title: The role of inflammatory markers in assessing disease severity and response to treatment in patients with psoriasis treated with etanercept.
abstract: BACKGROUND
  Psoriasis is a chronic, systemic, inflammatory disease. Inflammatory markers are used in clinical practice to detect acute inflammation, and as markers of treatment response. Etanercept blocks tumour necrosis factor (TNF)-α, which plays a central role in the psoriatic inflammation process.
  
  
  OBJECTIVE
  To reveal any possible association between disease severity [measured by Psoriasis Area and Severity Index (PASI)] and the inflammatory burden (measured by a group of inflammatory markers), before and after etanercept treatment.
  
  
  METHODS
  In total, 41 patients with psoriasis vulgaris, eligible for biological treatment with etanercept, were enrolled in the study. A set of inflammatory markers was measured, including levels of white blood cells and neutrophils, fibrinogen, ferritin, high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), haptoglobin, ceruloplasmin and α1-antitrypsin, before and after 12 weeks of etanercept 50 mg twice weekly.
  
  
  RESULTS
  All markers were reduced after treatment (P < 0.001). PASI correlated with fibrinogen and hs-CRP. Of the 41 patients, 19 (46.3%) achieved reduction of 75% in PASI (PASI75). An increase in hs-CRP and ESR difference (values before minus values after treatment) was related to higher likelihood of achieving PASI75.
  
  
  CONCLUSIONS
  Inflammatory markers, particularly hs-CRP and to a lesser extent, fibrinogen and ESR, can be used to assist in assessing disease severity and response to treatment in patients with psoriasis. A combination of selected inflammatory factors (which we term the Index of Psoriasis Inflammation) in combination with PASI might reflect inflammatory status in psoriasis more accurately than each one separately.
authors.affiliation: Second Department of Dermatology and Venereology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece. antkanel@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Kanelleas
authors.forename: C
authors.initials: C
authors.lastname: Liapi
authors.forename: A
authors.initials: A
authors.lastname: Katoulis
authors.forename: P
authors.initials: P
authors.lastname: Stavropoulos
authors.forename: G
authors.initials: G
authors.lastname: Avgerinou
authors.forename: S
authors.initials: S
authors.lastname: Georgala
authors.forename: T
authors.initials: T
authors.lastname: Economopoulos
authors.forename: N G
authors.initials: NG
authors.lastname: Stavrianeas
authors.forename: A
authors.initials: A
authors.lastname: Katsambas
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept