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]
- 2019/06/03 Focus on...News from our SPIN Columbian members
- 2019/05/21 Focus on...SPIN2019 is now available on your screen!
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2019/04/17 Focus on...Do not miss Spin Congress 2019 highlights
- 2018/07/16 Focus on...SPIN Sister Society Meeting at the EADV - 12 September 2018
News from the web office
- 2017/06/05PIN becomes SPIN - Skin Inflammation & Psoriasis International Network
- 2016/10/29PSO 2016 Congress - Webcasts Available!
- 2016/05/26PIN Survey on Phototherapy
- 2016/02/20PIN Study on Therapeutic Patient Education
- 2016/02/19World Directory of Psoriasis Medical Resources - February 2016 Update
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2018/07/16SPIN Symposium at the Spring continental meeting - Tehran, 25-27 April 2018
- 2018/02/222nd National Meeting of the Egyptian Society for Psoriasis
- 2018/02/211st Psoriasis Symposium - Sarajevo 2017
- 2017/06/2815th São Paulo Meeting of Psoriasis and Vitiligo
News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
- 2017/06/21Brazilian Center for Psoriasis Studies joins SPIN!
- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
- 2016/07/29Swiss S1 Guidelines for Systemic treatment of psoriasis vulgaris
News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
- 2016/05/26Senegal Patients Association joins PIN!
- 2015/08/04Epidermia Greece: a new partner association of PIN
- 2015/08/01Canadian Association of Psoriasis Patients joins PIN!
- 2015/04/09AEPSO Argentina launches digital map to find people with psoriasis in the country
Recent publications on Psoriasis and Atopic Dermatitis
Integrated analysis of gene expression profiles identifies transcription factors potentially involved in psoriasis pathogenesis.
J. Cell. Biochem.. 2019 Aug , 120, (8):12582-12594.
Psoriasis is a common inflammatory skin disease mediated by cells and molecules in both the innate and adaptive immune systems. Recently, gene expression profile analysis revealed a large set of immune-related differentially expressed genes (DEGs) in psoriasis. However, the associations between these DEGs and their transcriptional regulation mechanisms have not been completely elucidated. In this study, several psoriasis Gene Expression Omnibus data sets were systematically analyzed using (...)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
A vivid cytokines interaction model on psoriasis with the effect of impulse biologic (TNF-α inhibitor) therapy.
J. Theor. Biol.. 2019 Aug 07, 474:63-77.
Psoriasis is a chronic skin condition that produces plaques of condensed, scaling skin due to excessively rapid proliferation of keratinocytes. During the disease progression, keratinocyte proliferation is influenced by many immune cells and cytokines. This article deals with a five dimensional deterministic model, which has been derived using quasi-steady-state approximation for describing the dynamics of psoriasis in various cytokines environment. Equilibrium analysis of the system shows (...)see on pubmed
Prenatal perfluorooctanoic acid exposure is associated with early onset atopic dermatitis in 5-year-old children.
Chemosphere. 2019 Sep , 231:25-31.
Atopic dermatitis (AD) is the most common childhood skin disease and the first step of atopic march. Perfluoroalkyl substance (PFAS) exposure is associated with atopic diseases, including AD. However, whether PFAS exposure is related to earlier AD onset remains unclear. We aimed to investigate the association between prenatal PFAS exposure and earlier onset of AD in children in a 5-year follow-up study. From 2001 to 2005, 1264 mother-infant pairs were recruited from eight Taiwanese (...)see on pubmed
Synthesis of chitosan derivatives with organoselenium and organosulfur compounds: Characterization, antimicrobial properties and application as biomaterials.
Carbohydr Polym. 2019 Sep 01, 219:240-250.
In this study, Schiff bases of chitosan (CS) were synthesized using citronellal, citral, and their derivatives containing selenium and sulfur. Organoselenium and organosulfur compounds show attractive biological and pharmaceutical activities, which can be beneficial to CS-based materials. From the characterization analyses, it was found that the CS-derivatives containing organoselenium and organosulfur compounds exhibited the highest conversion degrees (23 and 28%). Biological assays were (...)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