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1 INDEX Note: PsA stands for psoriatic arthritis. Page numbers in italics indicate figures. Page numbers followed by a t indicate tables. Clinical trials and studies are indexed under the acronym of the name. Abatacept, 148t, 2-4 action mechanism, 2 clinical responses, 3-4, 3, 4 concurrent methotrexate, 3 dosing, 2-3, 4 effectiveness in PsA, 2-4, 3, 4 structure, 2 subcutaneous formula, 4 Achilles tendon, 46, 49, 73 ultrasound imaging, 91 Achilles tendonitis, 72 Acitretin, 182t, action mechanism, approved for psoriasis, 181 combined with phototherapy, 190 dosing, 182t high-dose, 190 efficacy, 190 indications for, 199 safety, 191 side effects and monitoring, 183t tolerability, 190, 191, 203 ACR20 response rate, 85-86, 86t Adalimumab (Humira), action mechanism, 206 approved for PsA, 116 approved for psoriasis, 206 safety risk, 213, 214t structure, 127 in treatment of PsA, ADEPT trial, , 129, 130, 131, clinical responses, , 129, 130, , 132,

2 Adalimumab (Humira), in treatment of PsA (continued) with methotrexate, radiographic progression, , 131 in treatment of psoriasis, 206, , clinical endpoints, 205t dosing, 205t efficacy, long-term, efficacy, loss of effect, 212 efficacy, short-term, Adenosine, 184 ADEPT (Adalimumab Effectiveness in Psoriatic Arthritis) trial, , 129, 130, 131, Age psoriasis and, 25 psoriatic arthritis and, 28 Alefacept, 148t, 5, withdrawn from US market, 148t, 5 Allergic dermatitis, 58 American College of Rheumatology (ACR): ACR20 response rate, 85-86, 86t Anakinra, 148t, 5 Animal models, Ankylosing spondylitis (AS), 21, 37t, 38 ASAS classification system, 38 ASAS response criteria, 80, 81t BASDAI, 80, 80t evaluation tools of use in psoriatic arthritis, Anthralin, combined with UVB, 173 Anti-TNF agents. See TNF inhibitors. Apremilast, , action mechanism, 101, , 195 adverse events, 106, 108t approved for PsA, 101 approved for psoriasis, 181, 195 cautions in pregnancy, 109 depression and, 106, 198 dosage titration for psoriasis, 182t, 197 for psoriatic arthritis (PsA), 106, 107t Apremilast (continued) indications for, 199 safety, side effects and monitoring, 183t, depression, 183t, 198 weight loss, 183t, 198 structure of, 101 in treatment of psoriasis, dosing, 182t, 197 efficacy, , 196 ESTEEM 1 and 2 trials, , 196 side effects and monitoring, 183t in treatment of psoriatic arthritis (PsA), clinical trials, PALACE 1-3, , 105 PALACE 4, 101, dosage titration, 106, 107t Arthritis mutilans, 45-46, 48 frequency of, 30t ASAS (Assessment in Ankylosing Spondylitis), 38 ASAS response criteria, 80, 81t Asymmetric oligoarthritis, 30t, 32, 42, 43 prevalence of, 41 Auspitz Sign, 55 Axial arthritis, 44-45, 47 Axial evaluation, ASAS response criteria, 80, 81t BASDAI, 80, 80t chest expansion measurement, 79 clinical outcome measurements, 80-83, 81t mobility measurements, 78-79, 79 Schober s test, 78, 79 Axial involvement in psoriatic arthritis (PsA), 13-16, 38, 42, 44-45, 47 evaluation for, GRAPPA treatment recommendations, 110 Axial spondyloarthropathy (in PsA), 30t Axial symptoms, Azathioprine,

3 Back pain, inflammatory, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 80, 80t Betamethasone dipropionate, 164, 166 Biologic therapy for psoriasis, agents alefacept, anti-tnf agents, , 205t efalizumab, 204 ustekinumab, conclusions on, 217 development of biologics, 203 for extensive areas, 203, 217 Biopsy of skin, 66-68, 68 Body surface area (BSA) involved, biologic therapy for extensive areas, 203, 217 in erythrodermic psoriasis, 61 in PASI (Psoriasis Area and Severity Index), 82 topical therapy and, 7 Bone destruction in joints, 21, Briakinumab, BSA. See Body surface area (BSA) involved. Calcipotriene, 163, 164, 166 Calcipotriol, 163 Calcitriol, 166 Cancer black box warning for tacrolimus and pimecrolimus, melanoma, PUVA and, 176 skin cancer cyclosporine and, 183t psoralen plus ultraviolet A (PUVA) and, 176 UVB and, TNF inhibitors and, 212, 214t ustekinumab and, 216 Cardiovascular disease congestive heart failure (CHF), , 212, 214t risk of, 222 Cardiovascular toxicity cyclosporine and, 183t, 194 TNF inhibitors and, , 212, 214t Cartilage degradation in joints, 21 CASPAR (Classification of Psoriatic Arthritis) criteria, 13, 30-32, 31t, 71 CCP (cyclic citrullinated peptide), antibodies to, 34, 83 CD4+ cells, 22 Certolizumab pegol (Cimzia), approved for PsA, 116 clinical responses, , 137 RAPID-PsA trial, , 137 safety profile, 136 Chest expansion, measurement of, 79 Chest wall pain, CHF, TNF inhibitors and, , 212, 214t Cimzia. See Certolizumab pegol (Cimzia). Classification. See also Clinical presentation; Epidemiology and classifi cation. ASAS classification system, 38 psoriasis, CASPAR criteria and, 31t, 32 clinical appearance of lesions, 26-28, 27 psoriatic arthritis (PsA), CASPAR criteria, 30-32, 31t, 71 Moll and Wright classification, 29-30, 30t subgroups, 29-30, 30t Climatotherapy, Clinical appearance of lesions, 26-28, 27, 80-83, 82 physician global assessment (PGA), 81 Psoriasis Area and Severity Index (PASI), 81-83, 82 Clinical presentation, 17. See also Clinical presentation of psoriasis; Clinical presentation of psoriatic arthritis. cardinal signs, 17, 26-28, enthesitis, 22, 32, 33, erythema (redness), 17, 26, 27, 54, 54 plaque elevation (induration), 17, 26, 27, 54, 54 scale, 17, 54, 54 clinical appearance of lesions, 26-28, 27, 80-83, 82 extent of body area (BSA) involved,

4 Clinical presentation (continued) of psoriasis, of psoriatic arthritis (PsA), Clinical presentation of psoriasis, appearance of lesions, 26-28, 27, 67-68, 67, 68 areas affected, 53 different presentations in multiple areas, 53 special locations, erythrodermic psoriasis, 28, 61-62, 62 guttate psoriasis, 56-57, 56 inverse psoriasis, 28 laboratory evaluation/histopathology, 66-68, 67, 68 nail changes, 33 palmar/plantar psoriasis, 28 palmar-plantar psoriasis, 57-59, 57, 58 plaque psoriasis, 28, 53-55, 54 Koebner phenomenon, 54, 55 prevalence of, 53 symptoms from, 55 pustular psoriasis, 59-61, 60, 61 special locations, genital psoriasis, inverse psoriasis, 63, 64 nail psoriasis, 65-66, 65 subtypes, 28, changes over time, 53 environmental factors and, 53 Clinical presentation of psoriatic arthritis (PsA), arthritis mutilans, 45-46, 48 aspects articular disease with synovitis, 41, 72 axial inflammatory arthritis, 41 concurrent psoriasis, 41 enthesitis, 41, 46-47, 49 skin disease/history of skin disease, 41 treatment effects on presentation, 42 asymmetric oligoarthritis, 30t, 32, 41, 42, 43 axial arthritis, 13-16, 38, 42, 44-45, 47 dactylitis, 31t, 32-33, 47, 50 DIP-predominant arthritis, 43-44, 45 Clinical presentation of psoriatic arthritis (PsA) (continued) enthesitis, 46-47, 49, eye involvement, 32, features, joint involvement, 32-33, 41-42, asymmetric oligoarthritis, 30t, 32, 41, 42, 43 axial involvement, 33 dactylitis, 31t, 32-33, 47, 50 DIP-predominant arthritis, 43-44, 45 enthesitis, 22, 32, 33, 46-47, 49 erythema (redness), 26, 27, 32, 43 joint counts, 72-73, 73 lower extremity involvement, 22, 32 lumbar spine involvement, 33 patterns of, sacroiliac arthritis/sacroiliitis, 33, 37, 38, 47 sausage digits, 32-33, 43 swollen/tender joints, 32, 43 symmetrical polyarthritis, 30t, 41, 42-43, 44 synovitis, 32-33, 72 joints in, nail changes, 33, 35, 44, 46, 49 prognosis and, SAPHO syndrome, 50 symmetrical polyarthritis, 30t, 41, 42-43, 44 Clinical trials ADEPT (adalimumab), , 129, 130, 131, apremilast, clinical appearance of lesions, 80-83, 82 ESTEEM 1 and 2 (apremilast), , 196 GO-REVEAL (golimumab), , 134 IMPACT and IMPACT 2 (infliximab), , 123t, 124, 125 MIPA (methotrexate), 100, 100t PALACE 1-3 (apremilast), , 105 PALACE 4 (apremilast), 101, physician global assessment (PGA), 81 PRESTA (etanercept), , 142 PSUMMIT 1 (ustekinumab), 0-1, 1 PSUMMIT 2 (ustekinumab),

5 Clinical trials (continued) RAPID-PsA (certolizumab pegol), , 137 RESPOND (infliximab and methotrexate), 99, 126, 127 Coal tar, Computed tomography (CT), 89 Congestive heart failure (CHF), TNF inhibitors and, , 212, 214t Conjunctivitis, 49 Contact dermatitis, 58, 59 Coordinated management of psoriasis and psoriatic arthritis, dermatologists, identification of psoriatic arthritis by, Quadrant Model, 229, 230 patient role in, rheumatologists, identifying psoriasis, 226 treatment plan, development of, , 230 Corticosteroids in management of PsA, 96 in management of psoriasis, 0-2 topical, for psoriasis, action mechanism, 160 choice of, 160 combined with salicylic acid, 9 combined with UVB, 173 combined with vitamin D, 164 facial application, cautions for, potency, 160, 166 side effects, withdrawal from and changes in clinical presentation of psoriasis, 53 pustular psoriasis following, 60 Coxibs, 95 Cyclic AMP, apremilast and, 101, , 195 Cyclosporine, 17, 98, action mechanism, 192 indications for, 199 safety, drug interactions, 193, 194 time limitation on use, 193 Cyclosporine (continued) side effects and monitoring, 183t, cardiovascular toxicity, 183t, 194 lab abnormalities, 183t renal toxicity, 183t, 193 skin cancer risk, 183t toxicity profile, 98 in treatment of PsA, 98 in treatment of psoriasis, 182t, dosing, 182t indications, 192 for pustular psoriasis, 61 side effects and monitoring, 183t Cytokines, 12, 18, 19, 20, 21, 206, 2. See also Interleukins (ILs). Cytopenia methotrexate and, TNF inhibitors and, 141 Dactylitis, 31t, 32-33, 47, 50 examination for, GRAPPA treatment recommendations, 110 Leeds Dactylitis Index (LDI), sausage digits, 32-33, 43, 47, 50 in spondyloarthropathies, 32 DAPSA (Disease Activity in Psoriatic Arthritis) scale, 86 DAREA (Disease Activity in Reactive Arthritis) scale, 86 Dead Sea phototherapy, Degenerative arthritis, Demyelinating disease, TNF inhibitors and, , 212, 214t Depression, apremilast and, 106, 198 Dermatitis, contact, 58, 59 Dermatologists, 222, 230 identification of psoriatic arthritis by, Dermis, 68, 68 Desquamation, in PASI (Psoriasis Area and Severity Index),

6 Diagnosis and evaluation of psoriatic arthritis (PsA), axial evaluation, ASAS response criteria, 80, 81t BASDAI, 80, 80t chest expansion measurement, 79 clinical outcome measurements, 80-83, 81t mobility measurements, 78-79, 79 Schober s test, 78, 79 clinical appearance of lesions, 26-28, 27, 80-83, 82 physician global assessment (PGA), 81 Psoriasis Area and Severity Index (PASI), 81-83, 82 composite disease activity scores, ACR20 response rate, 85-86, 86t DAPSA (Disease Activity in Psoriatic Arthritis) scale, 86 DAREA (Disease Activity in Reactive Arthritis) scale, 86 Psoriatic Arthritis Response Criteria (PsARC), 85, 85t dactylitis exam, dermatologist, identification by, differential diagnosis, 34-38, 37t ankylosing spondylitis, 37t, 38 arthritis associated with IBD, 37t, 38 degenerative arthritis, gout, 37t osteoarthritis, 34, 37t reactive arthritis, 37t, 38 rheumatoid arthritis (RA), entheseal exam, 73-76, history, joint counts, 72-73, 73, 74 joint exam, joint symptoms, timing in relation to skin disease, 71 laboratory testing, nail changes, 49, 83, 84t other imaging modalities, computed tomography (CT), 89 MRI, ultrasound, 89, 91 Diagnosis and evaluation of psoriatic arthritis (PsA) (continued) radiographic evaluation, 87-89, 88, 89 joint space narrowing, 87, 90 pencil-in-cup deformity, 87, 89 periostitis and distal tuft resorption, 87, 88 Sharp radiographic scoring system, 87, 90 screening tools, , 224t Diagnosis of psoriasis, 66. See also Clinical presentation of psoriasis. Diffuse idiopathic skeletal hyperostosis (DISH), 37, 191 DIP (distal interphalangeal) joints, 42-44, 45, 87 arthritis primarily involving, 30t DIP-predominant arthritis, 43-44, 45 extensor tendon and nail root, histology sections, in Moll and Wright classification, 30t, 42, 43 MRI, in patient with PsA, 35 nail abnormalities and, 33, 35, 36-37, 44, 46 osteoarthritis of, 34 Disease activity measures, ACR20 response rate, 85-86, 86t DAPSA (Disease Activity in Psoriatic Arthritis) scale, 86 DAREA (Disease Activity in Reactive Arthritis) scale, 86 PASI (Psoriasis Area and Severity Index), 81-83, 82 DISH (diffuse idiopathic skeletal hyperostosis), 37, 191 Distal interphalangeal joints. See DIP (distal interphalangeal) joints. Distal tuft resorption, 87, 90 DMARDs (disease-modifying antirheumatic drugs), See also Oral systemic therapy. terminology, 184 Edema, in erythrodermic psoriasis, 62 Efalizumab, 204 Emollients, 8-9 Enbrel. See Etanercept (Enbrel). Entheseal exam, 73-76, 91 Leeds Enthesitis Index (LEI), 75-76, 78 Maastricht Ankylosing Spondylitis Entheses Score (MASES), 74-75,

7 Entheseal exam (continued) Mander Enthesis Index (MEI), 74, 75 Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC), 75, 77 Enthesitis, 22, 32-33, 37, 46-47, 49, common locations, 73 GRAPPA treatment recommendations, 110 Environmental factors, 19, 20 clinical presentation and, 53 infections, 22 in pathogenesis, 19, 20, 22 Epidemiology and classification, changes in involvement patterns, 30 psoriasis, CASPAR criteria and, 31t, 32 classification, 26 clinical appearance of lesions, 26-28, 27, 67-68, 67, 68 mild, moderate, and severe, 28 psoriatic arthritis (PsA), CASPAR criteria, 30-32, 31t classification, 29-30, 30t features, laboratory findings, Moll and Wright classification, 29-30, 30t nail changes, 33, 35, prevalence, 29 severity of skin disease and, 33 subgroups, 29-30, 30t Epidermis, 67, 67, 68 Erythema, 17, 26, 27, 43, 54, 54 in PASI (Psoriasis Area and Severity Index), 82 Erythroderma, Erythrodermic psoriasis, 28, 61-62, 62 BSA in, 61 ESTEEM 1 and 2 trials, , 196 Etanercept (Enbrel), action mechanism, 206 approved for PsA, 116, 120 approved for psoriasis, 206 safety risk, 213, 214t Etanercept (Enbrel) (continued) structure, 116 in treatment of PsA, efficacy, , , 142 with methotrexate, 121 PRESTA trial, , 142 in treatment of psoriasis, 205t, , clinical endpoints, 205t dosing, 205t high-dose, 210 efficacy, long-term, efficacy, short-term, Etiology multifactorial, 11, 13 pathways involved with associated genes, 14t-t Etretinate, 97 Evaluation for psoriatic arthritis. See Diagnosis and evaluation of psoriatic arthritis. Excimer laser, Eye, side effects of topical corticosteroids, 160 Eye disease, inflammatory, 32, Facial psoriasis, topical corticosteroids, cautions for, topical macrolides (tacrolimus and pimecrolimus), Family history, 11, 71 Feet plantar psoriasis, 57-59, 58 sausage digits, 47, 50 tendinitis, 49 Fever, in erythrodermic psoriasis, 62 Fitzpatrick skin type, 170 Folic acid supplementation, 186, Quadrant Model, 229, 230 Fumaric acid esters, 181 Gender psoriasis and, psoriatic arthritis and, 28, 32 spondyloarthropathies and,

8 Genes associated with psoriasis and PsA, 12, 13, 14t-t CARD 14, 12 discovery timeline, 16 prognosis and, 16 PSORS 1 and 2, 12 Genetics, candidate genes, 12, 14t-t, 16 familial inheritance, 11 HLA loci, of psoriasis, 12-13, 14t-t of psoriatic arthritis (PsA), 11, 13-16, 16 twin studies, 11 Genital psoriasis, GO-REVEAL (Golimumab-Randomized Evaluation of Safety and Efficacy in Subjects With Psoriatic Arthritis Using a Human Anti-TNF Monoclonal Antibody), , 134 Goeckerman therapy (UVB and tar), 173 Golimumab (Simponi), approved for PsA, 116, 133 clinical responses, , 134 dactylitis responses, 133 GO-REVEAL trial, , 134 nail responses, 135 Gout, 37t, GRAPPA (Group for the Assessment of Psoriasis and Psoriatic Arthritis), 229 composite disease activity measurement, 87 treatment recommendations for PsA, 109, 110, 229 TNF inhibitors, 142 Guttate psoriasis, 56-57, 56 progression to plaque psoriasis, 57 Hands. See also DIP (distal interphalangeal) joints; Nail changes. arthritis mutilans and, 45-46, 48 palmar psoriasis, 57-59, 57 sausage digits, 32-33, 43 telescoping of digits, 45-46, 48 Hematologic toxicity, methotrexate and, 183t, Hepatic toxicity. See Liver toxicity. Hepatitis B, TNF inhibitors and, 139 Herpes zoster, TNF inhibitors and, 139 History family history of psoriasis or psoriatic arthritis, 11, 71 medical, HIV (human immunodeficiency virus), infection with, 22 HLA loci, 13-16, 50 HLA-B27 positivity, 83 Humira. See Adalimumab (Humira). IL. See Interleukins (ILs). Imaging, radiographic evaluation, 87-89, 88, 89 ultrasound, 89, 91 Immune activity in psoriasis and psoriatic arthritis, 17-18, 20 IMPACT and IMPACT 2 trials, , 123t, 124, 125 Induration, 26, 27, 54, 54 in PASI (Psoriasis Area and Severity Index), 82 Infections, 22, 56, 57 guttate psoriasis and, 56-57, 56 opportunistic, 138, , 214t pustular psoriasis and, 60 reactive arthritis and, 38 streptococcal, 56, 57 TNF inhibitors and, 138, , 214t ustekinumab and, 216 Inflammation genes and, 12 inflammatory cells in plaques, 17 Inflammatory bowel disease (IBD), 32 arthritis associated with, 37t, 38 cautions for NSAIDs with, 96 Infliximab (Remicade), action mechanism, 206 approved for PsA, 116, approved for psoriasis, 206 in treatment of PsA, clinical responses, 42, , 123t, 142 dactylitis and enthesitis responses, 124,

9 Infliximab (Remicade), in treatment of PsA (continued) IMPACT and IMPACT 2 trials, , 123t, 124, 125 with methotrexate (in RESPOND trial), 99, 126, 127 quality of life improvements, radiographic progression, , 124 in treatment of psoriasis, 205t, , 211 clinical endpoints, 205t dosing, 205t efficacy, long-term, 211 efficacy, short-term, Ingram therapy (UVB and anthralin), 173 Injection site reactions anakinra and, 5 TNF inhibitors and, 141 Interferon (IFN- ), 18, 19 Interleukins (ILs), 19 effects on keratinocytes, 18, 20 genes for receptors, 12 IL-1 receptor, anakinra and, 5 IL-6, 21, 5-6 antibody to (sarilumab), 5-6 receptor, antibody to (tocilizumab), 5-6 IL-12, 12, 2 antibody to (ustekinumab), 147, 2, 217 IL-17, 18, 20, 206, 2 IL-17 pathway, 18, 20, 21, 204 IL-20, 18, 206, 2 IL-22, 18, 20, 206, 2 IL-23, 12, 18, 20, 204, 206, 2 antibody to (ustekinumab), 147, 2, 217 inhibitors of, 18 in pathogenesis of psoriasis, 18-20, 19 Inverse psoriasis, 28, 63, 64 topical corticosteroids for, 166 topical macrolides (tacrolimus and pimecrolimus) for, vitamin A and D agents for, 166 Itching, 55 Joint counts, 72-73, 73, joint count, 72, 73 66/68-joint count, 72-73, 74 Joint involvement in PsA, 32-33, See also specifi c joints. arthritis mutilans, 45-46, 48 asymmetric oligoarthritis, 30t, 32, 41, 42, 43 axial involvement, 13-16, 33, dactylitis, 31t, 32-33, 47, 50 enthesitis, 22, 32, 33, 46-47, 49, erythema (redness), 26, 27, 32, 43 lower extremity involvement, 22, 32 Moll and Wright classification, 29-30, 30t, sausage digits, 32-33, 43 swollen/tender joints, 32, 43 synovitis, 32-33, 72 Joint space narrowing, 87, 90 Joint symptoms, timing in relation to skin disease, 71 Joints bone and cartilage destruction, 21 clinical presentation in psoriatic arthritis, Keratinocytes changes in psoriasis and PsA, 17, 18, 20 genes associated with growth and function, Keratolytic agents, Koebner phenomenon, 54, 55, 58 Laboratory testing/evaluation abnormalities with TNF inhibitors, 141 in psoriasis, 66-68, 67, 68 in psoriatic arthritis (PsA), 33-34, Lactic acid, 9 Laser phototherapy, Leeds Dactylitis Index (LDI), Leeds Enthesitis Index (LEI), 75-76, 78 Leflunomide, Ligament involvement. See Enthesitis. Liver biopsy, 187, 189t

10 Liver toxicity acitretin and, 183t, 191 methotrexate and, 183t, 187, 188t non-alcoholic steatohepatitis (NASH) and, 187 Locations of psoriasis. See Clinical presentation of psoriasis. Lower extremity involvement, 22, 32 Lumbar spine involvement, 33, 38 Lupus-like syndrome, 214t Lymphoma, TNF inhibitors and, 140, 214t Maastricht Ankylosing Spondylitis Entheses Score (MASES), 74-75, 76 Macrolides, topical (tacrolimus and pimecrolimus), Major adverse cardiac events (MACE), Major histocompatibility complex (MHC) MHC class I related genes (MICA), 13 MHC class II genes, 13 MHC I genetic locus, 12, 13, 16 Management. See Therapies. Mander Enthesis Index (MEI), 74, 75 MASES (Maastricht Ankylosing Spondylitis Entheses Score), 74-75, 76 MCP (metacarpophalangeal) joints, in Moll and Wright classification, 30t Melanoma, PUVA and, 176 Methotrexate, 96, , action mechanisms, advantages of, 184 anti-inflammatory effects, dosing for psoriasis, 182t, 188 for psoriatic arthritis, 100 folic acid supplementation and, 186, indications for, 198 safety concerns, hematologic toxicity, 183t, liver (hepatic) toxicity, 183t, 187, 188t liver biopsies, 187, 189t monitoring for, 183t, 189t Methotrexate, safety concerns (continued) monitoring, 183t, 188t, 189t pulmonary toxicity, 183t, 189 renal function, 183t, 186 side effects and monitoring, 183t, in treatment of psoriasis, approval for psoriasis, 181, 184 dosing, 182t, 188 efficacy, safety, side effects and monitoring, 183t vs cyclosporine, 185 in treatment of psoriatic arthritis (PsA), 96, , with adalimumab, dosing, 100 with infliximab, 99, 126, 127 MIPA trial, 100, 100t RESPOND trial, 99, 126, 127 MHC. See Major histocompatibility complex. MICA (MHC class I related genes), 13 MIPA (Methotrexate in Psoriatic Arthritis) trial, 100, 100t Modified Stoke Ankylosing Spondylitis Spinal Score (msasss), Moisturizers (emollients), 8-9 Moll and Wright classification, 29-30, 30t, MRI imaging, MSASSS (modified Stoke Ankylosing Spondylitis Spinal Score), MTP (metatarsophalangeal) joint involvement, 42 Nail changes in medical history, 71 Nail Psoriasis Severity Index (NAPSI), 83, 84t normal nail structure and function, 34 in PsA, 33, 35, 44, 46, 49, 83 extensor tendon and nail root, grading of, 83, 84t GRAPPA treatment recommendations, 110 prevalence of, 33 in psoriasis, 33 prevalence of,

11 Nail examination, 49 Nail psoriasis, 65-66, 65 detachment of the nail (onycholysis), nail matrix, 65, 65 oil drop spots, 65 NAPSI (Nail Psoriasis Severity Index), 83, 84t Neutrophils, 67 Non-alcoholic steatohepatitis (NASH), 187 Nonbiologic therapy (for PsA), apremilast, action mechanism, 101, approval for PsA, 101 clinical trials, corticosteroids, 96 cyclosporine, 98 DMARDs (disease-modifying antirheumatic drugs), azathioprine, 97 etretinate, 97 methotrexate, 96, , 100t sulfasalazine, 97-98, 97 leflunomide, methotrexate, 96, , 100t NSAIDs (nonsteroidal anti-inflammatory drugs), physical therapy, 95 Nonsteroidal anti-inflammatory drugs (NSAIDs), NSAIDs (nonsteroidal anti-inflammatory drugs), 95-96, 142 OMERACT (Outcomes Measures in Rheumatology), 87 Oral systemic therapy for psoriasis, agents approved for psoriasis, 181, 182t acitretin, 181, 182t, apremilast, 181, 182t, cyclosporine, 181, 182t, fumaric acid esters (Germany), 181 methotrexate, 181, 182t, general aspects, indications for, 181 side effects and monitoring, 181, 183t Osteitis, 21 Osteoarthritis (OA), 34, 37t, 43 Osteomyelitis, 50 Pain of palmar-plantar psoriasis, of plaque psoriasis, 55 PALACE trials, Palmar-plantar psoriasis, 28, 57-59, 57, 58 impact of, Pancytopenia, PASI (Psoriasis Area and Severity Index), 81-83, 82 improvement scores (PASI 75, PASI 90, etc.), 83 Pathogenesis, 11, environmental stress and, 19, 20, 22 immune activity and, 17-18, 20 infections and, 22, 56, 57 multiple factors influencing, 11 of psoriasis, 17-20, 19 histopathology, 67-68, 67, 68 of psoriatic arthritis (PsA), trauma and, 22, 53, 54 Patient with PsA and psoriasis co-management of, patient perspective of disease, patient role in management, Pencil-in-cup deformity, 87, 89 Periostitis, 87, 90 Phosphodiesterase inhibitors, apremilast, , 195 Phototherapy, active wavelengths, 169, 174 climatotherapy, Dead Sea phototherapy, efficacy of, Fitzpatrick skin type and, 170 indications for, 170t psoralen plus ultraviolet A (PUVA) therapy, 172t, action mechanism, 175 efficacy, indications for, 177, 178 number of treatments, 177 side effects,

12 Phototherapy (continued) ultraviolet B therapy (UVB), action mechanism, 170 combined with topical or systemic treatment, efficacy of, initiation/doses, 170, 171t narrowband, 169, 170, 171t, 178, 203 protocols for, 171t safety issues, , 175 targeted phototherapy (excimer laser), Physical therapy, 95 Physician global assessment (PGA), 81 Pimecrolimus, PIP (proximal interphalangeal) joints, 42, 43 in Moll and Wright classification, 30t, 42 Plantar fasciitis, 72, 73 Plantar psoriasis, 57-59, 58 Plaque psoriasis, 28, 53-55, 54 course and prognosis, 55 prevalence of, 53 small plaque psoriasis, Plaques, psoriatic, 17, 26-28, 27, 53-55, 54 elevation of, 26, 27, 54 size of, 26 symptoms from, 55 Poutrier s microabscesses, 67 Pregnancy cautions acitretin, 191 apremilast, 109 cyclosporine, 194 leflunomide, retinoids, 164 TNF inhibitors, 141 Presentation. See Clinical presentation. PRESTA (Psoriasis Randomized Etanercept Study in Subjects With Psoriatic Arthritis) trial, , 142 Prevalence of psoriatic arthritis (PsA), 29 Primary care, role of, , 230 screening tools for PsA, , 224t Progressive multifocal leukoencephalopathy (PML), 204 Pruritis, 55 Psoralen plus ultraviolet A (PUVA) therapy, 172t, , 178 Psoriasis. See also Psoriatic arthritis (PsA). age and, 25 animal models, chronic nature of, 55 clinical presentation, coordinated management of psoriasis and PsA, diagnosis of, 66 in rheumatology office, 226 distinctions from psoriatic arthritis (PsA), 21 epidemiology and classification, gender and, genes associated with, 12, 14t-t genetics of, 11, 12-13, 14t-t historical evidence of, 25 impact of disease, 58-59, 66 joint disease in. See Psoriatic arthritis (PsA). pathogenesis of, 17-20, 19, 224t screening tools and questionnaires, , 224t subtypes of, 28, changes over time, 53 therapies, See also specifi c therapies. biologic therapy, alefacept, anti-tnf agents, , 205t adalimumab, 205t, 206, , approved agents for psoriasis, 206 efficacy of, etanercept, 205t, , infliximab, 205t, , 211 safety, , 214t conclusions on, 217 development of biologics, 203 efalizumab, 204 ustekinumab, 205t, coordinated management of psoriasis and PsA,

13 Psoriasis, therapies (continued) oral systemic therapy, , 182t acitretin, 181, 182t, apremilast, 181, 182t, cyclosporine, 181, 182t, methotrexate, 181, 182t, phototherapy, topical therapy, Psoriasis Area and Severity Index (PASI), 81-83, 82 Psoriasis Epidemiology Screening Tool (PEST), 224t, 225 Psoriatic arthritis (PsA). See also Psoriasis. candidate genes, 13-16, 16 CASPAR criteria, 13, 30-32, 31t, 71 clinical presentation, coordinated management of psoriasis and PsA, diagnosis and evaluation, identifying in the dermatology office, distinctions from psoriasis, 21 epidemiology and classification, 28-38, 30t features of, gender and, 28, 32 genetics of, 11, 13-16, 16 pathogenesis of, peripheral vs axial arthritis, prevalence of, 29 subgroups, 29-30, 30t therapies, 95-6 coordinated management of psoriasis and PsA, nonbiologic therapy, apremilast, corticosteroids, 96 cyclosporine, 98 DMARDs, leflunomide, methotrexate, 96, , 100t NSAIDs, physical therapy, 95 Psoriatic arthritis (PsA), therapies (continued) other biologic therapy, 147-6, 148t abatacept, 148t, 2-4 alefacept, 148t, 5 anakinra, 148t, 5 rituximab, 148t, 5 sarilumab, 5-6 tocilizumab, 148t, 5-6 ustekinumab, 147-2, 148t TNF inhibitor therapy, See also TNF inhibitors. Psoriatic Arthritis Response Criteria (PsARC), 85, 85t Psoriatic Arthritis Screening and Evaluation (PASE), 224t, 225 PSUMMIT 1 trial, 0-1, 1 PSUMMIT 2 trial, 1-2 Pulmonary toxicity, methotrexate and, 183t, 189 Pustular psoriasis, 59-61, 60, 61 treatment, of von Zumbusch, 59-60, 60 Pustules, in palmar-plantar psoriasis, PUVA therapy, 169, 171, 172t PY-STAT3, 18 Radiographic evaluation, 87-89, 88, 89 distal tuft resorption, 87, 88 joint space narrowing, 87, 90 pencil-in-cup deformity, 87, 89 periostitis, 87, 88 Sharp radiographic scoring system, 87, 90 RANKL (receptor activator of nuclear factor B ligand), 21 RAPID-PsA trial, , 137 Reactive arthritis, 37t, 38 Remicade. See Infl iximab (Remicade). Renal function, methotrexate and, 183t, 186 RESPOND (Remicade Study in Psoriatic Arthritis Patients of Methotrexate-Naïve Disease), 99, 126, 127 Retinoids, 164 acitretin., Rheumatoid arthritis (RA) differences from psoriatic arthritis, 20-21, therapies also used in psoriatic arthritis,

14 Rheumatoid factor (RF) false positives, low levels possible in psoriatic arthritis, 33-34, 83 negative in CASPAR criteria, 31t, 33, 83 negative in psoriatic arthritis, 33, 83 negative in symmetric polyarthritis, 30t Rheumatologists, 222, 230 identifying psoriasis in rheumatology office, 226 Rituximab, 148t, 5 Sacroiliac arthritis, 33 Sacroiliitis, 37, 38, 47, 92 unilateral, 88 Salicylic acid, 9 SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, 32, 50 Sarilumab, 5-6 Sausage digits, 32-33, 43, 47, 50 Scale/scaling, 17, 54, 54 Scalp psoriasis, treatments, 9 Schober s test, 78, 79 Screening tools for PsA, , 224t Psoriasis Epidemiology Screening Tool (PEST), 224t, 225 Psoriatic Arthritis Screening and Evaluation (PASE), 224t, 225 Toronto Psoriatic Arthritis Screening (ToPAS), , 224t Sharp radiographic scoring system, 87, 90 Simponi. See Golimumab (Simponi). Skin biopsy, 66-68, 68 Skin cancer cyclosporine and, 183t psoralen plus ultraviolet A (PUVA) and, 176 TNF inhibitors and, 214t UVB and, Skin folds, psoriasis in (inverse psoriasis), 63, 64 Small plaque psoriasis, SPARCC (Spondyloarthritis Research Consortium of Canada Enthesitis Index), 75, 77 Spine. See also Axial evaluation; Axial involvement. axial evaluation, symptoms in, Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC), 75, 77 Spondyloarthropathies ASAS classification system, 38 differential diagnosis of, features of, 32-33, 46 SPARCC index, 75, 77 STAT-3, 18, 20 Sternoclavicular involvement, 50 Streptococcal infection, guttate psoriasis and, 56, 57 Sulfasalazine, 97-98, 97 Swollen joint count (SJC), 43 Symmetrical polyarthritis, 30t, 41, 42-43, 44 Syndesmophytes, Synovitis, 32-33, 72 Systemic therapies, See also Oral systemic therapy for psoriasis. T cells, 17-18, 20, 21 activated, 17 alefacept and, 5 methotrexate and, 184 apoptosis, phototherapy and, 170 T cell specific therapies, 17 Tacrolimus, Tar, combined with UVB, 173 Tazarotene, 164, 166 Telescoping of digits, 45-46, 48 Tendon involvement. See Enthesitis. Therapies, See also specifi c topics. coordinated management of psoriasis and psoriatic arthritis, dermatologists and, , Quadrant Model, 229, 230 patient role in, primary care physicians, ,

15 Therapies, coordinated management of psoriasis and psoriatic arthritis (continued) rheumatologists and, 226, 230 treatment plan, development of, , 230 early, aggressive therapy model, 95 psoriasis, biologic therapy, alefacept, anti-tnf agents, , 205t adalimumab, 205t, 206, , approved agents for psoriasis, 206 efficacy, etanercept, 205t, , infliximab, 205t, , 211 safety, , 214t conclusions on, 217 efalizumab, 204 ustekinumab, 205t, oral systemic therapy, acitretin, 181, 182t, apremilast, 181, 182t, cyclosporine, 181, 182t, methotrexate, 181, 182t, phototherapy, topical therapy, psoriatic arthritis (PsA), 95-6 evidence-based treatment recommendations, 110 GRAPPA treatment recommendations, 109, 110, 229 axial diseases, 110 dactylitis, 110 enthesitis, 110 peripheral arthritis, 110 skin and nail diseases, 110 nonbiologic therapy, apremilast, corticosteroids, 96 cyclosporine, 98 DMARDs, Therapies, psoriatic arthritis (PsA), nonbiologic therapy (continued) leflunomide, methotrexate, 96, , 100t NSAIDs, physical therapy, 95 other biologic therapy, 147-6, 148t abatacept, 148t, 2-4 alefacept, 148t, 5 anakinra, 148t, 5 rituximab, 148t, 5 sarilumab, 5-6 tocilizumab, 148t, 5-6 ustekinumab, 147-2, 148t TNF inhibitor therapy, See also TNF inhibitors. treatment guidance, 109, 110 TNF (tumor necrosis factor). See also TNF inhibitors. genes and, 13 TNF-, 13, 21, 113 binding of anti-tnf agents to, 206 inhibition of, 18, , 114, 206 monoclonal antibodies to, 206 TNF inhibitors, , See also specifi c agents. costs of, 141 persistence/tolerability, 143 safety in PsA, demyelinating disease and CHF, hepatitis B, 139 herpes zoster, 139 infections, 138 injection site reactions, 141 lab abnormalities, 141 lymphoma, 140 pregnancy, 141 tuberculosis, 139 safety in psoriasis, , 214t in treatment of psoriasis (anti-tnf agents), , 205t action mechanisms, additional effective agent: ustekinumab, 205t,

16 TNF inhibitors, in treatment of psoriasis (anti-tnf agents) (continued) approved agents, adalimumab (Humira), 205t, 206, , dosing, 205t endpoints for clinical trials, 205t, 207 etanercept (Enbrel), 205t, , infliximab (Remicade), 204, , 211 monoclonal antibodies, 206 continuous vs intermittent use, 212 efficacy, long-term efficacy, short-term efficacy, for pustular psoriasis, 61 safety, , 214t in treatment of psoriatic arthritis (PsA), action mechanism, , 114 approved agents, adalimumab (Humira), certolizumab pegol (Cimzia), comparable efficacy of agents, etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), efficacy, general management aspects, indications for, safety, Tocilizumab, 148t, 5-6 Topical corticosteroids, See also Corticosteroids. Topical therapy, adherence by patients, 7, 161 basic points for, benefits of, 7, 8t BSA and, 7, 161 classes and categories of, 8t combination agents vitamin A agents: retinoids, 164 vitamin D and topical corticosteroids, 164 combined with UVB, 173 Topical therapy (continued) delivery of medication, 7, 161 emollients and keratolytics, facial psoriasis, as first line therapy for psoriasis, 7 goals and indications, 7, 8t inverse psoriasis, physical agents, 8-160, 8t physiologic agents, 8t, tar and anthralin, topical corticosteroids, topical macrolides (tacrolimus and pimecrolimus), vitamin D derivatives, 163 Toronto Psoriatic Arthritis Screening (ToPAS), , 224t Trauma Koebner phenomenon, 54, 55 in pathogenesis of psoriasis, 53, 54 in pathogenesis of psoriatic arthritis, 22 Treatment. See Therapies. Tuberculosis prescreening for, 139 TNF inhibitors and, 139, 214t Tumor necrosis factor. See TNF. Twin studies, 11 Ultrasound imaging, 89, 91 Ultraviolet light therapy, broadband ultraviolet B, 170 indications for, 170t penetration, 169 psoralen plus ultraviolet A (PUVA) therapy, 172t, action mechanism, 175 efficacy, indications for, 177, 178 number of treatments, 177 side effects, UVB, action mechanism, 170 combined with topical or systemic treatment, efficacy of,

17 Ultraviolet light therapy, UVB (continued) initiation/doses, 170, 171t narrowband UVB, 169, 170, 171t, 178, 203 protocols for, 171t safety issues, , 175 skin cancer and, targeted phototherapy (excimer laser), wavelengths, 169, 174 Urea, 9 Ustekinumab, 147-2, adverse events, 1 approved for PsA, 147 approved for psoriasis, 147 structure, 147 in treatment of PsA, action mechanism, 21, 147 clinical responses, 148-0, 149, 1, 2 efficacy, vs TNF inhibitors, 1 intravenous administration, PSUMMIT 1 trial, 0-1, 1 PSUMMIT 2 trial, 1-2 trials of, 147-2, 148t in treatment of psoriasis, action mechanism, clinical endpoints, 205t dosing, 205t efficacy, long-term follow-up, safety, Uveitis, 32, Vitamin A agents acitretin, retinoids, 164 Vitamin D derivatives, 163 with topical corticosteroids, 164 White blood cell count elevated in erythrodermic psoriasis, 62 elevated in psoriasis,