מה זה פסוריאזיס?

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תיאור מקיף מאת האגודה הישראלית לפסוריאזיס אודות המחלה

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<ul><li> 1. ), ...( " - " -, </li></ul> <p> 2. : " 300.Corpus Hipocraticum " / =PSORA : :/ . =Lepra 3. )Prevalence( : - 2% " " 4.6% - . , 0.7%-0.4% . -:120,000 2,000 4. )Prevalence( : , 20-30 50-60 : 27 29 5. )Prevalence( : : 0.5-1.1% 16 8-12.5 - 6. )Prevalence( : 2/3 - 1/3 - - 5-8% - ) ( : 5% - 5 7. : :)Known Trigers( , ,NSAIDs ( ( HIV PR , , , , 8. : "": =100% / 9. : 2.5% 0.4%20-25% 3-5% DNA 457 ' 37 ' 28 3-4 , , 10. : : , .T , , , . . 11. : : : )APCs( T T Cyclosporine effect 12. : T IFNg - TNFa , " " . " " .T 13. : ,T - / )( . . . 14. Stimulus 15. : : 16% 50% 10% 70% )" ( 20% 16. : 14 - ! 17. : , , ! 18. : 68-89 6-10 - 91% 19. : , : , 20. S F - 3 6 H E A L T H S U R V E YImpact of Psoriasis vs Other Diseaseson Patient-Reported Physical OutcomesCongestive HeartFailure35Psoriasis 41DiabetesChronic Lung DiseaseMyocardial Infarction424243Arthritis 43Hypertension 44Depression 45Cancer 450 5 10 15 20 25 30 35 40 45 50Physical Component Summary Score (n=317)Lower scores reflect worse patient-reported outcomes.SF-36 ScoreRapp SR, et al. J Am Acad Dermatol. 1999;41:401-407.Ware JE Jr, et al. SF-36 Health Survey Manual and Interpretation Guide. The Health Institute; 1993. 21. Impact of Psoriasis vs Other Diseases onPatient-Reported Mental OutcomesDepression 35Chronic Lung Disease 44464949ArthritisCongestive Heart Failure 500 10 20 30 40 60Mental Component Summary Score (n=317)PsoriasisCancerRapp SR, et al. J Am Acad Dermatol. 1999;41:401-407.S F - 3 6 H E A L T H S U R V E YLower scores reflect worse patient-reported outcomes.SF-36 ScoreDiabetes 52Hypertension 52Myocardial Infarction 5250 22. How do personality systems interact in patientswith psoriasis, atopic dermatitis and urticaria?Bahmer JA, Kuhl J, Bahmer FA. Acta Derm Venereol. 2007;87(4):317-24' . - , . 23. Role of depression in quality of life for patientswith psoriasisSchmitt JM, Ford DE, Dermatology. 2007;215(1):17-2732% 16.5% ! 24. Psoriasis has a major secondary impact on the lives offamily members and partnersA.M. Eghlileb, et al, Br J Dermatol 156;6:1245-1250, June 200770% 57% 55% 44% , 37% , 37% 8% 25. : . 1/3 , ? / 26. : : 27. : D A : Climatotherapy UVB NB-UVB Laser PUVA : ' "" 28. : , , D Zorac ) ( A , , , )( ,Pix , ' , ' , , , ... 29. C B A200 400 700 800 900 1200 30. UVB 290-320 nm PUVA 320-400 nm NB UVB 311 nm Laser 308nm Laser 585nm 31. Bath PUVA and saltwater baths followed byUV-B phototherapy as treatments for psoriasis: arandomized controlled trialSchiener R et al Arch Dermatol. 2007 May;143(5):586-961241 , 4 , 4 , 8 ,)UVB-TW( UVB , PUVA ,UVB )UVB-SW( UVB - UVB-SW ,Bath Puva UVB-TW UVB 32. A Pragmatic Randomized Controlled Trial on theEffectiveness of Highly Concentrated Saline SpaWater Baths Followed by UVB Compared to UVBOnly in Moderate to Severe Psoriasis.Brockow T, et al, J Altern Complement Med. 2007 Sep;13(7):725-32The study indicates that HC-SSW-UVB are superior to routineUVB at the end of a 6-week treatment course 33. , 34. The percentage of patients achieving PASI 75 after 1 month andremission time after climatotherapy at the Dead Sea.Harari M, et al, Int J Dermatol. 2007 Oct;46(10):1087-1091. 4 PASI - 95.5% PASI 75 75.9% ,PASI 50 100% 23.1 33.6 35. Treatment advice to be given before conceptionin patients with psoriasisCopyright 2007 BMJ Publishing Group Ltd. Weatherhead, S. et al. BMJ 2007;334:1218-1220 36. Anti neoplastic Methotrexate Immunosuppressive Cyclosporine Mycophenolate Corticosteroids Methotrexate Metabolic stabilization Retinoids Neotigason Tigason Roaccutane Fumaric acid derivatives Fumaderm , , , , , , , , , , , , , 37. Biochemical and biophysical assessment of MTX-inducedliver fibrosis in psoriasis patients:Fibrotest predicts the presence and Fibroscanspredicts the absence of signicant liver fibrosisMaartje A. M. Berends, et al, Liver International 2007 27;5:639-645 Fibrotest accurately predicted the presenceof significant liver fibrosis while theFibroscan accurately predicted the absenceof significant liver fibrosis in MTX users . 38. Psoriasis Is a T-CellMediatedDiseaseNonlesional Skin Psoriatic PlaqueT CellsSource: Krueger JG. J Am Acad Dermatol. 2002;46:1-23.Vast Majority of T Cells AreMemory T CellsT Cells 39. "" ""Biological therapies for psoriasis &amp; psoriatic arthritisAgent Agent type Clinical stageInfliximab (Remicade) anti TNF mc-Ab Approved for PsoApproved for PAAdalimumab (Humira) anti TNF mc-Ab In phase IV trial for PsoApproved for PAEtanercept (Enbrel) Soluble TNF receptor FDA &amp; EMEA approved for PsoFDA &amp; EMEA approved for PAEfalizumab (Raptiva) T-cell modulator FDA &amp; EMEA approved for PsoFailed in PAAlefacept (amevive) T-cell modulator FDA &amp; IMH approved for Pso- - With MTX In phase II trial for PA 40. / 12 'Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacymeasures assessed over a 12-week treatment period. Nelson AA etal, J Am Acad Dermatol. 2007 Nov 7 41. " : 50% - 50 PASI ) (, PA - 12 - '" $12000 42. 12 - '. 12 '. ! 3 100 " , 3 50 " ! 4-6 , , " 43. A virus-like particle-based vaccine selectivelytargeting soluble TNF-alpha protects fromarthritis without inducing reactivation of latenttuberculosis.Spohn G, et al, J Immunol. 2007 Jun 1;178(11):7450-7 / ) ( 44. A phase 1, double-blind, placebo-controlledstudy evaluating singlesubcutaneous administrations of a humaninterleukin-12/23 monoclonal antibody insubjects with plaque psoriasisGottlieb AB, et al, Curr Med Res Opin. 2007 May;23(5):1081-9221 4 , ! PASI 75 13 17 45. Psoriatic disease-fromskin to boneRitchlin C. Nat Clin Pract Rheumatol. 2007Dec;3(12):698-706. "" ,, " 46. : )( 47. Comorbidities in psoriasis, Enno Christophers, Clinics in Dermatology (2007) 25, 529534 48. Smokers Report More Psoriasis: Results fromamong Adults Norwegian Population SurveyB K, Thoresen M, Dalgard F. Dermatology. 2008;216(1):40-5 .Psoriasis patients show signs of insulin resistanceBoehncke S, et al, Br J Dermatol. 2007 Oct 4 )PASI - ( 49. Anti-tumour necrosis factor-alpha therapy increasesbody weight in patients with chronic plaque psoriasis:a retrospective cohort study .Gisondi P etal, J Eur Acad Dermatol Venereol. 2007 Nov 14 ) 1.5-2.5"( 6 .MTX - 50. Curcumin as "Curecumin": From kitchen to clinicGoel A, et al Biochem Pharmacol. 2007 Aug 19Clinical trials suggest a potential therapeutic role forcurcumin in diseases such as familial adenomatouspolyposis, inflammatory bowel disease, ulcerativecolitis, colon cancer, pancreatic cancer,hypercholesteremia, atherosclerosis, pancreatitis,psoriasis, chronic anterior uveitis and arthritis. 51. Retinoic acid metabolism blocking agents (RAMBAs)Christel J. Verfaille et al, J Dtsch Dermatol Ges. 2007 Oct 18before treatment and aftertreatment with 1 mg talarozoledaily for 8 weeks. 52. Oral retinoic acid metabolism blocking agent Rambazole forplaque psoriasis: an immunohistochemical studyBovenschen HJ et al, Br J Dermatol. 2007 Feb;156(2):263-70Oral R115866 in the treatment of moderate to severe plaque-typepsoriasisVerfaille CJ et al, J Eur Acad Dermatol Venereol. 2007 Sep;21(8):1038-46Eight-week daily treatment with 1 mg R115866 resultedin a significant reduction in PASI from baseline toend of therapy. Additional improvement was seenafter the 2-week follow-up period. The drug was welltolerated. 53. Induction of apoptosis underlies the Radix Rubiae-mediated anti-proliferativeaction on human epidermal keratinocytes:implications for psoriasis treatmentTse WP et al, Int J Mol Med. 2007 Nov;20(5):663-72.Our experimental resultssuggest that Radix Rubiae isa promising source fromwhich a herb-based topicalagent could be developed forpsoriasis treatment 54. Clinical images of a patient with a good response (Psoriasis Area Severity Index [PASI] reduction&gt;= 50%) on both UV-irradiated and nonirradiated body sides (A-C) and of a patient with noresponse on the nonirradiated body side but complete response (PASI reduction to</p>