REVIEW - Psoriatic arthritis as a mountain

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Reumatismo. 2003;55(1):6-15.

Psoriatic arthritis as a mountain.

Rheumatology Unit, Nantes University Hospital, Nantes, France.

jeanmarie.berthelot@...

The concept of psoriatic arthritis (PsA) is not yet universally accepted.

Indeed, few of the features said to be characteristic for PsA are

pathognomonic, and a same patient can be classified as RA, SpA or PsA

depending on the physician seen. The heterogeneity of PsA, the lack of

significant differences in early-arthritis with and without psoriasis, and a

pathogenesis somewhat different in PsA and psoriasis, also argue against the

originality of PsA. Nevertheless, although PsA is possibly " just " a syndrome

depending on the combination of numerous co-factors (perhaps shared with SpA

and/or RA), its more achieved forms deserve to be segregated from other SpA

and RA. Indeed, PsA best bridges the gap with SAPHO syndromes. Moreover, the

profile of synovial cytokines seems somewhat different in PsA as compared to

RA and SpA, and a special pattern of vascularisation has been confirmed by

several teams which could account for the demonstrated link between trauma

and some PsA onsets. Both the greater familial risk for PsA than for RA or

psoriasis alone and the excessive paternal transmission of PsA strongly

suggest a genetic background, although so far only MICA-A9 (expressed on gut

epithelial cells) seems to be associated with susceptibility to PsA

independently from psoriasis. To make further genetics studies informative,

a careful selection of unequivocal cases of PsA is needed, which requires

criteria selecting patients at the " top of the mountain " of PsA. One can

expect that the sets of criteria proposed by McGonagle or Fournie could

satisfy this wish.

PMID: 12649695

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus & db=pubmed & cmd=R\

etrieve & dopt=abstractplus & list_uids=12649695

Not an MD