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<!—[endif]- - 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
on Psoriasis
Discovery of benzo[f]pyrido[4,3-b][1,4]oxazepin-10-one derivatives as orally available bromodomain and extra-terminal domain (BET) inhibitors with efficacy in an in vivo psoriatic animal model.
Bioorg Med Chem.
2021 Mar 15, 34:116015.
Bromodomain and extra-terminal domain (BET) protein plays an important role in epigenetic regulation, and the regulation of disruption contributes to the pathogenesis of cancer and inflammatory disease. With the goal of discovering novel BET inhibitors, especially BRD4 inhibitors, we designed and synthesized several compounds starting from our previously reported pyrido-benzodiazepinone derivative 4 to enhance BRD4 inhibitory activity while avoiding hERG inhibition. Molecular docking (...)
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 (...)
see on pubmed
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
Psychiatric and Nonpsychiatric Comorbidities Among Children With ADHD: An Exploratory Analysis of Nationwide Claims Data in Germany.
J Atten Disord.
2021 Apr , 25, (6):874-884.
This study examined the full spectrum of comorbid disorders in all statutory-health-insured children aged 5 to 14 years with ADHD in 2017 by using nationwide claims data in Germany. Children with ADHD ( = 258,662) were compared for the presence of 864 comorbid diseases with a control group matched by gender, age, and region of residence ( = 2,327,958). Among others, metabolic disorders (odds ratio [OR] = 9.18; 95% confidence interval [CI] = [8.43, 9.99]), viral pneumonia (OR = 4.95; 95% (...)
see on pubmed
Qingxue jiedu formulation ameliorated DNFB-induced atopic dermatitis by inhibiting STAT3/MAPK/NF-κB signaling pathways.
J Ethnopharmacol.
2021 Apr 24, 270:113773.
Qingxue jiedu Formulation (QF) is composed of two classic prescriptions which have been clinically used for more than 5 centuries and appropriately modified through basic theory of traditional Chinese medicine for treating various skin inflammation such as atopic dermatitis (AD), acute dermatitis and rash. Although QF possesses a prominent clinical therapeutic effect, seldom pharmacological studies on its anti-AD activity are (...)
see on pubmed
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 (...)
see on pubmed