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
In silico data mining of large-scale databases for the virtual screening of human interleukin-2 inhibitors.
Acta Pharm.
2021 Mar 01, 71, (1):33-56.
Interleukin-2 (IL-2) is involved in the activation and differentiation of T-helper cells. Uncontrolled activated T cells play a key role in the pathophysiology by stimulating inflammation and autoimmune diseases like arthritis, psoriasis and Crohn's disease. T cells activation can be suppressed either by preventing IL-2 production or blocking the IL-2 interaction with its receptor. Hence, IL-2 is now emerging as a target for novel therapeutic approaches in several autoimmune disorders. This (...)
see on pubmed
Clinical trait-connected network analysis reveals transcriptional markers of active psoriasis treatment with Liangxue-Jiedu decoction.
J Ethnopharmacol.
2021 Mar 25, 268:113551.
Psoriasis is a complex recurrent inflammatory skin disease with different pathological changes in different stages. Psoriasis in its active stage, which is comparable to the blood-heat type in traditional Chinese medicine (TCM), has been treated by Liangxue Jiedu Decoction (LJD) in TCM for decades, with proven efficacy. According to TCM theories, LJD has the function of removing heat and pathogenic factors from the (...)
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Catalpol ameliorates psoriasis-like phenotypes via SIRT1 mediated suppression of NF-κB and MAPKs signaling pathways.
Bioengineered.
2021 Dec , 12, (1):183-195.
Psoriasis is a chronic inflammatory skin disease that affects approximately 2% of worldwide population, and causing long-term troubles to the patients. Therefore, it is urgent to develop safe and effective therapeutic drugs. Catalpol is a natural iridoid glucoside, that has several remarkable pharmacological effects, however, whether catalpol can alleviated psoriasis has not been explored. The goal of the present work is to study the role of catalpol in psoriasis in vivo and in vitro. (...)
see on pubmed
on Atopic Dermatitis
IL-13 antagonists in the treatment of atopic dermatitis.
Tubau C et al.
IL-13 antagonists in the treatment of atopic dermatitis.
Immunotherapy.
2021 Mar , 13, (4):327-344.
Atopic dermatitis (AD) is a prevalent inflammatory skin disease. IL-13 contributes significantly to the pathogenesis of AD in several ways, and beneficial results have been demonstrated with anti-IL-13 therapies. Currently, the only monoclonal antibody (mAb) approved for AD treatment is dupilumab, an antagonist of the IL-4 receptor alpha (IL-4Rα) subunit common to IL-4 and IL-13 receptors, but clinical trials evaluating anti-IL-13 mAbs are providing promising results. The topics of this (...)
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Efficacy of Dupilumab in Concomitant Atopic Dermatitis and Chronic Rhinosinusitis With Nasal Polyps: A Preliminary Study.
Allergy Asthma Immunol Res.
2021 Mar , 13, (2):347-349.
Methicillin-resistant from infected skin lesions present several virulence genes and are associated with the CC30 in Brazilian children with atopic dermatitis.
Virulence.
2021 Dec , 12, (1):260-269.
Atopic dermatitis (AD) is a chronic inflammatory skin disease and colonization by may affect up to 100% of these patients. Virulent and resistant isolates can worsen AD patient clinical condition and jeopardize the treatment. We aimed to detect virulence genes and to evaluate the biofilm production of isolates from infected skin lesions of children with AD. Methicillin resistance was detected by phenotypic and molecular tests and the virulence genes were detected by PCR. Biofilm formation (...)
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