Treatment of psoriatic rheumatism can only be undertaken if the diagnosis is certain. This presupposes close collaboration between dermatologist and rheumatologist. The therapeutic strategy shall also be chosen jointly, in order to find the therapeutic solution that best improves the subject’s quality of life taking into account his/her skin and joints.
The treatments available are as follows:
- analgesics and non-steroidal anti-inflammatories;
- infiltrations into joints and synoviorthesis;
- general corticotherapy in small doses, 10 mg or less than 10 mg a day, as basic treatment. Dermatologists prefer to avoid this treatment in fear of exacerbating cutaneous psoriasis, but there is no evidence to support such fears;|Does not agree. We prefer Mtx to steroids and
- Salazopyrin is used at a dose of 2 g a day. It calls for G6PD activity dosage prior to treatment. Above all, it is used to treat peripheral arthritis. Supervision involves a complete blood count and transaminases dosage every month;
- methotrexate is the core treatment of psoriatic arthritis. It is used in cases where Salazopyrin has failed or immediately if progressive psoriatic rheumatism is involved;
- orally administered retinoids (etretinate and acitretin) have some degree of efficacy in psoriatic arthritis. However, this efficacy has never been precisely assessed and it is only registered in doses close to 1 mg per kilo per day, hence with side effects that often make treatment intolerable.
- in the event of difficulties, two new therapeutic options are now available:
- Leflunomide, which inhibits T lymphocyte activation fairly selectively. This drug is given at a dose of 100 mg for three consecutive days. This “attack dose” is followed by maintenance treatment at a dose of 10 or 20 mg a day. Arterial pressure is monitored monthly, as are complete blood count, platelets and transaminases. Diarrhoea is sometimes observed at the start of treatment.
- TNF-alpha inhibitors (etanercept, adalimumab and infliximab). The former is administered subcutaneously at a dose of 25 mg twice a week. The second is administered subcutaneously at a starting dose of 80 mg and thereafter at 40mg every other week. The third is administered intravenously as a slow perfusion at a dose of 5 mg per kilo. This treatment is repeated after two weeks, then four weeks later, then every three months. It is usually combined with small doses of methotrexate once a week. The TNF-alpha inhibitors can reactivate old tuberculosis or chronic infections. They seem to be capable of contributing to the appearance of autoimmunity. They are contraindicated in cases of cardiac insufficiency and their use is avoided in patients suffering from cancer or multiple sclerosis.
Treatment of psoriatic rheumatism with purely axial manifestations is based on non-steroidal anti-inflammatories and TNF-alpha inhibitors. [|Which patients deserve the more expensive new anti-TNF-? drugs etanercept, infliximab, and adalimumab, which gained FDA approval for the treatment of psoriatic arthritis in October, 2005 in the USA versus standard Methotrexate?? These drugs are expensive and yet show dramatic responses in both skin and joint disease, with joint manifestations frequently completely ameliorated within weeks of initiation on anti-TNF-? therapy. Question: Why do joints respond quicker than skin, even with maximum dosages of these drugs? Is it because there’s more TNF-? in the skin than in the joints, or is there a differential in the cellular infiltrate in skin and joints making joints more susceptible to therapy?|auteur215]
Le rhumatisme psoriatique. Th Bardin, Monographie sur le Psoriasis, La Revue du Praticien 2004
[“Psoriatic Rheumatism”. Th. Bardin, Monograph on Psoriasis, La Revue du Praticien, 2004]
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Recent publications on Psoriasis and Atopic Dermatitis
In vitro evaluation of Naltrexone HCl 1% Topical Cream in XemaTop™ for psoriasis.
Arch. Dermatol. Res.. 2020 Mar , 312, (2):145-154.
Psoriasis is a multifactorial skin disease involving abnormal cell proliferation and inflammation; an efficacious topical treatment is yet to be identified. A formulation containing 1% Naltrexone HCl in XemaTop™ base was compounded, characterized and evaluated in vitro as a possible treatment for psoriasis. A three-dimensional psoriasis tissue model was exposed to the formulation for 2 or 5 days and analyzed for the level of markers of cellular proliferation, and inflammatory cytokine IL-6. (...)see on pubmed
Hydrogen peroxide in neutrophil inflammation: Lesson from the zebrafish.
Dev. Comp. Immunol.. 2020 Apr , 105:103583.
The zebrafish has become an excellent model for the study of inflammation and immunity. Its unique advantages for in vivo imaging and gene and drug screening have allowed the visualization of dual oxidase 1 (Duox1)-derived hydrogen peroxide (HO) tissue gradients and its crosstalk with neutrophil infiltration to inflamed tissue. Thus, it has been shown that HO directly recruits neutrophils via the Src-family tyrosine kinase Lyn and indirectly by the activation of several signaling pathways (...)see on pubmed
IL-36α contributes to enhanced T helper 17 type responses in allergic rhinitis.
Cytokine. 2020 Apr , 128:154992.
T helper 17 (Th17) cell subsets, belongs to CD4+ T cell lineage, are proved to be closely related to pathophysiology of AR recently. The interleukin-36 (IL-36) had been reported to promote the up-regulation of Th17 cytokines in psoriasis. We investigated the regulation of Th17 inflammation by IL-36 family cytokines in allergic rhinitis (AR).see on pubmed
Atopic dermatitis induces anxiety- and depressive-like behaviors with concomitant neuronal adaptations in brain reward circuits in mice.
Prog. Neuropsychopharmacol. Biol. Psychiatry. 2020 Mar 02, 98:109818.
Clinically, it has been reported that atopic dermatitis (AD) has been linked with negative emotional problems such as depression and anxiety, thereby reducing the quality of life, but little is known about the molecular mechanism that underlies AD-associated emotional impairments. We sought to determine whether AD could induce anxiety- and depressive-like symptoms in mice and to identify pertinent signaling changes in brain reward circuitry. AD-like lesions were induced by the repeated (...)see on pubmed
Efficacy and safety of indigo naturalis ointment in Treating Atopic Dermatitis: A randomized clinical trial.
J Ethnopharmacol. 2020 Mar 25, 250:112477.
Indigo naturalis, a herbal medicine with a history of use dating back to ancient times, may be a good alternative topical treatment for atopic dermatitis (AD).see on pubmed
"Eczema" of the nape: A marker of pthiriasis capitis.
Parasitol. Int.. 2020 Apr , 75:102026.
Pthirus pubis usually infests the pubis, inguinal folds, buttocks and perianal region. In hairy males or when the infestation is longstanding, this louse can also occur on the thighs, abdomen, chest, axillae and beard. Eyelashes may be involved in children. The involvement of the scalp is very rare. We describe four girls with P. pubis infestation located exclusively on the scalp which was characterized by a rash on the nape that can suggest a head and neck form of atopic (...)see on pubmed