Sexuality is an important aspect of quality of life that is often neglected in research studies and is rarely assessed in routine clinical practice. Patients may feel embarrassed to mention their sexual concerns and many health care providers feel uncomfortable taking a sexual history. The exact prevalence of sexual dysfunction in the general population is not known, but it is clearly very common and women are affected more often than men. Since the majority of connective tissue diseases have a female predilection, sexual dysfunction likely has a large impact on many of our patients. Furthermore, the clinical manifestations of these diseases such as joint pain, deformity and decreased physical function among many others have a major effect on sexual function.We will report results on the prevalence of sexual dysfunction among women with systemic sclerosis from our own institution. A validated questionnaire, The Female Sexual Function Index (FSFI), consisting of six domains was used to assess the multidimensional nature of female sexual dysfunction among women with scleroderma. Our results show a high prevalence of sexual dysfunction among female scleroderma patients compared to a healthy control population.We will also provide a review of the literature on sexual dysfunction among women in a variety of other connective tissue diseases including rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome.

PurposeAlthough numerous treatment options are available for patients with psoriatic arthritis (PsA), a need for effective and tolerable treatments remains for patients with refractory disease who have failed previous therapies and continue to experience tender and/or swollen joints, pain, and disease activity. Repository corticotropin injection (RCI) is believed to produce steroidogenic, steroid-independent, anti-inflammatory, and immunomodulatory effects in patients with rheumatic disorders, such as PsA. Limited literature exists on the use of RCI in patients with refractory PsA. The objective of this case series is to provide information on the clinical features of patients with refractory PsA and their response to RCI.PatientsNine patients treated with RCI for refractory PsA were retrospectively identified and included in the case series.ResultsAll the nine patients experienced at least transient improvements in their active skin and joint disease. In some patients, it was necessary to titrate the RCI to an appropriate dose. RCI was used in some patients to bridge with another PsA therapy, such as apremilast or certolizumab. RCI was well tolerated, but discontinued in three patients due to preexisting conditions (hypertension and hyperglycemia).ConclusionRCI may be a safe and effective option for patients with refractory PsA who failed therapy with multiple previous treatments.

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Symmetric skin thickening of the limbs with deep fascial inflammation is the hallmark of eosinophilic fasciitis. We describe a woman who presented with unilateral progressive skin thickening. Examination of a full thickness skin biopsy revealed an inflammatory process and fascial changes consistent with eosinophilic fasciitis. In contrast to other scleroderma mimics, eosinophilic fasciitis generally responds rapidly to glucocorticoid therapy. It is possible that unilateral eosinophilic fasciitis is under-recognized and can easily be misdiagnosed as another scleroderma variant if a full thickness biopsy is not reviewed by a dermatopathologist. Recognition of this subtype of eosinophilic fasciitis is important given the profound differences in prognosis of eosinophilic fasciitis and other scleroderma variants.