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The classification of psoriatic arthritis

1998; Elsevier BV; Volume: 38; Issue: 6 Linguagem: Inglês

10.1016/s0190-9622(98)70176-8

1097-6787

J Bazex,

Skin and Cellular Biology Research

To the Editor:I read with great interest the article “The classification of psoriatic arthritis: What will happen in the future?” (J Am Acad Dermatol 1997;36:78-83).One particular clinical form was not mentioned by the authors. This was first described by Marguery et al. 1Marguery MC Baran R Pages M Bazex J. Acropachy-dermie psoriasique.Ann Dermatol Venereol. 1991; 118: 373-376PubMed Google Scholar under the title of “Psoriatic Acropachydermodactyly.” In this study we described ungual dystrophy suggestive of psoriasis with the distal part of the fingers enlarged as a result of thickening of the soft part of the distal phalanges; these lesions are painful. These cutaneous lesions are associated with inflammatory arthralgia of the distal phalanges with limited movement in flexion. Radiographs of the hands showed osteitis and periostitis of the distal phalanges and sometimes arthritis of the distal interphalangeal joint.We have proposed a physiopathologic hypothesis indicating a direct link between ungual lesions and lesions of the distal phalanx by its soft parts: the pathologic process concerns the enthesis connecting nail and bone, along with inflammatory processes involving the soft parts (fibrous sheets traversing the cellular fatty tissue). Often at the beginning, the distal interphalangeal joint is normal. This typical aspect sometimes involves only the big toes but can also involve the fingers as well as the other toes. Sometimes one toe, a few toes, and/or finger(s) are spared.The diagnosis of psoriatic acropachydermodactyly is easy if there are other psoriatic lesions, but this form may be the first sign of psoriasis. To the Editor:I read with great interest the article “The classification of psoriatic arthritis: What will happen in the future?” (J Am Acad Dermatol 1997;36:78-83).One particular clinical form was not mentioned by the authors. This was first described by Marguery et al. 1Marguery MC Baran R Pages M Bazex J. Acropachy-dermie psoriasique.Ann Dermatol Venereol. 1991; 118: 373-376PubMed Google Scholar under the title of “Psoriatic Acropachydermodactyly.” In this study we described ungual dystrophy suggestive of psoriasis with the distal part of the fingers enlarged as a result of thickening of the soft part of the distal phalanges; these lesions are painful. These cutaneous lesions are associated with inflammatory arthralgia of the distal phalanges with limited movement in flexion. Radiographs of the hands showed osteitis and periostitis of the distal phalanges and sometimes arthritis of the distal interphalangeal joint.We have proposed a physiopathologic hypothesis indicating a direct link between ungual lesions and lesions of the distal phalanx by its soft parts: the pathologic process concerns the enthesis connecting nail and bone, along with inflammatory processes involving the soft parts (fibrous sheets traversing the cellular fatty tissue). Often at the beginning, the distal interphalangeal joint is normal. This typical aspect sometimes involves only the big toes but can also involve the fingers as well as the other toes. Sometimes one toe, a few toes, and/or finger(s) are spared.The diagnosis of psoriatic acropachydermodactyly is easy if there are other psoriatic lesions, but this form may be the first sign of psoriasis. I read with great interest the article “The classification of psoriatic arthritis: What will happen in the future?” (J Am Acad Dermatol 1997;36:78-83). One particular clinical form was not mentioned by the authors. This was first described by Marguery et al. 1Marguery MC Baran R Pages M Bazex J. Acropachy-dermie psoriasique.Ann Dermatol Venereol. 1991; 118: 373-376PubMed Google Scholar under the title of “Psoriatic Acropachydermodactyly.” In this study we described ungual dystrophy suggestive of psoriasis with the distal part of the fingers enlarged as a result of thickening of the soft part of the distal phalanges; these lesions are painful. These cutaneous lesions are associated with inflammatory arthralgia of the distal phalanges with limited movement in flexion. Radiographs of the hands showed osteitis and periostitis of the distal phalanges and sometimes arthritis of the distal interphalangeal joint. We have proposed a physiopathologic hypothesis indicating a direct link between ungual lesions and lesions of the distal phalanx by its soft parts: the pathologic process concerns the enthesis connecting nail and bone, along with inflammatory processes involving the soft parts (fibrous sheets traversing the cellular fatty tissue). Often at the beginning, the distal interphalangeal joint is normal. This typical aspect sometimes involves only the big toes but can also involve the fingers as well as the other toes. Sometimes one toe, a few toes, and/or finger(s) are spared. The diagnosis of psoriatic acropachydermodactyly is easy if there are other psoriatic lesions, but this form may be the first sign of psoriasis.