title: Videocapillaroscopic findings in the microcirculation of the psoriatic plaque during etanercept therapy.
abstract: BACKGROUND
  Vascular endothelial growth factor (VEGF) is a pivotal cytokine in the pathogenesis of psoriasis, and upregulation of VEGF by tumour necrosis factor (TNF)-α and inflammatory factors causes marked alterations in the cutaneous microcirculation. Etanercept is a fully soluble TNF receptor fusion protein that primarily binds soluble TNF-α, thus blocking its pro-angiogenic function.
  
  
  OBJECTIVE
  To assess the modifications in the superficial capillary bed in psoriatic plaques during treatment with etanercept.
  
  
  METHODS
  The study enrolled 22 patients (13 men, 9 women; age range 31-74 years) with plaque psoriasis resistant to conventional therapy. The patients were stated on etanercept 50 mg/week, which was continued for 24 weeks. At the beginning of the study (baseline), and at weeks 6, 12, 18 and 24, in vivo videocapillaroscopy analysis of a selected plaque was performed. Levels of erythema, scaling and infiltration were assessed using a four-point plaque severity score, with an overall score obtained by the sum of these three scores. The Psoriasis Activity and Severity Index (PASI) was also determined.
  
  
  RESULTS
  Etanercept produced a significant reduction in PASI, plaque severity score and diameter of the basket-weave area at every time point. Four patients had complete remission, although none of the patients regained a normal capillaroscopic pattern.
  
  
  CONCLUSIONS
  Similar to other conventional therapies, etanercept is able to improve PASI, plaque severity score and basket-weave area diameter, but it is unable to induce normalization of the microcirculation in psoriatic plaques.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy. giuseppe.stinco@uniud.it
authors.forename: G
authors.initials: G
authors.lastname: Stinco
authors.forename: C
authors.initials: C
authors.lastname: Buligan
authors.forename: V
authors.initials: V
authors.lastname: Maione
authors.forename: F
authors.initials: F
authors.lastname: Valent
authors.forename: P
authors.initials: P
authors.lastname: Patrone
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002196:Capillaries / Q000187:drug effects; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D020678:Microscopic Angioscopy / Q000379:methods; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept