الفهرس 
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Abstract
Psoriasis is an inflammatory skin disease that affects up to 2-3% of the worldwide population. Its pathogenesis is complex and involves a wide variety of processes, including epidermal hyperproliferation, activation of the immune and inflammatory pathways or dermal angiogenesis.
YKL-40, a member of ’mammalian chitinase-like proteins’, is secreted by macrophages, neutrophils, chondrocytes, endothelial-, vascular smooth muscle-, and cancer cells. High serum YKL-40 is related to conditions of increased tissue remodelling, cancer, and inflammation.
The current study is a prospective interventional clinical study, conducted on 40 patients divided into 2 equal groups; group I had psoriasis only while group II had psoriasis with psoriatic arthritis.
All patients in our study received methotrexate and folic acid on a weekly basis. The effect of methotrexate on the improvement of the disease was assessed by PASI and DAPSA scores for psoriasis and psoriatic arthritis, respectively. We measured YKL-40 before treatment and at week 12 after treatment
We found that methotrexate could improve the PASI scores in all patients and its effect was more noted in patients with psoriasis more than in patients who developed psoriatic arthritis. We observed that methotrexate could also improve the psoriatic arthritis as seen in DAPSA score DROP after the treatment course.
We found that YKL-40 serum levels were higher in patients who had psoriasis with psoriatic arthritis than those with psoriasis only. This finding might be related due to the inflammatory burden of the psoriatic arthritis disease.YKL-40 serum levels in psoriasis patients had been reduced in response to methotrexate treatment and a positive correlation was found between the improvement of psoriasis skin condition activity scores (PASI) and the reduction in serum YKL-40 levels. YKL-40 level reduction was more evident in patients with psoriasis only than those experiencing psoriasis with psoriatic arthritis.
In conclusion, this work adds a powerful data about methotrexate as an important method of treatment in psoriasis.YKL-40 could be used as a disease predictor that is correlated the improvement of PASI scores. Although methotrexate is also effective in improving psoriatic arthritis, it could control the disease more in patients without psoriatic arthritis.