The association between axial and peripheral attacks is frequent and favours greatly diagnosis. The sacroiliitis may be asymptomatic, purely and simply radiological. The attack of a distal interphalangeal joint combined with that of the corresponding fingernail is quite distinctive. The existence of a sausage-like toe or finger, in association with articular and synovial attack, is also highly characteristic.
A schematic distinction is made between peripheral and central attacks.
Peripheral attacks are most commonly cases of asymmetrical oligoarthritis affecting one or two large joints as well as a hand joint often combined with tenosynovitis. In 15 to 20% of cases, it may arise as a symmetrical polyarthritis resembling rheumatoid polyarthritis. However, besides the data sourced from the familial questioning and an in-depth skin examination, several characteristics differentiate psoriatic arthritis and rheumatoid arthritis: in psoriatic arthritis, articular attacks are less symmetrical, there is impact on the distal interphalangeal joints - rarely in isolation - there are no subcutaneous nodules, there is often at least some radiological impairment on the sacroiliac joint and the rheumatic serology is negative.
[|In peripheral psoriatic
arthritis, involvement of all joints of one or several fingers or toes should
be differentiated from involvement of several distal interphalangeal joints
(DIPs), the latter often being associated with nail psoriasis.|auteur195]
In 5% of cases we find ourselves confronted with arthritis mutilans, which develops very fast and constitutes a matter of true therapeutic emergency. It is most often observed in a young subject. Generally, it is associated with sacroiliitis and is mostly observed when the skin episode is severe, as well as in certain circumstances such as HIV psoriasis. It may lead to severe disability.
Axial attack is frequent and is encountered in 40% of psoriatic arthritis cases. In half of such cases it is associated with a peripheral attack. Isolated sacroiliitis is possible. This sacroiliitis is often less serious than that observed in ankylosing spondylarthritis. It is often asymmetrical or even unilateral in 30% of cases. It is clinically asymptomatic and visible solely by X-ray in half of cases. It is particularly observed in the male and it is associated with the HLA B27 group in 50 to 70% of cases. Spinal attack is often tardier in developing psoriatic arthritis than in the development of ankylosing spondylarthritis and tends to predominate in the cervicodorsal region.
In the case of pustular psoriasis, particularly the Zumbusch type, activated neutrophilic polynuclears may produce the equivalent of a SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) and result in joint lysis.
It is also possible, albeit rarely, to observe aseptic osteomyelitis during psoriasis. This manifests itself in the form of muscle and bone pains not relieved by NSAIDs and is located around the long bones, the anterior thorax, the vertebrae and the mandibles.
Finally, it must not be forgotten that uric acid is increased in more than 30% of psoriatics and that gout is not rare.
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Recent publications on Psoriasis and Atopic Dermatitis
IL-33 contributes to disease severity in Psoriasis-like models of mouse.
Cytokine. 2019 Jul , 119:159-167.
Immune cells infiltrating the psoriatic skin secrete high amounts of pro-inflammatory cytokines IL-17, TNF-α, IL-21 and IL-36 resulting in chronic inflammation. However, the exact cellular and molecular mechanisms have not been fully understood. We report here elevation of IL-33 expression in psoriatic lesions. Studies in imiquimod (IMQ)-induced mice with psoriatic inflammation confirmed a critical role for IL-33 in driving the disease. IL-33 reduces the CD4 and CD8 cells, inhibits autophagy (...)see on pubmed
Association of plasma and urine metals levels with kidney function: A population-based cross-sectional study in China.
Chemosphere. 2019 Jul , 226:321-328.
Although environmental exposure to multiple metals is common, epidemiological studies on the associations of exposure to 23 metals with kidney function have not been analyzed. We aimed to investigate the associations of 23 metals levels with renal function.see on pubmed
Models of human psoriasis: Zebrafish the newly appointed player.
Dev. Comp. Immunol.. 2019 Aug , 97:76-87.
Psoriasis is a human chronic, immune disease with severe cutaneous and systemic manifestations. Its prevalence, among the world population, highly varies with ethnicity and geography, but not sex from remarkable low levels in Asia to 2.3% in Spain, or an impressive 11.5% in Norway. The pathogenesis of psoriasis derives from complex genetic and environmental interactions, which creates aberrant crosstalk between keratinocytes and variated immune cell, resulting in open amplified inflammatory (...)see on pubmed
What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 3: nomenclature and outcome assessment.
Clin. Exp. Dermatol.. 2019 Jun , 44, (4):376-380.
This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It presents the key findings from 11 systematic reviews published in 2016 that focus on AE outcome assessment, disease impact and nomenclature. Systematic reviews on the treatment and prevention of AE are summarized in Part 1 of this update, and systematic reviews on the epidemiology of and risk factors for AE are summarized in Part 2. Six reviews summarized what outcome measurement (...)see on pubmed
Discovery of a class of highly potent Janus Kinase 1/2 (JAK1/2) inhibitors demonstrating effective cell-based blockade of IL-13 signaling.
Bioorg. Med. Chem. Lett.. 2019 Jun 15, 29, (12):1522-1531.
Disruption of interleukin-13 (IL-13) signaling with large molecule antibody therapies has shown promise in diseases of allergic inflammation. Given that IL-13 recruits several members of the Janus Kinase family (JAK1, JAK2, and TYK2) to its receptor complex, JAK inhibition may offer an alternate small molecule approach to disrupting IL-13 signaling. Herein we demonstrate that JAK1 is likely the isoform most important to IL-13 signaling. Structure-based design was then used to improve the (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed