Successful treatment of psoriatic onycho‐pachydermo periostitis (POPP) with adalimumab

Bongartz, Tim; Härle, Peter; Friedrich, Sarah; Karrer, Sigrid; Vogt, Thomas; Seitz, Andreas E.; Müller‐Ladner, Ulf

doi:10.1002/art.20763

Cited by 36 publications

(43 citation statements)

References 13 publications

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“…The mechanism of bony damage has been conceptualised in relation to inflammation passing from the subungual dermis to the bone [33,34]. The MRI description of POPP clearly attests to a nail-enthesis-bone apparatus diffuse inflammatory disorder [35]. This is highly reminiscent of the diffuse digital inflammation, including enthesis-bone involvement, that we have commonly seen in PsA of the DIP joints in the hand [13,36].…”

Section: Imaging To Establish Subclinical Evidence Of Enthesitis In Pmentioning

confidence: 99%

Nailing down the Genetic and Immunological Basis for Psoriatic Disease

et al. 2010

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Psoriatic disease encompassing skin, joint and nail involvement is largely viewed as autoimmune – a finding supported by data from animal models, the human leucocyte antigen (HLA)-Cw6 disease association in man, T-lymphocyte infiltration in lesional skin and the favourable skin response to T-cell-directed therapies. However, this immunopathogenetic model only applies to the skin, as recent studies failed to demonstrate a HLA-Cw6 association with the nails or joints. Furthermore, the nails and joints are intimately associated with inflammation at points of ligament or tendon insertion (i.e., enthesitis), so it is now appreciated that both of these sites also share a common microanatomical basis. Moreover, inflammation at insertion sites and nails does not appear to be associated with a particular antigenic territory but is quite diffuse in nature. This suggests that an aberrant response to tissue stressing of the integrated nail-joint apparatus, rather than autoimmunity, is driving the inflammatory process. Therefore, HLA-Cw6-associated type 1 psoriasis is more closely linked to autoimmunity, whereas nail and joint disease may be linked to tissue-specific factors, including tissue biomechanical stressing and microtrauma, that lead to activation of aberrant innate immune responses. These observations that stem from nail disease point toward a relative differential involvement of adaptive and innate immunity in the psoriatic disease spectrum and offer a fresh perspective on the pathophysiology of psoriatic disease and how it can be classified along the immunological disease continuum of self-directed inflammation.

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Section: Imaging To Establish Subclinical Evidence Of Enthesitis In Pmentioning

confidence: 99%

Nailing down the Genetic and Immunological Basis for Psoriatic Disease

et al. 2010

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“…POPP can be extremely painful and frequently causes significant fuctional impairment. It has been recognized as an uncommon subset of psoriatic arthritis and, to date, only a few cases have been described (1)(2)(3)(4). In general, POPP is regarded as a unique variant of psoriatic arthritis, but its pathology and pathophysiology are not well understood.…”

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confidence: 99%

Clinical images: Drumstick‐like fingers indicating psoriatic onycho‐pachydermo periostitis

Tsubota

Abe

Shibaki

2005

Arthritis & Rheumatism

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The patient, a 38-year-old man with a 10-year history of deformation and pustules in his fingers and toes, presented in December 2002. Physical examination revealed tender, drumstick-like swelling in all of his fingers and toes. Erythematous, scaling, and pustular eruptions were observed on the distal area of the digits (A). The nail plates were completely destroyed. He reported having arthralgia in the distal area of the digits. Scaly erythematous and pustular eruptions were present on the forehead and right knee. Radiographs of the fingers and toes revealed remarkable bone resorption and destruction, especially in the distal phalanges (B). Histologic examination of sections of a skin lesion showed parakeratosis and neutrophils forming Munro's abscesses in the stratum corneum. Rheumatoid factor was negative. Based on the above-mentioned findings, the patient was diagnosed as having psoriatic onycho-pachydermo periostitis (POPP) combined with an axial manifestation of psoriatic arthritis. POPP was described by Fournie et al in 1989 (1). It consists of psoriatic onychodystrophy and connective tissue thickening above the distal phalanx, including a periosteal reaction. POPP can be extremely painful and frequently causes significant fuctional impairment. It has been recognized as an uncommon subset of psoriatic arthritis and, to date, only a few cases have been described (1-4). In general, POPP is regarded as a unique variant of psoriatic arthritis, but its pathology and pathophysiology are not well understood. Therapy for this rare disease is based on treatments used for psoriatic arthritis, such as sulfasalazine, methotrexate, and the anti-tumor necrosis factor antibody adalimumab (4).

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“…13 However, in another case, successful results were observed with adalimumab treatment. 14 In our case, after a definite diagnosis was established, 10 mg/week of methotrexate and 5 mg of prednisolone was initiated. A week later, the dosage of methotrexate was increased to 15 mg/week.…”

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confidence: 78%

A Rapidly Progressive Variant of Psoriatic Arthritis: Psoriatic Onycho-Pachydermo-Periostitis

2016

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It is an uncommon subset of psoriatic arthritis that is characterized by psoriatic onychodystrophy, onycholysis, connective tissue thickening above the distal phalanx as well as specific radiologic changes such as periosteal reaction and bone erosions of the distal phalanges.1 In this article, the case of a 53-year-old male patient with POPP who responded dramatically to methotrexate has been discussed. CASE REPORTA 53-year-old male patient was admitted to the dermatology clinic with nail changes and pain in all the fingers, which started approximately one year prior to admission. His nail biopsies were unremarkable and his condition was unresponsive to anti-fungal medications ordered by several dermatology clinics over the past one year. Thereafter, the patient was referred to our clinic for flexion deformity of the distal interphalangeal (DIP) joints. He had painful swellings with functional impairment in the DIP joints for seven to eight months after which the deformities started to develop. A written informed consent was obtained from the patient.Our patient was working as a documentalist with no history of trauma or repetitive injury. On rheumatologic evaluation, there were no remarkable findings such as recurrent genital aphthous ulcers, oral aphthous ulcers, dry eyes and mouth, back pain, morning stiffness, bowel related symptoms, repeated fever or abdominal pain, and any other dermatologic rash. He had no systemic diseases, history of infection, recent vaccinations, or regular drug use. Family history was negative for psoriasis or other skin diseases. A physical examination revealed erythematous swellings and flexion deformities in all the DIP joints. All the fingernails had severe dystrophic changes. A psoriatic plaque was present on the extensor surface of the right elbow. ABSTRACTWe present a case with psoriatic onychodystrophy, onycholysis, connective tissue thickening above the distal phalanx as well as specific radiologic changes diagnosed as psoriatic onycho-pachydermo-periostitis who responded dramatically to methotrexate with current literature review. In this article, we report a 53-year-old male patient with psoriatic onycho-pachydermo-periostitis who responded dramatically to methotrexate.

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Successful treatment of psoriatic onycho‐pachydermo periostitis (POPP) with adalimumab

Cited by 36 publications

References 13 publications

Nailing down the Genetic and Immunological Basis for Psoriatic Disease

Nailing down the Genetic and Immunological Basis for Psoriatic Disease

Clinical images: Drumstick‐like fingers indicating psoriatic onycho‐pachydermo periostitis

A Rapidly Progressive Variant of Psoriatic Arthritis: Psoriatic Onycho-Pachydermo-Periostitis

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