Psoriasis is a chronic, immune-mediated inflammatory disease that is always associated with overweight. At present, there are no effective therapeutic strategies to simultaneously manage psoriasis and comorbid overweight. Therefore, this study explores the long-term use of a traditional Chinese herbal tea formulation as a potential intervention. Traditional Chinese herbal tea can help regulate metabolism and inflammation. According to the theory of medicine and food homology, a Chinese herbal tea formula was developed for the treatment of blood stasis syndrome of psoriasis, and it aims to achieve both psoriasis relief and overweight reducing. To evaluate whether a standardized Chinese herbal tea can improve psoriasis severity and body mass index in adults with mild plaque psoriasis and overweight or obesity. This is a multicenter, open-label, randomized, controlled clinical trial. Participants aged ≥ 18 years with mild plaque psoriasis (PASI < 3, BSA < 3%) and overweight or obesity (BMI ≥ 24 kg/m²) will be randomly assigned (1:1) to either the Chinese herbal tea group or control group, with both groups continuing conventional care. The Chinese herbal tea group will take one dose for each day of traditional Chinese medicine (TCM) tea for 8 weeks. The control group will not receive additional interventions. The primary outcomes are changes in PASI score and BMI from baseline to week 8. Secondary outcomes include Dermatology Life Quality Index (DLQI), waist circumference (WC), lipid profiles, blood glucose, and inflammatory markers. After 8 weeks’ treatment, participants will be followed up for 24 weeks to assess the durability of response and recurrence rates. All adverse events will be documented and assessed for causality. This trial was registered at the International Traditional Medicine Clinical Trial Registry (ITMCTR2025002460) on 24 December 2025, prior to participant recruitment. Participant recruitment has not started. Recruitment is expected to begin in August 2026 and continue until June 2027. Data collection is expected to be completed in February 2028. This trial is expected to provide preliminary evidence regarding the role of Chinese herbal tea in improving psoriasis severity and metabolic abnormalities in patients with mild psoriasis and overweight or obesity. This trial was registered at the International Traditional Medicine Clinical Trial Registry on 24 December 2025 (registration number: ITMCTR2025002460), prior to participant recruitment.

Background:Psoriasis is a systemic inflammatory disease frequently comorbid with obesity, as both conditions share common pathogenic pathways. Acupoint catgut embedding (ACE), a sustained-release form of acupuncture, has demonstrated potential in modulating both immune and metabolic responses. This trial aims to evaluate the efficacy, safety, and underlying mechanisms of ACE in patients with mild psoriasis and concurrent overweight/obesity. Methods:This is a multicenter, randomized, double-blind, sham-controlled trial. Participants aged ≥ 18 years with mild plaque psoriasis (PASI< 3, BSA < 3%) and overweight (BMI ≥ 24 kg/m2) will be randomized (1:1) to receive either verum ACE at 14 specific acupoints or a sham procedure. Interventions will be administered every 2 weeks for 8 weeks. The primary endpoints are the changes in PASI score and BMI from baseline to week 8. Secondary outcomes include the Dermatology Life Quality Index (DLQI), waist circumference (WC), lipid profiles, and systemic inflammatory markers. The safety of the procedure will be monitored through the recording of adverse events and conducting laboratory tests. Participants will be followed through week 32 to evaluate long-term therapeutic durability. Discussion:This trial will provide high-quality evidence regarding the "dual-action" potential of ACE in simultaneously improving psoriatic lesions and metabolic dysfunction, establishing its role as an integrative therapy for this specific patient phenotype. Clinical trial registration:https://itmctr.ccebtcm.org.cn/, identifier ITMCTR2025002460.

BackgroundPsoriasis is a chronic inflammatory skin disease associated with multiple systemic comorbidities. Patients exhibit considerable individual variability in response to systemic therapies, making treatment outcomes and adverse reactions difficult to predict. Traditional Chinese Medicine (TCM) constitution theory may explain this variability, but prospective validation is lacking. This study primarily aims to evaluate the predictive value of TCM constitution types and multimodal clinical data for comorbidity risk in patients with psoriasis. As a secondary objective, it will also explore the association between TCM constitution and systemic treatment effectiveness and adverse events.MethodsThis is a multicenter, prospective, observational cohort enrolling 1000 adults (≥18 years) with psoriasis who are scheduled to initiate systemic therapy. Over a 52-week period, we will collect comprehensive data on TCM constitution types, syndrome patterns, and multimodal clinical data. All participants will be followed to monitor comorbidity progression and, secondarily, to assess the effectiveness of systemic therapies and record adverse events.DiscussionBy leveraging a digitized platform for TCM and clinical data collection, this prospective study aims to validate the relationship between TCM constitution types and psoriasis comorbidities and, secondarily, treatment responses. The ultimate objective is to build integrated predictive models for comorbidity risk as the primary outcome and treatment outcomes as secondary endpoints, combining TCM-based features with modern clinical indicators to advance personalized medicine in psoriasis.Ethics and disseminationThe study protocol was approved by the Medical Ethics Review Committee of The Second Affiliated Hospital of Hunan University (ID: 2025-KY-036-01) and the Medical Ethics Review Committee of Xiangya Hospital, Central South University (ID: 2025122317). Study results will be published in peer-reviewed journals and presented at national and international conferences. In addition, lay summaries of the findings will be made available to participants and the public via the hospitals’ websites and other public forums.Clinical trial registrationhttps://www.chictr.org.cn/searchprojEN.html, identifier [ITMCTR2025002518].

OBJECTIVE:Psoriasis is a chronic inflammatory dermatological condition characterized by the infiltration of inflammatory cells into the dermal layer. This study aimed to elucidate the anti-inflammatory properties and underlying molecular mechanisms of Ganoderic acid A in the treatment of psoriasis. METHODS:A psoriasis model was induced in mice using IMQ to evaluate the effects of Ganoderic acid A in vivo. The Psoriasis Area and Severity Index (PASI) was employed to assess the severity of skin inflammation in the lesions. Techniques such as hematoxylin-eosin staining, RNA sequencing and immunofluorescence assays were utilized to evaluate the efficacy. Both in vivo and exvivo experiments were conducted to confirm the clinical relevance and explore the regulatory mechanisms involved. RESULTS:The findings demonstrated that both intraperitoneal and topical applications of Ganoderic acid A alleviate psoriasis effectively. Specifically, Ganoderic acid A resulted in a reduction in skin thickness, erythema, scaling and the expression of inflammatory cytokines. Mechanistically, Ganoderic acid A was shown to reduce the secretion of skin inflammatory factors by inhibiting pyroptosis through the GSDMD pathway. CONCLUSION:Ganoderic acid A exhibits potential as a therapeutic agent for psoriasis and may be considered for inclusion in dietary recommendations for patients.

Psoriatic arthritis (PsA) is associated with various systemic conditions, among which cognitive impairment is significant. This study aims to explore the relationship between PsA and cognitive impairment and identify influencing factors. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Logistic regression analyses were performed to explore the relationship between PsA and cognitive impairment and to identify factors associated with cognitive impairment. The study included 94 patients with PsA, and 94 age-, and education-matched healthy controls (HCs). The prevalence of cognitive impairment was significantly higher in patients with PsA compared to the HCs (41.5

BACKGROUND:An increasing number of psoriatic patients are experiencing secondary failure with interleukin (IL)-17A inhibitors, highlighting the urgency to identify effective switching strategies. We evaluated the effectiveness and treatment patterns of intraclass versus interclass switching therapies in psoriasis patients experiencing secondary failure to IL-17A inhibitors over a 28-week period. METHODS:This single-center, retrospective analysis included psoriatic patients who experienced secondary failure to either ixekizumab or secukinumab and subsequently switched to another IL-17A inhibitor (ixekizumab or secukinumab; intraclass switching group) or to an IL-23 inhibitor (guselkumab; interclass switching group). RESULTS:80 patients were enrolled, including 47 in the intraclass switching group and 33 in the interclass switching group. The mean psoriasis area and severity index and dermatology life quality index were lower in the intraclass switching group compared to the interclass switching group at each time point over 28 weeks (p < .05). The discontinuation rate was higher in the interclass switching group (24.1%) compared to the intraclass switching group (2.7%; p < .05). Previous exposure to ≥2 biologics working on different pathways was identified as a risk factor for treatment failure in the interclass switching group. CONCLUSION:An intraclass switch following IL-17A inhibitors failure yielded better treatment outcomes than a switch to guselkumab.

BACKGROUND:Although interleukin (IL) 17 inhibitors like secukinumab and ixekizumab have shown significant efficacy in psoriasis, the impact of early intervention with biologics to modify the disease course and achieve long-term remission remains unclear. OBJECTIVES:To examine the potential of early intervention with IL-17 inhibitors for disease modification in psoriasis. METHODS:We conducted a multicenter retrospective cohort study on moderate-to-severe plaque psoriasis patients who received at least 4 weeks of treatment with secukinumab or ixekizumab between April 2019 and April 2023, taking the relapse rate 1 year after cessation of treatment as the primary endpoint. RESULTS:Among 400 patients who discontinued treatment after achieving Psoriasis Area and Severity Index 90, the median relapse time was 3.29 months (approximately 14 weeks). Of 141 patients who discontinued treatment after achieving Psoriasis Area and Severity Index 90 for over a year, 24 (88.89%) in the ultra-short disease duration (psoriasis duration ≤1 year) group and 33 (82.5%) in the short disease duration (psoriasis duration ≤2 years) group achieved 1 year of drug-free remission. LIMITATIONS:The potential impact of early intervention on comorbidity development was not addressed in this study. CONCLUSION:Early intervention with IL-17 inhibitors leads to faster responses and may promote disease modification in psoriasis.

Aim: Early diagnosis and accurate malignant melanoma (MM) staging are significant and decisive in clinical practice. [18F]DMPY2 is a promising PET tracer in vivo with high affinity and selectivity for melanin. The study aims to investigate the biodistribution and radiation dosimetry in healthy volunteers, and the potential clinical application of [18F]DMPY2 in MM patients. Materials and Methods: [18F]DMPY2 was synthesized via a one-pot reaction. The biodistribution, radiation dosimetry, and probe safety were estimated in three healthy volunteers. Thirty-one MM patients underwent [18F]DMPY2 and/or [18F]FDG PET/CT scans to explore the clinical use in early detection of melanoma metastasis. Diagnostic performance was assessed in fifty-one LN basins of twenty-seven MM patients after surgery, comparing PET uptake with pathological results. Results: [18F]DMPY2 was well tolerated by healthy volunteers and MM patients. The calculated effective dose of [18F]DMPY2 was 0.0122 mSv/MBq. In MM patients, we observed prominent [18F]DMPY2 tumor uptake and high tumor-to-background ratios in primary tumors. [18F]DMPY2 showed superior diagnostic performance in lymph node metastases compared to [18F]FDG, with sensitivity, specificity, accuracy, positive and negative predictive values of 66.7%, 100%, 88.9%, 100% and 85.7%, respectively, versus 50%, 42.9%, 46.7%, 50% and 42.9% for [18F]FDG. Additionally, [18F]DMPY2 PET imaging had a unique advantage in distinguishing [18F]FDG false-positive lesions. Conclusion: [18F]DMPY2 is a safe and well-tolerated melanin PET tracer and can be a powerful imaging tool for early detection and clinical staging of patients with MM.

ZusammenfassungZielDie Erstellung eines Vorhersagemodells für Psoriasis‐Arthritis (PsA) anhand klinischer und sonographischer Charakteristika bei Patienten mit Plaque‐Psoriasis (PsP).Patienten und MethodenDemographische, klinische und sonographische Daten von Patienten mit PsP und PsA wurden zwischen Mai 2019 und Dezember 2022 erfasst.ErgebnisseInsgesamt umfasste die Schulungskohorte 212 Patienten mit PsP und 123 Patienten mit PsA und die Validierungskohorte 91 Patienten mit PsP und 49 Patienten mit PsA. Mittels multivariater logistischer Regression wurden Nagelpsoriasis (Odds‐Ratio [OR] 1,88, 95%‐KI: 1,07–3,29), Synovitis (OR 18,23, 95%‐KI: 4,04–82,33), Enthesitis (OR 3,71, 95%‐KI: 1,05–13,14) und Knochenerosion (OR 11,39, 95%‐KI: 3,05–42,63) als effektive Prädiktoren für PsA identifiziert. Die Fläche unter der Kurve betrug für die Schulungskohorte 0,750 (95%‐KI, 0,691–0,806) und für die Validierungskohorte 0,804 (95%‐KI, 0,723–0,886). Der Hosmer‐Lemeshow‐Test zur Anpassungsgüte zeigte sowohl für die Schulungskohorte (p = 0,970) als auch für die Validierungskohorte (p = 0,967) eine gute Übereinstimmung. Außerdem wiesen die Kalibrierungskurven bei beiden Kohorten auf eine gute Kalibrierung hin. Laut Entscheidungskurvenanalyse hatte das Vorhersagemodell einen guten klinischen Nutzen.SchlussfolgerungenWir haben auf Grundlage von Nagelpsoriasis, Synovitis, Enthesitis und Knochenerosion ein quantitatives, intuitives und praktisches Vorhersagemodell zur Bewertung des PsA‐Risikos bei Patienten mit Plaque‐Psoriasis entwickelt.

Psoriasis is an immune-mediated inflammatory disease commonly accompanied by various metabolic disorders. It is widely known that biologics could affect the metabolic status and comorbidities in psoriasis patients, however, the effects of biologics on metabolism in psoriasis patients remain poorly understood. The aim of this study was to elucidate the characteristic changes of metabolic profiling in psoriasis vulgaris (PsV) patients before and after applying biologics. Plasma samples were collected from a retrospective cohort of 43 PsV patients. Non-targeted metabolomics analyses were performed using liquid chromatography-mass spectrometry (LC-MS) to compare the metabolic profiles before and after applying adalimumab (ADA) or ixekizumab (IXE) for 4 weeks. Additionally, correlation analyses were conducted to investigate the associations between metabolite expression levels and clinical characteristics. The biologics significantly affected the metabolic profiles of PsV patients especially in glycerophospholipids (GPs). First, phosphatidylcholine (PC), unsaturated lysophosphatidylcholine (LPC), unsaturated lysophosphatidic acid (LPA) and unsaturated lysophosphatidylethanolamine (LPE) were significantly up-regulated, whereas phosphatidylethanolamine (PE), saturated LPC, saturated LPA and saturated LPE were predominantly down-regulated after biologic treatment. What is more, the changes in PE and LPA were mainly observed after applying IXE instead of ADA. Second, we also found GPs including PC, unsaturated LPC, unsaturated LPA and unsaturated LPE were primarily negatively correlated with disease severity, whereas, PE, saturated LPC, saturated LPA and saturated LPE displayed inverse correlations. Biologics could affect GP metabolism and facilitate the transition of metabolic status from a pro-inflammatory to an anti-inflammatory phenotype in PsV patients.

Background: As one of the most effective biologic treatments for psoriasis, the short-term effectiveness of ustekinumab has yet to be studied extensively. Objective: The purpose of this study was to evaluate the short-term effectiveness and potential factors within four weeks after the first-dose ustekinumab treatment based on real-world data. Methods: The study enrolled 98 patients with moderate-to-severe psoriasis, given ustekinumab 45 mg at week 0, week 4, and then every 12 weeks. Based on clinical data collected at baseline and week 4, we investigated the short-term effectiveness of ustekinumab after the first dose and potential factors associated with the treatment. For evaluation, we collected demographic information, body data, medical history, laboratory examination results, Psoriasis Area and Severity Index (PASI), body surface area (BSA), and dermatology life quality index (DLQI). Response rates were calculated based on the number of patients that achieved a 75/90/100% reduction in PASI (PASI 75/90/100), and the primary treatment goal was to achieve PASI 75. Results: The response rates for PASI 75/90/100 at week 4 were 30.5%, 18.9%, and 16.8%, respectively. For PASI 75, the response rate was higher in patients without metabolic syndrome (MS) (without MS vs. with MS: 36.9% vs. 5.9%, p = 0.013); the serum triglyceride (TG) level was significantly lower in patients achieving PASI 75 (expressed as mean +/- standard deviation, achieved vs. unachieved: 1.82 +/- 1.79 vs. 3.59 +/- 8.89, p = 0.010). For PASI 100, the response rates were higher in female patients (female vs. male: 26.3% vs. 10.5%, p = 0.044) and patients with a family history of psoriasis (with family history vs. without family history: 44.4% vs. 13.9%, p = 0.042). In addition, the possibility of achieving PASI 75/90/100 went up along with the serum high-density lipoprotein cholesterol (HDL-C) level (expressed as adjusted odds ratio < 95% confidence interval>: PASI 75: 28.484 < 2.035-248.419>, p = 0.011; PASI 90: 28.226 < 2.828-281.729>, p = 0.004; PASI 100: 12.175 < 1.876-79.028>, p = 0.009). Conclusion: In this study, nearly one-third of patients achieved PASI 75 after only the first-dose ustekinumab treatment. Sex, family history of psoriasis, MS, serum TG level might affect the short-term effectiveness, and serum HDL-C level may be a potential factor. The possibility of achieving treatment goals (PASI 75/90/100) at week 4 increased along with serum HDL-C levels.

Psoriatic arthritis (PsA) is characterized by multi-joint involvement, primarily affecting the small joints in the hands and feet. However, the specific pattern of joint involvement at an individual level remains uncertain. This study aimed to elucidate the pattern of joint involvement in a PsA cohort. Patients diagnosed with PsA were recruited for this cross-sectional study. Demographic, clinical, laboratory, personal and family history, and comorbidity data were collected. Descriptive statistical analysis was performed, and univariate and multivariate regression models were used to examine baseline factors influencing joint involvement. A total of 264 PsA patients (156 males) were included in the study. The results revealed a predominant involvement of peripheral facet joints. The second proximal interphalangeal joint (PIP) of the right hand exhibited the highest prevalence of swelling (18.9%), while the right knee joint had the highest prevalence of tenderness (24.2%). Older age and earlier onset of PsA were identified as independent factors associated with the swelling of the second PIP of the right hand. Older age, earlier onset of PsA, lower Psoriasis Area and Severity Index and higher Dermatology Life Quality Index scores were identified as independent factors associated with the tenderness of the right knee joint. In conclusion, the most commonly affected joints in PsA are the second PIP of the right hand and the right knee joint.

ObjectiveTo construct a predictive model for Psoriatic Arthritis (PsA) based on clinical and ultrasonic characteristics in patients with plaque psoriasis (PsP).Patients and MethodsDemographic, clinical, and ultrasound data were collected from patients with PsP and PsA between May 2019 and December 2022.ResultsA total of 212 patients with PsP and 123 with PsA in the training cohort, whereas the validation cohort comprised 91 patients with PsP and 49 with PsA. The multivariate logistic regression identified nail psoriasis (odds ratio [OR] 1.88, 95% CI: 1.07-3.29), synovitis (OR 18.23, 95% CI: 4.04-82.33), enthesitis (OR 3.71, 95% CI: 1.05-13.14), and bone erosion (OR 11.39, 95% CI: 3.05-42.63) as effective predictors for PsA. The area under the curve was 0.750 (95% CI, 0.691-0.806) and 0.804 (95% CI, 0.723-0.886) for the training and validation cohorts, respectively. The Hosmer-Lemeshow goodness-of-fit test showed good consistency for both the training cohort (p = 0.970) and the validation cohort (p = 0.967). Calibration curves also indicated good calibration for both cohorts. The DCA revealed that the predictive model had good clinical utility.ConclusionsWe have developed a quantitative, intuitive, and convenient predictive model based on nail psoriasis, synovitis, enthesitis, and bone erosion to assess the risk of PsA in patients with plaque psoriasis.

BACKGROUND:Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening skin disease often requiring long-term therapy. We aimed to evaluate the use of Interleukin (IL)-17A inhibitors (secukinumab and ixekizumab) in GPP patients over 96 weeks. METHODS:We retrospectively analyzed a case series of 18 patients with GPP who received secukinumab (n = 13) and ixekizumab (n = 5) therapy with a 96-week follow-up period. The primary effectiveness analysis included determining the percentage of patients who achieved ≥90% or 100% improvement in the Generalized Pustular Psoriasis Area and Severity Index (GPPASI) score. Adherence was captured using the medication possession ratio (MPR). RESULTS:Using the as-observed (AO) method, 87% and 67% of patients treated with secukinumab or ixekizumab achieved GPPASI 90 and 100 responses, respectively. At Week 96, the mean GPPASI improvements from baseline GPPASI were 96.3% (95% CI: 0.91-1.01) using the AO method. After Week 48, 14 patients tapered (n = 8) or terminated (n = 6) the treatment. High-adherence therapy (MPR ≥ 80%) was significantly superior to the low-adherence group in the rate of patients achieving a GPPASI 100 response (AO, 100% vs. 38%, P < 0.05). By Week 96, 5 (27.8%) patients had new GPP flares, and 4 (80%) were in the low-adherence group. No new safety signals occurred. CONCLUSION:IL-17A inhibitors led to effective and sustained improvement in GPP patients, and high-adherence therapy had long-term positive effects on skin clearance. Given its relapsing nature, improving compliance is beneficial for long-term clinical management.

This study aimed to evaluate the discordance in patient-physician assessment of psoriatic arthritis disease activity and its association with the patient’s psychological health. This cross-sectional study recruited 135 patients with PsA from Xiangya Hospital of China between October 2021 and July 2022. The visual analogue scale was used to assess the disease activity of PsA, and an absolute difference of ≥ 10 points between the patient-physician global assessment on visual analogue scale was regarded as a clinically relevant discordance. In addition, the patients’ clinical data and self-reported questionnaire responses were collected to screen depressive and anxiety symptoms. Discordance in patient-physician assessment of psoriatic arthritis activity occurred in 88 (65.2

OBJECTIVE:To determine the minimal important change (MIC) and meaningful change value (MCV) of the Disease Activity Index for Psoriatic Arthritis (DAPSA) and the effect size (ES) of DAPSA. METHODS:This was a retrospective cohort study, recruiting 106 patients who agreed to participate in the research from the Department of Dermatology, Xiangya Hospital, between November 1, 2019, and April 1, 2023. An anchor-based method using linear regression analyses was used to determine the MICs and MCVs of the DAPSA. The anchor question assessed whether the patient's well-being had changed since their previous visit, employing a 5-point Likert scale that ranged from "much improved" to "much deteriorated." RESULTS:The overall MIC value was 8.4 (95% CI 0.01-16.75). The MIC improvement was 9.5 (95% CI 0.89-18.14) and MIC deterioration was 1.1 (95% CI -9.81 to 12.05). The overall MCV was 10.5 (95% CI 4.34-16.72). MCV improvement was 11.4 (95% CI 5.95-16.95) and MCV deterioration was 1.1 (95% CI -9.81 to 12.05). The ES was 0.6. CONCLUSION:A change in DAPSA of 8.4 is indicative of an MIC, offering physicians an additional means to contextualize the patient's perception of disease activity during treatment, and a change in DAPSA of 10.5 is likely to be regarded as MCV. These values can enhance the utility of DAPSA in psoriatic arthritis clinical trials.

Psoriatic arthritis (PsA) is associated with psoriasis, featured by its irreversible joint symptoms. Despite the significant impact on the healthcare system, it is still challenging to leverage machine learning or statistical models to predict PsA and its progression, or analyze drug efficacy. With 3961 patients' clinical records, we developed a machine learning model for PsA diagnosis and analysis of PsA progression risk, respectively. Furthermore, general additive models (GAMs) and the Kaplan-Meier (KM) method were applied to analyze the efficacy of various drugs on psoriasis treatment and inhibiting PsA progression. The independent experiment on the PsA prediction model demonstrates outstanding prediction performance with an AUC score of 0.87 and an AUPR score of 0.89, and the Jackknife validation test on the PsA progression prediction model also suggests the superior performance with an AUC score of 0.80 and an AUPR score of 0.83, respectively. We also identified that interleukin-17 inhibitors were the more effective drug for severe psoriasis compared to other drugs, and methotrexate had a lower effect in inhibiting PsA progression. The results demonstrate that machine learning and statistical approaches enable accurate early prediction of PsA and its progression, and analysis of drug efficacy.

To the Editor: Psoriatic arthritis (PsA) is a polygenic heterogeneous inflammatory disorder characterized by skin and joint symptoms, which can result in substantial negative effects on physical function and quality of life.1Ritchlin C.T. Colbert R.A. Gladman D.D. Psoriatic arthritis.N Engl J Med. 2017; 376: 957-970Crossref PubMed Scopus (744) Google Scholar Most (64.5%) patients with PsA develop skin lesions first, whereas other patients present with joint symptoms first (19.35%) or developed skin lesions and joint symptoms almost concurrently (16.1%).2Elmets C.A. Leonardi C.L. Davis D.M.R. et al.Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities.J Am Acad Dermatol. 2019; 80: 1073-1113Abstract Full Text Full Text PDF PubMed Scopus (235) Google Scholar The moderate/high disease activity (MDA/HDA) status might contribute to the progression of irreversible damage in patients with PsA.3Smolen J.S. Schöls M. Braun J. et al.Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.Ann Rheum Dis. 2018; 77: 3-17Crossref PubMed Scopus (434) Google Scholar A retrospective study was performed to evaluate the risk factors predicting the state of MDA/HDA status in a tertiary academic dermatology center. Adult participants who met the Classification Criteria for Psoriatic Arthritis (CASPAR) between April 2019 and October 2022 were recruited after acquiring approval from the Xiangya Hospital Ethics Committee. In the current study, the Psoriatic Arthritis Disease Activity Score (PASDAS) was used to assess disease activity and the Psoriasis Area and Severity Index was applied to evaluate the severity of skin lesions. PASDAS ≥ 3.2 was defined as MDA/HDA.4Coates L.C. Helliwell P.S. Defining low disease activity states in psoriatic arthritis using novel composite disease instruments.J Rheumatol. 2016; 43: 371-375Crossref PubMed Scopus (82) Google Scholar Univariate analysis (Student t test for continuous and χ2 test for categorical factors) and multivariable logistic regression analysis were carried out using SPSS (version 26.0). In total, 286 subjects with PsA, including 183 (64.0%) men, were included. Among them, 88 subjects were judged as having very low/low disease activity (PASDAS < 3.2) status. The characteristics of the 2 groups were comparable, except for the Dermatology Life Quality Index (DLQI) (P = .011), the severity of skin lesions (P = .002), and the onset sequence of symptoms (P = .011) (Table Ⅰ).Table IDemographic and clinical characteristics of patients with psoriatic arthritisVariablesTotal (n = 286)VLDA/LDA (n = 82)MDA/HDA (n = 204)PAge (y), mean ± SD45.68 ± 13.1445.91 ± 12.6945.59 ± 12.35.850Female, n (%)103 (36.01)24 (29.27)79 (38.73).132BMI (kg/m2), mean ± SD23.91 ± 3.3923.78 ± 3.0523.98 ± 3.52.629Education, n (%).778 Primary/middle school114 (39.86)33 (40.2)81 (39.7) High school56 (19.58)14 (17.1)42 (20.6) College or above116 (40.56)35 (42.7)81 (39.7)Duration of PsO (y), mean ± SD10.51 ± 8.9711.47 ± 8.4110.12 ± 9.18.25Duration of PsA (y), mean ± SD3.81 ± 5.703.17 ± 4.214.07 ± 6.19.225Temporal sequence of skin and joint symptoms onset, n (%).011 Skin and joint symptoms onset concurrence41 (14.3)4 (4.9)37 (28.2) Skin preceded joint symptoms224 (78.3)73 (89.0)151 (74.0) Joint preceded skin symptoms21 (7.3)5 (6.1)16 (7.8)Family history of psoriasis, n (%)43 (15.03)11 (13.4)32 (15.7).627PASI, mean ± SD6.97 ± 7.256.12 ± 7.907.31 ± 6.96.209PASI, n (%).002 Mild psoriasis (PASI <3)94 (32.9)38 (46.3)56 (27.5) Moderate-to-severe psoriasis (PASI ≥3)192 (67.1)44 (53.7)148 (72.5)DLQI, mean ± SD6.18 ± 5.194.95 ± 5.226.67 ± 5.10.011BMI, Body mass index; DLQI, Dermatology Life Quality Index; MDA/HAD, moderate/high disease activity; PASI, Psoriasis Area and Severity Index; PsA, psoriatic arthritis; PsO, skin psoriasis; VLDA/LDA, very low/low disease activity. Open table in a new tab BMI, Body mass index; DLQI, Dermatology Life Quality Index; MDA/HAD, moderate/high disease activity; PASI, Psoriasis Area and Severity Index; PsA, psoriatic arthritis; PsO, skin psoriasis; VLDA/LDA, very low/low disease activity. Multivariable logistic regression analysis in model 1 was performed with the adjustment for duration of PsA, the severity of skin lesions, DLQI, and the sequence of skin and joint symptoms, which revealed that the concurrent onset of skin and joint symptoms (adjusted odd ratio [AOR], 4.65; P = 0.007), moderate-to-severe psoriasis (AOR, 2.23; P = 0.005) and DLQI (AOR,1.06; P = 0.034) were significantly associated with a higher likelihood of MDA/HDA status. The AORs remained significant by further adjusting for sex and age in model 2 (Table Ⅱ).Table IIMultivariable regression analyses of the relationship of disease activity status with patient characteristics according to Psoriatic Arthritis Disease Activity ScoreVariablesMDA/HDAModel 1∗Adjusted by duration of PsA, skin and joint symptoms onset concurrence, severity of skin lesions, and DLQI.PModel 2†Adjusted by sex, age, duration of PsA, skin and joint symptoms onset concurrence, severity of skin lesions, and DLQI.PORAOR (95% CI)AOR (95% CI)Duration of PsA1.03 (0.98-1.09)1.01 (0.95-1.08).7231.01 (0.95-1.08).952Skin and joint symptoms onset concurrence4.47 (1.54-13.02)4.65 (1.53-14.13).0074.70 (1.54-14.31).006ref: skin preceded joint symptomsJoint preceded skin symptoms1.55 (0.55-4.39)1.85 (0.57-6.00).3091.76 (0.54-5.80).351ref: skin preceded joint symptomsModerate-to-severe psoriasis (PASI ≥3)2.28 (1.34-3.89)2.23 (1.27-3.91).0052.38 (1.35-4.20).003ref: mild psoriasis (PASI <3)DLQI1.07 (1.02-1.14)1.06 (1.00-1.12).0341.06 (1.00-1.12).044AOR, Adjusted odds ratio; DLQI, Dermatology Life Quality Index; MDA/HDA, moderate/high disease activity; OR, odds ratio; PASI, Psoriasis Area and Severity Index; PsA, psoriatic arthritis; ref, reference.∗ Adjusted by duration of PsA, skin and joint symptoms onset concurrence, severity of skin lesions, and DLQI.† Adjusted by sex, age, duration of PsA, skin and joint symptoms onset concurrence, severity of skin lesions, and DLQI. Open table in a new tab AOR, Adjusted odds ratio; DLQI, Dermatology Life Quality Index; MDA/HDA, moderate/high disease activity; OR, odds ratio; PASI, Psoriasis Area and Severity Index; PsA, psoriatic arthritis; ref, reference. Notably, the above results uncover new information that the concurrent onset of skin lesions, and joint symptoms was correlated with an increased likelihood of MDA/HDA status on the basis of PASDAS, indicating that dermatologists and rheumatologists should pay extra attention to the sequence of onset between the skin and joint symptoms in the disease management of PsA. Additionally, although previous reports suggested a positive relationship between Psoriasis Area and Severity Index, quality of life impairment and disease activity,5Gado S.E. El-Khouly R.M. Aboelhawa M.A. Fouda M.H. El-Banna H.S. The association between IL17, fatigue and quality of life in psoriatic arthritis patients.Expert Rev Clin Immunol. 2021; 17: 539-544Crossref PubMed Scopus (3) Google Scholar the current study, on the basis of further multivariable logistic regression analysis, demonstrated that moderate-to-severe psoriasis and higher DLQI scores were the risk variables of higher PASDAS in patient with PsA. Since our analyses were on the basis of respective cross-sectional data from a single center, the findings in this research letter should be interpreted with caution by considering limitations, like selection bias and lack of adjustment of unknown confounders. Nevertheless, special attention should be paid to the onset sequence of symptoms, the severity of skin psoriasis, and the quality of life in patients with PsA. None declared.