I just got the bill for my next Stelara injection; I pay USD75 (about 57 euro), my insurance pays $11,292 (€8,648).

Now my employer has filed for chapter 11 bankruptcy, not only is my pension in jeopardy, who knows what the medical plan will look like next year.........

Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails according to new research.

Objective:
Enthesopathy is a major feature of psoriatic arthritis (PsA), which is supported by imaging studies. Given that nail disease often predates PsA and that the nail is directly anchored to entheses, the authors asked whether nail involvement in psoriasis equates with a systemic enthesopathy.

Methods:
Forty-six patients with psoriasis (31 with nail disease) and 21 matched healthy controls (HC) were recruited. 804 entheses of upper and lower limbs were scanned by an ultrasonographer blinded to clinical details.

Results:
Psoriasis patients had higher enthesitis scores than HC (median (range) 21 (0–65) vs 11 (3–39), p=0.005). Enthesopathy scores were higher in patients with nail disease (23 (0–65)) than in patients without nail disease (15 (5–26), p=0.02) and HC (11 (3–39), p=0.003). Inflammation scores of patients with nail disease (13 (0–34)) were higher than patients without nail disease (8 (2–15), p=0.02) and HC (5 (0–19), p<0.001). Modified nail psoriasis severity index scores were correlated to both inflammation (r2=0.45, p=0.005) and chronicity scores (r2=0.35, p=0.04). No link between the psoriasis area and severity index and enthesitis was evident.

Conclusion:
The link between nail disease and contemporaneous subclinical enthesopathy offers a novel anatomical basis for the predictive value of nail psoriasis for PsA evolution.

Source: ard.bmj.com

Background:
The reason psoriasis favours extensor skin is unknown. We hypothesized that psoriasis may involve extensor skin preferentially because of differences in the number or type of dermal dendritic cells (dDCs) between flexural and extensor skin.

Objective:
We sought to compare dDC type and distribution in normal-appearing flexural and extensor skin, psoriasis, and nummular dermatitis (ND).

Methods:
Using immunohistochemical markers, the number, distribution, and type of Langerhans cells, myeloid dendritic cells (DCs), and plasmacytoid DCs was compared in normal-appearing skin, psoriasis, and ND.

Results:
Significant differences in dDC density were not identified between flexural and extensor skin, although extensor skin contained fewer CD11a+ and CD11c+ cells. Compared with normal-appearing skin, cells expressing CD11a, CD11c, CD123, CD303, and CD207 were increased in psoriasis. ND lesions showed similar increases. No significant difference between psoriasis and ND was evident with the exception of decreased S100A6+ cells in psoriasis.

Limitations:
We did not study seasonal variation in DC density or assess nonlesional skin from patients with psoriasis.

Conclusions:
The data did not support the hypothesis that psoriasis favors extensor skin because of differences in DC localization. However, dDCs were significantly increased in psoriasis by comparison with normal-appearing skin, supporting existing evidence that they are involved in the overall pathogenesis of psoriasis.

Well firstly I don't think I spelt the name right lol

anyways...


some time ago (about 7yrs ago) pretty much most of my psoriasis cleared.
At that point in my life, I left my perents home, I started drinking alcohol most nights, I was stuck in a tiny room with my ex smoking LOTS of weed and his mates also, I was smoking fags like no tomorrow, I didn't give a second thought as to what I was eating and I can assure you apart from the odd orange juice it was all pretty much junk and sugar!!!

I left him...moved back home and yup psoriasis came back...

I moved out of home 2 years ago, at that point I stoppped my methotrexate and BAM my worst flare ever, wearing clothes (if I managed to dress myself) were painful :(

so I started cyclosprin, was on that for a year I stopped it in october and in septemember I started eating better and have also given up smoking for 2 months my lower lefs are just psoriasis, never had so much. My only saving grace is that it isn't thick at all!

Also I had P when I was 4yrs old and when in my teens just had it on my elbows.........I only ever ate sweets, like a whole bag of haribo for breakfast most days!!!! and my folks smoked all the time inside.

so if pagano is right surely I should be clearing now and should of had psoriasis worse than I do now in the times of my life that my lifestyle and diet were so bad!!!


My other issue is that the 7 yrs ago.....I had my 2nd lot of UVB previous and my psoriasis was comming back bad I was trying all sorts, I called the derm for an appointment and they said they would call me back Weeks had gone by with no call, so I just thought F'em they not helping. I still had loads of emotional stuff and was always thinking of killing myself.
but about a year or 2 after that point it started to clear by itself!!
Part of me can't help but feel maybe I should just grin and bare what my skin throws at me and not have UVB or any meds and see what happens!!


just thought I would share some of what I've been through!!

(also the whole nightshade thing.....I no thats it's all related to the deadly night shade etc....BUT if you think about it, if you ate an uncooked kidney bean that can make you really ill but cooked it's fine!!)

Robert Ader, Ph.D., a founder of the field of study that investigates links between the mind and the body’s immune system and a professor emeritus of Psychiatry at the University of Rochester Medical Center, died Dec. 20 at the Highlands at Pittsford. He was 79.

Dr. Ader coined the word psychoneuroimmunology to describe the field of study he helped create. He launched the journal Brain, Behavior and Immunity and was a Medical Center faculty member for 50 years.

He was the founder and past president of the Psychoneuroimmunology Research Society, and also past president of the Academy of Behavioral Medicine Research and the American Psychosomatic Society.

His theories that the human mind could significantly affect the ability of the immune system to fight disease initially were greeted with heated skepticism and sometimes scorn when he first proposed them more than 30 years ago, but now they are applied and studied in many medical specialties, not only psychiatry, by researchers around the world.

“Bob Ader and his colleagues transformed the way that we think about the relationship between life events and our environment, and how our bodies respond biologically,” said Eric Caine, M.D., chair of the Department of Psychiatry at the University of Rochester Medical Center. “His work has extraordinary implications, not only for understanding immunological responses to stress and disease, but also for appreciating the potentially powerful positive effects of what so many call the ‘placebo effect.’ ’’

In 2009 in his most recent paper in the journal Psychosomatic Medicine, he and his fellow Medical Center researchers described using the placebo effect to successfully treat psoriasis patients with a quarter to a half of the usual dose of a widely used steroid medication. Early results in human patients suggest that this new technique could improve treatment for several chronic diseases that involve mental state or the immune system.

“Our study provides evidence that the placebo effect can make possible the treatment of psoriasis with an amount of drug that should be too small to work,” Dr. Ader said then. “While these results are preliminary, we believe the medical establishment needs to recognize the mind’s reaction to medication as a powerful part of many drug effects, and start taking advantage of it,”

Source: urmc.rochester.edu

Metabolic syndrome is significantly more common in patients with psoriatic arthritis than in those with rheumatoid arthritis, based on data from nearly 2,000 adults.

Previous studies have suggested that metabolic syndrome is associated with "a state of chronic, low-grade inflammation," said Dr. Asena Bahce-Altuntas of Albert Einstein College of Medicine in New York.

"Since psoriatic arthritis [PsA] is characterized by inflammation of both skin and joints, we may be underestimating this cardiovascular risk in PsA," she said at the annual meeting of the American College of Rheumatology.

To compare the prevalence of metabolic syndrome in patients with PsA versus rheumatoid arthritis (RA), Dr. Bahce-Altuntas and her colleagues used data from the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a prospective, observational cohort including 4,014 patients with PsA and 25,976 patients with RA in academic and private practices throughout the United States. Lipid profile data were available for 1,956 patients from the CORRONA registry: 294 with PsA and 1,662 with RA.

Overall, 27% of PsA patients met criteria for metabolic syndrome, compared with 19% of RA patients. In addition, several specific components of metabolic syndrome were significantly more common in PsA patients.

In particular, significantly more PsA patients than RA patients had triglycerides greater than 150 mg/dL (38% vs. 28%).

Significantly more PsA patients than RA patients were male (54% vs. 23%, respectively), and the mean age was significantly greater in RA patients than in PsA patients (62 years vs. 56 years, respectively). However, after age, sex, and ethnicity were controlled for, the odds of metabolic syndrome remained significantly higher for PsA patients (odds ratio, 1.44).

Metabolic syndrome was defined as a body mass index greater than 30 kg/m2 and any two of the following criteria: triglycerides greater than 150 mg/dL, HDL less than 40 mg/dL for men or less than 50 mg/dL for women, a diagnosis of hypertension, or a diagnosis of diabetes.

In a subanalysis of obese patients (133 PsA patients and 654 RA patients with a BMI greater than 30), the prevalence of metabolic syndrome remained significantly higher in PsA patients (60%) than in RA patients (49%), as did the prevalence of patients with triglycerides greater than 150 mg/dL (51% vs. 39%).

The results suggest that metabolic syndrome and its components are significantly more common in PsA than in RA. "High triglycerides appear to drive the estimated increase in risk of metabolic syndrome in PsA vs. RA

Hi! My name is Michelle. I've been living with psoriasis for about 17 years now...

EDIT: Since making this thread there is a better explanation here: Codes in your posts

I'm playing about with "Possibly Related Threads"

At the bottom of a thread you will sometimes see links to other threads that could be similar to the one you are reading. I need to get the settings right so it gives you good alternatives, so your feedback is welcome.

Thanks.

SCORES of patients will be forced to travel extra miles from their homes for skin treatment after Staffordshire's main hospital suspended its service.

The dermatology department at the University Hospital of North Staffordshire (UHNS) yesterday started sending people still awaiting appointments back to their GPs to be found another centre.

Alternative venues include Congleton War Memorial and Crewe's Leighton hospitals, and centres at Macclesfield, Buxton and Knutsford.

The closure to non-urgent cases comes after the unit at UNHS's central outpatients department was hit by a doubling in the number of referrals from family doctors of patients with ailments which could be cancer.

And that has left its clinics unable to guarantee people with non life-threatening ailments can be under treatment within the 18-week target laid down by the Government.

Even though only 18 patients are breaching the deadline, it means UHNS can no longer be included on the list of choices placed before patients when telling GPs where they want to be seen.

The restrictions affect people with conditions such as acne, psoriasis, eczema, minor skin infections and benign lumps and bumps.

The trust had offered to bring in an extra locum dermatologist to cut the backlog but the area's primary care trusts which fund North Staffordshire's NHS have capped its contracts with hospitals to levels agreed at the start of the financial year in April.

The suspension of the service which sees scores of patients a month is scheduled to last until January 16 but will be reviewed before then.

The suspension left GP leader Dr Paul Golik baffled as the option of referring patients to UHNS was still showing up on his Norton surgery's systems – with the first available appointment being on March 26.

The secretary of the 270-GP local medical committee said: "Other hospitals have no problem getting enough consultants so one wonders why UHNS struggles."

Hospital operations director Dereth Baker said: "We have not taken this action lightly and urgent referrals will continue to be treated. But we are unable to accept patients with non-urgent conditions.

Source: thisisstaffordshire.co.uk

Combination Treatments for Psoriasis: A Systematic Review and Meta-analysis

Objective:  To summarize the current state of evidence for combination topical and systemic therapies for mild to severe psoriasis.

Data Sources:  We performed a systematic search for all entries in pub med, CINAHL, Cochrane Review, and EMBASE related to combination treatments for psoriasis through July 2010.

Study Selection:  We included randomized controlled trials that reported proportion of disease clearance or mean change in clinical severity score (or provided these data through communication with study authors) for efficacy of a combination treatment for psoriasis compared with 1 or more corresponding monotherapies.

Data Extraction: Study data were extracted by 3 independent investigators, with disagreement resolved by consensus. The proportion of patients who achieved clearance, definition of clearance, means and standard deviations for baseline disease symptom score and final disease symptom score, and major design characteristics were extracted for each study.

Data Synthesis:  Combination treatments consisting of vitamin D derivative and corticosteroid, vitamin D derivative and UV-B, vitamin A derivative and psoralen–UV-A, vitamin A derivative and corticosteroid, vitamin A derivative and UV-B, corticosteroid and hydrocolloid occlusion dressings, UV-B and alefacept, and vitamins A and D derivatives were more effective than 1 or more monotherapies using the likelihood of clearance as the outcome. Blinding status and potency of the corticosteroid treatment used were significant sources of heterogeneity between studies.

Conclusions: The results demonstrate the need for additional long-term trials with standardized outcome measures to evaluate the efficacy and adverse effects of combination therapies for psoriasis and highlight the possible effects of trial design characteristics on results.

Today I made my third visit in 2 months to the doc about a dry cough, and sinus pressure. Previously diagnosed bronchitis, but didn't respond to antibiotic. So, I get a chest x-ray, which led to a TB test.

I go back in 2 days to have it read, but based on my own amateur diagnosis (based of course on internet research), it sure looks positive. I have no other symptoms, in fact I feel pretty good apart from the sinusitis and cough. I been getting these TB tests annually since starting Stelara a year and a half ago, and never had any kind of reaction, now I have at least 25mm of induration across the site.

Has anyone experienced this before -- is there any chance this will resolve over the next two days, and be a negative result?

My next injection is coming up, 5 January, I sure don't want to miss it.

Hello,
I'm new to your forum, but not new to psoraisis, having dealt with it for, oh let's see, about 45 years. It was mostly an annoyance for about 35 of those, before it really got bad. So much better now, 1st with Remikade, and now Stelara.

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AbGenomics International will regain global rights to AbGn-168H from Boehringer Ingelheim, with effect from 13 February 2012.

The move was made following the termination of collaboration between both the companies.

AbGn-168H, a humanized monoclonal antibody against CD-162 preferentially induces apoptosis of late-stage activated T-cells and is under development to treat psoriasis and other immunological diseases.

AbGenomics intends to carry on with the development of AbGn-168H in psoriasis as well as in other immune and inflammatory disease indications and hence will seek a new partner.

AbGenomics founder and CEO Rong- Hwa Lin said the company had a good collaboration agreement with Boehringer Ingelheim since 2005.

"While we will continue to develop AbGn-168H for psoriasis, regaining the global rights will also permit us to consider other indications that will take advantage of the full therapeutic potential of this drug," Hwa Lin added.

Source: pharmaceutical-business-review.com

Pulsed dye laser therapy may be an attractive new option for treating nail psoriasis, according to Dr. Veronique Blatiere.

Nail psoriasis is challenging to treat because the psoriatic disease process damages the nails while they are still being formed. But Turkish investigators have reported positive results with three once-monthly pulsed dye laser (PDL) treatment sessions in a small uncontrolled patient series, Dr. Blatiere reported at the annual congress of the European Academy of Dermatology and Venereology.

Dr. Yasemin Oram and coworkers at the American Hospital in Istanbul, Turkey, reported on five patients with nail psoriasis treated using PDL. The laser therapy was applied at 595 nm with a pulse duration of 1.5 milliseconds, a beam diameter of 7 mm, and an energy fluence of 8-10 J/cm2. A treatment session was continued until a purple discoloration appeared.

Nail bed lesions, particularly onycholysis and subungual hyperkeratosis, responded to PDL better than did nail matrix lesions. After three treatment sessions, the average Nail Psoriasis Severity Index (NAPSI) score for nail bed lesions dropped from 14.8 to 8.

While the Turkish report is certainly encouraging, it should be viewed as a proof of concept pilot study, said Dr. Blatiere of Saint Eloi University Hospital in Montpellier, France. It needs confirmation with larger numbers of patients, a control arm, and blinded investigator assessment.

Source: skinandallergynews.com

Hi, I have just joined. Will spend a bit of time just finding my way around before I say anything interesting. In the meantime nice to meet you all.

UCD clinician scientists and researchers from NUI Maynooth and Trinity College led by Conway Fellow, Professor Donal O’Shea have reported an improvement in the severity of psoriasis in patients following glucagon-like peptide-1 (GLP-1) analogue therapy. Their findings raise the possibility of therapeutic applications for GLP-1 in inflammatory conditions due to the direct impact on innate natural killer T (iNKT) cells.

The clinical team based in St Vincent’s University Hospital found an unexpected improvement in the severity of psoriasis in a patient with type 2 diabetes within days of starting GLP-1 analogue therapy. They surmised this was due to the direct action of GLP-1 on iNKT cells.

The team began treating two obese patients with type 2 diabetes and psoriasis with the GLP-1 analogue, liraglutide. Both patients experienced relief from their psoriasis symptoms within days of starting treatment and the psoriasis area and severity index (PASI) decreased in both.

Describing the laboratory findings, Dr. Andrew E. Hogan, UCD Newman Scholar and senior scientist said, “There was an alteration in iNKT cell number before and after commencing treatment; an increased number in the circulation and decreased number in psoriatic plaques. We also found that iNKT cells expressed GLP-1 receptor and modulated cytokine production”.

Professor Donal O’Shea believes that “Although extensive research will be required to investigate GLP-1 immune cell interactions, the potential benefit for inflammatory conditions such as psoriasis is promising”.

Source: medicalxpress.com

Enbrel treatment for psoriasis may be associated with an increased risk for multiple squamous cell carcinomas (SCCs), suggest results from a case series and review of the literature.

There is some prior evidence to suggest that anti-tumor necrosis factor drugs such as Enbrel may increase the risk for skin cancers such as SCC, but reports to date have been conflicting.

Writing in the International Journal of Dermatology, Jerry Brewer (Mayo Clinic, Rochester, Minnesota, USA) and colleagues describe four cases of patients with psoriasis and multiple SCCs thought to be a result of Enbrel treatment.

The patients in the series were aged 53 to 85 years and all had lifelong psoriasis. The mean time to first SCC onset was 11 months (range 1-17 months) after beginning Enbrel therapy, with all patients having between five and more than 50 SCCs in total and three of the four patients having aggressive grade III or IV SCCs.

The four psoriasis patients did not have a family history of skin cancer, but all four had previously had SCCs before using Enbrel.

Brewer and team reviewed the literature to evaluate previous reports of links between Enbrel and SCC. They found four further reports of psoriasis patients (n=10) who were treated with Enbrel going on to develop SCC, in one case in addition to non-Hodgkin lymphoma.

In contrast, another study found no increased risk for SCC with Enbrel treatment in 1440 patients with psoriasis. In addition, mice deficient in tumor-necrosis factor-α were shown to be resistant to skin cancer in a further study.

"Although some studies suggest there is no increased risk of cutaneous malignancy in patients treated with Enbrel, more research is needed to better characterize the effect of Enbrel on the development of SCCs in patients with psoriasis," say Brewer and co-authors.

"Until further research is available, sun-protective behavior, education into skin cancer prevention, and regular self-examinations and dermatologic examinations are warranted for patients with psoriasis treated with Enbrel," they conclude.

Source: medwire-news.md