pig with a predisposition for psoriasis. The unique animal is expected to transform dermatological research and pave the way for safer and more effective skin treatments in the future.

Born in July, the pig was created using a new ‘handmade cloning’ technique pioneered in Denmark at Foulum Research Centre. The breakthrough offers new opportunities in the future for studying not only psoriasis, but also an array of skin diseases, from child eczema to skin cancer.

The successful result - part of a €6.4m project called Pigs and Health co-financed by the Danish National Advanced Technology Foundation ¬- will be presented in an all-day seminar at the Danish Agriculture and Food Council on 21 November in Copenhagen.

“This is an exciting breakthrough - not only for future psoriasis treatment, but also for the entire field of dermatological research,” says Thomas Kongstad Petersen, Director of Preclinical Development at LEO Pharma.

“Now we have the potential to test new drugs and therapies for a multitude of skin conditions, from eczema to skin cancer. We strongly believe that this animal will play a significant role in our future drug research and help us radically improve treatment for people with skin diseases.”

Cutting-edge cloning
The research also represents a globally significant advance in cloning, according to the research team at Aarhus University.

“The result is extremely promising. With this new discovery, we have established the genetic fundamentals for generating transgenic pig models of human skin disease”, says Jacob Giehm Mikkelsen, Associate Professor at the Department of Biomedicine, Aarhus University.

Thanks to the recent Danish progress in pig transgenesis – where this result is one of a series of breakthroughs - Denmark is now a global front runner in the production of cloned transgenic mini pigs by somatic cell nuclear transfer.

‘Handmade cloning’ involves removing an egg’s genetic material and replacing it with a genetically engineered somatic cell nucleus from a donor pig. The resulting egg is then transferred to a surrogate pig’s womb. To create the transgenic mini pigs with a predisposition for skin disease, the ‘handmade’ eggs were modified to carry two human genes. The next step is to standardise the animal model, which is expected to take up to two years.

Also involved in the Pigs and Health project are PixieGene, Danish Agriculture and Food Council, Pig Research Centre, University of Copenhagen, Technical University of Denmark and Ellegaard Göttingen Mini-pigs. The project aims to produce pigs that are sensitive to human disease for use in medical research.

Transgenetic means to have genetic material, or DNA, from another species.
A mini pig is raised under standardised conditions. For practical reasons, a mini pig therefore often used in scientific research and development of medicine.
‘Handmade cloning’ involves removing an egg’s genetic material and replacing it with a genetically engineered somatic cell nucleus from a donor pig. The resulting egg is then transferred to a surrogate pig’s womb.
Pigs are similar to humans in terms of physiology and anatomy, making them more suited for drug testing than mice or rats.
A somatic cell is a body cell i.e. from skin. 

Source: leo-pharma.com

BioTrends Survey of Over 1,300 Patients with Autoimmune Disorders Indicates High Disease Impact on Quality of Life Metrics and Challenges Patients Face with Their Disease.

In a comparison of patient reported ratings on autoimmune disease impact on quality of life metrics, BioTrends Research Group found that patients with ankylosing spondylitis (AS) and Lupus/SLE (SLE) reported significantly higher impact on “Activities of Daily Living” and “Emotional Health” compared to patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Leading up to diagnosis, patients reported struggling with symptoms for many months before receiving a diagnosis. About one-third of AS and PsA patients had symptoms for more than one year before being diagnosed and close to half of these patients saw more than two physicians before receiving a diagnosis. On average, AS patients were symptomatic for nearly three years, often receiving another diagnosis prior to AS. By comparison, PsA and RA patients were typically diagnosed within the first year of presentation and gout patients were diagnosed almost immediately.

The degree to which loved ones are involved in the care of these patients also varies by disease as does the extent to which the patients are active versus passive seekers of information. While the treating physician plays the lead role in providing disease information for all of the conditions, other sources also influence the patients in their awareness about their disease and treatment options.

Reports are based on surveys and qualitative interviews with patients diagnosed with various diseases including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, chronic kidney disease, multiple sclerosis and hepatitis c. These reports seek to understand the patient journey from symptoms to diagnosis to current status. The reports also explore how often and in what ways patients seek information and probe into patient’s awareness about their disease, the treatments available and desired features in new treatment options.

Source: bio-trends.com

Objectives: 
To assess patients' preferences for psoriasis treatments and to identify the effect of sociodemographic and socioeconomic characteristics on these preferences.

Design:
A computer-based conjoint analysis experiment was conducted to analyze the preferences of individuals with moderate or severe psoriasis for outcome attributes (probability, magnitude, and duration of benefit, as well as probability, severity, and reversibility of adverse effects) and process attributes (treatment location, frequency, duration, delivery method, and individual cost) of psoriasis treatments. Relative importance scores (RISs) for each attribute were calculated. The effect of sociodemographic (age, sex, and marital status) and socioeconomic (income and employment) characteristics and Psoriasis Area and Severity Index and Dermatology Life Quality Index scores on preferences was assessed using analysis of variance, post hoc testing, and multivariate regression analysis.

Setting:
Outpatient dermatology clinic at a German university medical center.

Participants:
Patients with moderate or severe psoriasis (N = 163).

Main Outcome Measure: 
Relative importance scores for treatment attributes.

Results: 
The attribute considered to be most important in patients' preferences for psoriasis treatments was treatment location (RIS, 26.76), followed by probability of benefit (RIS, 23.77) and method of delivery (RIS, 23.49). The RISs for all process attributes were higher than for adverse effect–related attributes. Older individuals (≥65 years) were less concerned about the probability of benefit (β = –0.24; P = .005) compared with younger individuals.

Conclusions: 
When choosing among treatment options, individuals with psoriasis appear to be willing to accept treatment-related adverse effects to obtain process attributes compatible with their personal and professional life. Incorporating preferences in shared decision making may facilitate treatment adherence and optimize outcome.

Source: .ama-assn.org

It's a normal cause and effect reaction that when you get an itch, you scratch it. But for individuals with psoriasis, the "itchy" feeling can be taken to truly excruciating levels where scratching doesn't stop the itch and can may it even worse.

An array of prescription and over-the-counter (OTC) remedies specifically target the itch of psoriasis. This disorder is from an immune system glitch that causes skin cells to turn over much faster than normal, producing red, scaly skin lesions. To date, there is no cure for the disorder or the itching, only treatements.

The word psoriasis, in fact, is derived from the Greek word psora, meaning "itch," and alludes to one of the most troubling symptoms.

Although many people who have psoriasis (or "psoriatics") are disturbed by how the crusty lesions, or plaques, look -- particularly when they appear on the face and hands -- some are even more concerned with the itchiness.

For example, a 2004 study found that itching was the most frequent complaint among patients hospitalized for psoriasis, which can result in lesions on any area of the body, including the genitals, palms and soles of the feet.

Also, a survey of the National Psoriasis Foundation members indicated that only the scaling of lesions outranked the itch as the most vexing symptom of the condition.

Whenever a condition causes a chronic itch, it's likely to have an impact on quality of life. That's certainly the case with psoriasis, as evidenced by another scientific study. This study revealed that people with psoriasis reported various symptoms, including itchiness that disrupted their sleep, reduced their sex drive and interfered with their ability to concentrate.

However, many options are available to counter this uncomfortable symptom. Besides reducing discomfort, treatment can help avoid what's known as the "itch-scratch cycle," in which regular scratching can increase the inflammation, which leads to still more itching.

Moreover, scratching can actually trigger psoriasis flare-ups through the Koebner phenomenon, in which skin damage -- such as cuts, insect bites or sunburn -- elicits a disease response. This occurs in a wide range of psoriatics -- between 11% to 75%, depending on the study -- as well as in several other skin conditions.

In no particular order, here are some of the most common itch-fighters for psoriasis, including prescription, OTC and homemade preparations. Specific brand names may be mentioned because they're easy to find, but each of these remedies is sold under various labels. Consult a doctor about any unexpected reactions.

1) Antihistamines: These medications target the nerve pathways related to itching and can have a sedative effect, which may help psoriatics sleep through their itching. Look for "non-drowsy" antihistamines for daytime usage. Be sure to follow dosage guidelines.

2) Creams and lotions: The simple act of smoothing on a rich layer of emollients can help keep itch away, because dry skin tends to be itchy skin -- even in a person without psoriasis. Creams are more moisturizing than lotions. Certain anti-itch creams are particularly helpful for psoriasis, including Gold Bond Medicated Anti-Itch Cream and Aveeno Overnight Itch Relief (with oatmeal).

3) Topical corticosteroids: Whether in prescription or OTC strength, steroids -- such as Cortaid or Lanacort -- are widely used to treat various sorts of itching. However, you should exercise care in using these products. Over the long term, steroid creams can result in skin-thinning.

4) Capsaicin: An ingredient derived from hot peppers, capsaicin is proven to help itching, although for some it stings or burns at first. This product is available OTC, known as Capsin and Capzasin-P.

5) Topical anesthetics: An application of one of these nerve-deadening products can keep itch at bay for hours. Topical anesthetics include both prescription medications -- such as benzocaine and lidocaine -- and OTC products -- such as menthol and camphor -- found in Sarna lotion, Bengay and Vicks VapoRub.

6) Oatmeal baths: Especially for those with widespread plaques, oatmeal baths soothe all affected areas in one step. Just pour in the recommended amount of ground colloidal oatmeal (such as Aveeno Soothing Bath Treatment) as you fill up the tub and soak in its milky smoothness for awhile. Immediately after drying off, follow with a liberal layer of moisturizing cream for longer-lasting itch relief.

7) Ice packs: Among the quickest and easiest solutions, a frozen gel pack applied to psoriatic skin not only eases itch by numbing nerve endings, but cools the rawness of inflamed patches.

8) Plastic wrap over lotion: Covering psoriasis-covered areas with lotion and then plastic wrap, socks or gloves -- known as occlusion -- keeps medicated or nonmedicated preparations airtight for hours, increasing their itch-fighting effect and helping to discourage scratching. Check with a doctor to determine which preparations may work best for your case.

Data Presented at the American College of Rheumatology Annual Scientific Meeting Are Welcome and Exciting News for Patients with Ankylosing Spondylitis and Psoriatic Arthritis

There is currently no cure for ankylosing spondylitis.  Current medical treatments for spondyloarthropathy are all aimed at reducing overall inflammation, and include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) including both traditional medications and newer biologics.

Psoriatic arthritis is also a spondyloarthropathy and is associated with the skin condition psoriasis, which is caused by immune system problems that result in increased cell growth. In the United States, approximately three percent of the population, or more than five million adults, have psoriasis.  For people with psoriatic arthritis, quality of life is impacted by both the physical symptoms of the disease and the emotional burden of disfiguring skin symptoms.

Continued research has pointed the way to new methods of fine-tuning the immune response and controlling inflammation that may someday offer better relief with fewer side effects. One study seen at ACR was of an investigational treatment that may be the first small molecule to show an effect in both psoriatic arthritis as well as the axial and peripheral components of ankylosing spondylitis.

"Exciting advancements in research are going on in spondyloarthropathies.  Apremilast – is a novel oral therapy that could potentially offer a new disease-modifying treatment option for people who are affected by this debilitating condition," said Dr. Peter Taylor, Professor of Musculoskeletal Sciences, Honorary Consultant Rheumatologist and Head of Clinical Trials, Kennedy Institute of Rheumatology, University of Oxford, UK. "I am delighted to be working with the Spondylitis Association of America in order to educate people about this disease and show them the hope that potential new treatments may provide."

Spondyloarthropathies (sometimes called spondyloarthritis) are a group of interrelated chronic diseases that cause inflammation in the spine (spondylo) and other joints, as well as at the points where ligaments and tendons attach to the bone.  Ankylosing spondylitis (AS) is a crippling form of arthritis falling under this category that generally strikes young people in their teens and twenties, sometimes even earlier. Left untreated, it causes pain, disability and can eventually cause the spinal vertebrae to fuse together forming one brittle bone, often in a stooped over position.  The most common symptoms of ankylosing spondylitis are pain and stiffness. 

Source: prnewswire.com

Skin is the largest organ of the human body and the average adult skin has a surface area of between 1.5-2.0 square metres, its thickness varies from 0.5mm on your eyelids to 4mm or more on the palms of your hands. The average 6.5 cm² of skin holds 650 sweat glands, 20 blood vessels, 60,000 melanocytes, and more than 1,000 nerve endings.

Skin acts as a waterproof, insulating shield, guarding the body against extremes of temperature, damaging sunlight, and harmful chemicals. It also exudes antibacterial substances that prevent infection and manufactures vitamin D for converting calcium into healthy bones. Skin additionally is a huge sensor packed with nerves for keeping the brain in touch with the outside world. At the same time, skin allows us free movement and without it, we'd literally evaporate.

Skin is composed of three primary layers:
#1 the epidermis, which provides waterproofing and serves as a barrier to infection.
#2 the dermis, which gives the organ its strength and elasticity.
#3 the hypodermis (subcutis) contains blood vessels and nerves It also works as insulation and cushions us from knocks and falls.

Skin offers Protection, Sensation, Heat and Evaporation Regulation, Storage and Synthesis, Excretion and Absorption, it’s also Water Resistant and can even Heal Itself.

So remember even though you have psoriasis and your epidermis cells reproduce in 2-10 days instead of 20-30, the skin is still a wonderful organ.

Psoriatic arthritis patients on biologic therapy reported a decrease in pain, but MR imaging of their joints showed that there was still active disease, researchers reported here.

Among 29 patients who responded to treatment with adalimumab (Humira), the patient perception of pain dropped markedly as measured on a visual analog scale from 62 at baseline to 12 at week 48 (P<0.0001), said Rene Poggenborg, MD, research fellow in rheumatology at Glostrup University Hospital, Copenhagen.

"A surprising finding was that the synovitis -- the inflammation of the joint -- did not decrease very much," Poggenborg told MedPage Today at his poster presentation during the annual meeting of the American College of Rheumatology.

At baseline the PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Scale) score was a 9, and after a year it was a 6 (on a scale of 0 to 36).

"While this was of borderline significance (P<0.05), it did not correlate with clinical response, which was very good," he said. "So we had a very good clinical outcome, but not much of an improvement radiologically. We were able to document, using a contrast agent, that inflammation in the joints of patients disappeared after 48 weeks of treatment."

Poggenborg noted that the use of MRI to assess outcomes in these patients is useful, but is also time-consuming. "It takes a while to do the scoring on these scans; I estimate it takes about an hour per patient," he said.

"We had 29 responders among the 41 patients in the study. There were dropouts and in others, for some reason, adalimumab didn't appear to work. This is one way to monitor how well patients are doing on certain treatments," Poggenborg added.

"There is a disconnect between clinical remission and MRI remission in patients with rheumatoid arthritis," commented Amanda Brown, MD, assistant professor of pediatrics at Children's Hospital New Orleans at the Louisiana State University Health Science Center. "Some of the adult data has shown about a six-month difference."

In Poggenborg's study, more than half the patients were women and the average age of the study cohort was 49. They had experienced skin disease for about 20 years and had experienced joint disease for about nine years.

In the visual analog scale of global discomfort, the baseline score was 65. At 48 weeks, the responders had a score of 11 (P<0.0001). The visual analog scale using the doctors' perception of pain was 50 at baseline and 3 among responders after 48 weeks of therapy (P<0.0001), Poggenborg reported.

In addition to the decrease in synovitis, flexor tenosynovitis decreased from 2 to 1 on a scale of 0 to 36 (P<0.005). Bone erosion scores increased from 2 at baseline to 3 after a week of treatment on a scale of 0 to 240 (P=NS); and the overall MRI inflammation score decreased from 16 to 9 on a scale of 0 to 168 (P<0.005).

Poggenborg said the patient population had relatively early disease so there wasn't much bone damage, but even after a year of therapy, the MRI still indicated some disease activity persisted.

"Once the joints are clinically silent there is still activity on MRI," Brown told MedPage Today. "We have the opportunity to put these patients in remission with biologics, but are we really putting them into remission?"

Brown, who presented a similar study of imaging among pediatric patients with forms of rheumatoid arthritis, but who was not a researcher on the Danish study, noted, "One of the goals in rheumatoid arthritis is to treat to target, but is this really enough? Is this mild synovitis we see on MRI clinically important or are we just finding it because we are looking for it?

"I think there definitely is a lag time between clinical improvement and imaging improvement, but we don't know how long that is," she said. Brown added that although treatment with biologics can put patients in clinical, and eventual radiological remission from rheumatoid diseases, few patients ever return to baseline.

Source: medpagetoday.com

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