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.
SPIN Presentation
Recent news
- 2019/08/12 Focus on...
Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis
- 2019/06/03 Focus on...
- 2019/05/21 Focus on...
- 2019/04/18 Focus on...
- 2019/04/17 Focus on...
News from the web office
- 2016/10/29
- 2016/05/26
- 2016/02/20
Events
- 2019/04/18 Focus on...
- 2018/02/21
News from medical groups
- 2018/04/18
- 2017/06/21
News from patients associations
- 2017/02/08
- 2016/05/26
Recent publications on Psoriasis and Atopic Dermatitis
on Psoriasis
JAK-inhibitors in dermatology: current evidence and future applications.
Ciechanowicz P et al.
JAK-inhibitors in dermatology: current evidence and future applications.
J Dermatolog Treat.
2019 Nov , 30, (7):648-658.
The Janus kinase (JAK) and signal transducer and activator of transcription (STAT) pathway is a ubiquitous intracellular signaling network. Selective JAK-inhibitors have anti-inflammatory properties and have been approved in many countries for the treatment of rheumatoid arthritis (tofacitinib, baricitinib) and myelofibrosis or polycythemia vera (ruxolitinib). The aim of the publication was to summarize and critically analyze the efficacy and safety of JAK-inhibitors in skin diseases, such (...)
see on pubmed
Patient preferences for attributes of topical anti-psoriatic medicines.
Vasconcelos V et al.
Patient preferences for attributes of topical anti-psoriatic medicines.
J Dermatolog Treat.
2019 Nov , 30, (7):659-663.
Patient preferences should be considered when prescribing topical treatments to drive up adherence and improve clinical outcomes. The aim of this work was to identify the most important attributes of topical medicines for psoriasis treatment in the patients' view, and explore the sociodemographic and clinical determinants of these preferences. A questionnaire for the evaluation of the relevancy given to specific attributes of topical medicines used for psoriasis treatment was developed (...)
see on pubmed
Salidroside inhibits MAPK, NF-κB, and STAT3 pathways in psoriasis-associated oxidative stress via SIRT1 activation.
Redox Rep..
2019 Dec , 24, (1):70-74.
To unveil the role of SIRT1 in limiting oxidative stress in psoriasis and to further discuss the therapeutic prospects of salidroside in psoriasis. Literature from 2002 to 2019 was searched with "psoriasis", "oxidative stress", "SIRT1", "salidroside" as the key words. Then, Oxidative stress in psoriasis and the role of SIRT1 were summarized and the potential role of salidroside in the disease was speculated. Oxidative stress might contribute to the pathogenesis of psoriasis. High levels (...)
see on pubmed
on Atopic Dermatitis
A case of infective endocarditis associated with atopic dermatitis perioperatively treated with dupilumab.
J Dermatolog Treat.
2019 Nov , 30, (7):674-676.
Several case reports and reviews support a relationship between atopic dermatitis (AD) and infective endocarditis (IE). Here, we present a case of severe AD suspected of causing IE. A 21-year-old man with severe AD was admitted to our hospital due to unidentified fever, syncope, and headache. He was diagnosed with IE with cerebral embolism and mitral regurgitation. Before elective cardiac surgery, he was subcutaneously administered dupilumab for 2 months to control AD. Dupilumab improved (...)
see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
Choi EJ et al.
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
Sublingual immunotherapy of atopic dermatitis in mite-sensitized patients: a multi-centre, randomized, double-blind, placebo-controlled study.
Artif Cells Nanomed Biotechnol.
2019 Dec , 47, (1):3540-3547.
Allergen-specific immunotherapy is widely used for allergic rhinitis and asthma treatment worldwide. This study explored the efficacy and safety of sublingual immunotherapy (SLIT) with the extracts of ( Drops) on house dust mites (HDM)-induced atopic dermatitis (AD). 239 patients with HDM-induced AD were recruited and exposure to a multi-centre, randomized, double-blind, and placebo-controlled clinical trials for 36 weeks, which were randomly divided into placebo and sublingual Drops (...)
see on pubmed
