Systemic amyloidosis manifestation in a patient with psoriatic arthritis

Abstract Systemic amyloidosis secondary to psoriatic arthritis is rare, and published data are based mainly on case reports and are associated with increased mortality. This is the report of a patient with long-term psoriatic arthritis and chronic sialadenitis, who showed an inadequate response to therapy. The diagnosis of secondary amyloidosis was attained through biopsies of genital skin lesions. Although very rare, it is important that dermatologists and general practitioners consider the possibility of amyloidosis in patients with chronic inflammatory diseases, since an early intervention can be implemented, and thus, the prognosis of this condition can be improved.

Risk factors associated with osteoporosis and fracture in psoriatic arthritis / 中华医学杂志(英文版)

BACKGROUND@#Although there are few studies mentioned there may be some relationship between psoriatic arthritis (PsA) and osteoporosis, clinical data in real world still need to be clarified in China. The aim of this study was to assess the areal and volumetric bone mineral density (BMD), frequency of fracture, and risk factors in patients with PsA.@*METHODS@#A total of one hundred PsA patients who visited Peking University First Hospital and one hundred age- and sex-matched healthy controls with DXA data were enrolled in the study. Patients with clinical fractures confirmed by X-ray during follow-up were also recorded. Clinical characteristics of the patients were recorded and compared between the abnormal BMD group and the normal BMD group, as well as between the fracture and non-fracture groups. Risk factors for fracture and low BMD were analyzed.@*RESULTS@#Mean BMD at the total hip and femoral neck was significantly lower in PsA patients than that in healthy controls (0.809 ± 0.193 vs. 0.901 ± 0.152 g/cm2, P  = 0.041; 0.780 ± 0.146 vs. 0.865 ± 0.166 g/cm2, P  = 0.037, respectively). Moreover, lumbar spine BMD was negatively correlated with psoriasis duration, swollen joint count and DAS28-CRP (r = -0.503, -0.580, -0.438; P < 0.05). Total hip BMD and femoral neck BMD were negatively correlated with HAQ (r = -0.521, -0.335; P < 0.05). Fractures occurred in 29 patients during the follow-up period. Logistic regression analysis showed that older age (OR 1.132 [95%CI: 1.026-1.248), P < 0.05], higher HAQ score (OR 1.493, 95%CI: 1.214-1.836, P < 0.01), higher disease activity index for psoriatic arthritis (OR 1.033, 95% CI: 1.002-1.679, P < 0.05) and hip joint involvement (OR 6.401, 95% CI: 4.012-44.180, P < 0.05) were risk factors for fracture in the multivariate model.@*CONCLUSIONS@#Increased risks of osteoporosis and fracture were found in PsA patients compared to healthy controls. Besides age, high disease activity and hip joint involvement were risk factors for decreased BMD and fracture.

Análise do perfil clínico e epidemiológico de pacientes com artrite psoriásica em ambulatório de reumatologia na Região Amazônica / Clinical and epidemiological profile analysis of patients with psoriatic arthritis in a rheumatology clinic in the Amazon Region

Objetivo: Conhecer o perfil clínico e epidemiológico de pacien- tes portadores de artrite psoriásica de uma região brasileira. Método: Pesquisa observacional, transversal, epidemiológica e documental, baseada na coleta de dados obtidos a partir da análise de 53 prontuários de pacientes cadastrados do Ambu- latório de Reumatologia da Universidade do Estado do Pará, na Região Amazônica. Resultados: Houve predominância do padrão do tipo poliartrite simétrica, sem distinção entre os sexos, com a presença de manifestações extra-articulares, pso- ríase em placas, em uso de metotrexato em doses médias. Con- clusão: Apesar da etiopatogenia da doença ser dependente de fatores genéticos, ambientais e imunológicos e da população amazônica ser muito particular, de uma miscigenação entre eu- ropeus, ameríndios e negros, o perfil clínico e epidemiológicos dos pacientes do Ambulatório de Reumatologia da Universidade do Estado do Pará é semelhante ao das literaturas nacional e internacional.

Objective: To know the clinical and epidemiologic profile of pso- riatic arthritis patients of a Brazilian region. Method: This is an observational, cross-sectional, epidemiological, and documental study, based on the data obtained from the analysis of the medi- cal records of 53 patients registered on the Rheumatology Cli- nic of the Universidade do Estado do Pará, in the Amazon area. Results: There was a predominance of the symmetrical polyar- ticular pattern, with no sexual distinction, extra articular invol- vement, plaque psoriasis, and treatment withn methotrexate, in medium doses. Conclusion: Despite the etiopathogenesis being dependent on genetic, environmental, and immunological fac- tors, and the population of the Amazon being a mix of Europeans, Amerindians, and black people, the clinical and epidemiological profile of the patients of the Rheumatology clinic of the Univer- sidade do Estado do Pará is similar to the ones described on the national and international literature.

Cambio de diagnóstico y de categoría diagnóstica en pacientes con artritis idiopática juvenil en 7 años de seguimiento / Change of diagnosis and diagnostic category in patients with juvenile idiopathic arthritis within 7 years of follow-up

Resumen: Introducción: Al menos 50% de los pacientes pediátricos portadores de artritis idiopática juvenil (AIJ) continuará control en reumatología adulto. La clasificación de la Liga Internacional de Asociaciones de Reumatología (ILAR) vigente, actualmente en revisión, difiere de la clasificación de las artritis inflamatorias del adulto. Se ha reportado cambios de categoría en 10,8% de los pacientes durante el seguimiento. Objetivo: Analizar los pacientes con AIJ seguidos al menos 7 años para objetivar cambios de diagnós tico en la transición, e identificar factores de mal pronóstico funcional. Pacientes y Método: Estudio retrospectivo en base a registros clínicos. Se incluyó a la totalidad de los pacientes con AIJ controla dos en policlínico pediátrico del Hospital de Puerto Montt entre el año 2005 y 2017, que cumplieron siete o más años de seguimiento. Se realizó análisis descriptivo en base a variables clínicas: categoría diagnóstica, tiempo de evolución al diagnóstico, actividad clínica y serológica, y tiempo de evolución al inicio de la terapia farmacológica. Resultados: Se evaluaron 18 pacientes, 3 Oligo-articular (OA) persistente, 1 OA extendida, 4 Poli-articular (PA) factor reumatoide (FR) negativo, 4 PA FR positivo, 5 Sistémicas, 1 Psoriática, todos con seguimiento mayor a 7 años. Once de 18 niños fueron transfe ridos a adultos. Tres de 11 cambiaron de diagnóstico a Artritis Reumatoide (AR) más otra enferme dad autoinmune: Síndrome de Sjögren + Lupus eritematoso sistémico, Púrpura trombocitopénico inmune, Enfermedad autoinmune no clasificada y cinco de 11 niños de categoría ILAR: OA a Artritis reumatoide juvenil, OA extendida a PA FR negativo, 3 Sistémicas a PA FR negativo. Edad de inicio, formas poli-articulares, retrasos en diagnóstico y comienzo de terapia se asociaron a secuelas e infla mación persistente. Conclusiones: Ocho de once pacientes transferidos cambiaron denominación diagnóstica y/o presentaron otras enfermedades autoinmunes. Algunos factores de mal pronóstico deben mejorar.

Abstract: Introduction: At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. Objective: To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. Patients and Method: Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. Results: We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. Conclusions: Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.

Cardiovascular Risk Factors and Risk Measurement in Patients with Psoriatic Arthritis in a University Hospital

Abstract Background: Psoriatic Arthritis is the spondyloarthritis associated with psoriasis, which is often related to high mortality due to cardiovascular causes. Objectives: To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis. Methods: Patients with psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis, aged between 30 and 74 years and without any other clinically manifest chronic inflammatory disease, atherosclerotic disease or heart failure were included. After an interview, clinical examination and data extraction from medical records, risk stratification was performed using a calculator available on the online platform of the Framingham Heart Study. We considered p < 0.05 as significant. Chi-square test and Fisher's exact test were used to compare frequencies, as well as correlation measurements. Results: 45 patients were included, 68,9% of which were women and the mean age was 53,94 years. Dyslipidemia was confirmed in approximately 93%, hypertension in 46%, obesity in 40%, 33.3% were diabetics and, 13.3%, smokers; 95% had increased abdominal circumference. It was observed that 53% had high cardiovascular risk, 29% had intermediate risk and 18% had low risk. Individuals with altered C-reactive protein and erythrocyte sedimentation rate presented, respectively, higher levels of LDL-C and total cholesterol. Conclusions: There was a high occurrence of risk factors and the majority of the sample was stratified into high or intermediate cardiovascular risk.

Diseases, conditions, and drugs associated with cicatricial ectropion / Doenças, condições e drogas associadas ao ectrópio cicatricial

ABSTRACT Cicatricial ectropion may be a consequence of certain systemic diseases as well as the result of drug use. Our goal here was to research the different causes of this condition as reported in the literature, including more recently suspected etiologies. A detailed PubMed literature search indicated many different etiologies were associated with cicatricial ectropion development, from severe cases of systemic diseases, such as ichthyosis and lupus erythematosus, to reversible scenarios secondary to anti-glaucomatous drug use. More recently reported connections include periorbital necrotizing fasciitis, frontal osteomyelitis, and antineoplastic agents. Indeed, cicatricial ectropion may be highly symptomatic; being able to determine its real etiology is imperative to managing patients properly. In this investigation, we felt that an explicitly multidisciplinary approach was essential, especially for cases associated with systemic conditions.

RESUMO O ectrópio cicatricial pode ser uma consequência de certas doenças sistêmicas, bem como o resultado do uso de drogas. Nosso objetivo aqui foi pesquisar as diferentes causas desta condição, conforme relatado na literatura, incluindo mais recentemente suspeitas de etiologias. Uma pesquisa bibliográfica detalhada do PubMed indicou que muitas etiologias diferentes estavam associadas ao desenvolvimento do ectrópio cicatricial, desde casos graves de doenças sistêmicas, como ictiose e lúpus eritematoso, até cenários reversíveis secundários ao uso de drogas antiglaucomatosas. Conexões relatadas mais recentemente incluem fasceíte necrosante periorbitária, osteomielite frontal e agentes antineoplásicos. De fato, o ectrópio cicatricial pode ser altamente sintomático; ser capaz de determinar sua etiologia real é imperativo para o manejo adequado dos pacientes. Nesta investigação, sentimos que uma abordagem explicitamente multidisciplinar era essencial, especialmente para casos associados a doenças sistêmicas.

Comparative microscopic analysis of nail clippings from patients with cutaneous psoriasis and psoriatic arthritis

Abstract: BACKGROUND: The nail involvement in psoriasis is related to psoriatic arthritis and may represent a predictor of the disease. OBJECTIVES: To analyze, through nail clipping, clinically normal and dystrophic nails of patients with cutaneous psoriasis and psoriatic arthritis. METHODS: This is a cross-sectional multicenter study, conducted between August 2011 and March 2012. Patients were divided into four groups: patients with cutaneous psoriasis and onychodystrophy, patients with cutaneous psoriasis and clinically normal nails, patients with psoriatic arthritis and onychodystrophy and patients with psoriatic arthritis and clinically normal nails. We calculated NAPSI (Nail Psoriasis Severity Index) of the nail with more clinically noticeable change. After collection and preparation of the nail clipping, the following microscopic parameters were evaluated: thickness of the nail plate and subungual region, presence or absence of parakeratosis, serous lakes, blood, and fungi. RESULTS: There were more layers of parakeratosis (p=0.001) and a greater thickness of the subungual region in patients with cutaneous psoriasis and onychodystrophy (p=0.002). Serous lakes were also more present in the same group (p=0.008) and in patients with psoriatic arthritis and normal nails (p=0.047). The other microscopic parameters showed no significant difference between normal and dystrophic nails or between patients with psoriatic arthritis or cutaneous psoriasis. STUDY LIMITATIONS: Small sample size and use of medications. CONCLUSIONS: Nail clipping is a simple and quick method to assess the nails of patients with nail psoriasis although does not demonstrate difference between those with joint changes or exclusively cutaneous psoriasis.

Incidence, clinical manifestations and clipping of nail psoriasis in the dermatology center of the Hospital Universitário Evangélico de Curitiba

Abstract: Background: Psoriasis is a chronic inflammatory skin disease that often progresses with nail alterations. It is suspected that there is a correlation between nail psoriasis and enthesitis of the distal interphalangeal joint, seeming to serve as a predictor. Objectives: To analyze the profile of patients with nail psoriasis and correlate the presence of nail alterations with psoriatic arthritis, quality of life, extent of psoriasis and the histopathology of the nail. Methods: An observational cross-sectional study with 40 patients with a diagnosis of psoriasis and without systemic treatment. The patient profile was researched, including quality of life and evaluated for the presence of psoriatic arthritis. The severity of the skin psoriasis and the presence of nail lesions were evaluated. Nail fragments were collected and analyzed through clipping. It obtained 100% of positivity for psoriasis in the histopathology exam of the nail plate. Results: Of the 40 patients, 65% were diagnosed with nail psoriasis. Suggestive findings of psoriatic arthritis in hands were present in 33%, being more frequent in those with nail alteration (p = 0.01). In 92.3% of patients diagnosed with psoriatic arthritis in the hands there was some nail injury. The most frequent injuries were pitting and onycholysis. Conclusions: Patients with nail psoriasis are usually men, with worse quality of life and higher chance of psoriatic arthritis. The correlation between the nail involvement of psoriasis and psoriatic arthritis in hands confirms the association between these two forms. The clinical diagnosis of nail psoriasis did not correlate with the histological diagnosis.

Incidence of active mycobacterial infections in Brazilian patients with chronic inflammatory arthritis and negative evaluation for latent tuberculosis infection at baseline - A longitudinal analysis after using TNFa blockers

Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)a blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNFa blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNFatherapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNFa blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.

Síndrome da ceratomalácia (Corneal Melting) periférica na artrite psoriásica tratada com adalimumabe / Peripheral corneal melting syndrome in psoriatic arthritis treated with adalimumab

RESUMOA síndrome do corneal melting periférica é uma rara condição imune caracterizada por afinamento da margem da córnea e, às vezes, perfuração. Está associada a doenças reumáticas e não reumáticas. Poucos casos de síndrome do corneal melting periférica foram relatados em pacientes com psoríase. A patogênese não foi completamente entendida, mas as metaloproteinases podem ter papel patogênico. A terapia Anti-TNF diminuiu os níveis de metaloproteinases na pele e no sangue em psoríase. Reportamos o caso de um homem de 61 anos com síndrome do corneal melting periférica associada à artrite psoriásica que recebeu adalimumabe para controlar a inflamação na pele e no olho. Pelo que sabemos, este é o primeiro caso de síndrome do corneal melting periférica em artrite psoriática tratado com adalimumabe mostrando evolução nas lesões cutâneas e cura total da perfuração da córnea em três meses.

ABSTRACTPeripheral corneal melting syndrome is a rare immune condition characterized by marginal corneal thinning and sometimes perforation. It is associated with rheumatic and non-rheumatic diseases. Few cases of peripheral corneal melting have been reported in patients with psoriasis. The pathogenesis is not fully understood but metalloproteinases may play a pathogenic role. Anti-TNF therapy has shown to decrease skin and serum metalloproteinases levels in psoriasis. We report a 61-year-old man with peripheral corneal melting syndrome associated with psoriatic arthritis who received adalimumab to control skin and ocular inflammation. To our knowledge, this is the first case report of peripheral corneal melting syndrome in psoriatic arthritis treated with adalimumab showing resolution of skin lesions and complete healing of corneal perforation in three months.

As diferenças do Doppler espectral, na artrite psoriática e onicomicose / Differences of spectral Doppler in psoriatic arthritis and onychomycosis

Objetivo Utilizar o Doppler espectral (DE) para quantificar atividade inflamatória e detectar diferenças ecotexturais ungueais em pacientes com artrite psoriásica e onicomicose. Métodos Foram incluídos dois pacientes, um com artrite psoriásica, mas sem dores nas articulações e sem alterações clínicas ungueais; e outro paciente com onicomicose e artrite reumatoide. O exame de ultrassom, pela escala cinza, demonstrou alterações na presença regular da ecotextura na inserção da unha, aumento da espessura do leito ungueal e perda do padrão trilaminar da unha. O Doppler espectral, através do índice de resistência (IR), detecta o processo inflamatório nas enteses ungueais. Resultados Sete articulações interfalângicas distais (IFD) nos dois pacientes foram avaliadas em dois planos, obtendo nove IR. O autor encontrou no paciente com artrite psoriásica: perda normal do padrão trilaminar da unha; leitos ungueais e cápsulas articulares das IFDs preservados. O Doppler espectral evidenciou IR<1, com média±DP igual a 0,50±0,75 em microcirculação nas enteses ungueais e caracterizou erosão óssea ativa em 3a IFD esquerda, com IR igual a 0,38 e 0,63 em planos transversal e longitudinal, respectivamente. O paciente com onicomicose mostrou as seguintes alterações: hipoecogenicidade na inserção ungueal; perda do formato da unha e o Doppler espectral nas enteses ungueais com IR>1, com média±DP igual a 1,71±0,98. Conclusão O uso do ultrassom pode detectar alterações nos leitos ungueais nessas doenças. Futuros estudos poderão melhor caracterizar essas mudanças. .

Objective To evaluate the use of the spectral Doppler (SDoppler) to quantify inflammatory activity and to detect nail echotextural differences in patients with psoriatic arthritis and onychomycosis. Methods Two patients, one with psoriatic arthritis but with no joint pain nor nail clinical change and the other with onychomycosis and rheumatoid arthritis were included. The gray scale ultrasound study, showed changes in the regular presence of echotexture at the nail insertion, thickening of the nail bed and loss of trilaminar nail pattern. The spectral Dopplerresistance index (RI), detects the inflammatory process in nail entheses. Results Seven distal interphalangeal (DIP) joints in both patients were evaluated in two planes, getting nine RI. In the patient with psoriatic arthritis the author found: loss of normal trilaminar nail plate aspect, and nail beds and DIP joint capsules preserved. The spectral Doppler showed RI<1, with mean±SD=0.50±0.75 in the microcirculation at nail entheses, with characterization of a bone erosion in the third left DIP joint, with RI=0.38 and 0.63 in transverse and longitudinal planes, respectively. The patient with onychomycosis showed the following changes: hypoechogenicity at nail insertion; loss of nail shape, and spectral Doppler in nail entheses with RI>1, with mean±SD=1.71±0.98. Conclusion The use of ultrasound can detect changes in the nail beds in these diseases. Future studies will further characterize these changes. .

Disfunção sexual em pacientes com psoríase e artrite psoriásica - uma revisão sistemática / Sexual dysfunction in patients with psoriasis and psoriatic arthritis - a systematic review

A psoríase é uma doença cutaneoarticular, cuja incidência varia entre 1%-3%. O estresse tende a ser um fator desencadeante ou de agravamento na psoríase. Além disso, a própria doença pode gerar estresse emocional, pelo constrangimento das lesões. Uma série de alterações psicológicas pode estar associada à psoríase, e são comuns os relatos de sentimentos de raiva, depressão, vergonha e ansiedade, culminando no isolamento social e, possivelmente, na disfunção sexual. Apesar de a disfunção sexual ser uma queixa comum, são poucos os dados encontrados a respeito na literatura. O objetivo deste estudo foi realizar uma revisão sistemática da prevalência da disfunção sexual na psoríase e na artrite psoriásica, avaliando a participação de fatores como depressão e extensão da doença nessa relação. O resultado da revisão sistemática sobre o assunto aponta que os dados a respeito das dificuldades sexuais nos pacientes com psoríase são limitados. As hipóteses aventadas para explicar a ocorrência de disfunção sexual nesse grupo de pacientes incluem a extensão do quadro cutâneo, os efeitos psicológicos da condição no paciente, a preocupação do parceiro e os efeitos colaterais relacionados aos tratamentos médicos para a psoríase. Os dados apresentados enfatizam a negligência frequente dada a este tipo de sintomatologia na prática médica e ressaltam a importância da avaliação do impacto da psoríase não apenas em relação ao acometimento cutâneo e articular, mas também psicossocial e sexual. Face às diversidades socioculturais de cada população, sugere-se a necessidade de um estudo específico na população brasileira a fim de fornecer maiores informações sobre nossos pacientes.

Psoriasis is a cutaneous-articular disease, whose incidence ranges from 1% to 3%. Stress tends to be a triggering or aggravating factor in psoriasis. In addition, the disease itself can generate emotional stress because of its lesions. Several psychological disorders can be associated with psoriasis, and feelings such as rage, depression, shame, and anxiety have been commonly reported, which can culminate in social isolation and sexual dysfunction. Despite being a common complaint among patients with psoriasis, sexual dysfunction has been rarely reported in the literature. This study aimed at performing a systematic review of the prevalence of sexual dysfunction in psoriasis and psoriatic arthritis, assessing the role played by factors such as depression and severity of disease in this relation. This systematic review showed that data on the sexual difficulties of patients with psoriasis are scarce. The hypotheses to explain sexual dysfunction in that group of patients include the severity of skin findings, the psychological effects of the condition on the patient, concerns of the sexual partner, and side effects of the medical treatments for psoriasis. Those data emphasize that this type of symptomatology is frequently neglected in medical practice, and stress the importance of assessing the impact of psoriasis regarding not only cutaneous and joint involvements, but also psychosocial and sexual impairments. Considering the sociocultural diversities of each population, a specific study of the Brazilian population to provide more information about our patients is required.

Prevalence of eye disease in Brazilian patients with psoriatic arthritis

OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal). Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

Amiloidosis: revisión a propósito de un caso clínico / Amyloidosis: review of clinical case purpose

La amiloidosis constituye un grupo de enfermedades caracterizadas por el depósito extracelular de material proteico autólogo, fibrilar e insoluble. Existe una variedad que se asocia a enfermedades inflamatorias crónicas mal controladas que presentan manifestaciones orientadoras al diagnóstico, lo que es importante de conocer, ya que hace variar el pronóstico de la enfermedad de base. A continuación se presenta un caso clínico de amiloidosis secundaria a artropatía psoriásica, discutiendo su diagnóstico y posibilidades terapéuticas tanto para la enfermedad de base como para su asociación y complicación por amiloidosis.

Amyloidosis is a group of diseases characterized by the extracellular deposition of protein material autologous fibrillar insoluble. There is a variety that is associated with poorly controlled chronic inflammatory diseases that have manifestations in the diagnosis. Below we present a clinical case of secondary amyloidosis in psoriatic arthropathy and discuss its diagnosis and further management.

Psoriasis y artritis psoriásica / Psoriasis and psoriasica arthritis

La psoriasis es una enfermedad inflamatoria de la piel, de carácter crónico y recurrente, caracterizada por lesiones eritemato - descamativas. En su patogénesis se conjugan factores inmunogenéticos y ambientales. La artritis psoriática, que es una artropatía seronegativa, en la mayoría de los casos sigue a un curso crónico de psoriasis cutánea. En este artículo analizamos las formas mas frecuentes de presentación de la psoriasis cutánea y revisamos la artropatía psoriática, con indicaciones para el tratamiento de esta última

Uveítes associadas a doenças reumáticas / a

Uveíte é uma inflamação do trato uveal ocular. Pode estar associada à doenças reumáticas em até 40 por cento dos casos, sendo a uveíte anterior e a pan-uveíte agudas as formas de apresentação mais encontradas. A uveíte anterior aguda (UAA) pode estar associada com a positividade do HLA-B27, freqüente nas espondiloartropatias soronegativas e na artrite reumatóide juvenil (ARJ) pauciarticular tipo II. Pode ser encontrada também na sarcoidose e na doença de Behçet. A uveíte anterior crônica é muito menos freqüente que a UAA e comumente ocorre em associação com a ARJ pauciarticular tipo I e com a presença de anticorpos antinucleares. A uveíte posterior pode ocorrer no lúpus eritematoso sistêmico (LES) e a pan-uveíte pode ser encontrada principalmente na sarcoidose

Espóndiloartropatía indiferenciada en un paciente con sindrome de inmunodeficiencia adquirida (Sida) / Undifferentiated spondyloarthropathy in a patient with acquired immunodeficiency syndrome (AIDS)

Se comenta el caso clínico de un enfermo en quien una espóndiloartropatía indiferenciada fue la manifestación reveladora de la infección por el virus de la inmunodeficiencia humana (VIH). La sospecha clínica de infección retroviral fue confirmada por estudio serológico. Historicamente el sindrome de Reiter (SR) fue la primera artropatía reportada como asociada a la infección por el VIH y tanto esta entidad como la artritis psoriásica (AP) son más frecuentes en esa población. En el infectado por el VIH ambas entidades suelen tener algunas particularidades: mayor severidad, evolución más prolongada, posible resistencia a los antiinflamatorios habituales, frecuencia relativa de artritis reactiva (AR) en personas HLA-B27 negativas. Debe sospecharse la infección retroviral especialmente cuando el cuadro clínico es atípico, severo o de rápida progresión, la psoriasis es extensa o adquiere formas clínicas poco habituales, hay falta de respuesta al tratamiento convencional, se acompaña de otras afecciones que pueden vincularse a la infección por ese virus o el paciente tiene conductas de riesgo para adquirirlo. Conocer si el enfermo está infectado por el VIH es importante en el momento de decidir el tratamiento. En esta situación los planes terapéuticos están dictados por la severidad de las lesiones cutáneas y musculoesqueléticas y el estado del sistema inmune. Los efectos secundarios y las interacciones medicamentosas pueden limitar las opciones terapéuticas, especialmente el uso de las drogas inmunodepresoras