DOCSLIB.ORG

Tumour Necrosis Factor (TNF) in Psoriatic Arthritis: Pathophysiology and Treatment with TNF Inhibitors P J Mease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Tumour Necrosis Factor (TNF) in Psoriatic Arthritis: Pathophysiology and Treatment with TNF Inhibitors P J Mease 298 REVIEW Ann Rheum Dis: first published as 10.1136/ard.61.4.298 on 1 April 2002. Downloaded from Tumour necrosis factor (TNF) in psoriatic arthritis: pathophysiology and treatment with TNF inhibitors P J Mease ............................................................................................................................. Ann Rheum Dis 2002;61:298–304 High levels of proinflammatory cytokines, including hyperproliferation of psoriasis.12 The cytokines tumour necrosis factor (TNF), have been detected in produced in response to immune activation are also critical contributors to disease pathogenesis. psoriatic skin lesions and joints of patients with the For example, proinflammatory cytokines such as inflammatory disease. Early results of treatment of TNF are found in high levels in the skin lesions psoriatic arthritis and psoriasis with TNF neutralising and plasma of patients with psoriasis.13 In some cases, psoriasis may be triggered by environmen- agents are encouraging, but whether these agents will tal stimuli, such as streptococcal or other infec- be able to improve long term outcomes, such as tion, trauma, or certain drugs.11 14 disability, is not yet known. .......................................................................... “Multiple genetic, immunological, and environmental factors have been implicated in the pathogenesis of PsA.” Agents that neutralise tumour necrosis factor (TNF), a proinflammatory cytokine, have recently Why a subset of patients with psoriasis also been shown to relieve the signs and symptoms of experience PsA joint manifestations is not psoriatic arthritis (PsA).12 The mechanism by known. In approximately 75% of patients with which these agents provide this benefit is related PsA, the appearance of skin lesions precedes to the role of TNF in this chronic inflammatory arthritic symptoms. About 10–15% of patients arthritis. Psoriatic arthritis virtually always have simultaneous onset of psoriasis and PsA, occurs in patients with psoriasis, which is present and another 10–15% show signs of characteristic in 1–3% of the general population.34From 5% to PsA before developing psoriasis. The onset of PsA over 30% of patients with psoriasis develop is typically between 30 and 55 years of age, but a PsA.3 5–7 Although PsA was once considered juvenile form may strike children younger than benign, recent studies have shown that even 5 16. Men and women are equally affected. http://ard.bmj.com/ actively treated patients can have significant joint PsA may have a variety of clinical features that damage and deformity.8 One study showed that can overlap with one another in presentation. 57% of patients had erosive arthritis, and 19% Patients with PsA may present with asymmetrical displayed moderate to severe functional oligoarthritis (fewer than five affected joints); impairment.9 The pathogenesis of PsA remains symmetrical or asymmetrical polyarthritis (five or unclear; however, evidence suggests that disease more affected joints); distal interphalangeal progression is predicted by significant inflamma- 10 (DIP) joint involvement; arthritis mutilans, a tion early in the course of the disease. on September 26, 2021 by guest. Protected copyright. rare, severely deforming type of arthritis (fig 1); FEATURES AND CONSEQUENCES OF and an ankylosing spondylitis-like inflammatory arthritis affecting the spine.31516 Polyarthritis in PSORIASIS AND PSA PsA may be similar to rheumatoid arthritis (RA) The skin lesions of the major form of psoriasis, and is asymmetrical in about half of cases.15 The plaque psoriasis, are typically erythematous pa- onset and relative severity of PsA may not corre- pules topped by a silvery white scale. Other late with the onset and severity of psoriasis in any disease variants include guttate, pustular, and given patient.17 erythrodermic psoriasis. Generally, psoriasis be- Because of its heterogeneous nature, PsA may gins to appear in patients between the ages of 20 be difficult to differentiate from other forms of and 50 years. The papules coalesce to form inflammatory arthritis. Most patients are sero- plaques of varying shapes and patterns, especially negative for rheumatoid factor, so PsA is classified on the elbows, knees, scalp, groin, and nails. as a seronegative spondyloarthropathy, a category Although the cause and pathogenesis of that includes ankylosing spondylitis, Reiter’s dis- psoriasis are unknown, genetic factors, immuno- ....................... ease, and enteropathic arthropathies. However, logical factors, and environmental agents are rheumatoid factor is sometimes found in patients Correspondence to: believed to have a role.11 Certain HLA antigens are ProfessorPJMease, associated with psoriasis, particularly HLA-Cw6 Seattle Rheumatology in white subjects and HLA-A1 and HLA-DR1 in Associates, 1101 Madison ................................................. St, Seattle, WA 98104, Asians, but considerable genetic heterogeneity Abbreviations: DIP, distal interphalangeal; DMARDs, USA; pmease@ exists in these loci among patients with u.washington.edu psoriasis.11 Activation of T lymphocytes, antigen disease modifying antirheumatic drugs; IM, intramuscular; MTX, methotrexate; NSAIDs, non-steroidal presenting cells, and adhesion molecules through Accepted anti-inflammatory drugs; PASI, Psoriasis Area and Severity 15 October 2001 autoimmune mechanisms is believed to play a Index; PsA, psoriatic arthritis; RA, rheumatoid arthritis; ....................... key, probably overlapping, role in the epidermal SSZ, sulfasalazine; TNF, tumour necrosis factor www.annrheumdis.com Tumour necrosis factor in psoriatic arthritis 299 Ann Rheum Dis: first published as 10.1136/ard.61.4.298 on 1 April 2002. Downloaded from Figure 1 Distal interphalangeal joint involvement in the fingers of a patient with arthritis mutilans, a severe form of psoriatic arthritis. with PsA, which complicates the task of distinguishing between PsA and RA, especially as PsA may occur before the appearance of psoriasis symptoms.18 Five clinical subgroups of PsA have been proposed by Moll and Wright: (a) arthritis of DIP joints, (b) arthritis mutilans, (c) symmetrical arthritis Figure 2 Tumour necrosis factor (TNF) expression in a synovial similar to RA but with negative rheumatoid factor, (d) asym- membrane section from an affected joint of a patient with a severe form of psoriatic arthritis, arthritis mutilans (original magnification metrical pauciarticular arthritis with dactylitis, and (e) anky- × 10 16 600). The section was stained with a monoclonal antibody to TNF. losing spondylitis with or without peripheral arthritis. Reproduced from Danning et al, 200027 with permission. Unfortunately, the sensitivity of these criteria is low,19 leading to suggestions that the criteria should be updated.19 20 The definitive diagnosis of PsA remains a complex issue. seen in patients with RA. This difference may be attributed to PsA can result in severe deformity and functional impair- reduced trafficking of immune cells in the joints of patients ment. In one prospective study, 57% of patients were found to with PsA as compared with those with RA, possibly owing to have erosive arthritis, resulting in moderate to severe reduced expression of the adhesion molecule E-selectin in the 24 functional impairment in 19%, at the time of referral to the synovial membranes of patients with PsA. rheumatology clinic.9 Inflammation early in the course of the Cytokines derived primarily from monocytes/macrophages, disease appears to be a significant predictor of disease such as TNF, interleukin 1, interleukin 6, and interleukin 8, are progression. A 14 year prospective study found that a high raised in the synovial fluid and membranes of affected joints 13 26–28 number of effusions upon first presentation at a PsA clinic (fig 2) and in synovial explants. Although most studies correlated with future progression of joint damage, and a low have found that the levels of these cytokines are somewhat erythrocyte sedimentation rate correlated with little disease lower than those found in the joints of patients with RA, the progression.10 The majority of PsA-induced joint damage overall pattern of cytokine expression is similar, suggesting appears to occur early in the course of disease, as indicated by that these intracellular messengers may be general mediators 26 27 the fact that the rate of disease progression slows over time.8 of joint inflammation and destruction. Cytokines produced Although the underlying damage may occur early, the course by the T helper 1 (Th1) subpopulation (for example, http://ard.bmj.com/ γ α of PsA is typically one of cumulatively increasing numbers of interleukin 2, interferon , and lymphotoxin ) are also raised 28 29 affected joints over time. A prospective evaluation found that in the synovial fluids and tissues of patients with PsA. the proportion of patients with five or more damaged joints These results suggest that complex interactions between T doubled from 19% to 41% during the five year study.8 cells and monocytes/macrophages help drive the pathogenesis of PsA.28 PATHOGENESIS As with psoriasis, environmental factors, such as viral and As with psoriasis, multiple genetic, immunological, and envi- bacterial infections, have been implicated in the pathogenesis on September 26, 2021 by guest. Protected copyright. 11 ronmental factors have been implicated in the pathogenesis of of PsA. High levels of antibodies to a streptococcal exotoxin PsA. Immunogenetic phenotyping has disclosed associations and to peptidoglycans, cell
Load more

Recommended publications
  • Conditions Related to Inflammatory Arthritis
    Conditions Related to Inflammatory Arthritis There are many conditions related to inflammatory arthritis. Some exhibit symptoms similar to those of inflammatory arthritis, some are autoimmune disorders that result from inflammatory arthritis, and some occur in conjunction with inflammatory arthritis. Related conditions are listed for information purposes only. • Adhesive capsulitis – also known as “frozen shoulder,” the connective tissue surrounding the joint becomes stiff and inflamed causing extreme pain and greatly restricting movement. • Adult onset Still’s disease – a form of arthritis characterized by high spiking fevers and a salmon- colored rash. Still’s disease is more common in children. • Caplan’s syndrome – an inflammation and scarring of the lungs in people with rheumatoid arthritis who have exposure to coal dust, as in a mine. • Celiac disease – an autoimmune disorder of the small intestine that causes malabsorption of nutrients and can eventually cause osteopenia or osteoporosis. • Dermatomyositis – a connective tissue disease characterized by inflammation of the muscles and the skin. The condition is believed to be caused either by viral infection or an autoimmune reaction. • Diabetic finger sclerosis – a complication of diabetes, causing a hardening of the skin and connective tissue in the fingers, thus causing stiffness. • Duchenne muscular dystrophy – one of the most prevalent types of muscular dystrophy, characterized by rapid muscle degeneration. • Dupuytren’s contracture – an abnormal thickening of tissues in the palm and fingers that can cause the fingers to curl. • Eosinophilic fasciitis (Shulman’s syndrome) – a condition in which the muscle tissue underneath the skin becomes swollen and thick. People with eosinophilic fasciitis have a buildup of eosinophils—a type of white blood cell—in the affected tissue.
    [Show full text]
  • Still Disease
    University of Massachusetts Medical School eScholarship@UMMS Open Access Articles Open Access Publications by UMMS Authors 2019-02-17 Still Disease Juhi Bhargava Medstar Washington Hospital Center Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/oapubs Part of the Immune System Diseases Commons, Musculoskeletal Diseases Commons, Pathological Conditions, Signs and Symptoms Commons, Skin and Connective Tissue Diseases Commons, and the Viruses Commons Repository Citation Bhargava J, Panginikkod S. (2019). Still Disease. Open Access Articles. Retrieved from https://escholarship.umassmed.edu/oapubs/3764 Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Articles by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Still Disease Juhi Bhargava; Sreelakshmi Panginikkod. Author Information Last Update: February 17, 2019. Go to: Introduction Adult Onset Still's Disease (AOSD) is a rare systemic inflammatory disorder characterized by daily fever, inflammatory polyarthritis, and a transient salmon-pink maculopapular rash. AOSD is alternatively known as systemic onset juvenile idiopathic arthritis. Even though there is no specific diagnostic test, a serum ferritin level more than 1000ng/ml is common in AOSD. Go to: Etiology The etiology of AOSD is unknown. The hypothesis remains that AOSD is a reactive syndrome in which various infectious agents may act as triggers in a genetically predisposed host. Both genetic factors and a variety of viruses, bacteria like Yersinia enterocolitica and Mycoplasma pneumonia and other infectious factors have been suggested as important[1][2].
    [Show full text]
  • Multifocal Tubercular Dactylitis: a Rare Case Series
    Review Article Clinician’s corner Images in Medicine Experimental Research Case Report Miscellaneous Letter to Editor DOI: 10.7860/JCDR/2017/27879.10115 Case Report Postgraduate Education Multifocal Tubercular Dactylitis: A Rare Case Series Section Presentation of Skeletal Tuberculosis in Internal Medicine an Adult Short Communication PRAVAT THATOI1, MANOJ PARIDA2, RAKESH BARIK3, BIDYUT DAS4 ABSTRACT Tubercular dactylitis is an uncommon form of osteo-articular tuberculosis seen in children. Multifocal involvement, simultaneously involving hands and feet is extremely uncommon. Here we report an adult patient with tubercular dactylitis involving multiple digits of both hands and second digit of right foot in absence of any risk factors like immunodeficiency or any debilitating condition. The patient was successfully treated with anti-tubercular drugs for six months. Mycobacterium tuberculosis infection of bones and joints can present in an unusual way but early diagnosis and treatment caries a good prognosis. Keywords: Mycobacterial infection, Osteo-articular tuberculosis, Spina ventosa CASE REPORT His complete blood count showed a hemoglobin of 12.2 gm/dl, total A 30-year-old male presented with pain and swelling of right second leukocyte count 6800/ mm3 with 56% polymorphonuclear cells, 40% toe followed by pain and swelling of thumb, index and little fingers lymphocytes and 4% eosinophils, and platelet count 2,25,000/mm3. of left hand, and index and little fingers of right hand for six months. Red blood cells were normocytic and normochromic. His Erythrocyte The patient was apparently asymptomatic six months back when he Sedimentation Rate (ESR) was 42 mm in first hour and C - Reactive noticed mild pain and swelling of right second toe for which he took Protein (CRP) was 22 mg/L.
    [Show full text]
  • Juvenile Idiopathic Arthritis Associated Uveitis
    children Review Juvenile Idiopathic Arthritis Associated Uveitis Emil Carlsson 1,*, Michael W. Beresford 1,2,3, Athimalaipet V. Ramanan 4, Andrew D. Dick 5,6,7 and Christian M. Hedrich 1,2,3,* 1 Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK; [email protected] 2 Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK 3 National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK 4 Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol BS2 8DZ, UK; [email protected] 5 Translational Health Sciences, University of Bristol, Bristol BS2 8DZ, UK; [email protected] 6 UCL Institute of Ophthalmology, London EC1V 9EL, UK 7 NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK * Correspondence: [email protected] (E.C.); [email protected] (C.M.H.); Tel.: +44-151-228-4811 (ext. 2690) (E.C.); +44-151-252-5849 (C.M.H.) Abstract: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. The development of associated uveitis represents a significant risk for serious complications, including permanent loss of vision. Initiation of early treatment is important for controlling JIA-uveitis, but the disease can appear asymptomatically, making frequent screening procedures necessary for patients at risk. As our understanding of pathogenic drivers is currently incomplete, it is difficult to assess which JIA patients are at risk of developing uveitis.
    [Show full text]
  • Pediatric Cutaneous Bacterial Infections Dr
    PEDIATRIC CUTANEOUS BACTERIAL INFECTIONS DR. PEARL C. KWONG MD PHD BOARD CERTIFIED PEDIATRIC DERMATOLOGIST JACKSONVILLE, FLORIDA DISCLOSURE • No relevant relationships PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C CUTANEOUS BACTERIAL PATHOGENS • Staphylococcus aureus: OSSA and MRSA • Gp A Streptococcus GABHS • Pseudomonas aeruginosa CUTANEOUS BACTERIAL INFECTIONS • Folliculitis • Non bullous Impetigo/Bullous Impetigo • Furuncle/Carbuncle/Abscess • Cellulitis • Acute Paronychia • Dactylitis • Erysipelas • Impetiginization of dermatoses BACTERIAL INFECTION • Important to diagnose early • Almost always
    [Show full text]
  • Reactive Arthritis Information Booklet
    Reactive arthritis Reactive arthritis information booklet Contents What is reactive arthritis? 4 Causes 5 Symptoms 6 Diagnosis 9 Treatment 10 Daily living 16 Diet 18 Complementary treatments 18 How will reactive arthritis affect my future? 19 Research and new developments 20 Glossary 20 We’re the 10 million people living with arthritis. We’re the carers, researchers, health professionals, friends and parents all united in Useful addresses 25 our ambition to ensure that one day, no one will have to live with Where can I find out more? 26 the pain, fatigue and isolation that arthritis causes. Talk to us 27 We understand that every day is different. We know that what works for one person may not help someone else. Our information is a collaboration of experiences, research and facts. We aim to give you everything you need to know about your condition, the treatments available and the many options you can try, so you can make the best and most informed choices for your lifestyle. We’re always happy to hear from you whether it’s with feedback on our information, to share your story, or just to find out more about the work of Versus Arthritis. Contact us at [email protected] Registered office: Versus Arthritis, Copeman House, St Mary’s Gate, Chesterfield S41 7TD Words shown in bold are explained in the glossary on p.20. Registered Charity England and Wales No. 207711, Scotland No. SC041156. Page 2 of 28 Page 3 of 28 Reactive arthritis information booklet What is reactive arthritis? However, some people find it lasts longer and can have random flare-ups years after they first get it.
    [Show full text]
  • Symptomatic Psoriatic Dactylitis Is Associated with Ultrasound Determined Extra-Synovial Inflammatory Features and Shorter Disease Duration
    Clinical Rheumatology (2019) 38:903–911 https://doi.org/10.1007/s10067-018-4400-z ORIGINAL ARTICLE Symptomatic psoriatic dactylitis is associated with ultrasound determined extra-synovial inflammatory features and shorter disease duration Nicolò Girolimetto1 & Luisa Costa 1 & Luana Mancarella2 & Olga Addimanda2,3 & Paolo Bottiglieri1 & Francesco Santelli4 & Riccardo Meliconi2,3 & Rosario Peluso1 & Antonio Del Puente1 & Pierluigi Macchioni5 & Carlo Salvarani5,6 & Dennis McGonagle7 & Raffaele Scarpa1 & Francesco Caso1 Received: 13 November 2018 /Revised: 3 December 2018 /Accepted: 9 December 2018 /Published online: 19 December 2018 # International League of Associations for Rheumatology (ILAR) 2018 Abstract Objectives To explore the link between ultrasonographic features of dactylitis in psoriatic arthritis (PsA) and symptoms, digital tenderness and duration of dactylitis. Methods Forty-eight cases of PsA dactylitis were investigated using high frequency ultrasound (US) both in grey scale (GS) and Power Doppler (PD), evaluating the presence and the degree of flexor tenosynovitis, peri-tendinous oedema, subcutaneous PD, extensor tendon involvement, GS synovitis and intra-articular PD signal (PDS) of the involved digits. Patients were compared according to the presence of local pain and digital tenderness, the duration of dactylitis and the concomitant treatment. Results The presence of pain/tenderness was positively associated with US GS flexor tenosynovitis of grade >2(p <0.001),PD- flexor tenosynovitis (p < 0.001), peri-tendinous oedema (p < 0.001) and subcutaneous PDS (p < 0.001); moreover, it was nega- tively associated with GS synovitis (p < 0.001) and intra-articular PD (p < 0.001). The same positive and negative association with US findings were found comparing patients with duration of dactylitis shorter or longer than the median (24 weeks) (p < 0.001 for all comparisons).
    [Show full text]
  • Adult-Onset Still's Disease
    Journal of Clinical Medicine Review Adult-Onset Still’s Disease: Clinical Aspects and Therapeutic Approach Stylianos Tomaras 1,* , Carl Christoph Goetzke 2,3,4 , Tilmann Kallinich 2,3,4 and Eugen Feist 1 1 Department of Rheumatology, Helios Clinic Vogelsang-Gommern, 39245 Gommern, Germany; [email protected] 2 Department of Pediatrics, Division of Pulmonology, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), 10117 Berlin, Germany; [email protected] (C.C.G.); [email protected] (T.K.) 3 German Rheumatism Research Center (DRFZ), Leibniz Association, 10117 Berlin, Germany 4 Berlin Institute of Health, 10178 Berlin, Germany * Correspondence: [email protected] Abstract: Adult-onset Still’s disease (AoSD) is a rare systemic autoinflammatory disease charac- terized by arthritis, spiking fever, skin rash and elevated ferritin levels. The reason behind the nomenclature of this condition is that AoSD shares certain symptoms with Still’s disease in children, currently named systemic-onset juvenile idiopathic arthritis. Immune dysregulation plays a central role in AoSD and is characterized by pathogenic involvement of both arms of the immune system. Furthermore, the past two decades have seen a large body of immunological research on cytokines, which has attributed to both a better understanding of AoSD and revolutionary advances in treatment. Additionally, recent studies have introduced a new approach by grouping patients with AoSD into only two phenotypes: one with predominantly systemic features and one with a chronic articular Citation: Tomaras, S.; Goetzke, C.C.; disease course.
    [Show full text]
  • Prevalence and Characteristics Associated with Dactylitis in Patients with Early Spondyloarthritis: Results from the Esperanza Cohort M.I
    Prevalence and characteristics associated with dactylitis in patients with early spondyloarthritis: results from the ESPeranza cohort M.I. Tévar-Sánchez1, V. Navarro-Compán2, J.J. Aznar3, L.F. Linares4, M.C. Castro5, E. de Miguel2, on behalf of the Esperanza Group 1Rheumatology Department, Hospital Vega Baja, Orihuela, Alicante, Spain; 2Rheumatology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain; 3Rheumatology Department, Hospital de Mérida, Mérida, Badajoz, Spain; 4Rheumatology Department, Clínica Universitaria Hospital Virgen de la Arrixaca, Murcia, Spain; 5Rheumatology Department, Hospital Universitario Reina Sofía, Cordoba, Spain. Abstract Objective Dactylitis is a typical feature of psoriatic arthritis. However, dactylitis was included as a spondyloarthritis (SpA) feature for both (axial and peripheral) of the ASAS classification criteria, but data about its prevalence are scarce, especially in patients with a recent onset of the disease. Our objective was to determine the prevalence and characteristics associated with dactylitis in patients with early SpA. Methods A baseline dataset from the ESPeranza cohort was used. This programme included patients who were suspected of having SpA (age <45 years, symptoms duration of 3–24 months and with inflammatory back pain, or asymmetrical arthritis, or spinal/joint pain plus ≥1 of the SpA features). For this study, 609 patients who were diagnosed with SpA by their physician were included. Descriptive, univariable and multivariable logistic regression analyses were employed to investigate the association between the presence of dactylitis and the characteristics associated with SpA. Results Fifty-eight (9.5%) patients currently or previously had dactylitis. In the multivariable analysis, dactylitis was independently associated with peripheral arthritis (OR= 4.83; p<0.001), enthesitis (OR= 2.49; p=0.01), psoriasis (OR= 3.62; p<0.01) and the physician’s visual analogue scale (OR= 0.82; p=0.01).
    [Show full text]
  • Psoriatic Arthritis (Psa) Clinic Referral Pathway
    Psoriatic arthritis (PsA) clinic referral pathway Who to refer The hallmark of PsA is joint, digit (finger or toe), entheses and tendon swelling associated with pain or stiffness. It can also cause axial inflammation, similar to ankylosing spondylitis. Up to 30% of patients with psoriasis develop psoriatic arthritis. NICE guidelines for the management of psoriasis (CG153, 2012) and NICE quality standard (QS40, August 2013) recommend annual assessment for PsA in all patients with psoriasis, using the PEST tool (see appendix 1). PsA can affect either: One large joint (knee, hip) or ≥ 3 small joints with early morning stiffness > 30 minutes and pain on squeezing joint or enthesitis (plantar fasciitis, epicondylitis, Achilles tendonitis) or inflammatory back pain * (see ASAS criteria below in appendix 2) Please refer: 1. All patients with psoriasis or family history of psoriasis and good history of inflammatory arthritis (stiffness in any joints lasting > 30 minutes after awakening). 2. All patients with psoriasis or family history of psoriasis presenting with enthesitis 3. All patients with a swollen digit (dactylitis). 4. Patients with psoriasis or a family history of psoriasis and either swollen or painful joints (either subjectively from history or objectively from examination). Please refer as soon as PsA is suspected. NB raised CRP or ESR or positive RF not necessary for diagnosis however raised CRP (+/- ESR) can suggest severe, progressive PsA Clinical signs may be masked by NSAIDs or systemic corticosteroids What investigations should be ordered: FBC, urea and electrolytes and liver function C-reactive protein (CRP): This is often normal in PsA Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies (exclude rheumatoid arthritis) X-rays affected joint(s) (often normal in early disease) Sacro-iliac joint X-rays: if inflammatory back pain How to refer Patients with suspected psoriatic arthritis can be referred to rheumatology through Choose and Book into the psoriatic arthritis clinic.
    [Show full text]
  • Isolated Tuberculous Dactylitis (Spina Ventosa) in a 9 Year Old Boy - a Rare Entity
    International Journal of Basic and Applied Medical Sciences ISSN: 2277-2103 (Online) An Online International Journal Available at http://www.cibtech.org/jms.htm 2012 Vol. 2 (2) May-August,pp.52-55/Panchonia et al. Research Article ISOLATED TUBERCULOUS DACTYLITIS (SPINA VENTOSA) IN A 9 YEAR OLD BOY - A RARE ENTITY *Ashok Panchonia, C. V. Kulkarni, Rakesh Mehar and Sourabh Mandwariya Department of Pathology, M.G.M. Medical College, Indore, M.P. India *Author for Correspondence ABSTRACT Tuberculosis is an infectious disease caused by Mycobacterium tuberculosisand manifested by formation of tubercles and caseous necrosis in tissues. In the musculoskeletal system, TuberculousSpondylitis is the most typical form of the disease; however joint changes in extraspinal sites such as the hip, knee, wrist and elbow also may occur. Tuberculosis of the metacarpals, metatarsals and phalanges is an uncommon disease. Tuberculous infection of metacarpals, metatarsals and phalanges is known as TuberculousDactylitis. There is aspindle shaped expansion of the short tubular bones due to tuberculous granuloma. Hence it is also known as SpinaVentosa. We describe a nine year old boy with a swelling in the right ring finger diagnosed as TuberculousDactylitison histopathological examination. Key Words: Tuberculosis, Spinaventosa, Dactylitis, Granuloma INTRODUCTION It is of historic interest that Rankin in 1886 identified Tuberculous Dactylitis by histological technique and Feilchenfeld in 1896 described Tuberculous Dactylitisroentgeno graphically in children. The spine is the most frequent site of skeletal involvement; occurring in 1 to 3% of patients with extra pulmonary tuberculosis. The diagnosis is often delayed because osseous tuberculosis is a paucibacillary lesion. Tuberculosis of the metacarpals, metatarsals and phalanges is an uncommon disease.
    [Show full text]
  • Title of Program
    OVERVIEW OF PSORIATIC ARTHRITIS: CLINICAL CONSIDERATIONS FOR HEALTHCARE PROFESSIONALS JAMIE L. MCCONAHA, PHARMD, NCTTP, BCACP, CDE FACULTY DISCLOSURES I have no conflicts of interest to disclose. I do not intend to discuss non-FDA approved drugs or investigational use of any product/device. OBJECTIVES Describe the epidemiology and pathophysiology of PsA List the clinical features and manifestations of PsA that may aid in diagnosis and assessment of disease severity Describe screening tools for patients suspected of having PsA Discuss the importance of early detection of PsA and methods and tests used to diagnose the disease Review treatment and management strategies for patients with PsA PSORIATIC ARTHRITIS (PSA) WHAT IS PSORIATIC ARTHRITIS? Chronic, progressive, inflammatory arthritis Considered a type of spondyloarthropathy Swelling, stiffness, and pain in and around the joints, as well as overall fatigue Early recognition, diagnosis and treatment is crucial to prevent permanent damage INCIDENCE Prevalence in patients with psoriasis ranges between 6-42% Affects approximately 1% of the general population Estimates vary due to delayed or missed diagnoses Psoriatic arthritis. National Psoriasis Foundation. Available at:https://www.psoriasis.org/about-psoriatic-arthritis. Gelfand JM, et al. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005. Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs. 2014. EPIDEMIOLOGY Affects both men and women equally Usually occurs between 30-50 years, but can affect any age Relationship to psoriasis (skin): 85% of patients present with skin psoriasis first 10-37% have skin and joint disease simultaneously 6-18% have arthritis preceding psoriasis Liu JT, Yeh, HM, Liu SY, Chen KT.
    [Show full text]