Bone betrayal: avascular necrosis in psoriatic arthritis
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20252553Keywords:
Psoriatic arthritis, Avascular necrosis, Hip joint, EnthesitisAbstract
Psoriatic arthritis is a multifaceted inflammatory condition with varied musculoskeletal manifestations. Although hip joint involvement remains uncommon, but may lead to severe sequelae such as avascular necrosis (AVN), especially in the presence of steroid exposure. We report the case study of a young male with history of chronic plaque psoriasis who presented with pain of lower back and right hip. There were no records of any corticosteroid exposure, trauma, alcohol consumption or any metabolic disorders. On examination, the patient was found to have enthesitis and nail changes, suggesting possibility of psoriatic arthritis. Magnetic resonance imaging revealed grade 2 AVN of the right femoral head without sacroiliitis. This case study highlights the possible occurrence of AVN in patient with psoriatic arthritis. This could be attributable to the mechanisms causing systemic inflammation and disruption of the vascular integrity. It emphasizes the need to screen for atypical manifestations in PsA so as to enable timely management.
Metrics
References
Patrick MT, Stuart PE, Raja K, Gudjonsson JE, Tejasvi T, Yang J, et al. Genetic signature to provide robust risk assessment of psoriatic arthritis development in psoriasis patients. Nat Commun. 2018;9(1):4178. DOI: https://doi.org/10.1038/s41467-018-06672-6
Chiu HY, Wang IT, Huang WF, Tsai YW, Shiu MN, Tsai TF. Increased risk of avascular necrosis in patients with psoriatic disease: A nationwide population-based matched cohort study. J Am Acad Dermatol. 2017;76(5):903-10. DOI: https://doi.org/10.1016/j.jaad.2016.11.001
Kim TH, Hong JM, Oh B, Cho YS, Lee JY, Kim HL, et al. Association of polymorphisms in the Interleukin 23 receptor gene with osteonecrosis of femoral head in Korean population. Exp Mol Med. 2008;40(4):418-26. DOI: https://doi.org/10.3858/emm.2008.40.4.418
Shigemura T, Nakamura J, Kishida S, Harada Y, Ohtori S, Kamikawa K, Ochiai N, Takahashi K. Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study. Rheumatology (Oxford). 2011;50(11):2023-8. DOI: https://doi.org/10.1093/rheumatology/ker277
Klippel JH, Gerber LH, Pollak L, Decker JL. Avascular necrosis in systemic lupus erythematosus. Silent symmetric osteonecroses. Am J Med. 1979;67(1):83-7. DOI: https://doi.org/10.1016/0002-9343(79)90077-9
Park CS, Kim DS, Lee HJ, Cha KW, Lee CW, Oh DH, et al. Avascular necrosis of the femoral head in a patient with psoriatic arthritis. Korean J Rheumatol. 2003;10(3):305-8.
Hickman JG, Tindall JP, McCollum DE. Aseptic (avascular) necrosis of the femoral head in psoriasis. South Med J. 1979;72(10):121-6. DOI: https://doi.org/10.1097/00007611-197902000-00004
Michet CJ, Mason TG, Mazlumzadeh M. Hip joint disease in psoriatic arthritis: risk factors and natural history. Ann Rheum Dis. 2005;64(8):1068-70. DOI: https://doi.org/10.1136/ard.2004.022228
Tang DZ, Hou W, Zhou Q. TNF-α Directly Enhances Osteocyte RANKL Expression and Promotes Osteoclast Formation. Front Immunol. 2019;10:2925. DOI: https://doi.org/10.3389/fimmu.2019.02925
Lechner J, Rudi T, von Baehr V. Osteoimmunology of tumor necrosis factor-alpha, IL-6, and RANTES/CCL5: a review of known and poorly understood inflammatory patterns in osteonecrosis. Clin Cosmet Investig Dent. 2018;10:251-62. DOI: https://doi.org/10.2147/CCIDE.S184498
Downloads
Published
How to Cite
Issue
Section
