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Role of MicroRNAs in Inflammatory Joint Diseases: A Review

Syed NH, Mussa A, Elmi AH, Jamal Al-Khreisat M, Ahmad Mohd Zain MR, Nurul AA

Immunol Invest, 2024 Feb;53(2):185-209.
PMID: 38095847 DOI: 10.1080/08820139.2023.2293095

Inflammatory arthritis commonly initiates in the soft tissues lining the joint. This lining swells, as do the cells in it and inside the joint fluid, producing chemicals that induce inflammation signs such as heat, redness, and swelling. MicroRNA (miRNA), a subset of non-coding small RNA molecules, post-transcriptionally controls gene expression by targeting their messenger RNA. MiRNAs modulate approximately 1/3 of the human genome with their multiple targets. Recently, they have been extensively studied as key modulators of the innate and adaptive immune systems in diseases such as allergic disorders, types of cancer, and cardiovascular diseases. However, research on the different inflammatory joint diseases, such as rheumatoid arthritis, gout, Lyme disease, ankylosing spondylitis, and psoriatic arthritis, remains in its infancy. This review presents a deeper understanding of miRNA biogenesis and the functions of miRNAs in modulating the immune and inflammatory responses in the above-mentioned inflammatory joint diseases. According to the literature, it has been demonstrated that the development of inflammatory joint disorders is closely related to different miRNAs and their specific regulatory mechanisms. Furthermore, they may present as possible prognostic and diagnostic biomarkers for all diseases and may help in developing a therapeutic response. However, further studies are needed to determine whether manipulating miRNAs can influence the development and progression of inflammatory joint disorders.

Matched MeSH terms: Arthritis, Psoriatic*
Pattern of psoriatic arthritis in an Asian population (Malaysia)

Veerapen KK

APLAR Journal of Rheumatology, 2007;10(4):287-294.
DOI: 10.1111/j.1479-8077.2007.00308.x

Objective: To profile the pattern of psoriatic arthritis (PsA) and its relationship to disease duration. Methods: Forty-six consecutive patients with PsA were entered into a cross-sectional study. Demographic data, disease duration and disability were recorded. Joint involvement was documented at 6 months from onset and at presentation. X-rays of the sacroiliac (SI) joints, thoracolumbar spine, and hands were taken. HLA B27 typing was done. Results: The male: Female ratio was 2.3: 1, mean age at onset of arthritis was 35.8 years and mean duration of PsA was 4.2 years. Oligoarticular involvement predominated (63%) at onset. Progression from oligoarthritis to polyarthritis occurred largely in the second year; 65.2% reported asymmetrical disease at onset while 50% had asymmetrical disease when disease duration was >.1 year. The frequency of involvement at onset was as follows: Sausage toes, metatarsophalangeals (MTPs) and interphalangeals (IPs) in 50% (each), proximal interphelangeals (PIPs) in 47.8%, sausage fingers 34.7% and knees 30%. With mean duration of 4.2 years it was: Sausage toe 71.1%, IP 69.5%, PIP and MTP 63%, knees 60.8%, distal interphalangeals (DIPs) 54.3%, sausage finger 52.1%, wrist 47.8%, followed by neck and back pain. Disability related to lower limb functions predominated and occurred early. Forty-one percent had radiological sacroiliatis/spondylitis and 46% had erosive arthritis in the hands; 10.2% were HLA B27 positive. Conclusion: PsA was progressive, starting predominantly as an asymmetrical oligoarthritis and becoming largely polyarticular within 2 years from onset. Lower limb disability was evident early and erosive changes in hand X-rays were seen in more than half the patients after 1 year. © 2007 Asia Pacific League of Associations for Rheumatology.

Matched MeSH terms: Arthritis, Psoriatic*
Effect of ethnicity on disease activity and physical function in psoriatic arthritis in a multiethnic Asian population

Leung YY, Fong W, Lui NL, Thumboo J

Clin Rheumatol, 2017 Jan;36(1):125-131.
PMID: 27796663 DOI: 10.1007/s10067-016-3460-1

Geographic differences in manifestation of psoriatic arthritis (PsA) could be related to differences in genetic or environmental factors. We aimed to compare the disease activity and functional status using validated outcome measures among patients with PsA of different ethnicities living in the same environment. We performed a cross-sectional study on consecutive patients with PsA classified by the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria from a single center. Sociodemographic data, clinical variables, and patient-reported outcomes were collected using a standardized protocol. Disease activities were assessed by validated composite scores: clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), Composite Psoriatic Disease Activity Index (CPDAI), and minimal disease activity (MDA). Physical function was assessed with Health Assessment Questionnaire (HAQ) and the Medical Outcome Study Short-Form 36 (SF36) physical function subscales. Linear regression analyses were performed to identify variables associated with disease activities and physical function. Ninety-eight patients (51.5%, men) with mean (±SD) age and duration of PsA of 51.5 ± 13.8 and 5.5 ± 8.4 years were recruited. Indian was overrepresented compared with the national distribution of ethnicities. Compared to Chinese, Indian patients were more likely to be using biological therapies, have higher tender joint count, and worse enthesitis. Higher proportion of Indians had higher disease activity categories measured by cDAPSA, CPDAI, and MDA and had poorer physical function. In the multivariable analysis, ethnicity was significantly associated with HAQ and SF36-PF. Compared to Chinese, Indians with PsA living in the same environment had worse disease activity and physical function measured by validated outcomes.
Study site: Psoriatic arthritis clinic in a tertiary referral center, Singapore

Matched MeSH terms: Arthritis, Psoriatic/diagnosis; Arthritis, Psoriatic/ethnology*; Arthritis, Psoriatic/physiopathology*
A study of intima media thickness and their cardiovascular risk factors in patients with psoriatic arthritis

Mazlan SA, bin Mohamed Said MS, Hussein H, binti Shamsuddin K, Shah SA, Basri H

Acta Medica (Hradec Kralove), 2009;52(3):107-16.
PMID: 20073422 DOI: 10.14712/18059694.2016.114

INTRODUCTION: Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has put forward for consideration several questions regarding its specific CVS mortality and morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32).

OBJECTIVE: Prevalence of carotid intima media thickness in patients with Psoriatic arthritis is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis in patients with psoriatic arthritis and disease activity association and its predictors in a series of patients with PsA attended to the rheumatology clinic, tertiary hospitals.

METHODS: A total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was measured in both right and left carotid artery by using high resolution B-mode ultrasound. This was a cross sectional study first done in Malaysia for PsA patients.

RESULTS: The positive IMT (IMT > 1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %) regardless of background cardiovascular risk. The mean +/- SD of IMT was 0.725 +/-0.260 mm for this study. Variables significantly associated with positive IMT (p < 0.05) included age at the time of study (p = 0.005), waist circumference (p = 0.001), Hypertension (p = 0.007), Diabetes (p = 0.002) and Metabolic syndrome (p = 0.001) and not associated with gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above all, only age had positive IMT independent predictor (p = 0.032), with OR 1.116; 95 % CI (1.010-1.234).

CONCLUSIONS: There was a significant association between CVS risk and positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no association in disease activity, disease severity and DMARDS therapy with positive Intima Media Thickness in Psoriatic Arthritis patients. The study was approved by Research and Ethics Committee of the faculty of medicine, Universiti Kebangsaan Malaysia with project code FF-114-2008 and by Community Research Center (CRC) of National Institutes of Health (NIH) for the case study in Hospital Putrajaya with the project code NMRR-08-970-2125.

Matched MeSH terms: Arthritis, Psoriatic/complications; Arthritis, Psoriatic/pathology*
Patterns of psoriatic arthritis in Orientals

Thumboo J, Tham SN, Tay YK, Chee T, Mow B, Chia HP, et al.

J Rheumatol, 1997 Oct;24(10):1949-53.
PMID: 9330937

OBJECTIVE: To determine the clinical features of psoriatic arthritis (PsA) in a multiethnic Oriental population and to study the effect of ethnicity on disease patterns.
METHODS: A retrospective study of 80 patients with PsA seen at either a rheumatology or dermatology referral center. Patients and case records were reviewed and data abstracted according to a standard protocol. Eighty consecutive patients with psoriasis without PsA seen at the dermatology center were recruited as controls.
RESULTS: Asymmetric polyarthritis developing in the 4th decade with an equal male to female ratio was the commonest pattern of arthritis among Chinese, Indians, and Malays. Clinically apparent lumbar spondylitis was significantly more common in Indians than Chinese (10/11 vs 11/20, respectively; p = 0.046), although the prevalence of lumbar spondylitis was similar in all ethnic groups. Eighty-nine percent of subjects required nonsteroidal antiinflammatory drugs and 51% required disease modifying antirheumatic drugs at some time for control of joint disease. PsA was significantly more common among Indians compared to the ethnic distribution of the Singapore population (p < 0.000001). Multiple logistic regression identified Indian ethnicity as a risk factor for the development of PsA (OR 2.39, 95% confidence interval 1.02 to 5.60).
CONCLUSION: The commonest pattern of PsA in all ethnic groups was asymmetric polyarthritis. Ethnicity affected the development and presentation of PsA in our series: Indians with psoriasis had double the risk of developing PsA compared to Chinese with psoriasis, and lumbar spondylitis when present in Chinese subjects was asymptomatic in 45%, being detectable only on radiological examination.

Matched MeSH terms: Arthritis, Psoriatic/ethnology*; Arthritis, Psoriatic/epidemiology*
Case series analysis of psoriatic arthritis: A two-centre experience

Mohd Shahrir MS, Eashwary M, Heselynn H, Mohd Shahdan S

APLAR Journal of Rheumatology, 2007;10(1):32-36.
DOI: 10.1111/j.1479-8077.2007.00252.x

Aim: To provide the first case series analysis for psoriatic arthritis (PsA) in Malaysia.
Methods: Patient records were studied from rheumatology clinics in Universiti Kebangsaan Malaysia Hospital and Putrajaya Hospital in Malaysia.
Results: Thirty-one patients from two rheumatology centres were studied. Thirteen patients (41.9%) were male and 18 patients (58.1%) were female. Nineteen patients (61.3%) were Malays, four (12.9%) were Chinese, seven (22.6%) were Indians and one (3.2%) was a Sikh. The majority of patients were in the >.50 years age-group (11 [35.5%]) followed by the 41-50 years age-group (10 [32.3%]). Thirteen patients (41.9%) had the disease since 41-50 years of age. Twenty-three patients (77.4%) had no family history of PsA. Twenty-three patients (74.2%) had psoriasis first, seven (22.6%) had arthritis first and one (3.2%) developed psoriasis and arthritis at the same time. Twenty-four patients (77.4%) had positive activity correlation for skin and arthritis. The majority of patients had symmetrical arthritis (20 [64.5%]) and chronic plaque-like lesions (22 [71.0%]). These patients were on NSAIDS and methotrexate (14 [45.2%]). One patient (3.6%) needed surgery for joint replacement.
Conclusion: Patients who were diagnosed as having PsA were Malays, age group of more than 50, disease onset at 41-50 years of age, no family history, had symmetrical and chronic plaque lesions, had psoriasis first and needed NSAIDS and methotrexate.

Matched MeSH terms: Arthritis, Psoriatic*
Psoriatic nail involvement in Malaysia: A 14-year registry review (2007-2020)

Tan WF, Robinson S, Tang MM, Malaysian Psoriasis Registry Working Group

Clin Dermatol, 2024;42(6):616-624.
PMID: 39278515 DOI: 10.1016/j.clindermatol.2024.09.017

Nail psoriasis affects 20% to 30% of psoriasis patients and is an early predictor of psoriatic arthritis (PsA). We evaluated the prevalence, clinical characteristics, and impact on quality of life of patients with nail psoriasis. We conducted a multicenter retrospective cohort study of patients registered with The Malaysian Psoriasis Registry from January 1, 2007 to December 31, 2020. Of the 24,147 patients, 13,081 (54.2%) had nail psoriasis. Patients with nail psoriasis had later onset of psoriasis (34.0 ± 16.6 years vs 32.9 ± 17.6 years, P < .001) and longer disease duration (11.4 ± 10.5 years vs 8.5 ± 9.4 years, P < .01), with a man-to-woman ratio of 1.2:1. They were more likely to have a family history of psoriasis, cardiometabolic diseases, smoking history, higher body mass index, severe disease, PsA, face and scalp involvement, and higher mean Dermatology Life Quality Index scores (9.36 ± 6.84 vs 8.87 ± 6.60). Systemic treatment and biologics were more commonly prescribed in this cohort (25.0% vs 13.2%, P < .001). Overall, 54.2% of the Malaysian Psoriasis Registry patients had nail involvement. Nail psoriasis was associated with longer duration of psoriasis, older age of onset, male sex, and a family history of psoriasis. It proved to be an important predictor for PsA, severe psoriasis, face and scalp involvement, increased cardiometabolic risk, and a greater impairment of quality of life.

Matched MeSH terms: Arthritis, Psoriatic/epidemiology
Fulltext Severe psoriatic acroosteolysis in the absence of psoriatic arthropathy

Sakthiswary R, Naicker AS, Htwe O, Shahrir MS, Sazliyana SS

BMJ Case Rep, 2011;2011.
PMID: 22669957 DOI: 10.1136/bcr.09.2011.4794
Matched MeSH terms: Arthritis, Psoriatic
Ocular surface disease in psoriatic patients in a developing country

Goh Y, Kwan Z, Han WH, Iqbal T, Yahya F, Khang TF, et al.

Int Ophthalmol, 2021 Jun;41(6):2139-2147.
PMID: 33788072 DOI: 10.1007/s10792-021-01771-8

PURPOSE: To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia.
METHODS: An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls.
RESULTS: One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear film break-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9).
CONCLUSION: Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.

Matched MeSH terms: Arthritis, Psoriatic
Cerebral tuberculoma with pulmonary tuberculosis in a patient with psoriasis treated with adalimumab, an anti-tumor necrosis factor-α agent

Selvarajah L, Choon SE, Tarekh NA, Chhetri AD

Int J Dermatol, 2016 Feb;55(2):e115-7.
PMID: 26566776 DOI: 10.1111/ijd.13047
Matched MeSH terms: Arthritis, Psoriatic/drug therapy*
Fulltext More than meets the naked eye: an unusual psoriatic arthritis mimicry and the important role of dermoscopic examination

Anne LJ, Rahim MJC, Ghazali WSW, Ahmed WAW, Isa SAM

BMC Rheumatol, 2021 Apr 12;5(1):10.
PMID: 33840385 DOI: 10.1186/s41927-021-00182-7

BACKGROUND: Psoriatic arthritis (PsA) can manifest in various forms. This includes mimicry of other diseases. We describe an unusual mimicry of PsA.
CASE PRESENTATION: We report a case of a middle-aged lady who presented with severe pain and morning stiffness over the small joints of the left hand for 3 months and painless deformity of the affected joints 1 year before. She was under treatment for pruritic rash over her ankles and knees for the past 1 year as well. Physical examination revealed a fixed flexion deformity, swelling and tenderness of the left ring and little fingers' distal interphalangeal (DIP) joints. Left hand radiograph showed sclerotic joint margin, narrowed joint space and marginal osteophytes of the affected DIP joints. Dermoscopic examination showed red- violaceous, flat-topped papules and plaques with minimal scales on both ankles; hyperpigmented scaly plaques over both knees and vertical fingernail ridges. Serum autoimmune screening and inflammatory markers were unremarkable. Left ankle skin biopsy showed features consistent of psoriasis. PsA was diagnosed. Weekly titrated oral methotrexate and topical steroid were started. The patient showed significant improvement after 1 month of treatment.
CONCLUSION: PsA is a great mimicker. Dermoscopy is an accessible and valuable tool to assess skin lesions in greater detail. Clinicians should be aware of coexisting diseases or misdiagnosis when patients do not respond to treatment.

Matched MeSH terms: Arthritis, Psoriatic

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