1
|
Diagnosis and Management of a Chronic Lower-Limb Wound in a Patient with Felty Syndrome. Adv Skin Wound Care 2022; 35:1-4. [PMID: 35723962 DOI: 10.1097/01.asw.0000831076.19727.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The authors report the case of a 55-year-old patient with a chronic lower-limb wound thought to be secondary to vasculitis. This case illustrates the importance of maintaining a high index of suspicion for vasculitic ulcers in patients with autoimmune disease. Management considerations in this context are also discussed.
Collapse
|
2
|
Sánchez-Cárdenas G, Contreras-Yáñez I, Guaracha-Basáñez G, Pacheco-Santiago LD, Méndez-Flores S, Barrera-Vargas A, Merayo-Chalico J, Domínguez-Cherit J, Pascual-Ramos V. Cutaneous manifestations are frequent and diverse among patients with rheumatoid arthritis and impact their quality of life: a cross-sectional study in a cohort of patients with recent-onset disease. Clin Rheumatol 2021; 40:3581-3590. [PMID: 33651260 DOI: 10.1007/s10067-021-05664-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION/OBJECTIVES Cutaneous involvement is often overlooked in rheumatoid arthritis (RA). We described cutaneous findings in outpatients attending a recent-onset cohort and identified factors associated with skin involvement and reduced (R) dermatological quality of life (DQoL). METHODS Skin and rheumatological examinations were performed in 122 patients. DQoL was assessed through the Dermatology Life Quality Index (DLQI). Skin findings were classified as RA-specific and RA-nonspecific. Multiple regression analysis identified factors associated to skin involvement and RDQoL (DLQI score > 1). RESULTS Patients were middle-aged females (91%), with a 1-year mean disease activity score in 28 joints as 2.0 (interquartile range: 1.5-2.6). There were 94 (77%) patients in whom at least one cutaneous finding was observed: 17 (13.1%) had RA-specific findings (all were rheumatoid nodules) and 91 (96.8%) had at least one RA-nonspecific finding, further classified into skin diseases (35.2%), hair diseases (20.9%), and skin-related signs (76.9%, among whom 94.3% had xerosis). Age (odds ratio [OR]: 1.054, 95% confidence interval [CI]: 1.015-1.094) and skin-health concerns (OR: 5.657, 95% CI: 1.771-18.070) were associated with cutaneous involvement, whereas increased age and DLQI score were associated with a higher number of skin findings/patient. There were 29 patients (24.2%) with RDQoL, which were associated with the Short Form-36 emotional component (OR: 0.955, 95% CI: 0.923-0.988) and the number of skin findings/patient (OR 2.873, 95% CI 1.723-4.791). Pruritus and hair diseases were the individual categories associated with RDQoL. CONCLUSIONS Cutaneous manifestations are frequent in RA patients and have the potential to impact the emotional component of health-related quality of life. Key Points • Up to 77% of the RA patients with substantial follow-up, from a recent-onset disease cohort, had cutaneous manifestations; these were primarily RA-nonspecific findings, whereas 13.1% had RA-specific findings. • Skin-health concerns and age were associated with cutaneous involvement; meanwhile, increased age and Dermatology Life Quality Index (DLQI) score were associated with a higher number of cutaneous findings/patient. • Reduced dermatological quality of life (RDQoL) was documented in one in four patients and was associated with the SF-36 emotional component and the number of cutaneous findings/patient.
Collapse
Affiliation(s)
- Gabriela Sánchez-Cárdenas
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Lexli D Pacheco-Santiago
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Silvia Méndez-Flores
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico.
| |
Collapse
|
3
|
Psoriasis and Connective Tissue Diseases. Int J Mol Sci 2020; 21:ijms21165803. [PMID: 32823524 PMCID: PMC7460816 DOI: 10.3390/ijms21165803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/16/2022] Open
Abstract
Psoriasis is a chronic systemic inflammatory disease with various co-morbidities, having been recently considered as a comprehensive disease named psoriatic disease or psoriatic syndrome. Autoimmune diseases are one form of its co-morbidities. In addition to the genetic background, shared pathogenesis including innate immunity, neutrophil extracellular trap (NETs), and type I interferon, as well as acquitted immunity such as T helper-17 (Th17) related cytokines are speculated to play a significant role in both psoriasis and connective tissue diseases. On the other hand, there are definite differences between psoriasis and connective tissue diseases, such as their pathomechanisms and response to drugs. Therefore, we cannot expect that one stone kills two birds, and thus caution is necessary when considering whether the administered drug for one disease is effective or not for another disease. In this review, several connective tissue diseases and related diseases are discussed from the viewpoint of their coexistence with psoriasis.
Collapse
|