Previous studies have profiled the gut microbiota among psoriatic patients compared to that among healthy individuals. However, a comprehensive understanding of the magnitude, direction, and detailed compositional and functional profiles remains limited. Additionally, research exploring the gut microbiota in the context of both plaque psoriasis (PsO) and psoriatic arthritis (PsA) is lacking. To assess the taxonomic and functional characteristics of the gut microbiota in PsO and PsA patients and investigate potential links between the gut microbiota and disease pathogenesis. We collected fecal samples from 70 psoriatic patients (44 PsO and 26 PsA) and 25 age- and gender-matched healthy controls (HC) and employed deep metagenomic sequencing to characterize their gut microbiota. We noted significant alternations in the gut microbiota compositions of both PsO and PsA patients compared to those of HC. Despite limited effect sizes in alpha diversity (12.3% reduction of microbial richness but unchanged evenness in psoriatic patients) and beta diversity (disease accounts for 3.5% of total variations), we consistently observed substantial reductions of Eubacterium rectale in both PsO and PsA patients, with PsA patients exhibiting even lower levels of E. rectale than PsO patients. Additionally, two Alistipes species were also depleted in psoriatic patients. These microorganisms are known to play crucial roles in carbohydrate metabolism pathways, mainly producing short-chain fatty acids with anti-inflammatory effects. Overall, our observations supplemented the profiling of altered gut microbiota in patients with PsO and PsA at the species level and described a link between the dominant short-chain fatty acid-producing bacterial species and systemic immunity in psoriatic patients. IMPORTANCE In this observational clinical study with sufficient sample size and metagenomic sequencing to profile the gut microbiota, we identified consistent signals of the depleted abundance of Eubacterium rectale and related functional genes among psoriatic patients, including those with psoriatic arthritis. E. rectale may serve as an ecologically important functional unit in the gut microbiota, holding potential as a diagnostic marker and target for therapeutic interventions to achieve lasting effects. Our findings provide comprehensive gut microbiota profiling in psoriasis, resolving previous contradictions and generating new hypotheses for further investigation. These insights may significantly impact psoriasis management and related conditions.

IntroductionThis study aims to describe the demographic, clinical, laboratory, and ultrasonic characteristics of patients with psoriatic arthritis (PsA) in the Psoriatic Arthritis cohort of West China Hospital.MethodsIn this cross-sectional study, we included patients diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis, collected their demographic information, medical histories, and treatments, evaluated all domains (skin and nail lesions, tenderness, swelling, enthesitis, dactylitis, and axial arthritis) related to PsA, and then performed descriptive statistical analyses of all data.ResultsA total of 275 patients with PsA were included in this study. The ratio of male to female patients was 2.16:1. Skin lesions preceded arthritis in 86.5% of these patients with PsA with a mean interval of 10.1 years. The metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints of fingers, and sacroiliac joints are the most commonly involved sites of tenderness, swelling, and the spine, respectively. Among all comorbidities, fatty liver has the highest incidence with 33.1%. Finally, we noted that the mean disease duration of PsA was 4.2 years, suggesting a delay in the diagnosis of PsA.ConclusionOur study proposes that the prevalent population of PsA are male patients with psoriasis over 40 years of age who have a long disease course. For patients with PsA, MCP, PIP joints of fingers, and sacroiliac joints are the most frequently affected anatomical sites. With respect to comorbidities, the association between PsA and fatty liver and the underlying molecular mechanisms are worthy of further exploration.

Background . The global impact of coronavirus 2019 (COVID‐19) has raised concerns about the management of psoriasis patients, especially among those using biologics. Methods . We conducted a survey‐based research among Omicron‐infected (confirmed, probable, and suspected ones) psoriasis patients in the department of dermatology, West China Hospital, Sichuan University, from January 9th to January 22nd, 2023. We collected demographic and clinical information (psoriasis‐ and COVID‐19‐related) and conducted statistics analysis. Results . Of the 240 patients enrolled, they were classified by the psoriatic treatment, as biologics ( n = 138), nonbiological systematic treatment ( n = 52), and topical treatment or without pharmacological treatment ( n = 50). This study showed the characteristics of Omicron‐related symptoms and cutaneous signs in patients. We observed that patients who received topical treatment or without pharmacological treatment had a lower risk of presenting with COVID‐19 symptoms in the fully adjusted logistic model (OR = 0.40, 95% CI: 0.18–0.90, and P = 0.025). Moreover, in the model for skin manifestations, nonbiological systematic treatment (OR = 2.15, 95% CI: 1.08–4.27, and P = 0.029) and high BMI (OR = 1.10, 95% CI: 1.00–1.20, and P = 0.042) were correlative factors. Conclusions . Our data suggested that differential psoriatic treatment might be a correlative factor in developing symptomatic or asymptomatic Omicron infection and presenting cutaneous signs.

目的 探讨注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(益赛普)治疗银屑病关节炎的临床疗效.方法 纳入2011年4月—2021年2月四川大学华西医院皮肤科使用益赛普治疗的银屑病关节炎患者共30例.回顾性收集患者的人口统计学数据、临床数据、检验检查结果等.结果 本研究共纳入30例银屑病关节炎患者,男性患者26例(86.67％,26/30),开始使用益赛普治疗时患者平均年龄为(44.96±11.50)岁.29例(96.67％,29/30)患者未经生物制剂治疗.既往治疗以传统治疗为主,其中使用甲氨蝶呤治疗共计24例(80.00％,24/30).治疗过程中15例(50.00％,15/30)患者联合甲氨蝶吟治疗.8例患者在基线及治疗后3～6个月完善了临床评估及关节超声.其中7例患者在治疗后临床评估疾病活动度有明显改善,达到美国风湿学会标准所定义的关节疼痛、肿胀数量减少20％、50％以及 70％(American College of Rheumatology 20/50/70 criteria,ACR 20/50/70),其中4例患者达到ACR70,2例患者达到ACR50,1例患者达到ACR20.该7例患者的关节超声表现中滑膜增厚及血流信号均有不同程度改善.结论 本研究发现,益赛普可以快速控制银屑病关节炎,治疗3～6个月时评估发现临床评估与关节超声改善情况基本平行,关节超声能辅助临床评估,并有助于检测疾病活跃程度变化.

关节病型银屑病为多基因遗传模式,临床表现具有异质性,可表现为滑膜炎、指趾炎、附着点炎、骶髂关节炎等.从单纯银屑病到关节病型银屑病进展间隔时间较长,因此,发现可能的易感基因可以探索促使其进展的因素.本文总结了 HLA分型、全基因组关联分析、全外显子测序及三代测序等基因组学技术在关节病型银屑病中的应用与前景.

The Journal of DermatologyEarly View LETTER TO THE EDITOR Ixekizumab successfully treated refractory psoriasis concurrent bullous pemphigoid Yue Xiao, Yue Xiao orcid.org/0000-0003-3013-9655 Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorYuanxia Gu, Yuanxia Gu Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorDengmei Xia, Dengmei Xia orcid.org/0000-0002-7200-5754 Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorXingli Zhou, Xingli Zhou Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorWei Li, Corresponding Author Wei Li liweihx_hxyy@scu.edu.cn orcid.org/0000-0002-9585-2884 Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, China Correspondence Wei Li, Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, 37 Guo Xue Alley Chengdu, Sichuan 610041, China. Email: liweihx_hxyy@scu.edu.cnSearch for more papers by this author Yue Xiao, Yue Xiao orcid.org/0000-0003-3013-9655 Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorYuanxia Gu, Yuanxia Gu Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorDengmei Xia, Dengmei Xia orcid.org/0000-0002-7200-5754 Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorXingli Zhou, Xingli Zhou Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, ChinaSearch for more papers by this authorWei Li, Corresponding Author Wei Li liweihx_hxyy@scu.edu.cn orcid.org/0000-0002-9585-2884 Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, Sichuan, China Correspondence Wei Li, Department of Dermatology and Venereology, Rare Diseases Center, West China Hospital, Sichuan University, 37 Guo Xue Alley Chengdu, Sichuan 610041, China. Email: liweihx_hxyy@scu.edu.cnSearch for more papers by this author First published: 26 August 2022 https://doi.org/10.1111/1346-8138.16559 Yue Xiao and Yuanxia Gu contributed equally to this work. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

The utilization of biologics in patients with psoriasis with latent tuberculosis infection (LTBI) has garnered significant attention. Although the tuberculosis (TB) safety profile of second-generation biologics, including secukinumab, has been partially confirmed in both clinical trials and real-world studies, the necessity for prophylactic therapy in patients with LTBI prior to administering this class of biologics remains a topic of controversy. This study enrolled 62 patients with psoriasis with LTBI who underwent secukinumab with routine TB reexamination. Patients were divided into two groups based on whether they received antituberculosis therapy (ATB; n = 48) or not (NTB; n = 16). We performed a propensity score-matched (PSM) analysis between ATB and NTB subgroups and retrospectively reviewed their interferon-gamma release assays (IGRA) and radiographic results. No active TB case was reported on the basis of medical records and chest radiographs in either two group. Before PSM, the mean reexamining IGRA value was significantly elevated in patients who received prophylactic therapy (P = 0.00), but no significant increase was observed in patients who were not. After PSM, there was no significant IGRA value enhancement whether or not patients received prophylactic treatment. Our data provide additional information on the safety profile of secukinumab in patients with psoriasis with LTBI. Furthermore, our presentation of the reexamined IGRA results revealed no significant elevation in the ATB or NTB group. As such, we believe further exploration is necessary to determine whether anti-TB medication is required prior to administering secukinumab. In the past decade, biologics have revolutionized psoriasis treatment. Among patients receiving biologics, tuberculosis infection is a big concern. Secukinumab, an interleukin-17 inhibitor, belongs to the second-generation biologics. Clinical trials and real-life experience have partially reported its tuberculosis safety. In 2020, a systematic review of randomized clinical trials of secukinumab found no reactivate tuberculosis case. However, when participants tested positive for latent tuberculosis infection at screening in the clinical trials, they received antituberculosis treatment. Should patients with latent tuberculosis infection receive antituberculosis medication before receiving secukinumab? The answer is controversial and lacks evidence. This study enrolled patients with psoriasis with latent tuberculosis infection who underwent secukinumab with routine tuberculosis reexamination. Then, the patients were divided into two groups based on whether they received antituberculosis therapy and not. We observed that neither of these two groups presented tuberculosis activation cases. We also matched patients who received antituberculosis therapy and those who did not. The interferon-gamma release assay showed no significant increase after balancing the baseline. Our data indicated that secukinumab is safe among patients with latent tuberculosis infection even when they did not receive antituberculosis treatment.

Refractory livedoid vasculopathy successfully treated with baricitinib Dear Editor, Livedoid vasculopathy (LV) is a rare, chronic, refractory ulcerative disease mainly affecting females (male to female ratio = 1:3). Previous research suggested coagulopathies and defective fibrinolysis jointly orchestrate the pathophysiological changes of LV. Hence, the anticoagulant is the most frequently chosen medicine for LV, while the steroid is the second most common monotherapy. Nonetheless, some patients respond

A growing number of biologics have recently been approved in China for psoriasis treatment, and some of these are eligible for Chinese medical insurance, resulting in a significant increase in the number of patients receiving these biologics. Nevertheless, real-world data on the efficacy and safety of biologics for treating moderate-to-severe plaque psoriasis in Chinese patients are limited, and relevant pharmacoeconomic studies are lacking. Therefore, we performed a prospective, single-center study to evaluate the efficacy and safety of adalimumab (ADA) and secukinumab (SEC) in real-world practice. A cost-effectiveness analysis (CEA) was also conducted. Participants were enrolled between January 2019 and December 2020 at the West China Hospital, Sichuan University. Baseline and follow-up assessments were conducted, and an appropriate statistical analysis was performed. A total of 183 patients were included. At week 12, the number of patients achieving a psoriasis area and severity index reduction of 75% (PASI 75) with SEC treatment was higher than that with ADA and methotrexate (MTX) (SEC versus ADA versus MTX, 90.59% versus 58.70% versus 17.14%, respectively). Adverse events (AEs) were reported in 44.83% and 56.36% of patients in the SEC and ADA groups, respectively. The cost-effectiveness ratio in the SEC group was 46,311.83 Chinese yuan(CNY), compared with 17,580.92 CNY in the ADA group. In real-world practice, SEC and ADA are effective and safe for moderate-to-severe plaque psoriasis treatment in Chinese patients. On the basis of drug prices during our study period without considering access to health insurance, ADA was more cost-effective in real-world practice. Adalimumab and secukinumab are two monoclonal antibodies used for the treatment of psoriasis, which target different cytokines in the pathogenesis. A growing number of biologics have recently been approved in China for psoriasis treatment including adalimumab and secukinumab, which are eligible for Chinese medical insurance, resulting in a significant increase in the number of patients receiving these biologics. With the purpose of evaluating its efficacy and safety in the real world, we registered the data of eligible patients in West China Hospital, Sichuan University over the past two years and conducted statistical analysis. In order to provide different therapeutic strategies for patients based on case-specific needs and access to financial resources, we performed pharmacoeconomic analyses to evaluate the cost-effectiveness of the two drugs. Our study demonstrated that adalimumab and secukinumab were effective and safe for moderate-to-severe plaque psoriasis in Chinese patients in the real-world practice. Based on drug prices during our study period and without taking into consideration access to health insurance, ADA was more cost-effective in real-world practice.

Introduction The tuberculosis (TB) positive conversion rate among psoriasis patients who received biologics has been reported worldwide, particularly in regions with low TB risk. Nonetheless, the TB-related safety of biologics such as adalimumab and secukinumab remains elusive in areas with high TB risk. According to the World Tuberculosis Report 2021, China is the country with the second highest TB burden, but data on TB conversion are also limited. Thus, we performed a retrospective, single-center study to profile the TB infection status conversion ratio among psoriasis patients treated with adalimumab and secukinumab in China. Methods Patients were enrolled between April 2019 and February 2021 from West China Hospital, Sichuan University. Baseline and relevant clinical information were summarized, and proper statistical analysis was used under different conditions. Results Five (5.43%) patients suffered TB conversion in the adalimumab group, two of whom developed active TB within the first 6 months. In the secukinumab group, four (5.26%) patients had TB positive conversion with no reports of active TB. Conclusion Our data show a relatively high rate of TB conversion among these psoriasis patients after mean treatment duration of 17.13 months. We recommend that, in patients who receive adalimumab, TB be reevaluated after the first 3 months and then monitored semiannually for the next 2 years. For patients treated with secukinumab, annual examination is sufficient.

患者男,20岁,面部红斑、丘疹5年,肿胀4余年.皮肤科情况:全脸非凹陷性水肿,触之有浸润感;面部散在红斑、丘疹.皮损组织病理示:表皮基底层灶性空泡变性,真皮全层小血管周围较多淋巴细胞浸润,真皮胶原间疑似黏液沉积.阿辛蓝染色可见真皮胶原间弥漫性黏液沉积.弹力纤维染色示:真皮弹力纤维数量减少,弹力纤维碎片化.诊断:Morbihan综合征.

亚临床期关节病型银屑病是指任何有影像学上的滑膜-起止点炎症病变但并不满足CAS-PAR分类标准的银屑病患者,早期识别这类群体并及时作出干预有利于改善患者生活质量.本文综述了亚临床期关节病型银屑病相关概念的产生、影像学特点及系统治疗对其影响的研究进展.

Azathioprine (AZA) is the preferred immunosuppressant for treating pemphigus vulgaris (PV), with discontinuation mainly attributed to hematological adverse events (AE). Reportedly, nucleoside diphosphate‐linked moiety X‐type motif 15 ( NUDT15 ) polymorphisms have been strongly associated with thiopurine‐induced leukopenia. To investigate hematological AE of low‐dose AZA based on NUDT15 genotypes among patients with PV, a prospective cohort study was conducted in patients with PV, followed‐up for the first 8 weeks after AZA administration. All patients were divided into wild homozygous and heterozygous NUDT15 groups. Both groups initiated AZA at low dose (50 mg/day) and continued with different dose‐escalating approaches. Bone marrow suppression was considered the principal outcome. Overall, 62 patients with PV were enrolled (48 in the wild homozygous NUDT15 group vs. 14 in the heterozygous NUDT15 group). Except for median maintenance doses of AZA, no statistically significant differences were observed between the two groups in terms of age, sex, white blood cells, neutrophil count, platelet count, hemoglobin level, median final doses of corticosteroids (mg prednisone equivalent), pemphigus disease area index, and anti‐desmoglein 1/3 autoantibodies. In both groups, patients presented similar hematological AE and treatment responses after administration of different low‐dose AZA treatment strategies. Low‐dose AZA based on NUDT15 genotypes can reduce the risk of early hematological AE among patients with PV.

This study aimed to develop a predictive model based on ultrasound variables which can be used to screen patients with psoriasis who are prone to progress to psoriatic arthritis (PsA) in clinical practice. This is a cross-sectional study conducted in a single center from October 2018 to November 2020. All subjects (non-PsA group, PsA group, and control group) underwent an ultrasound examination and their ultrasound abnormalities were recorded. On the basis of statistical analysis and clinical experts’ advice, several variables were selected for modelling. We used logistic regression to establish the prediction model. To assess the discrimination and accuracy of this model, internal validation and external validation were performed. A total of 852 patients with psoriasis but without PsA, 261 patients with PsA, and 86 healthy volunteers were included. Ultimately, the predictive model consisted of six variables, namely hand joint power Doppler (PD) signals (grade 0: OR 2.94, 95% CI 1.94–4.47; grade ≥ 1: OR 109.30, 95% CI 14.35–832.27; P < 0.001), wrist joint synovial thickening (grade 1: OR 1.29, 95% CI 0.69–2.43; grade 2: OR 4.30, 95% CI 1.92–9.65; grade 3: OR 11.05, 95% CI 1.01–120.64; P = 0.001), knee joint PD signals (grade 0: OR 1.01, 95% CI 0.56–1.80; grade ≥ 1: OR 14.77, 95% CI 3.99–54.69; P < 0.001), toe joint PD signals (grade 0: OR 1.18, 95% CI 0.78–1.79; grade ≥ 1: OR 5.74, 95% CI 2.84–11.63; P < 0.001), quadriceps tendon and patellar tendon enthesitis (OR 1.95, 95% CI 1.36–2.78, P < 0.001), Achilles tendon and plantar aponeurosis enthesitis (OR 1.63, 95% CI 1.14–2.32, P = 0.007). C-index for the predictive model was 0.80 (95% CI 0.76–0.83). After bootstrapping validation (1000 times), it was confirmed to be 0.79. The external validation showed the accuracy of the predictive model is 0.87 (95% CI 0.69–0.95). This study succeeded in developing a predictive model with a high degree of accuracy to predict the risk of PsA in patients with psoriasis. Psoriatic arthritis often occurs in the population of patients with psoriasis. It brings a huge burden and pain to patients. At present, the diagnosis for psoriatic arthritis is very challenging. Numerous research studies have begun to focus on identifying patients with psoriasis at increased risk of psoriatic arthritis. Among a lot of modalities, ultrasound has been considered as a sensitive and convenient tool for screening early psoriatic arthritis. Our study successfully established a predictive model based on ultrasound variables to screen patients with psoriasis at high risk of transiting to psoriatic arthritis. After internal and external validation, it showed great accuracy and generalizability. We recommend that clinicians perform ultrasound screening of patients with psoriasis in clinical routine and get their risk value of transiting to psoriatic arthritis by using this model. For those patients with a high risk of progression to psoriatic arthritis, clinicians should refer them to a rheumatology department as soon as possible so that they could have access to early and effective management which might bring them good clinical and imaging outcomes.

The objective of this study is to identify the potential risk factors for progression from subclinical to clinical psoriatic arthritis (PsA). A retrospective, longitudinal, case–control study was conducted at a single hospital, including 25 patients with clinically confirmed PsA in the case group and 137 controls without confirmed PsA. All patients in both groups had a medical history of subclinical PsA. Various baseline covariates were collected from all patients when they had a status of subclinical PsA. Univariate, multivariate, stratified, and interaction analyses were employed to identify potential risk factors of transiting to clinical PsA from subclinical PsA. In multivariate logistic regression analysis, older age (OR 10.15, 95% CI 2.79–36.91, p = 0.00), alcohol drinking (OR 3.43, 95% CI 1.17–10.12, p = 0.03), elevated high-sensitivity C-reactive protein (hs-CRP) (OR 1.05, 95% CI 1.01–1.09, p = 0.03) were identified as risk factors for transition from subclinical to clinical PsA. Stratified and logistic regression analyses suggest a significant interaction between age and fatty liver. For patients aged less than 45 years old, the association between fatty liver and clinical PsA was statistically significant. Older age, alcohol drinking, elevated hs-CRP, and the presence of fatty liver at less than 45 years old appear to increase the risk of transition from subclinical to clinical PsA. These findings call for a need to manage these risk factors.

银屑病是一种慢性炎症性疾病,约30％的银屑病患者可发展为银屑病性关节炎.目前银屑病性关节炎的治疗目标是控制症状,提高患者生活质量,防止结构损伤和残疾.该病的治疗药物近年来进展迅速,本文就银屑病性关节炎的生物制剂治疗做一综述.