Psoriatic Arthritis Cases Research Articles

乾せん性関節炎により両側人工股関節置換術に至った２例

Psoriatic arthritis (PsA) is a psoriasis-associated inflammatory arthritis that is usually seronegative for rheumatoid factor. In Japan, the prevalence of PsA in general population ranges from 0.02 to 0.04%. We report two cases of PsA who under went total hip arthroplasty of both hips. It is a known fact that, patients with PsA have higher infection rates after total arthroplasty. Precautions are thus required in the preoperative as well as postoperative periodto prevent joint sepsis. In particular, the use of a topical corticosteroid or other dermatologic treatment should be considered for skin protection in total joint arthroplasty.

Arthrodèses du poignet pour arthropathie inflammatoire: Influence de la fusion des interlignes intra-carpiens sur le résultat fonctionnel

We retrospectively analysed 25 wrist arthrodeses performed in 23 patients because of inflammatory joint disease (21 rheumatoid arthritis, 1 case of Still's disease, 1 case of psoriatic arthritis) to assess: 1) the functional result, the position and the fusion rate; 2) the correlation between the radiographic features and the results on pain. The results were evaluated after an average of 56 months (12-121) by an observer not involved in surgery. 8 wrists were pain-free, 12 caused occasional pain, 4 caused frequent pain and 1 wrist was responsible for continuous pain at follow-up. The position of the arthrodesis was acceptable in the sagittal plane (mean extension 4.3 degrees), but with a slight ulnar tilt (mean ulnar tilt 12.8 degrees). Fusion was achieved in all cases after a mean of 8.2 weeks (5-16). All the intracarpal joints had united in only 8 cases, while the scaphotrapezo-trapezoid joint had not united in 17 cases, but fusion was spontaneously obtained in 8 cases. We identified 5 non-unions between lunatum and triquetrum, 5 non-unions between hamatum and capitatum and 3 non-unions between triquetrum and hamatum. Pain at follow-up was related to non-union of triquetro-lunate joints (p = 0.035). Wrist arthrodesis remains appropriate for severe lesions of the rheumatoid wrist in order to restore function and relieve pain.

Psoriatic arthritis and synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome.

Psoriatic arthritis is an inflammatory arthropathy associated with psoriasis, and its clinical presentation varies from case to case. Distal interphalangeal involvement is characteristic but not seen in all patients. Enthesopathy, including that of the spine, is common and contributes to the classification of psoriatic arthritis as a seronegative spondyloarthropathy. The etiopathogenesis of psoriatic arthritis is not well understood, and evolution as measured by follow-up is variable. Treatment includes nonsteroidal anti-inflammatory drugs and some of the drugs used in the treatment of rheumatoid arthritis. Sulfasalazine and, in the more severe cases, cyclosporine, are being studied for efficacy and tolerance. Some cases of psoriatic arthritis are associated with an inflammatory bone disease, frequently seen on the anterior chest wall, which is part of the newly described SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. SAPHO syndrome is characterized by this bone involvement, which can affect the spine and peripheral bones. Various skin conditions are associated with this syndrome, but they do not necessarily occur in all cases. Chronic recurrent multifocal osteomyelitis, which is seen mostly in children, may be a presentation of SAPHO syndrome. Associations with sacroiliitis, bowel disease, and psoriasis link SAPHO syndrome with the spondyloarthropathies.

Psoriatic arthropathy of the temporomandibular joint

A case of psoriatic arthritis of both temporomandibular joints is described with a brief review of the literature and discussion on the management of this condition. To date, psoriatic arthritis has been successfully treated by conservative means. In the case reported, surgical replacement of the condyles became necessary to eliminate pain and restore function.

Contrast sensitivity and visual disability in chronic simple glaucoma.

A battery of vision tests was used to quantify visual defect in a group of 50 patients with chronic simple glaucoma. The vision tests were near and distance visual acuity, visual fields, and contrast sensitivity to static and temporally modulated sinusoidal grating patterns. Of these, static contrast sensitivity function appears to be the most sensitive method of measuring visual defect in glaucoma patients. The visual disability experienced by the glaucoma patients was quantified by means of a questionnaire, and the relationship between perceived visual disability and visual defect was examined. It was found that results from a group of tests, near visual acuity, visual field, and contrast sensitivity measures, are the best predictors of the difficulty experienced by patients in performing visually dependent daily activities.

Study of enzyme inhibitors in the rheumatoid pannus-cartilage area.

Immunoperoxidase studies were carried out on the pannus-cartilage junction (PCJ) of patients with rheumatoid arthritis (RA) and psoriatic arthritis to investigate the distribution of the enzyme inhibitors alpha 2 macroglobulin (alpha 2 M) and alpha 1 antitrypsin (alpha 1 AT). Comparisons were made with the equivalent synovial cartilage junctional area in osteoarthritis (OA). In all 12 patients with RA, prominent deposits of alpha 2 M and alpha 1 AT were found within the PCJ whereas in OA patients and the case of psoriatic arthritis fewer or no deposits were seen. Inhibitors were localised in pannus synovial lining cells, perivascular inflammatory cells, macrophage and fibroblast-like cells invading the cartilage as well as along the junctional cartilage matrix and in the adjacent pannus-free cartilage. Deposits of immunoglobulins were found in similar areas to enzyme inhibitors. The presence of enzyme inhibitors at the PCJ suggests that this area is not unprotected against enzymatic attack. Thus the concept that pannus is a prime area for cartilage damage because aggressive, invasive cells release destructive enzymes in an environment free from inhibitors should be reviewed.

Metacarpal shortening

A case of Psoriatic Arthritis with disabling flexion deformities at the metacarpo-phalangeal joints of the fingers is described. Skeletal shortening decreased the deformity and improved the function.

Psoriatic arthritis in a child.

AbstractPresented is a case of psoriatic arthritis in a child. A detailed report of this entity has not previously been published. The similarity between this patient's disease and psoriatic arthritis in adults is discussed.

PSORIATIC ARTHRITIS

A case of psoriatic arthritis is presented showing changes in the hands. The pathological and radiological changes are discussed. The differential diagnosis is mentioned.

Centipede Bites

<h3>Background</h3> Obesity is associated with an increased risk of psoriasis; however, its potential impact on the risk of psoriatic arthritis (PsA) remains unclear. <h3>Objectives</h3> To evaluate the association between body mass index (BMI) and the risk of PsA among patients with psoriasis from the general population. <h3>Methods</h3> The authors conducted a cohort study using data from The Health Improvement Network, an electronic medical records database representative of the UK general population, collected between 1995 and 2010. The exposure of interest was the first BMI measured after psoriasis diagnosis and endpoints were incident cases of physician-diagnosed PsA. The authors estimated the RR of PsA after adjusting for age, sex, and histories of trauma, smoking and alcohol consumption. <h3>Results</h3> Among 75 395 individuals with psoriasis (43% male, mean follow-up of 5 years, and mean age of 52 years), 976 developed PsA (incidence rate, 26.5 per 10 000 person-years). The PsA incidence rates increased with increasing BMI. Compared with psoriasis patients with BMI &lt;25 kg/m², the RRs for developing PsA were 1.09 (0.93–1.28) for BMIs from 25.0 to 29.9, 1.22 (1.02–1.47) for BMIs from 30.0 to 34.9 and 1.48 (1.20–1.81) for BMIs ≥35.0. In our secondary analysis among all individuals, regardless of psoriasis (∼2 million), the corresponding multivariate RRs tended to be stronger (1.0, 1.17, 1.57, 1.96; p for trend &lt;0.001). <h3>Conclusions</h3> This general population study suggests that obesity is associated with an increased risk of incident PsA and supports the importance of weight reduction among psoriasis patients who often suffer from the metabolic syndrome and obesity.