The clinical spectrum of psoriatic spondylitis.

Forty-three psoriatic patients with spondylitic involvement (19 women and 24 men, mean age 41 years) have been reviewed. Three different subsets were recognized. The first (PS1), with predominant involvement of the axial skeleton, occurred in 22 (seven women and 15 men, mean age 39). The second (PS2) and the third (PS3) showed an overlap of spondylitis and peripheral articular disease. In PS2 this consisted of distal interphalangeal (DIP) arthritis (five women and three men, mean age 41), while in PS3 there was symmetrical polyarthritis (seven women and six men, mean age 42). Spinal involvement, present in every case, was characterized by unilateral and asymmetrical syndesmophytes, often nonmarginal and randomly affecting the vertebral column. Sacroiliitis, absent in the PS2 subset, was present in 15 of the PS1 and in two of the PS3 subgroup and was bilateral in six and unilateral in 11. The HLA-B27 antigen, absent in the PS2 subgroup, was found in 12 of the PS1 and in two of the PS3 subset. It was associated with sacroiliitis in 13 cases and with spondylitis without sacroiliitis in only one case. Nail changes were recorded in 30% of the total cases and showed a strict relationship with the PS2 subset (40%). Extra-articular symptoms, consisting almost exclusively of ocular involvement, occurred in three patients only (two cases of conjunctivitis and one of acute anterior uveitis). The clinical course of psoriatic spondylitis appeared less disabling than that of the idiopathic form.

Cyclophosphamide treatment in polyarteritis nodosa.

Five male patients with polyarteritis nodosa were treated with cyclophosphamide as follows: 3 mg/Kg/die i.v. up to maximum of 3 g.; subsequently, 200 mg/die per os for two weeks, then 100 mg per os every other day for three months; finally, 100 mg every fourth day until the 18th month. One patient, who also had fever, received 25 mg/die of prednisone for the initial three weeks of treatment. Before treatment ESR, WBC, and circulating immune-complexes were increased, while C3a, C3c and C4 serum complement components levels were normal. Skin ulcers healed within 4 months. A progressive marked improvement of visceral damages in the first months of therapy have been noted (e.g. blood pressure values in normal range after suspension of concomitant antihypertensive treatment, regression of peripheral neuropathy, etc. etc.). No further ischemic lesions occurred during treatment. Significant decreases of ESR and serum immune-complexes levels were detected. No untoward effects due to cyclophosphamide were observed. These findings support the effectiveness of this drug in polyarteritis. The possibility of association with glucocorticoids during the acute phase of disease is also discussed.

Psoriatic arthritis in psoriatic patients.

One hundred and eighty patients with psoriasis have been studied in the Neapolitan area to find the prevalence of arthritis in psoriasis. Wright and Moll's criteria for the diagnosis of arthritis were applied. Of 180 psoriatic patients, 62 exhibited arthritis (34.4% of total cases) According to Moll and Wright's five broad clinical forms of arthritis, the following distribution was found: polyarticular in 38.7% of arthritic patients, mono-oligoarticular in 16.1%, distal interphalangeal in 7.5%, deforming or mutilans in 2.3% and spondylitic and/or sacro-iliitic in 20.9%. In 14.5% of arthritic patients an overlap of the spondylitic form and peripheral involvement was also found. Stratification by age of patient populations shows that cutaneous pathology has a homogeneous distribution in the various age decades, while joint symptoms are seen maximally in the sixth decade and are absent in the first two decades. The relationship between the onset of skin lesions and joint pathology demonstrates that skin lesions preceded arthritis in 64.5% of the cases, whilst arthritis antedated psoriasis in only 19.35%. In 16.1% of cases psoriasis and arthritis began almost simultaneously. Nail changes were present in 63% of arthritic patients and in 37% of psoriatic subjects without arthritis. Furthermore, in 88% of arthritic patients in whom arthritis preceded skin lesions, nail changes antedated the onset of clinically apparent psoriasis. Extra-articular features were not found. This absence might be associated with the usual seronegativity for rheumatoid factor in psoriatic arthritis, also confirmed in this survey.

[Hypercupremia: a marker of articular phlogosis?]. / L'ipercupremia: un marker della flogosi articolare?

Serum copper, iron and ceruloplasmin concentrations were determined in 45 subjects (20 males and 23 females, medium age 50.3, range 25-76) diagnosed as psoriatic arthritis patients, 63 patients (30 males and 33 females, medium age 32.4, range 10-78) with psoriasis, and in 60 blood donors (32 women and 28 men) as reference value group. Mean serum copper, iron and ceruloplasmin were significantly different (p less than .001) in psoriatic arthritis when compared with controls or subjects with psoriasis alone. The number of synovial joints affected was significantly correlated to changes in these serum parameters. Indeed serum copper, iron and ceruloplasmin were found significantly different from normals in the polyarticular subgroup, (p less than .001) while only copper and ceruloplasmin were different in mono-oligoarticular form (respectively p less than .001 and p less than .01). No significant changes were found in the spondiloarticular subgroup. In the polyarticular subgroup a direct correlation was found between another disease activity marker (e.g.ESR) and serum changes in iron, cerulosplasmin and copper (p less than .001).