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Psoriasis and lichen planus
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
It has been seen that psoriasis results in systemic inflammation which results in the following:Arthritis: the various types of presentation are given in Table 9.2. Psoriatic arthritis can range from mild inflammation to a severe mutilating form known as arthritis mutilans (Figure 9.11). The rheumatoid factor is absent in this arthritis and it is accompanied with tendon, ligament, and joint capsule inflammations (enthesitis) and dactylitis.Inflammatory bowel diseaseCardiovascular disease: psoriasis has been known to cause an increase in CRP levels and BMI, resulting in hyperlipidemia and increased waist circumference which increases the risk of an adverse cardiovascular event.Depression
Musculoskeletal (including trauma and soft tissues)
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Multicentric reticulohistiocytosis results in widespread, symmetrical and progressive arthropathy, beginning in the wrists and interphalangeal joints, and spreading to the metacarpophalangeal joints. Erosions tend to be large and punched out. Arthritis mutilans may result.
Practice Paper 2: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Psoriatic arthritis affects 5% of patients with psoriasis, but it may precede the onset of skin symptoms. It is more common in psoriasis patients who have nail disease (e.g. onycholysis and nail pitting). Psoriatic arthritis is characterized by distal interphalangeal joint involvement and dactylitis (sausage-shaped swelling of the fingers from inflammation). Arthritis mutilans is a severe form of psoriatic arthritis where there is destruction of the small bones of the hand, resulting in shortening of the fingers. The shortened fingers can be passively extended to their original length (telescoping). An X-ray of the hand in arthritis mutilans demonstrates central joint erosions in the interphalangeal joints, resulting in a ‘pencil in cup’ appearance. Although the hand may look significantly deformed, functional ability is well preserved.
Efficacy and safety of adalimumab in Japanese patients with psoriatic arthritis and inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs): A prospective, observational study
Published in Modern Rheumatology, 2020
Akimichi Morita, Ryuhei Okuyama, Norito Katoh, Chiharu Tateishi, Koji Masuda, Toshifumi Komori, Eisaku Ogawa, Takamitsu Makino, Emi Nishida, Shohei Nishimoto, Kenzo Muramoto, Daisuke Tsuruta, Hironobu Ihn
Of 42 enrolled patients, 39 were included in the study (Figure 1). Three patients were excluded as they did not meet the inclusion criteria (not meeting the CASPAR criteria, n = 1; not having received treatment at a stable dose of NSAIDs, DMARDs, or oral corticosteroids for at least 4 weeks before study start, n = 2). Of these, 37 patients were treated (analysis population), and 33 completed the study. Among the analysis population, mean (SD) age was 56.2 (13.0) years and most (73.0%) patients were male (Table 1). Mean duration of PsA was 119.4 (99.8) months, and mean number of tender and swollen joints was 10.7 (12.3) and 10.8 (11.1), respectively. Twenty-nine (78.4%) patients had comorbidities. All patients used concomitant medications, most commonly NSAIDS (22 (59.5%)), followed by DMARDs (10 (27.0%)) and biologics (9 (24.3%)). According to the Moll and Wright classification [26], many patients had symmetric polyarthritis (11 (29.7%)), distal interphalangeal arthropathy (9 (24.3%)), or asymmetric oligoarthritis and spondylitis (8 (21.6%) each). Only one (2.7%) patient had arthritis mutilans. More than half of patients had inflammation of fingers (right, 20 (54.1%); left, 21 (56.8%)), spondylitis (20 (54.1%)), and inflammation of cervical spine (20 (54.1%)). In patients with previous use of biologics (n = 9), the mean (SD) tender and swollen joint counts were numerically lower than those in patients without previous use of biologics (n = 28): 7.9 (7.9) and 8.4 (6.2), respectively, vs. 11.6 (13.3) and 11.5 (12.2), respectively. Mean (SD) duration of PsA was comparable between patients with and without previous use of biologics: 128.3 (69.1) vs. 116.5 (108.7) months.