ABSTRACT
BACKGROUND AND OBJECTIVES: Early diagnosis of psoriatic arthritis poses a particular challenge. A novel fluorescence optical imaging technique, the Xiralite® system is very useful in this regard as it allows for visualization of microvasculature and perfusion. The present study is the first to systematically examine fluorescence optical signals in a large psoriatic arthritis cohort. PATIENTS AND METHODS: In the primary study, we reviewed and analyzed extra-articular fluorescence optical signal patterns in 241 imaging sequences obtained from 187 psoriatic arthritis patients; 36 fluorescence optical sequences from 31 patients with rheumatoid arthritis served as controls. In a follow-up study, 203 consecutive fluorescence optical sequences from 54 psoriatic arthritis patients and 149 control subjects with various inflammatory rheumatic disorders were retrospectively evaluated in order to validate the primary study results in terms of the patterns previously identified. RESULTS: Psoriatic arthritis patients exhibited three different fluorescence optical signal patterns in projection of the nails that have not been previously described. One of these patterns was the "green nail" sign, which was highly specific (97 %) for psoriatic arthritis. In the follow-up study, the specificity of this phenomenon in psoriatic arthritis was 87 % in comparison to the control cohort. CONCLUSIONS: In the present study, fluorescence optical signals in the nail region proved to be highly specific for psoriatic arthritis. The "green nail" phenomenon seems to be of particular diagnostic interest as a potential sign of impaired microcirculation of the nail bed.
Subject(s)
Arthritis, Psoriatic/diagnostic imaging , Arthritis, Rheumatoid/diagnostic imaging , Nails/pathology , Optical Imaging/methods , Arthritis, Psoriatic/pathology , Arthritis, Psoriatic/physiopathology , Diagnosis, Differential , Early Diagnosis , Female , Fluorescence , Follow-Up Studies , Humans , Male , Microcirculation , Middle Aged , Nail Diseases/pathology , Nails/blood supply , Nails/diagnostic imaging , Nails/ultrastructure , Retrospective StudiesABSTRACT
PURPOSE OF REVIEW: Certain outdoor activities show a particularly high risk for being stung by Hymenoptera species. Avoidance of such stings is preferable for preventing unwanted local or systemic sting reactions. The purpose of this review is to evaluate the current knowledge on risk factors and management of Hymenoptera venom allergy. We will specifically focus on patients with an intense occupational exposure to Hymenoptera venom. RECENT FINDINGS: Repeated stings were found to increase the risk for subsequent severe anaphylactic sting reactions. The male preponderance for severe anaphylactic sting reactions probably reflects in part a sex-specific occupational exposure being higher in males. When selecting a specific venom for therapy, current knowledge of cross-reactivity between venoms of various species should be considered. If available, venom immunotherapy should be performed using the venom of the culprit insect. Recently, a pilot study also showed the efficacy of venom immunotherapy when treating large local reactions. SUMMARY: If an intensely exposed patient presents with a systemic anaphylactic sting reaction, efficacy of venom immunotherapy should be demonstrated by a tolerated sting challenge before allowing this patient to return to his/her occupation. Patients with bee venom allergy and an intense exposure should be treated with an increased maintenance dose of 200 µg bee venom. Patients with a history of large local reactions should be provided with an emergency kit, which should contain oral antihistamines and corticosteroids. In patients in whom local sting reactions induce symptoms of high clinical significance, an off-label use of venom immunotherapy may be discussed.
