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
on Psoriasis
UV spectrophotometric method for simultaneous estimation of betamethasone valerate and tazarotene with absorption factor method: Application for in-vitro and ex-vivo characterization of lipidic nanocarriers for topical delivery.
Spectrochim Acta A Mol Biomol Spectrosc.
2020 Jul 05, 235:118310.
The present study elucidates the development of an accurate, precise and simple simultaneous estimation method for the routine analysis of Betamethasone Valerate (BV) and Tazarotene (TZ). This combination is widely used in the treatment of psoriasis. No method has been reported so far for the simultaneous estimation of BV and TZ in topical dosage forms. The method proposed by this study for the quantification of BV and TZ is the Absorption factor method. The developed method was validated (...)
see on pubmed
Sensing of endogenous nucleic acids by ZBP1 induces keratinocyte necroptosis and skin inflammation.
J. Exp. Med..
2020 Jul 06, 217, (7).
Aberrant detection of endogenous nucleic acids by the immune system can cause inflammatory disease. The scaffold function of the signaling kinase RIPK1 limits spontaneous activation of the nucleic acid sensor ZBP1. Consequently, loss of RIPK1 in keratinocytes induces ZBP1-dependent necroptosis and skin inflammation. Whether nucleic acid sensing is required to activate ZBP1 in RIPK1-deficient conditions and which immune pathways are associated with skin disease remained open questions. Using (...)
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Tackling the various classes of nano-therapeutics employed in topical therapy of psoriasis.
Drug Deliv.
2020 Dec , 27, (1):662-680.
Psoriasis is a dermatological chronic skin condition with underlying autoimmune etiology. It deeply affects patients' quality of life. Therefore, it was an interesting target for researchers throughout the past years. Conventionally, the treatment options include anti-inflammatory agents, immune suppressants, biologic treatment, and phototherapy. Nanotechnology offers promising characteristics that allow for tailoring a drug carrier to achieve dermal targeting, improved efficacy and (...)
see on pubmed
on Atopic Dermatitis
Physiology and Pathophysiology of Itch.
Cevikbas F et al.
Physiology and Pathophysiology of Itch.
Physiol. Rev..
2020 Jul 01, 100, (3):945-982.
Itch is a topic to which everyone can relate. The physiological roles of itch are increasingly understood and appreciated. The pathophysiological consequences of itch impact quality of life as much as pain. These dynamics have led to increasingly deep dives into the mechanisms that underlie and contribute to the sensation of itch. When the prior review on the physiology of itching was published in this journal in 1941, itch was a black box of interest to a small number of neuroscientists (...)
see on pubmed
Correction to: Atopic dermatitis and autoimmunity: the occurrence of autoantibodies and their association with disease severity.
Arch. Dermatol. Res..
2020 Jul , 312, (5):393.
Two of the references included in this review concern antigens derived from the fungus Malassezia globosa that have also been found in human sweat.
see on pubmed
Update on canine filaggrin: a review.
Combarros D et al.
Update on canine filaggrin: a review.
Vet Q.
2020 Dec , 40, (1):162-168.
Human filaggrin (FLG) plays a key role in epidermal barrier function, and loss-of-function mutations of its gene are primarily responsible for the development of human atopic dermatitis (AD). FLG expression is also reduced in the epidermis of atopic patients, due to the transcriptional effect of Th2 type cytokines. Canine atopic dermatitis (CAD) is a prevalent skin disease that shares many clinical and pathogenic features with its human homologue. The aim of this review is discuss current (...)
see on pubmed
