Psoriatic fasciitis in a pediatric patient: A case report

Abstract

BACKGROUNDDiffuse fasciitis with psoriatic arthritis on magnetic resonance imaging (MRI) has not been previously described in childhood. Here we present the first case report of a pediatric patient developing fasciitis, beyond plantar fasciitis, with psoriatic arthritis.CASE SUMMARYAn 11-year-old female was admitted with the complaints of psoriatic rash on the body associated with severe pain in the lower extremities and arthritis in the right knee. Psoriasis was confirmed by skin biopsy, she diagnosed with juvenile psoriatic arthritis. Diagnostic tests did not indicate any pathology except MRI. MRI of the femur and tibia revealed that high-signal inflammatory changes in the subdermal fascia. These findings led to a diagnosis of psoriatic fasciitis. Methotrexate was given for 3 mo but the patient showed no response to therapy; therefore, etanercept was added. However, there was no response to treatment. Etanercept was switched to adalimumab at the sixth month of therapy. Clinical improvement started with therapy of adalimumab within one month. Fasciitis finding in MRI disappeared at seventh months on adalimumab therapy. She has no complaint for two years with adalimumab.CONCLUSIONThe most effective imaging method is MRI and adalimumab may be the best choice of treatment for psoriatic fasciitis.

The histopathological landscape of the major psoriasiform dermatoses

“…The most frequent forms (psoriasis, pustular psoriasis, Reiter's syndrome) share common immune-mediated mechanisms, which involve certain human lymphocyte antigens -HLA-B13, HLA-Bw17, HLA-B27, the latter being known as a major factor for the pathogenesis of ankylosing spondylitis, a chronic immune-mediated inflammatory disease with systemic involvement [4] and for Reiter's syndrome genetic component, where the reactive disease is triggered by enteric infections, such as Chlamydia subspecies [1,3]. The association of psoriasis and arthritis is also described in children, as juvenile psoriatic arthritis (JPsA), a rare disease in which patients can develop besides the above conditions, plantar fasciitis [5]. The genetic mechanisms in psoriasis are supported by the "allelic instability in mitosis" model [1].…”

Güneydoğu Anadolu Bölgesi jüvenil idiyopatik artrit hastalarında alt tip dağılımı ve üveit sıklığı

“…'nın çalışmasında persistan oligoartrit grubundaki hastalarının en yüksek remisyon oranına sahip olduğu (%43-73) ve RF pozitif poliartiküler JİA hastalarının en az remisyon oranına (%0-15) sahip olan gruplar olduğu belirtilmiştir (19). Psoriatik artritte JİA içinde tedavisi zor bir grubu oluşturmaktadır (20). Serimizde genel olarak yüksek bir remisyon oranı (%81.4) yakalanmış olmasına rağmen psoriatik artrit ile RF negatif poliartiküler ve RF pozitif poliartiküler artrit hastaları remisyon oranının en az olduğu grupları oluşturmuşlardır.…”