Evaluation of the glycemic effect of methotrexate in psoriatic arthritis patients with metabolic syndrome: A pilot study
Identifieur interne : 000489 ( Pmc/Curation ); précédent : 000488; suivant : 000490Evaluation of the glycemic effect of methotrexate in psoriatic arthritis patients with metabolic syndrome: A pilot study
Auteurs : Tannaz Dehpouri [Iran] ; Ghasem Rahmatpour Rokni ; Nematollah Ahangar Narenjbon [Iran] ; Mohamad Goldust ; Paul S. Yamauchi [États-Unis] ; Uwe Wollina [Allemagne] ; Torello Lotti [Italie] ; Leon Kircik [États-Unis] ; Vito Giuseppe Di Lernia ; Sidharth Sonthalia ; Aleksandra Vojvodic [Serbie] ; Jacek Szepietowski [Pologne] ; Philippe Bahadoran [France] ; Enzo Errichetti [Italie] ; Carmen Cantisani [Italie] ; Laura Atzori [Italie] ; Elham Rezaee [Iran] ; Zekayi Kutlubay [Turquie] ; Burhan Engin [Turquie] ; Steven Nistic [Italie] ; Giovanni Damiani [Italie] ; Rosalynn R. Z. Conic [États-Unis] ; Andy Goren [Italie] ; Leo Abrijan [Croatie] ; Georgi Tchernev [Bulgarie]Source :
- Dermatology Reports [ 2036-7392 ] ; 2019.
Abstract
Methotrexate (MTX) is a systemic immunosuppressant drug used for the treatment of psoriasis and psoriatic arthritis. Previous studies demonstrated a potential association between psoriasis and diabetes mellitus, obesity, atherosclerosis, hypertension, eventuating into metabolic syndrome. This study aimed at exploring the glycemic effects of MTX in psoriatic arthritis (PsA) patients. In this prospective cross-sectional study, 27 patients with PsA were evaluated. The status of PsA and presence of accompanying metabolic syndrome was determined by standard criteria and indices. Blood indicators including HbA1c, erythrocyte sedimentation rate, fasting blood sugar, total cholesterol, high-density lipoprotein, triglycerides, and C-reactive protein were examined before and 12 weeks after MTX therapy. There were no significant changes between HbA1c levels before and after MTX therapy in both genders (men: P=0.131, women: P=0.803). In addition, HbA1c levels in PsA patients with metabolic syndrome were not different before and after treatment (P=0.250). Finally, HbA1c levels did not change in PsA patients without metabolic syndrome before and after therapy (P=0.506). MTX in PsA patients does not appear to have hyperglycaemic effects in the short-term and can be safely used in patients with metabolic syndrome and diabetes.
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DOI: 10.4081/dr.2019.7965
PubMed: 31210916
PubMed Central: 6547029
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id="aff0012">Department of Dermatology and Venereology,<institution>Military Medical Academy</institution>,<addr-line>Belgrade, Serbia</addr-line></nlm:aff><country xml:lang="fr">Serbie</country><wicri:regionArea>Belgrade</wicri:regionArea></affiliation></author><author><name sortKey="Szepietowski, Jacek" sort="Szepietowski, Jacek" uniqKey="Szepietowski J" first="Jacek" last="Szepietowski">Jacek Szepietowski</name><affiliation wicri:level="1"><nlm:aff id="aff0013">Department of Dermatology, Venereology and Allergology,<institution>Wroclaw Medical University</institution>,<addr-line>Wroclaw, Poland</addr-line></nlm:aff><country xml:lang="fr">Pologne</country><wicri:regionArea>Wroclaw</wicri:regionArea></affiliation></author><author><name sortKey="Bahadoran, Philippe" sort="Bahadoran, Philippe" uniqKey="Bahadoran P" first="Philippe" last="Bahadoran">Philippe Bahadoran</name><affiliation wicri:level="1"><nlm:aff id="aff0014">Department of Dermatology,<institution>University Hospital of Nice</institution>,<addr-line>Nice, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Nice</wicri:regionArea></affiliation></author><author><name sortKey="Errichetti, Enzo" sort="Errichetti, Enzo" uniqKey="Errichetti E" first="Enzo" last="Errichetti">Enzo Errichetti</name><affiliation wicri:level="1"><nlm:aff id="aff0015">Department of Experimental and Clinical Medicine,<institution>Institute of Dermatology, University of Udine</institution>,<addr-line>Udine, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Udine</wicri:regionArea></affiliation></author><author><name sortKey="Cantisani, Carmen" sort="Cantisani, Carmen" uniqKey="Cantisani C" first="Carmen" last="Cantisani">Carmen Cantisani</name><affiliation wicri:level="1"><nlm:aff id="aff0016">Department of Dermatology, “Umberto I” Hospital,<institution>“Sapienza” University of Rome</institution>,<addr-line>Rome, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rome</wicri:regionArea></affiliation></author><author><name sortKey="Atzori, Laura" sort="Atzori, Laura" uniqKey="Atzori L" first="Laura" last="Atzori">Laura Atzori</name><affiliation wicri:level="1"><nlm:aff id="aff0017">Dermatology Clinic, Department Medical Sciences and Public Health,<institution>University of Cagliari</institution>,<addr-line>Cagliari, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Cagliari</wicri:regionArea></affiliation></author><author><name sortKey="Rezaee, Elham" sort="Rezaee, Elham" uniqKey="Rezaee E" first="Elham" last="Rezaee">Elham Rezaee</name><affiliation wicri:level="1"><nlm:aff id="aff0018">Department of Pharmaceutical Chemistry,<institution>School of Pharmacy, Shahid Beheshti University of Medical Sciences</institution>,<addr-line>Tehran, Iran</addr-line></nlm:aff><country xml:lang="fr">Iran</country><wicri:regionArea>Tehran</wicri:regionArea></affiliation></author><author><name sortKey="Kutlubay, Zekayi" sort="Kutlubay, Zekayi" uniqKey="Kutlubay Z" first="Zekayi" last="Kutlubay">Zekayi Kutlubay</name><affiliation wicri:level="1"><nlm:aff id="aff0019">Department of Dermatology, Cerrahpasa Faculty of Medicine,<institution>University of Istanbul</institution>,<addr-line>Istanbul, Turkey</addr-line></nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul</wicri:regionArea></affiliation></author><author><name sortKey="Engin, Burhan" sort="Engin, Burhan" uniqKey="Engin B" first="Burhan" last="Engin">Burhan Engin</name><affiliation wicri:level="1"><nlm:aff id="aff0019">Department of Dermatology, Cerrahpasa Faculty of Medicine,<institution>University of Istanbul</institution>,<addr-line>Istanbul, Turkey</addr-line></nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul</wicri:regionArea></affiliation></author><author><name sortKey="Nistic, Steven" sort="Nistic, Steven" uniqKey="Nistic S" first="Steven" last="Nistic">Steven Nistic</name><affiliation wicri:level="1"><nlm:aff id="aff0020">Department of Health Sciences,<institution>“Magna Graecia” University of Catanzaro</institution>,<addr-line>Catanzaro, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Catanzaro</wicri:regionArea></affiliation></author><author><name sortKey="Damiani, Giovanni" sort="Damiani, Giovanni" uniqKey="Damiani G" first="Giovanni" last="Damiani">Giovanni Damiani</name><affiliation wicri:level="1"><nlm:aff id="aff0021">Department of Medical and Surgical Pathophysiology and Transplantation,<institution>University of Milan</institution>, Dermatology Unit, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico,<addr-line>Milan, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Milan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0022"><institution>Young Dermatologists Italian Network (YDIN), Centro Studi GISED</institution>,<addr-line>Bergamo, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Bergamo</wicri:regionArea></affiliation></author><author><name sortKey="Conic, Rosalynn R Z" sort="Conic, Rosalynn R Z" uniqKey="Conic R" first="Rosalynn R. Z." last="Conic">Rosalynn R. Z. Conic</name><affiliation wicri:level="1"><nlm:aff id="aff0023">Department of Dermatology,<institution>Case Western Reserve University</institution>, Cleveland,<addr-line>OH, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>OH</wicri:regionArea></affiliation></author><author><name sortKey="Goren, Andy" sort="Goren, Andy" uniqKey="Goren A" first="Andy" last="Goren">Andy Goren</name><affiliation wicri:level="1"><nlm:aff id="aff007">Department of Dermatology,<institution>“Guglielmo Marconi” University</institution>,<addr-line>Rome, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rome</wicri:regionArea></affiliation></author><author><name sortKey=" Abrijan, Leo" sort=" Abrijan, Leo" uniqKey=" Abrijan L" first="Leo" last=" Abrijan">Leo Abrijan</name><affiliation wicri:level="1"><nlm:aff id="aff0024">Department of Dermatovenereology,<institution>Rijeka Clinical Hospital Center</institution>,<addr-line>Rijeka, Croatia</addr-line></nlm:aff><country xml:lang="fr">Croatie</country><wicri:regionArea>Rijeka</wicri:regionArea></affiliation></author><author><name sortKey="Tchernev, Georgi" sort="Tchernev, Georgi" uniqKey="Tchernev G" first="Georgi" last="Tchernev">Georgi Tchernev</name><affiliation wicri:level="1"><nlm:aff id="aff0025"><institution>Medical Institute of Ministry of Interior (MVR)</institution>, Department of Dermatology, Venereology and Dermatologic Surgery,<addr-line>Sofia, Bulgaria</addr-line></nlm:aff><country xml:lang="fr">Bulgarie</country><wicri:regionArea>Sofia</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31210916</idno><idno type="pmc">6547029</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547029</idno><idno type="RBID">PMC:6547029</idno><idno type="doi">10.4081/dr.2019.7965</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000489</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000489</idno><idno type="wicri:Area/Pmc/Curation">000489</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000489</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Evaluation of the glycemic effect of methotrexate in psoriatic arthritis patients with metabolic syndrome: A pilot study</title><author><name sortKey="Dehpouri, Tannaz" sort="Dehpouri, Tannaz" uniqKey="Dehpouri T" first="Tannaz" last="Dehpouri">Tannaz Dehpouri</name><affiliation wicri:level="1"><nlm:aff id="aff001">Student Research Committee,<institution>Mazandaran University of Medical Sciences</institution>, Ramsar International Branch,<addr-line>Ramsar, Iran</addr-line></nlm:aff><country xml:lang="fr">Iran</country><wicri:regionArea>Ramsar</wicri:regionArea></affiliation></author><author><name sortKey="Rokni, Ghasem Rahmatpour" sort="Rokni, Ghasem Rahmatpour" uniqKey="Rokni G" first="Ghasem Rahmatpour" last="Rokni">Ghasem Rahmatpour Rokni</name><affiliation><nlm:aff id="aff002">Department of Dermatology,<institution>Mazandaran University of Medical Sciences</institution>, Sari,<addr-line>Iran</addr-line></nlm:aff></affiliation></author><author><name sortKey="Narenjbon, Nematollah Ahangar" sort="Narenjbon, Nematollah Ahangar" uniqKey="Narenjbon N" first="Nematollah Ahangar" last="Narenjbon">Nematollah Ahangar Narenjbon</name><affiliation wicri:level="1"><nlm:aff id="aff003">Department of Pharmacology, Faculty of Pharmacy,<institution>Mazandaran University of Medical Sciences</institution>,<addr-line>Sari, Iran</addr-line></nlm:aff><country xml:lang="fr">Iran</country><wicri:regionArea>Sari</wicri:regionArea></affiliation></author><author><name sortKey="Goldust, Mohamad" sort="Goldust, Mohamad" uniqKey="Goldust M" first="Mohamad" last="Goldust">Mohamad Goldust</name><affiliation><nlm:aff id="aff002">Department of Dermatology,<institution>Mazandaran University of Medical Sciences</institution>, Sari,<addr-line>Iran</addr-line></nlm:aff></affiliation></author><author><name sortKey="Yamauchi, Paul S" sort="Yamauchi, Paul S" uniqKey="Yamauchi P" first="Paul S." last="Yamauchi">Paul S. Yamauchi</name><affiliation wicri:level="1"><nlm:aff id="aff004"><institution>Dermatology Institute and Skin Care Center</institution>, Santa Monica,<addr-line>California, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff005">Division of Dermatology,<institution>David Geffen School of Medicine at University of California</institution>, Los Angeles,<addr-line>California, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>California</wicri:regionArea></affiliation></author><author><name sortKey="Wollina, Uwe" sort="Wollina, Uwe" uniqKey="Wollina U" first="Uwe" last="Wollina">Uwe Wollina</name><affiliation wicri:level="1"><nlm:aff id="aff006">Department of Dermatology and Allergology, Städtisches Klinikum Dresden,<institution>Academic Teaching Hospital of the Technical University of Dresden</institution>,<addr-line>Dresden, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Lotti, Torello" sort="Lotti, Torello" uniqKey="Lotti T" first="Torello" last="Lotti">Torello Lotti</name><affiliation wicri:level="1"><nlm:aff id="aff007">Department of Dermatology,<institution>“Guglielmo Marconi” University</institution>,<addr-line>Rome, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rome</wicri:regionArea></affiliation></author><author><name sortKey="Kircik, Leon" sort="Kircik, Leon" uniqKey="Kircik L" first="Leon" last="Kircik">Leon Kircik</name><affiliation wicri:level="1"><nlm:aff id="aff008"><institution>Icahn School of Medicine at Mount Sinai</institution>,<addr-line>New York, NY, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Lernia, Vito Giuseppe Di" sort="Lernia, Vito Giuseppe Di" uniqKey="Lernia V" first="Vito Giuseppe Di" last="Lernia">Vito Giuseppe Di Lernia</name><affiliation><nlm:aff id="aff009">Dermatology Unit,<institution>Santa Maria Nuova-IRCCS Hospital</institution>, Reggio Emilia,<addr-line>Italy</addr-line></nlm:aff></affiliation></author><author><name sortKey="Sonthalia, Sidharth" sort="Sonthalia, Sidharth" uniqKey="Sonthalia S" first="Sidharth" last="Sonthalia">Sidharth Sonthalia</name><affiliation><nlm:aff id="aff0010"><institution>Skinnocence: The Skin Clinic & Research Center</institution>, Gurugram, Haryana,<addr-line>India</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="aff0011"><institution>Dermasource India</institution>, Gurugram, Haryana,<addr-line>India</addr-line></nlm:aff></affiliation></author><author><name sortKey="Vojvodic, Aleksandra" sort="Vojvodic, Aleksandra" uniqKey="Vojvodic A" first="Aleksandra" last="Vojvodic">Aleksandra Vojvodic</name><affiliation wicri:level="1"><nlm:aff id="aff0012">Department of Dermatology and Venereology,<institution>Military Medical Academy</institution>,<addr-line>Belgrade, Serbia</addr-line></nlm:aff><country xml:lang="fr">Serbie</country><wicri:regionArea>Belgrade</wicri:regionArea></affiliation></author><author><name sortKey="Szepietowski, Jacek" sort="Szepietowski, Jacek" uniqKey="Szepietowski J" first="Jacek" last="Szepietowski">Jacek Szepietowski</name><affiliation wicri:level="1"><nlm:aff id="aff0013">Department of Dermatology, Venereology and Allergology,<institution>Wroclaw Medical University</institution>,<addr-line>Wroclaw, Poland</addr-line></nlm:aff><country xml:lang="fr">Pologne</country><wicri:regionArea>Wroclaw</wicri:regionArea></affiliation></author><author><name sortKey="Bahadoran, Philippe" sort="Bahadoran, Philippe" uniqKey="Bahadoran P" first="Philippe" last="Bahadoran">Philippe Bahadoran</name><affiliation wicri:level="1"><nlm:aff id="aff0014">Department of Dermatology,<institution>University Hospital of Nice</institution>,<addr-line>Nice, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Nice</wicri:regionArea></affiliation></author><author><name sortKey="Errichetti, Enzo" sort="Errichetti, Enzo" uniqKey="Errichetti E" first="Enzo" last="Errichetti">Enzo Errichetti</name><affiliation wicri:level="1"><nlm:aff id="aff0015">Department of Experimental and Clinical Medicine,<institution>Institute of Dermatology, University of Udine</institution>,<addr-line>Udine, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Udine</wicri:regionArea></affiliation></author><author><name sortKey="Cantisani, Carmen" sort="Cantisani, Carmen" uniqKey="Cantisani C" first="Carmen" last="Cantisani">Carmen Cantisani</name><affiliation wicri:level="1"><nlm:aff id="aff0016">Department of Dermatology, “Umberto I” Hospital,<institution>“Sapienza” University of Rome</institution>,<addr-line>Rome, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rome</wicri:regionArea></affiliation></author><author><name sortKey="Atzori, Laura" sort="Atzori, Laura" uniqKey="Atzori L" first="Laura" last="Atzori">Laura Atzori</name><affiliation wicri:level="1"><nlm:aff id="aff0017">Dermatology Clinic, Department Medical Sciences and Public Health,<institution>University of Cagliari</institution>,<addr-line>Cagliari, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Cagliari</wicri:regionArea></affiliation></author><author><name sortKey="Rezaee, Elham" sort="Rezaee, Elham" uniqKey="Rezaee E" first="Elham" last="Rezaee">Elham Rezaee</name><affiliation wicri:level="1"><nlm:aff id="aff0018">Department of Pharmaceutical Chemistry,<institution>School of Pharmacy, Shahid Beheshti University of Medical Sciences</institution>,<addr-line>Tehran, Iran</addr-line></nlm:aff><country xml:lang="fr">Iran</country><wicri:regionArea>Tehran</wicri:regionArea></affiliation></author><author><name sortKey="Kutlubay, Zekayi" sort="Kutlubay, Zekayi" uniqKey="Kutlubay Z" first="Zekayi" last="Kutlubay">Zekayi Kutlubay</name><affiliation wicri:level="1"><nlm:aff id="aff0019">Department of Dermatology, Cerrahpasa Faculty of Medicine,<institution>University of Istanbul</institution>,<addr-line>Istanbul, Turkey</addr-line></nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul</wicri:regionArea></affiliation></author><author><name sortKey="Engin, Burhan" sort="Engin, Burhan" uniqKey="Engin B" first="Burhan" last="Engin">Burhan Engin</name><affiliation wicri:level="1"><nlm:aff id="aff0019">Department of Dermatology, Cerrahpasa Faculty of Medicine,<institution>University of Istanbul</institution>,<addr-line>Istanbul, Turkey</addr-line></nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul</wicri:regionArea></affiliation></author><author><name sortKey="Nistic, Steven" sort="Nistic, Steven" uniqKey="Nistic S" first="Steven" last="Nistic">Steven Nistic</name><affiliation wicri:level="1"><nlm:aff id="aff0020">Department of Health Sciences,<institution>“Magna Graecia” University of Catanzaro</institution>,<addr-line>Catanzaro, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Catanzaro</wicri:regionArea></affiliation></author><author><name sortKey="Damiani, Giovanni" sort="Damiani, Giovanni" uniqKey="Damiani G" first="Giovanni" last="Damiani">Giovanni Damiani</name><affiliation wicri:level="1"><nlm:aff id="aff0021">Department of Medical and Surgical Pathophysiology and Transplantation,<institution>University of Milan</institution>, Dermatology Unit, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico,<addr-line>Milan, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Milan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0022"><institution>Young Dermatologists Italian Network (YDIN), Centro Studi GISED</institution>,<addr-line>Bergamo, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Bergamo</wicri:regionArea></affiliation></author><author><name sortKey="Conic, Rosalynn R Z" sort="Conic, Rosalynn R Z" uniqKey="Conic R" first="Rosalynn R. Z." last="Conic">Rosalynn R. Z. Conic</name><affiliation wicri:level="1"><nlm:aff id="aff0023">Department of Dermatology,<institution>Case Western Reserve University</institution>, Cleveland,<addr-line>OH, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>OH</wicri:regionArea></affiliation></author><author><name sortKey="Goren, Andy" sort="Goren, Andy" uniqKey="Goren A" first="Andy" last="Goren">Andy Goren</name><affiliation wicri:level="1"><nlm:aff id="aff007">Department of Dermatology,<institution>“Guglielmo Marconi” University</institution>,<addr-line>Rome, Italy</addr-line></nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rome</wicri:regionArea></affiliation></author><author><name sortKey=" Abrijan, Leo" sort=" Abrijan, Leo" uniqKey=" Abrijan L" first="Leo" last=" Abrijan">Leo Abrijan</name><affiliation wicri:level="1"><nlm:aff id="aff0024">Department of Dermatovenereology,<institution>Rijeka Clinical Hospital Center</institution>,<addr-line>Rijeka, Croatia</addr-line></nlm:aff><country xml:lang="fr">Croatie</country><wicri:regionArea>Rijeka</wicri:regionArea></affiliation></author><author><name sortKey="Tchernev, Georgi" sort="Tchernev, Georgi" uniqKey="Tchernev G" first="Georgi" last="Tchernev">Georgi Tchernev</name><affiliation wicri:level="1"><nlm:aff id="aff0025"><institution>Medical Institute of Ministry of Interior (MVR)</institution>, Department of Dermatology, Venereology and Dermatologic Surgery,<addr-line>Sofia, Bulgaria</addr-line></nlm:aff><country xml:lang="fr">Bulgarie</country><wicri:regionArea>Sofia</wicri:regionArea></affiliation></author></analytic><series><title level="j">Dermatology Reports</title><idno type="ISSN">2036-7392</idno><idno type="eISSN">2036-7406</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Methotrexate (MTX) is a systemic immunosuppressant drug used for the treatment of psoriasis and psoriatic arthritis. Previous studies demonstrated a potential association between psoriasis and diabetes mellitus, obesity, atherosclerosis, hypertension, eventuating into metabolic syndrome. This study aimed at exploring the glycemic effects of MTX in psoriatic arthritis (PsA) patients. In this prospective cross-sectional study, 27 patients with PsA were evaluated. The status of PsA and presence of accompanying metabolic syndrome was determined by standard criteria and indices. Blood indicators including HbA1c, erythrocyte sedimentation rate, fasting blood sugar, total cholesterol, high-density lipoprotein, triglycerides, and C-reactive protein were examined before and 12 weeks after MTX therapy. There were no significant changes between HbA1c levels before and after MTX therapy in both genders (men: P=0.131, women: P=0.803). In addition, HbA1c levels in PsA patients with metabolic syndrome were not different before and after treatment (P=0.250). Finally, HbA1c levels did not change in PsA patients without metabolic syndrome before and after therapy (P=0.506). MTX in PsA patients does not appear to have hyperglycaemic effects in the short-term and can be safely used in patients with metabolic syndrome and diabetes.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Puig, L" uniqKey="Puig L">L Puig</name></author><author><name sortKey="Strohal, R" uniqKey="Strohal R">R Strohal</name></author><author><name sortKey="Husni, Me" uniqKey="Husni M">ME Husni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reich, K" uniqKey="Reich K">K Reich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sommer, Dm" uniqKey="Sommer D">DM Sommer</name></author><author><name sortKey="Jenisch, S" uniqKey="Jenisch S">S Jenisch</name></author><author><name sortKey="Suchan, M" uniqKey="Suchan M">M Suchan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Channual, J" uniqKey="Channual J">J Channual</name></author><author><name sortKey="Wu, Jj" uniqKey="Wu J">JJ Wu</name></author><author><name sortKey="Dann, Fj" uniqKey="Dann F">FJ Dann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gladman, Dd" uniqKey="Gladman D">DD Gladman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahlehoff, O" uniqKey="Ahlehoff O">O Ahlehoff</name></author><author><name sortKey="Gislason, Gh" uniqKey="Gislason G">GH Gislason</name></author><author><name sortKey="Charlot, M" uniqKey="Charlot M">M Charlot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kwon, O" uniqKey="Kwon O">O Kwon</name></author><author><name sortKey="Kang, Sj" uniqKey="Kang S">SJ Kang</name></author><author><name sortKey="Kang, Sh" uniqKey="Kang S">SH Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boscarino, Ja" uniqKey="Boscarino J">JA Boscarino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jialal, I" uniqKey="Jialal I">I Jialal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruan, H" uniqKey="Ruan H">H Ruan</name></author><author><name sortKey="Lodish, Hf" uniqKey="Lodish H">HF Lodish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chandalia, M" uniqKey="Chandalia M">M Chandalia</name></author><author><name sortKey="Cabo Chan, Av" uniqKey="Cabo Chan A">AV Cabo-Chan</name></author><author><name sortKey="Devaraj, S" uniqKey="Devaraj S">S Devaraj</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grundy, Sm" uniqKey="Grundy S">SM Grundy</name></author><author><name sortKey="Cleeman, Ji" uniqKey="Cleeman J">JI Cleeman</name></author><author><name sortKey="Daniels, Sr" uniqKey="Daniels S">SR Daniels</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Lw" uniqKey="Johnson L">LW Johnson</name></author><author><name sortKey="Weinstock, Rs" uniqKey="Weinstock R">RS Weinstock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pereira, Rmr" uniqKey="Pereira R">RMR Pereira</name></author><author><name sortKey="De Carvalho, Jf" uniqKey="De Carvalho J">JF de Carvalho</name></author><author><name sortKey="Bonfa, E" uniqKey="Bonfa E">E. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Dermatol Reports</journal-id><journal-id journal-id-type="publisher-id">DR</journal-id><journal-title-group><journal-title>Dermatology Reports</journal-title></journal-title-group><issn pub-type="ppub">2036-7392</issn><issn pub-type="epub">2036-7406</issn><publisher><publisher-name>PAGEPress Publications, Pavia, Italy</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31210916</article-id><article-id pub-id-type="pmc">6547029</article-id><article-id pub-id-type="doi">10.4081/dr.2019.7965</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Evaluation of the glycemic effect of methotrexate in psoriatic arthritis patients with metabolic syndrome: A pilot study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Dehpouri</surname><given-names>Tannaz</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rokni</surname><given-names>Ghasem Rahmatpour</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Narenjbon</surname><given-names>Nematollah Ahangar</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Goldust</surname><given-names>Mohamad</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yamauchi</surname><given-names>Paul S.</given-names></name><xref ref-type="aff" rid="aff004"><sup>4</sup></xref><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wollina</surname><given-names>Uwe</given-names></name><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lotti</surname><given-names>Torello</given-names></name><xref ref-type="aff" rid="aff007"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kircik</surname><given-names>Leon</given-names></name><xref ref-type="aff" rid="aff008"><sup>8</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lernia</surname><given-names>Vito Giuseppe Di</given-names></name><xref ref-type="aff" rid="aff009"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sonthalia</surname><given-names>Sidharth</given-names></name><xref ref-type="aff" rid="aff0010"><sup>10</sup></xref><xref ref-type="aff" rid="aff0011"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vojvodic</surname><given-names>Aleksandra</given-names></name><xref ref-type="aff" rid="aff0012"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Szepietowski</surname><given-names>Jacek</given-names></name><xref ref-type="aff" rid="aff0013"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bahadoran</surname><given-names>Philippe</given-names></name><xref ref-type="aff" rid="aff0014"><sup>14</sup></xref></contrib><contrib contrib-type="author"><name><surname>Errichetti</surname><given-names>Enzo</given-names></name><xref ref-type="aff" rid="aff0015"><sup>15</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cantisani</surname><given-names>Carmen</given-names></name><xref ref-type="aff" rid="aff0016"><sup>16</sup></xref></contrib><contrib contrib-type="author"><name><surname>Atzori</surname><given-names>Laura</given-names></name><xref ref-type="aff" rid="aff0017"><sup>17</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rezaee</surname><given-names>Elham</given-names></name><xref ref-type="aff" rid="aff0018"><sup>18</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kutlubay</surname><given-names>Zekayi</given-names></name><xref ref-type="aff" rid="aff0019"><sup>19</sup></xref></contrib><contrib contrib-type="author"><name><surname>Engin</surname><given-names>Burhan</given-names></name><xref ref-type="aff" rid="aff0019"><sup>19</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nisticò</surname><given-names>Steven</given-names></name><xref ref-type="aff" rid="aff0020"><sup>20</sup></xref></contrib><contrib contrib-type="author"><name><surname>Damiani</surname><given-names>Giovanni</given-names></name><xref ref-type="aff" rid="aff0021"><sup>21</sup></xref><xref ref-type="aff" rid="aff0022"><sup>22</sup></xref></contrib><contrib contrib-type="author"><name><surname>Conic</surname><given-names>Rosalynn R.Z.</given-names></name><xref ref-type="aff" rid="aff0023"><sup>23</sup></xref></contrib><contrib contrib-type="author"><name><surname>Goren</surname><given-names>Andy</given-names></name><xref ref-type="aff" rid="aff007"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Čabrijan</surname><given-names>Leo</given-names></name><xref ref-type="aff" rid="aff0024"><sup>24</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tchernev</surname><given-names>Georgi</given-names></name><xref ref-type="aff" rid="aff0025"><sup>25</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label>Student Research Committee,<institution>Mazandaran University of Medical Sciences</institution>, Ramsar International Branch,<addr-line>Ramsar, Iran</addr-line></aff><aff id="aff002"><label>2</label>Department of Dermatology,<institution>Mazandaran University of Medical Sciences</institution>, Sari,<addr-line>Iran</addr-line></aff><aff id="aff003"><label>3</label>Department of Pharmacology, Faculty of Pharmacy,<institution>Mazandaran University of Medical Sciences</institution>,<addr-line>Sari, Iran</addr-line></aff><aff id="aff004"><label>4</label><institution>Dermatology Institute and Skin Care Center</institution>, Santa Monica,<addr-line>California, USA</addr-line></aff><aff id="aff005"><label>5</label>Division of Dermatology,<institution>David Geffen School of Medicine at University of California</institution>, Los Angeles,<addr-line>California, USA</addr-line></aff><aff id="aff006"><label>6</label>Department of Dermatology and Allergology, Städtisches Klinikum Dresden,<institution>Academic Teaching Hospital of the Technical University of Dresden</institution>,<addr-line>Dresden, Germany</addr-line></aff><aff id="aff007"><label>7</label>Department of Dermatology,<institution>“Guglielmo Marconi” University</institution>,<addr-line>Rome, Italy</addr-line></aff><aff id="aff008"><label>8</label><institution>Icahn School of Medicine at Mount Sinai</institution>,<addr-line>New York, NY, USA</addr-line></aff><aff id="aff009"><label>9</label>Dermatology Unit,<institution>Santa Maria Nuova-IRCCS Hospital</institution>, Reggio Emilia,<addr-line>Italy</addr-line></aff><aff id="aff0010"><label>10</label><institution>Skinnocence: The Skin Clinic & Research Center</institution>, Gurugram, Haryana,<addr-line>India</addr-line></aff><aff id="aff0011"><label>11</label><institution>Dermasource India</institution>, Gurugram, Haryana,<addr-line>India</addr-line></aff><aff id="aff0012"><label>12</label>Department of Dermatology and Venereology,<institution>Military Medical Academy</institution>,<addr-line>Belgrade, Serbia</addr-line></aff><aff id="aff0013"><label>13</label>Department of Dermatology, Venereology and Allergology,<institution>Wroclaw Medical University</institution>,<addr-line>Wroclaw, Poland</addr-line></aff><aff id="aff0014"><label>14</label>Department of Dermatology,<institution>University Hospital of Nice</institution>,<addr-line>Nice, France</addr-line></aff><aff id="aff0015"><label>15</label>Department of Experimental and Clinical Medicine,<institution>Institute of Dermatology, University of Udine</institution>,<addr-line>Udine, Italy</addr-line></aff><aff id="aff0016"><label>16</label>Department of Dermatology, “Umberto I” Hospital,<institution>“Sapienza” University of Rome</institution>,<addr-line>Rome, Italy</addr-line></aff><aff id="aff0017"><label>17</label>Dermatology Clinic, Department Medical Sciences and Public Health,<institution>University of Cagliari</institution>,<addr-line>Cagliari, Italy</addr-line></aff><aff id="aff0018"><label>18</label>Department of Pharmaceutical Chemistry,<institution>School of Pharmacy, Shahid Beheshti University of Medical Sciences</institution>,<addr-line>Tehran, Iran</addr-line></aff><aff id="aff0019"><label>19</label>Department of Dermatology, Cerrahpasa Faculty of Medicine,<institution>University of Istanbul</institution>,<addr-line>Istanbul, Turkey</addr-line></aff><aff id="aff0020"><label>20</label>Department of Health Sciences,<institution>“Magna Graecia” University of Catanzaro</institution>,<addr-line>Catanzaro, Italy</addr-line></aff><aff id="aff0021"><label>21</label>Department of Medical and Surgical Pathophysiology and Transplantation,<institution>University of Milan</institution>, Dermatology Unit, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico,<addr-line>Milan, Italy</addr-line></aff><aff id="aff0022"><label>22</label><institution>Young Dermatologists Italian Network (YDIN), Centro Studi GISED</institution>,<addr-line>Bergamo, Italy</addr-line></aff><aff id="aff0023"><label>23</label>Department of Dermatology,<institution>Case Western Reserve University</institution>, Cleveland,<addr-line>OH, USA</addr-line></aff><aff id="aff0024"><label>24</label>Department of Dermatovenereology,<institution>Rijeka Clinical Hospital Center</institution>,<addr-line>Rijeka, Croatia</addr-line></aff><aff id="aff0025"><label>25</label><institution>Medical Institute of Ministry of Interior (MVR)</institution>, Department of Dermatology, Venereology and Dermatologic Surgery,<addr-line>Sofia, Bulgaria</addr-line></aff><author-notes><corresp id="cor1">Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran. <phone>+989125443956</phone> - <fax>+981133261248</fax>. <email>Dr.rokni@yahoo.com</email></corresp><fn fn-type="con"><p>Contributions: the manuscript has been read and approved by all the authors.</p></fn><fn fn-type="COI-statement"><p>Conflict of interest: the authors declare no potential conflict of interest.</p></fn></author-notes><pub-date pub-type="epub"><day>09</day><month>5</month><year>2019</year></pub-date><pub-date pub-type="collection"><day>23</day><month>1</month><year>2019</year></pub-date><volume>11</volume><issue>1</issue><elocation-id>7965</elocation-id><history><date date-type="received"><day>04</day><month>12</month><year>2018</year></date><date date-type="accepted"><day>18</day><month>1</month><year>2019</year></date></history><permissions><copyright-statement>©Copyright T. Dehpouri et al., 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder>Licensee PAGEPress, Italy</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</uri>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Methotrexate (MTX) is a systemic immunosuppressant drug used for the treatment of psoriasis and psoriatic arthritis. Previous studies demonstrated a potential association between psoriasis and diabetes mellitus, obesity, atherosclerosis, hypertension, eventuating into metabolic syndrome. This study aimed at exploring the glycemic effects of MTX in psoriatic arthritis (PsA) patients. In this prospective cross-sectional study, 27 patients with PsA were evaluated. The status of PsA and presence of accompanying metabolic syndrome was determined by standard criteria and indices. Blood indicators including HbA1c, erythrocyte sedimentation rate, fasting blood sugar, total cholesterol, high-density lipoprotein, triglycerides, and C-reactive protein were examined before and 12 weeks after MTX therapy. There were no significant changes between HbA1c levels before and after MTX therapy in both genders (men: P=0.131, women: P=0.803). In addition, HbA1c levels in PsA patients with metabolic syndrome were not different before and after treatment (P=0.250). Finally, HbA1c levels did not change in PsA patients without metabolic syndrome before and after therapy (P=0.506). MTX in PsA patients does not appear to have hyperglycaemic effects in the short-term and can be safely used in patients with metabolic syndrome and diabetes.</p></abstract><kwd-group><title>Key words</title><kwd>Psoriatic arthritis</kwd><kwd>Metabolic syndrome</kwd><kwd>HbA1c</kwd><kwd>Methotrexate</kwd></kwd-group><funding-group><funding-statement>Funding: none.</funding-statement></funding-group><counts><fig-count count="2"></fig-count><table-count count="1"></table-count><equation-count count="0"></equation-count><ref-count count="39"></ref-count><page-count count="5"></page-count></counts></article-meta></front><floats-group><fig id="fig001" orientation="portrait" position="float"><label>Figure 1.</label><caption><p>The level of HbA1c based on the gender of psoriatic arthritis patients. The results are presented as mean ± SEM. Statistically significant differences between control and patients (P<0.05).</p></caption><graphic xlink:href="dr-11-1-7965-g001"></graphic></fig><fig id="fig002" orientation="portrait" position="float"><label>Figure 2.</label><caption><p>The level of HbA1c based on the National Cholesterol Education Program Adult Panel index in psoriatic arthritis patients patients with and without metabolic syndrome. Results are presented as mean ± SEM. Statistically significant differences between control and patients (P<0.05).</p></caption><graphic xlink:href="dr-11-1-7965-g002"></graphic></fig><table-wrap id="table001" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Demographic and clinical features of the study patients.</p></caption><table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Variation</th><th align="center" valign="top" rowspan="1" colspan="1">Patients with PsA before treatment n=27</th><th align="center" valign="top" rowspan="1" colspan="1">Patients with PsA after treatment n=27</th><th align="center" valign="top" rowspan="1" colspan="1">P value</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td><td align="center" valign="top" rowspan="1" colspan="1">43.22±8.9</td><td align="center" valign="top" rowspan="1" colspan="1">-</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Gender</td><td align="center" valign="top" rowspan="1" colspan="1"> </td><td align="center" valign="top" rowspan="1" colspan="1"> </td><td align="center" valign="top" rowspan="1" colspan="1"> </td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Men N (%)</td><td align="center" valign="top" rowspan="1" colspan="1">18 (66.7)</td><td align="center" valign="top" rowspan="1" colspan="1">-</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Women N (%)</td><td align="center" valign="top" rowspan="1" colspan="1">9 (33.3)</td><td align="center" valign="top" rowspan="1" colspan="1">-</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">History of diabetes N (%)</td><td align="center" valign="top" rowspan="1" colspan="1">2 (10.0)</td><td align="center" valign="top" rowspan="1" colspan="1">-</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">History of stroke N (%)</td><td align="center" valign="top" rowspan="1" colspan="1">10 (35.0)</td><td align="center" valign="top" rowspan="1" colspan="1">-</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">History of Hyperlipidemia N (%)</td><td align="center" valign="top" rowspan="1" colspan="1">7 (20.0)</td><td align="center" valign="top" rowspan="1" colspan="1">-</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">FBS (mg/dL)</td><td align="center" valign="top" rowspan="1" colspan="1">103.2±30.2</td><td align="center" valign="top" rowspan="1" colspan="1">101.3±22.8</td><td align="center" valign="top" rowspan="1" colspan="1">624</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Total cholesterol (mg/dL)</td><td align="center" valign="top" rowspan="1" colspan="1">165.7±26.9</td><td align="center" valign="top" rowspan="1" colspan="1">166.5±33.2</td><td align="center" valign="top" rowspan="1" colspan="1">0.881</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">HDL (mg/dL)</td><td align="center" valign="top" rowspan="1" colspan="1">39.6±7.7</td><td align="center" valign="top" rowspan="1" colspan="1">42.8±6.2</td><td align="center" valign="top" rowspan="1" colspan="1">0.005</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">LDL (mg/dL)</td><td align="center" valign="top" rowspan="1" colspan="1">98.7±22.7</td><td align="center" valign="top" rowspan="1" colspan="1">104.6±22.7</td><td align="center" valign="top" rowspan="1" colspan="1">0.059</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">CRP</td><td align="center" valign="top" rowspan="1" colspan="1">100% negative</td><td align="center" valign="top" rowspan="1" colspan="1">100% negative</td><td align="center" valign="top" rowspan="1" colspan="1">0.21</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ESR (mm/hour)</td><td align="center" valign="top" rowspan="1" colspan="1">24.2±17.9</td><td align="center" valign="top" rowspan="1" colspan="1">23.5±17.6</td><td align="center" valign="top" rowspan="1" colspan="1">0.722</td></tr></tbody></table><table-wrap-foot><fn><p>PsA, psoriatic arthritis patients; FBS, fasting blood sugar; HDL, high-density lipoprotein cholesterol; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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