Psoriasis: Scarpa R

Salvarani C, Olivieri I, Pipitone N, Cantini F, Marchesoni A, Punzi L, Scarpa R, Matucci-Cerinic M, Anonymous00280. · Rheumatology Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. · Clin Exp Rheumatol. · Pubmed #16539822 No free full text.

Abstract: AIM: To propose recommendations for the use of biologic (TNF-alpha blocking) agents in the treatment of psoriatic arthritis (PsA). METHODS: We developed these recommendations by reviewing the evidence published in medical journals and in abstracts of the American College of Rheumatology (ACR) and of the European League against Rheumatism. A draft of the recommendations was circulated to a group of Italian Rheumatologists with a special interest in PsA and in therapy with biologic agents, and their suggestions were incorporated in the final version. RESULTS: A consensus was achieved regarding the initiation and the monitoring of anti-TNF-alpha agents in PsA. More specifically, we propose that anti-TNF-alphaagents be considered in active PsA resistant to non-steroidal anti-inflammatory drugs, to at least two local steroid injections and at least 2 conventional disease-modifying anti-rheumatic agents (in cases of oligo/monoarthritis and/or enthesitis), and to at least two conventional disease-modifying anti-rheumatic agents (in patients with peripheral joints synovitis). Disease activity monitoring should be based on a variety of outcome measures including the ACR response criteria modified for use in PsA, the Bath ankylosing spondylitis disease activity index (BASDAI), and the Maastricht ankylosing spondylitis enthesis score (MASES). A favorable Expert opinion, based on evaluation of clinical symptoms and signs, of laboratory investigations (particularly acute phase reactants), and of imaging studies (whenever appropriate) should also be obtained. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should receive biologic therapy. Regular updates of these recommendations will be implemented on the basis of the results of new clinical studies and of data from post-marketing surveillance.

Salvarani C, Olivieri I, Cantini F, Marchesoni A, Punzi L, Scarpa R, Matucci-Cerinic M. · No affiliation provided · Reumatismo. · Pubmed #15470517 links to  free full text

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Olivieri I, Padula A, D'Angelo S, Scarpa R. · No affiliation provided · J Rheumatol. · Pubmed #19004049 links to  free full text

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Olivieri I, Padula A, Scarano E, Scarpa R. · No affiliation provided · J Rheumatol. · Pubmed #17552053 links to  free full text

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Scarpa R, Ayala F, Caporaso N, Olivieri I. · No affiliation provided · J Rheumatol. · Pubmed #16465649 links to  free full text

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Scarpa R. · No affiliation provided · J Rheumatol. · Pubmed #10606353 No free full text.

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D'Auria MC, Scarpa R, Parodi M, Silvestri E, Garlaschi G, Cimmino MA. · Sezione di Diagnostica per Immagini, Dipartimento di Medicina Sperimentale, Università di Genova. · Reumatismo. · Pubmed #17435836 links to  free full text

Abstract: OBJECTIVE: Magnetic resonance imaging (MRI) has been widely used for the evaluation of rheumatoid arthritis (RA), with only a minority of studies considering other types of arthritis. This review is concerned with an evaluation of the MRI appearance of peripheral joints in psoriatic arthritis (PsA). METHODS: A Medline search was performed to identify all publications from the years 1985 to 2006 concerning MRI of the peripheral joints and PsA. Additional papers were retrieved by scanning the references to the Medline-listed articles. Articles written in English, French, German, and Italian were included. RESULTS: Most papers studied the hand and wrist, and only few of them were concerned with the knee, foot, temporomandibular joint, and elbow. Patients with PsA showed often, but not always, a pattern of joint inflammation which extended beyond the capsule into the extraarticular tissue. Bone oedema and erosions were less frequent than in RA. In particular, bone oedema at the entheseal junction was seen, especially in the knee. The degree of synovitis, assessed by dynamic MRI, was similar in PsA and RA. DISCUSSION: Data on MRI of the peripheral joints in PsA are scanty. Only few studies were specifically designed to evaluate the pattern of arthritis in PsA, with most information deriving from papers where different types of arthritis were considered together. An enthesis-related origin of PsA has been proposed in contrast to the primarily synovial inflammation of RA. This pathogenic interpretation is likely to be true, but does not explain all cases of PsA, and needs to be confirmed by further studies.

Scarpa R, Mathieu A. · Cattedra di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, Italy. · Curr Opin Rheumatol. · Pubmed #10910179 No free full text.

Abstract: Articles included in this review reflect the recent advances made in basic research and the clinical management of psoriatic arthritis in 1999. Some of these advances are destined to modify the current approach to the disease. The problems related to nosology and epidemiology, the two still controversial aspects, are discussed first. Genetic susceptibility to psoriasis and psoriatic arthritis, and the inciting role played by some bacteria, are confirmed, and attention is focused on the role of T cells, cytokines, adhesion molecules, and angiogenetic factors in the skin and synovial membrane. New classification criteria are provided and a simplified spectrum of the disease seems to emerge from clinical studies. Modern imaging techniques enable early articular changes to be discovered, support innovative pathogenetic hypotheses, and allow new therapeutic approaches.

Scarpa R. · Department of Internal Medicine, University Federico II, Naples, Italy. · Adv Exp Med Biol. · Pubmed #10599345 No free full text.

Abstract: The definition of psoriatic arthritis may be at least inadequate. Moreover, diagnostic criteria proposed may be too restrictive. This may have affected the collection of reliable epidemiological data and may also influenced the classification of the disease. In this article all these aspects are discussed with the aim of offering an up-date on this intriguing disease. Therapeutic options are also examined.

Mameli A, Cauli A, Taccari E, Scarpa R, Punzi L, Lapadula G, Peluso R, Ramonda R, Spadaro A, Iannone F, Fanni V, Vacca A, Passiu G, Fiorillo MT, Carcassi C, Sorrentino R, Mathieu A. · 2nd Chair of Rheumatology and Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy. · Clin Exp Rheumatol. · Pubmed #18799098 No free full text.

Abstract: OBJECTIVE: Analysis of the association between psoriatic arthritis (PsA) clinical forms and MICA gene transmembrane polymorphisms. METHODS: Patients were classified as having peripheral asymmetric oligoarthritis (AO), peripheral symmetric poly-arthritis (PA) and spondylitis (SP), or disease combinations (PA/SP, OA/SP). Two hundred and twenty-six patients with PsA were typed for MICA exon 5 microsatellite (TM) by heteroduplex analysis and compared with 225 normal controls. RESULTS: MICA-TM microsatellite typing revealed that, among the different clinical forms of PsA, only the combined PA/SP subset shows a significant positive association with MICA-A9 and a lower frequency of MICA-A4, A5 genotype in PsA patients with a decrease, only in the PA/SP cohort, of all MICA-A5 combinations except MICA-A5, -A9. CONCLUSION: These results suggest a role for genes within the HLA region in the pathogenesis of PsA, and reinforce the idea that the different forms of PsA may have heterogeneous genetic basis.

Olivieri I, de Portu S, Salvarani C, Cauli A, Lubrano E, Spadaro A, Cantini F, Cutro MS, Mathieu A, Matucci-Cerinic M, Pappone N, Punzi L, Scarpa R, Mantovani LG, Anonymous00045. · Rheumatology Department, Ospedale San Carlo, Contrada Macchia Romana, 85100 Potenza, Italy. · Rheumatology (Oxford). · Pubmed #18725374 links to  free full text

Abstract: OBJECTIVE: To evaluate costs, benefits and cost-effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment. METHODS: A total of 107 patients, from nine Italian rheumatology centres, with different forms of PsA were given anti-TNF treatment, mainly etanercept (87%). Information on resource use, health-related quality of life, disease activity, function and laboratory values were collected at baseline and through out the 12 months of therapy. Cost (expressed in euro 2007) and utility (measured by EuroQol) before and after anti-TNF therapy initiation were compared in order to estimate the incremental cost per quality-adjusted life year (QALY) gained, and cost-effectiveness acceptability curve was calculated. RESULTS: At the end of 12 months, there was a significant increase in direct cost due to an increase of drug cost caused by TNF inhibitors that was only partially offset by the decrease in indirect cost. In the last 6 months of therapy, the direct cost increased by euro5052, the cost for the National Health System (NHS) by euro5044 and the social cost by euro4638. However, a gain of 0.12 QALY resulted in a cost per QALY gained of euro40 876 for the NHS and of euro37 591 for the society. The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of euro60 000 per QALY gained. CONCLUSION: Cost-effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.

Scarpa R, Cuocolo A, Peluso R, Atteno M, Gisonni P, Iervolino S, Di Minno MN, Nicolai E, Salvatore M, del Puente A. · Department of Clinical and Experimental Medicine, Early Psoriatic Arthritis Clinic, Rheumatology Research Unit, University Federico II, Naples, Italy. · J Rheumatol. · Pubmed #18050372 No free full text.

Abstract: OBJECTIVE: To characterize the clinical pattern of early psoriatic arthritis (PsA). METHODS: We studied 47 consecutive patients: 29 had definite PsA and 18 had the "sine psoriasis" subset. Inclusion criteria were articular and/or entheseal involvement of < or =12 weeks' duration and the exclusive use, before enrollment, of nonsteroidal antiinflammatory drugs to control articular symptoms. All patients underwent clinical examination, blood tests, total-body bone scintigraphy, articular ultrasonography, and radiography of clinically involved joints and/or entheses. RESULTS: On the basis of clinical examination, early PsA was an oligo-enthesoarthritis in over 75% of patients studied. In contrast, the number of joints and/or entheses showing increased tracer uptake on bone scintigraphy was 3 times greater, compared to the clinical evidence (p < 0.001). Articular ultrasonography confirmed the inflammatory involvement of synovium and/or entheses in all articular sites active at time of bone scintigraphy, but silent at clinical examination. In addition, 7 patients showed the occurrence of joint and/or entheseal erosions on standard radiography. CONCLUSION: Bone scintigraphy yields a more accurate evaluation of entheso-articular involvement and distribution in patients with early PsA. Our results suggest that clinical oligo-enthesoarthritic presentation of early PsA might represent in most cases a polyarticular condition that is at increased risk for clinical progression. These findings have a significant influence on the clinical decision-making process in patients with early PsA.

Scarpa R, Peluso R, Atteno M, Manguso F, Spanò A, Iervolino S, Di Minno MN, Costa L, Del Puente A. · Early Psoriatic Arthritis Clinic, Rheumatology Research Unit, University Federico II of Naples, via Sergio Pansini no. 5, 80131 Naples, Italy. · Clin Rheumatol. · Pubmed #18030515 No free full text.

Abstract: Thirty-five patients with Early Psoriatic Arthritis (EPA) (17 female and 18 male; mean age 25.6 years) entered this randomised 6-month study. At the enrolment, all patients were on non-steroidal anti-inflammatory drug (NSAID) therapy on demand and were divided in two matched groups (A and B). Group A continued NSAID therapy at full dosage in the following 3 months and then added methotrexate (MTX) for another 3 months. Group B was under the combination of NSAID and MTX for the entire 6-month period. Clinical and laboratory assessment included the count of tender joints and/or entheses (TJC), the count of swollen joints and/or entheses (SJC), patient's global assessment (PGA), physician's global assessment (PhGA), patient's assessment of pain (VAS), erythrocyte sedimentation rate (ESR) and serum concentration of C-reactive protein (CRP). All variables were done at baseline (T0), at 3 (T3) and at 6 months (T6). In both group A and in group B, there was a significant improvement of all variables at T3 and T6. However, in comparison to the patients of group A, patients included in group B showed a more rapid and marked improvement of TJC and SJC, which was statistically significant at T3 (p < 0.05). In contrast, the improvement of PGA, PhGA, VAS, ESR and CRP was not significantly different between groups. The early use of MTX in EPA patients markedly improves TJC and SJC. In fact, at T3, other markers used to quantify EPA disease activity, in particular PGA, PhGA, VAS, ESR and CRP, did not show significant differences in EPA patients treated with either NSAIDs or MTX. This finding suggests an incomplete control under MTX of the pathogenetic process and stimulates further interest on early use of other therapeutical approaches capable of modifying the course of disease.

Scarpa R, Soscia E, Peluso R, Atteno M, Manguso F, Del Puente A, Spanò A, Sirignano C, Oriente A, Di Minno MN, Iervolino S, Salvatore M. · Department of Clinical and Experimental Medicine, Rheumatology Research Unit and the Radiology Unit, University Federico II, Naples, Italy. · J Rheumatol. · Pubmed #16758507 No free full text.

Abstract: OBJECTIVE: To study distal interphalangeal (DIP) joints in patients with psoriatic arthritis (PsA) with or without onychopathy, using magnetic resonance imaging (MRI). METHODS: Twenty-three patients with PsA (9/14 F/M, median age 47 yrs), 12 with onychopathy (2/10 F/M, median age 44 yrs) and 11 without (7/4 F/M, median age 52 yrs), and 10 control subjects (5/5 F/M, median age 43.2 yrs) were enrolled. MRI of nail and distal phalanx (DP) including examination of DIP joints was carried out. MRI was performed with a surface coil in a 1.5 T device. For each selected finger, both longitudinal and axial scans were performed. The involvement of nail, DP, and DIP joint was scored. RESULTS: Nail thickening with or without surface irregularity occurred in 95.7% of cases (100% with onychopathy and 90.9% without). MRI nail involvement was more frequent in patients with clinical evidence of onychopathy than in those without (p = 0.003). Similarly, 95.7% of patients showed MRI abnormalities of DP (100% with onychopathy and 90.9% without). MRI DP abnormalities were more marked in patients with clinical evidence of onychopathy than in those without (p = 0.009). Involvement of DIP joints was present in 34.8% of cases (58.3% with onychopathy and 9.1% without), and onychopathic patients showed marked MRI DIP joint involvement in 5 cases and mild in 2, while patients without onychopathy showed minimal changes in one case (p = 0.03). Considering the entire group of patients, MRI involvement of DIP joints was always associated with MRI DP changes, and in no case was it present alone. CONCLUSION: MRI nail involvement was present in almost all patients with PsA studied, even in those without clinically evident onychopathy. MRI involvement of DP always overlapped with nail involvement, since it was present in all psoriatic cases showing MRI nail involvement. In contrast, MRI DIP joint involvement was almost exclusively in a lower percentage of the patients with clinical nail involvement and was always associated with MRI DP changes. Our results suggest that DIP joint involvement is always secondary to nail and DP involvement.

Cervini C, Leardini G, Mathieu A, Punzi L, Scarpa R. · Clinica Reumatologica, Università di Ancona, Italia. · Reumatismo. · Pubmed #16380757 links to  free full text

Abstract: Because there is the impression that psoriatic arthritis is a composite disorder with mild forms close to more severe and aggressive ones, we conducted a multicenter study with the aim of characterizing disease expression in a large cohort of Italian patients. One-thousand-three-hundred-six patients fulfilled inclusion criteria and were analyzed in this study. Psoriasis antedated the onset of arthritis in the majority of the cases (67.7%). More rare was inverse or simultaneous onset which occurred in 17.3% and 15.0% of the cases, respectively. Peripheral articular involvement (mono-oligo or polyarthritis) was recorded in 88.7% of the cases while spondylitis occurred in 11.3%. Peripheral enthesopathies were found in 28.1% of the cases with a marked occurrence in patients with axial involvement (64.5% vs 35.5% in oligo or polyarthritis). Abnormal levels of ESR and CRP respectively occurred in 52.2% and in 52.6% of the cases, while rheumatoid factor was detected in 5.0% of the cases. On the basis of distribution of joint involvement, symmetry and presence of peripheral enthesopathies we recognized three clusters of arthritis. Patients included in Cluster 1 and Cluster 2 showed a severe form of polyarthritis in most of the cases (82.9%), with increased serum levels of inflammatory indices in more than 85% of the cases. Almost all the hospitalized patients (97.1%) were included in this two clusters. They markedly assumed steroids and methotrexate or another DMARD. About half of the patients (51.1%) included in Cluster 3 showed mono-oligo articular involvement. Serum inflammatory indices were increased in 20.8% of the cases while hospitalization occurred only in 2.9% of the cases and NSAIDs were the treatment of choice. The evidence in our country of a large prevalence of severe forms of arthritis needing specific and aggressive approach outlines the requirement of an intense educational action aimed at increasing the awareness of this condition.

Paladini F, Taccari E, Fiorillo MT, Cauli A, Passiu G, Mathieu A, Punzi L, Lapadula G, Scarpa R, Sorrentino R. · University La Sapienza, Rome, Italy. · Arthritis Rheum. · Pubmed #16200572 links to  free full text

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Scarpa R, Manguso F, Oriente A, Peluso R, Atteno M, Oriente P. · Department of Clinical and Experimental Medicine, University Federico II, via Sergio Pansini 5, 80131, Naples, Italy. · Clin Rheumatol. · Pubmed #14749978 No free full text.

Abstract: The aim of this study was to investigate the relationship between onychopathy and distal interphalangeal (DIP) joint involvement in psoriatic patients. Twenty-five consecutive unselected, unrelated patients with psoriatic onychopathy and 25 consecutive unselected, unrelated patients with psoriatic arthritis without onychopathy, were enrolled in the study. X-ray films of the hands were taken to identify DIP arthritic involvement and/or bone changes of the distal phalanx, which were categorized into five classes (0: no lesions; 1: tuftal minimal erosions; 2: tuftal bone resorption; 3: tuftal periosteal osteitis; 4: overlap of erosive and osteitic changes). Ten psoriatic patients with onychopathy and 8 without showed DIP arthritis, with no statistical differences in this distribution ( p=0.556). Bone changes of the distal phalanx were found in all 25 psoriatic patients with onychopathy and in 18 without. The distribution of patients in different categories of involvement of the distal phalanx showed that patients without onychopathy were markedly distributed in the categories with no or minimal lesions, whereas patients with onychopathy had structural changes prevailing included in categories with more severe bone changes (osteitis and overlap of erosive and osteitic changes) ( p=0.002). Onychopathic patients with DIP arthritis were older than those without ( p<0.0001) and showed a longer duration of onychopathy ( p<0.0001). Although the occurrence of DIP arthritis seems to depend on the duration of nail involvement, no statistical difference has been found in the distribution of DIP arthritis in psoriatic patients with or without onychopathy. In contrast, a topographical association between bone changes of the distal phalanx and dystrophy of the adjacent nail may be advanced.

Scarpa R, Cosentini E, Manguso F, Oriente A, Peluso R, Atteno M, Ayala F, D'Arienzo A, Oriente P. · Department of Clinical and Experimental Medicine, University Federico II, via Sergio Pansini 5, 80131 Naples, Italy. · J Rheumatol. · Pubmed #14719207 No free full text.

Abstract: OBJECTIVE: To characterize the clinical pattern of psoriatic arthritis (PsA) sine psoriasis. METHODS: Fifty-seven patients (31 men, 26 women, mean age 46.32 +/- 14.12 yrs) with undifferentiated spondyloarthropathy (SpA) were studied. Two subsets were defined: (1) 21 patients with familial psoriasis (12 men, 9 women, mean age 49.29 +/- 14.17 yrs); (2) 36 patients without familial psoriasis (19 men, 17 women, mean age 44.58 +/- 14.00 yrs). The prevalence of the following clinical variables was evaluated: low back pain, enthesopathy, dactylitis, distal interphalangeal (DIP) arthritis, spinal involvement, and discitis. In all patients the following HLA haplotypes were tested: B7, B13, B17, B18, B27, B38, Cw6, and DR7. RESULTS: Dactylitis and DIP arthritis were markedly present in the articular subset with familial psoriasis (p < 0.0001) that also showed a high frequency rate of HLA-Cw6 (p < 0.0001 vs controls and patients without familial psoriasis). HLA-B27 was markedly frequent in patients without familial psoriasis (p < 0.0001 vs controls and p = 0.019 vs patients with familial psoriasis). In addition, in patients with familial psoriasis the log-linear model showed that the presence of HLA-Cw6 was related to the presence of DIP arthritis as well as dactylitis (likelihood ratio chi-square change of 5.891 and p = 0.015). CONCLUSION: A subset of patients with PsA "sine psoriasis" is identified by the occurrence of a SpA with dactylitis and/or DIP arthritis, presence of HLA-Cw6, and familial psoriasis in first or second-degree relatives.

Scarpa R, Manguso F, D'Arienzo A, D'Armiento FP, Astarita C, Mazzacca G, Ayala F. · Istituto di Reumatologia, Università Federico II, Napoli, Italy. · J Rheumatol. · Pubmed #10813294 No free full text.

Abstract: OBJECTIVE: To evaluate colonic mucosa of patients with both active psoriasis and psoriatic arthritis (PsA) without bowel symptoms. METHODS: Fifteen persons (9 men, 6 women) who had both active psoriasis and PsA without bowel symptoms underwent colonoscopy with multiple biopsies of bowel mucosa. Ten nonhospitalized healthy subjects in followup colonoscopy after resection of benign polyps (8 men, 2 women) took part as a control group. RESULTS: Six psoriatic patients (40%) showed macroscopically normal colonic mucosa. In the remaining 9 reddening was frequently recorded (6 cases). while edema and granular changes appeared less commonly (3 cases each, respectively). Friability was markedly rare (only one case) and bleeding and ulcerations were absent. All 15 patients showed microscopic changes. Increase in lamina propria cellularity (consisting of plasma cells and lymphocytes) and lymphoid aggregates were found in all cases. Active inflammation, evident as neutrophilic polymorph infiltration occurred in 9 patients. Glandular atrophy was found in 3 cases; mucosal surface changes and crypt abnormalities occurred in one case each. No control had macroscopic or microscopic inflammatory changes of bowel mucosa. CONCLUSION: Bowel mucosa of patients with PsA without bowel symptoms show microscopic lesions even when mucosa appeared macroscopically normal. This result may support a pathogenetic link between skin, joints, and gut in psoriatic patients with arthritis even in the absence of bowel symptoms.

Scarpa R. · Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy. · J Rheumatol. · Pubmed #10782825 No free full text.

Abstract: OBJECTIVE: To evaluate the prevalence and clinical features of destructive abnormalities of the discovertebral junction in psoriatic arthritis (PsA). METHODS: One hundred consecutive patients with PsA (38 with spondylitis, 48 with polyarthritis, 14 with oligoarthritis; 52 men and 48 women; mean age 45.74 years, range 18-76, mean duration of disease 79.84 mo, range 8-336) were evaluated. The study protocol included a questionnaire on the patient's usual work, occurrence of previous trauma or infection to the spine, characteristics of articular involvement, and presence and characteristics of back pain. Radiographic study of involved joints and of the spine was performed and lesions occurring at the discovertebral junction were classified according to Cawley's suggestions. RESULTS: Twelve patients showed destructive abnormalities of the discovertebral junction (12.0%). These patients had age and disease duration significantly greater than the patients without abnormalities (p = 0.0001 and 0.0001, respectively). Nine of them had spondylitis and 3 polyarthritis (p = 0.02). Cervical tract was affected in 4 cases (33.3%) and thoracic in 12 (100%). Lumbar spine changes occurred in 6 patients (50%). Lesions were localized to only one level in 4 cases and at multiple levels in the remaining 8. According to Cawley's classification type 1 lesions involved 6 thoracic discovertebral junctions, type 2 involved 15 junctions (4 cervical, 5 thoracic, 6 lumbar), type 3 only one thoracic junction. Back pain occurred in only 5 cases (41.6%), all belonging to the spondylitic subset. Pain was localized to those tracts of the spine with radiographically documented disease and was exacerbated with physical activity. CONCLUSION: Discovertebral erosions seem to be another characteristic aspect of spondyloarthropathies. In PsA, the lesions occur markedly in older spondylitic patients with a greater duration of disease and may often be totally asymptomatic.