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Case Reports
. 2023 Jan 28;13(1):177-189.
doi: 10.3390/clinpract13010016.

Treatment in Patients with Psoriatic Disease and Rheumatoid Arthritis: Seven Case Reports

Tomoko Akeda  1 , Keiichi Yamanaka  1
Affiliations
Case Reports

Treatment in Patients with Psoriatic Disease and Rheumatoid Arthritis: Seven Case Reports

Tomoko Akeda et al. Clin Pract. .

Abstract

The incidence of psoriasis, an intractable long-lasting inflammatory skin disease, is increasing and has many complications and comorbidities. Approximately 14% of patients have psoriatic arthritis (PsA). Rheumatoid arthritis (RA) is not a rare disease worldwide, and some patients may have both PsA and RA. In the present study, we encountered seven patients with concurrent diagnoses of RA and psoriatic disease and reported the details of clinical data, treatment efficacy, and X-ray findings. The diagnosis may require not only classification criteria but also a comprehensive judgment in collaboration with rheumatology over time. In addition to methotrexate as an anchor drug, anti-tumor necrosis factor-α agents are the first choice of biological agents for treatment, and interleukin (IL)-17 inhibitors may be effective, as IL-17 is also involved in the pathogenesis of RA. When treating patients with both PsA and RA, it may be essential to consider the treatment strategy, depending on which disease is more active.

Keywords: Il-17; TNF-α inhibitor; biologics; methotrexate; psoriatic arthritis; rheumatoid arthritis.

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Conflict of interest statement

T.A. has received speaker’s fees from AbbVie, Eisai, Eli Lilly Japan, Janssen, Maruho, Sun Pharma, Sanofi, and Taiho Yakuhin. K.Y. has served as the investigator of a clinical trial for AbbVie, Boehringer Ingelheim, Eli Lilly Japan, LEO Pharma, Janssen, Maruho, MSD, Parexel, and UCB Japan. He has received research funding from AbbVie, Eisai, Eli Lilly Japan, Maruho, Sasaki Chemical, Sun Pharma, Taiho Yakuhin, and Torii Yakuhin. In addition, he has received speaker’s fees and chair’s fees from AbbVie, Astellas Seiyaku, Celgene, Daiichi-Sankyo, Eisai, Eli Lilly Japan, Janssen, Kyowa-Hakko Kirin, LEO Pharma, Maruho, Nippon Kayaku, Nippon Zouki, Novartis, Sun Pharma, Sato Seiyaku, Sanofi, Taiho Yakuhin, Tanabe Mitsubishi and Torii Yakuhin.

Figures

Figure 1
Figure 1
Clinical photographs and radiographs of the hands in case 1. The finger joints are swollen and deformed. Radiographs show symmetrical subluxation of the second MCP joints and bone erosions at the PIP and MCP joints (red arrow). Severe osteolysis and destruction occur on multiple joint surfaces. Severe joint space narrowing and tonic change are depicted in both carpal bones. The left DIP and right PIP joints show bone proliferation suspicious for PsA (white arrow). MCP, metacarpophalangeal; PIP, peripheral interphalangeal; DIP, distal interphalangeal.
Figure 2
Figure 2
Clinical photograph and radiograph of the hands in case 2. There is nail psoriasis in the left third and fourth fingers and tenderness in the same DIP joints. Joint space narrowing is depicted in the same DIP joints (red arrow). Additionally, joint space narrowing is shown in the left carpal joint (white arrow), and the left styloid process is smaller than the right one (blue arrow). DIP, distal interphalangeal.
Figure 3
Figure 3
Clinical photographs and radiographs of the hands in case 3. Swan-neck deformities of the left fifth finger and both hitchhiker’s thumbs are shown. Radiographs depict joint space narrowing in the left second and fifth DIP joints (red arrow). Radiographs show subluxation of the left second MCP joints and bone erosions at the left fourth PIP and wrist joint (white arrow). MCP, metacarpophalangeal; PIP, peripheral interphalangeal; DIP, distal interphalangeal.
Figure 4
Figure 4
Clinical photographs and radiographs of the hands in case 4. Swelling, pain, and redness are noted in the left second and right fifth joints. There is bone proliferation at the left third DIP and right first MCP joints due to PsA (red circle), marginal erosion in the left fifth proximal metacarpal and fourth PIP joints (red arrow), and joint space narrowing in the left carpal bone (blue circle). MCP, metacarpophalangeal; PIP, peripheral interphalangeal; DIP, distal interphalangeal.
Figure 5
Figure 5
Clinical photographs and radiographs of the hands in case 5. Right-hand fingers show mild ulnar deviation. On the radiographs, the MCP joints are subluxated symmetrically. Radiographs show bone erosion, narrowing joint space, and destruction in both hands’ MCP, PIP, and DIP joints. MCP, metacarpophalangeal; PIP, peripheral interphalangeal; DIP, distal interphalangeal.
Figure 6
Figure 6
Clinical photographs and radiographs of the hands in case 6. Radiographs show bone erosion, loss of cleft space, and joint destruction in the PIP joint of the hands (red arrow). PIP, peripheral interphalangeal.
Figure 7
Figure 7
Clinical photographs and radiographs of the hands in case 7. Radiographs show erosions adjacent to periarticular bone proliferation at the collateral ligament and capsular joint attachment site (red arrow). Bone erosions are noted in the right third and fourth PIP joints (white arrow). PIP, peripheral interphalangeal.
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