Clinical characteristics and treatment status of pustulotic arthro‐osteitis: A single‐center study involving 51 cases

Abstract

Pustulotic arthro‐osteitis (PAO) is a major complication of palmoplantar pustulosis (PPP). In orthopedic surgery outpatient clinics, PPP patients with osteoarticular symptoms are seen frequently, but PAO's clinical features remain not well known. To determine Japanese patients’ clinical features and treatment status with PAO, we conducted a single‐center retrospective epidemiologic survey. Clinical features, including gender, age, smoking habit, the onset pattern, interval between skin manifestation and osteoarticular symptoms, and the incidence of sternoclavicular joint lesions, axial and peripheral joint lesions, were examined. The association between physical status and image findings by X‐ray, computed tomography, bone scintigraphy with Technetium99, or magnetic resonance imaging was evaluated. The distribution pattern of peripheral joint lesions and the treatment status were evaluated. We identified 51 patients, 10 men and 41 women, with PAO. The average age was 48 years and 59% were smokers. The frequency of onset patterns was skin‐leading type (63%), simultaneous onset (18%), and osteoarticular leading type (16%). The average interval between skin involvement and osteoarticular involvement in skin‐leading type was significantly longer than that in osteoarticular leading type (7.1 years vs. 2.0 years). A sternoclavicular joint (SCJ) lesion was detected in 65% cases, and the physical findings of SCJ were significantly related to the image findings. Axial and peripheral joint lesions were detected in the same ratio (23 cases, 45%). In the peripheral joints, the finger joint was the most common (26%), followed by the shoulder joint (21%). Patients were treated with nonsteroidal anti‐inflammatory drugs (76%), followed by conventional synthetic disease‐modifying antirheumatic drugs (DMARDs) (29%) and biological DMARDs (9.8%). Tonsillectomy was performed in 11 cases. In conclusion, PAO more frequently involves SCJ in middle‐aged women who smoke. Given that osteoarticular leading type was detected in 16% cases, seronegative oligoarthritis patients should be monitored for PPP, leading to a diagnosis of PAO.

Clinical characteristics of pustulotic arthro‐osteitis in Korea

“…As PsA is frequently undiagnosed among patients with PsO, this prevalence also might be lower than the true prevalence, as it is difficult for patients to link the skin eruptions on the palms and soles with the characteristic joint symptoms of PAO involving the chest wall; therefore, they might not report their joint symptoms to dermatologists 22,23 . Two previous Japanese studies reported that 59–70% of the patients had an interval less than 2 years between skin and joint symptoms, but the proportion was lower in the present study 19,20 . A higher rate of prolonged interval can also be a hindrance to linking the two symptoms.…”

“…Pustulotic arthro‐osteitis has been frequently studied in Japan 8,9,19,20 . However, reports involving a large number of PAO patients are relatively uncommon in other countries 15,16,21 .…”

“…The pattern of arthritis was not significantly different between PAO and PsA in terms of the location of joint involvement ( Pustulotic arthro-osteitis has been frequently studied in Japan. 8,9,19,20 However, reports involving a large number of PAO patients are relatively uncommon in other countries. 15,16,21 In the present study, the clinical features of PAO in Korean patients were investigated and compared with those of PsA.…”

“…22,23 Two previous Japanese studies reported that 59-70% of the patients had an interval less than 2 years between skin and joint symptoms, but the proportion was lower in the present study. 19,20 A higher rate of prolonged interval can also be a hindrance to linking the two symptoms. Therefore, dermatologists should pay attention to joint involvement for early diagnosis of PAO.…”