MPO antibody-positive vasculitis in a patient with psoriatic arthritis and gold-induced membranous glomerulonephritis

Renal disorders in rheumatologic diseases: the spectrum is changing (part 2. Arthridides)

This review is devoted to rheumatologic diseases mainly characterized by different types of arthritis. They may involve also different organs, including the kidney, but renal disease is more frequently caused by the nephrotoxicity of drugs to relieve pain or to interfere with the pathophysiology of the underlying disease. Rheumatoid arthritis is the prototype of arthropathies. This autoimmune disease mainly attacks joints, tendons and ligaments but can also involve internal organs including the kidney. Psoriatic arthritis is a complex disease in which psoriasis, a chronic inflammatory disease, is associated with the development of peripheral arthritis or spondylitis. The disease or its treatment may lead to kidney complications. Gout is a form of inflammatory arthritis which is characterized by an increase in the serum uric acid deposits in and around the joints of the extremities, the so called tophi. The disease is often associated with a metabolic syndrome with diabetes, obesity, hypertension, and cardiovascular disease. Kidney injury is frequent. It may be caused by kidney stones, urinary tract obstruction, tubulointerstitial and vascular lesions leading to CKD and renal failure.

Autoantibodies Other than Antineutrophil Cytoplasmic Antibodies Are Not Positive in Patients with Psoriasis Vulgaris

There is a great deal of evidences that a link may exist between psoriasis and autoimmunity. In this study, thirty-six patients with psoriasis vulgaris and twenty healthy controls were screened for antinuclear antibody (ANA), anti-ds-DNA antibodies, anti-SSA (anti-Ro), anti-SSB (anti-La), anti-Scl-70, anti-Jo-1, rheumatoid factor (RF), C3 and C4 levels, IgG and IgM anti-cardiolipin antibodies (aCL) and anti-neutrophil cytoplasmic antibodies (pANCA and cANCA) in order to determine the role of autoimmunity in the pathogenesis. In addition, the MPO-ANCA test was performed on pANCA-positive patients. In ANA screening, one patient showed 1/80 granular positivity. No positive results were obtained from either the study or control groups for anti-dsDNA, anti-SSA, anti-SSB, anti-Scl-70, or anti-Jo-1 determinations. For RF, 5.8% of the patients had positive values. Both C3 and C4 levels were found to be significantly elevated in psoriasis patients compared to healthy controls (p<0.001). IgG-aCL and IgM-aCL positivity was not significantly different between the two group. pANCA was positive in 33.3% of the patients and a significant difference was observed between study and control groups (p<0.05). MPO-ANCA was negative in all the pANCA-positive patients. In conclusion, only serum C3 and C4 levels and pANCA determinations showed significant differences when compared to healthy controls. Our findings may be evidence of associations between autoimmunity and psoriasis vulgaris. However, more detailed studies in this field need to be done to determine the relationship between them.

Nephrotic syndrome preceding psoriasis in children

Nephrotic syndrome is considered to be a late complication of psoriasis, reported usually in adults and characterized by IgA nephropathy or focal segmental glomerulosclerosis. We report on four children in whom steroid-resistant nephrotic syndrome either preceded (n = 3), by 41-120 months, or occurred simultaneously (n = 1) with psoriasis; renal histology showed minimal change disease. Therapy with corticosteroids and cyclosporine resulted in remission of renal and cutaneous symptoms. Minimal change nephrotic syndrome and psoriasis might share similar mechanisms of pathogenesis involving cell-mediated immunity.

Purpura and serum mixed cryoglobulinemia in psoriatic arthritis

We here firstly describe the case of a psoriatic arthritis associated with cutaneous purpura and lower limbs weakness. The presence of type III mixed cryoglobulinemia in serum was the only possible detected cause. Discrepancies with the hepatitis C virus-related mixed cryoglobulinemia picture are discussed.