Latest news with #systematic review
Medscape
16-07-2025
- Health
- Medscape
Imaging Detects Early Synovitis in Psoriasis Without PsA
TOPLINE: Patients with psoriasis without any clinical signs of psoriatic arthritis (PsA) had more than a twofold greater risk for synovitis than healthy individuals, according to a systematic review and meta-analysis. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 12 cross-sectional and case-control studies through October 2024. The analysis included 2606 participants: 1593 patients with psoriasis without musculoskeletal involvement (mean age, 46.4 years; 61.6% men), 327 patients with PsA (mean age, 50.2 years; 64.2% men), and 686 healthy individuals (mean age, 45.7 years; 48.8% men). The mean duration of psoriasis was 14.8 years in patients with psoriasis and *9.8 years in those with PsA; the mean Psoriasis Area and Severity Index scores were 8.2 and 7.6, respectively. The main outcome was detection of synovitis on imaging in patients with psoriasis vs those with PsA and control individuals. TAKEAWAY: Synovitis was present in significantly more patients with psoriasis compared with healthy individuals (risk ratio [RR], 2.55; P < .001). Both ultrasonography (RR, 2.50; P = .03) and MRI (two studies; RR, 6.40; P = .003) detected synovitis, but detection rates were higher with MRI. The risk for synovitis was not significantly different in patients with psoriasis than those with PsA (RR, 0.50; P = .19), although more patients with PsA had synovitis. IN PRACTICE: 'Although imaging may serve as a valuable tool for identifying patients with psoriasis at higher risk of developing PsA, its role in routine clinical practice should be approached cautiously,' considering 'limitations, costs, and resource requirements,' the authors wrote. 'Future longitudinal studies,' they added, 'are needed to better characterize the transition from psoriasis to PsA, determine the predictive value of subclinical synovitis, and assess whether early intervention strategies could modify disease progression and reduce the risk of PsA development.' SOURCE: This study was led by Shanti Mehta, BSc, University of Toronto, Toronto, Ontario, Canada, and was published online on July 16 in JAMA Dermatology. LIMITATIONS: The studies were limited by nonstandardized protocols, variability in imaging and diagnostic criteria, and a relatively homogeneous patient population. The predominance of cross-sectional designs also limited assessment of the temporal link between synovitis and progression from psoriasis to PsA. DISCLOSURES: The authors did not report any funding information. One author reported receiving honoraria for speaking engagements from AbbVie, Janssen, Novartis, Sandoz, and Amgen. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
11-07-2025
- Health
- Medscape
Pyoderma Gangrenosum in Pregnancy Often Misdiagnosed
TOPLINE: A systematic review of 63 cases found that pyoderma gangrenosum (PG) during pregnancy or postpartum was often misdiagnosed, delaying treatment and leading to inappropriate interventions. METHODOLOGY: Researchers conducted a systematic review of 62 studies describing 63 patients (average age, 29.9 years) with PG during pregnancy or up to 6 weeks postpartum through September 2023. Of all patients, 27% of patients had a history of PG or PG-like symptoms, 7.9% had a history of inflammatory bowel disease, and 4.8% had another systemic rheumatologic disease. In 71.4% of cases, preceding trauma to the skin was reported. Outcomes included the misdiagnosis rate, treatment, and maternal and fetal complications. TAKEAWAY: During pregnancy, 15.9%, 11.1%, and 7.9% of cases appeared in the first, second, and third trimesters, respectively, while 65.1% were postpartum — primarily at the site of cesarean section scars (55.6%). Of the 47 cases where an initial diagnosis was reported, only 2 cases were recognized as PG; 45 (95.7%) were initially misdiagnosed as bacterial infections, necrotizing fasciitis, or another skin disorder. Among the 26 cases with data on time to diagnosis, the diagnosis was delayed by more than 7 days in 77%. Before the diagnosis of PG, surgical wound intervention and broad-spectrum antibiotics were the most frequent treatments, whereas systemic corticosteroids (88.9%) and cyclosporine (33.3%) were most commonly used after PG was diagnosed. All patients showed improvement after treatment, and treatment-related adverse effects were uncommon. Cesarean section was performed in 40 cases, and 22 of 41 cases with gestational age data were preterm, and there was one case of intrauterine fetal demise. IN PRACTICE: These results highlighted 'the frequent misdiagnosis of PG in this population, leading to treatment delays and inappropriate interventions that worsen the condition,' the authors of the study wrote. The study, 'supported by immunological research,' suggested that pregnancy 'may independently contribute to the development of PG,' they added, noting that further research on safe and effective treatment protocols is needed. SOURCE: This study was led by Gretchen D. Ball, and Sarah Romanelli, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, and was published online on June 30 in the Journal of Drugs in Dermatology. LIMITATIONS: This study was limited by its small sample size and inconsistencies in data reporting across case reports. Collecting comprehensive pregnancy outcomes data was challenging due to limited pregnancy details provided in dermatology journals. DISCLOSURES: This study was supported by the International Dermatology Outcome Measures nonprofit group. One author disclosed receiving grants and honoraria, and holding stocks in various organizations, including Amgen, AnaptysBio, Avotres Therapeutics, Eli Lilly and Company, Novartis, Sanofi, and XBiotech. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
