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dc.contributor.authorSinnathurai, Premarani
dc.date.accessioned2019-05-28
dc.date.available2019-05-28
dc.date.issued2018-10-03
dc.identifier.urihttp://hdl.handle.net/2123/20466
dc.description.abstractPsoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis, with a wide range of phenotypic expression. Comorbid medical conditions may play a role in disease expression and outcomes. Cardiovascular comorbidities are common, and obesity associated with increased risk of incident PsA, and poorer response to therapy. In this thesis we aim to test the following hypotheses: 1. Comorbid conditions including obesity are associated with chronic systemic inflammation and adversely impact outcomes in PsA. 2. Adipokines contribute to systemic inflammation, may serve as biomarkers for disease phenotype in PsA, and be associated with disease activity. Analysis from the Australian Rheumatology Association Database highlights the high prevalence of comorbidity in PsA. Physical inactivity was common, and uptake of healthy lifestyle modifications was low. Treatment with biologic disease-modifying therapy was associated with lower rates of cardiovascular events, suggesting reduction of chronic inflammation may improve patient outcomes. We explored the contribution of joint stiffness and adipokines to patient outcomes in PsA. Stiffness was an important aspect of patient experience, and independently predicted physical function. Systematic review of circulating adipokines in PsA revealed conflicting data. Existing studies are heterogeneous in design and quality, and none report phenotypic subgroups. Preliminary results from a PsA cohort study found obesity was associated with higher active joint counts, and adipokine levels varied with phenotypic subgroups. This thesis highlights the burden of comorbidity in PsA, and supports the hypotheses that chronic systemic inflammation both contributes to cardiovascular comorbidity, and is driven in obesity by adipokines. Further research is needed to define the impact of comorbidity on phenotype and response to treatment in PsA, which may contribute to development of personalised, patient-centred management strategies.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherNorthern Clinical Schoolen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectpsoriatic arthritisen_AU
dc.subjectcomorbidityen_AU
dc.subjectadipokinesen_AU
dc.subjectoutcome measuresen_AU
dc.subjectcardiovascular diseaseen_AU
dc.subject.otherincludes published articlesen_AU
dc.titleComorbidity and Patient-Centred Health Outcomes in Psoriatic Arthritisen_AU
dc.typePhD Doctorateen_AU
dc.type.pubtypeDoctor of Philosophy Ph.D.en_AU
dc.description.disclaimerAccess is restricted to staff and students of the University of Sydney . UniKey credentials are required. Non university access may be obtained by visiting the University of Sydney Library.en_AU


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