Rheumatology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
Diagnosis: arthritis associated with psoriasis (Fig. 17.14). may closely mimic oligo- or polyarticular JIA.characteristic dactylitis or swelling of toes/fingers (Fig. 17.15) (sausage-shaped). nail pitting and a psoriatic rash (or a firstdegree relative with psoriasis) are part of the diagnostic criteria.psoriasis may occur many years after the onset of arthritis.ANA positive in 50% of patients, with increased risk of chronic anterior uveitis.
Diagnosing Skin Disease
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in Roxburgh's Common Skin Diseases, 2022
The location of dermatologic disease can also be an important determinant of the degree of disability that it causes. Although the severity of most dermatologic conditions is correlated with the body surface area of involvement, even small and localized lesions on the palms and soles can be debilitating given their functional importance. For example, patients with dactylitis in psoriasis and psoriatic arthritis may be unable to work with their hands as effectively, if at all. Plantar warts and clavus can likewise cause discomfort during ambulation, which can limit mobility. Diseases, such as atopic dermatitis, can also cause fissuring around joints, which can result in discomfort with movement and subsequent immobilization.
Rheumatology for general practitioners
Maneesh Bhatia, Tim Jennings in An Orthopaedics Guide for Today's GP, 2017
Typically, these conditions display asymmetrical involvement of the large joints, such as knees and ankles which feature strongly. Upper limb joints can also be affected. Specifically ask for peripheral joint pain and swelling. A history of dactylitis (inflammation and swelling in one or more digits of the hand or foot) is common in this disease subtype. Patients may also complain of inflammatory back pain. This is pain that typically worsens after inactivity and rest, which often improves with exercise and which responds well to non-steroidal anti-inflammatory medication.
Tailored biological treatment for patients with moderate-to-severe psoriasis
Published in Expert Review of Clinical Immunology, 2023
Martina Maurelli, Paolo Gisondi, Giampiero Girolomoni
PsA is the major comorbidity associated with psoriasis characterized by the involvement of different musculoskeletal domains. The prevalence of PsA is around one-third of Caucasian patients with psoriasis, ranging between 6% and 42%, and is highest among patients between 30 and 60 years. The majority of patients first develop psoriasis and only later develop PsA by a median of 8 years, although in 15% of cases, PsA and psoriasis occur simultaneously or PsA precedes cutaneous disease. In many cases, PsA is a mild-to-moderate disease with a fluctuating course, but the risk of development of bone erosion with a disabling form of arthritis is high. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recognized different domains of PsA to suggest a more appropriate treatment to reach the lowest disease activity in each domain. These include peripheral arthritis, axial disease, enthesitis, dactylitis, skin disease, and nail disease. Enthesitis can be found in 30–50% of patients and affects generally the plantar fascia and Achilles’ tendon, causing pain around patella, iliac crest and epicondyles. Dactylitis is observed in 40–50% of patients, involving asymmetrically particularly the third and fourth toes, but also other toes and hands [8–11].
Inner Ear Complications in Children and Adolescents with Sickle Cell Disease
Published in Hemoglobin, 2020
Azza A.G. Tantawy, Safaa W. Ibrahim, Togan T. Abdel-Aziz, Amr N. Rabie, Sara M. Makkeyah, Iman A. Ragab
The membranous labyrinth is supplied by the labyrinthine artery that either arises from the anterior inferior cerebellar artery or as a direct branch of the BA. Whether the flow velocity could be predictive of labyrinthine pathology remains to be answered; vaso-occlusion in patients with sickle cell disease can occur within any organ and the labyrinthine artery has a higher chance of vaso-occlusion due to its small caliber. It is of interest that two out the five patients with abnormal MRI findings had past history of frequent dactylitis in early life. Those two patients also had silent MRI ischemic foci, however, none of them had SNHL. A significant relationship between hearing loss and dactylitis in early childhood was previously reported by other investigators [7], however, they did not investigate the inner ear MRI findings in their study cohort.
Psoriatic arthritis for dermatologists
Published in Journal of Dermatological Treatment, 2020
Alice Gottlieb, Joseph F. Merola
Dactylitis is also measured using multiple approaches (Table 4). The simplest assessment is counting dactylitic digits (tender and non-tender or just tender) (85). Alternative clinical indices include a 0–3 scale of physician-rated severity to assess all 20 digits (86), the Leeds Dactylitis Index (LDI), and LDI-Basic (87,88). The LDI and LDI-Basic multiply the tenderness score of each affected digit (based on the Ritchie index – graded 0–3 for LDI or binary score for LDI-Basic) by the ratio of the circumference of the affected digit to the circumference of the digit on the opposite hand or foot. Results from clinical trials using these indices to evaluate the effects of treatment on dactylitis are summarized in Table 5. Drugs that have shown statistically significant improvements in dactylitis indices compared with placebo include infliximab, certolizumab pegol, intravenous golimumab, subcutaneous golimumab 100 mg, ustekinumab, guselkumab, secukinumab, and ixekizumab. Statistical significance was not reached or was not tested for in trials of adalimumab, etanercept, tofacitinib, apremilast, and abatacept. It is not possible to indirectly compare results across trials because different clinical indices and different reporting methods were used to assess dactylitis across studies. At present, there is no consensus on the best method for assessing dactylitis in PsA clinical trials, and minimal clinically important difference (MCID) thresholds have not been established for available dactylitis indices.
Related Knowledge Centers
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- Sarcoidosis
- Spondyloarthropathy
- Leprosy
- Tuberculosis
- Sickle Cell Disease
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