Vol 98, No 4 (2022)

The role of biomechanical stress and trauma in the initiation of inflammation of the joints and periarticular structures in psoriatic arthritis (PA) is currently not fully understood. Soft tissues and joints are the target for constant biomechanical stress and microtrauma, leading to inflammation. There is an opinion that this inflammation in PA is due to an analogue of the skin isomorphic reaction that develops in the skin of psoriatic patients in response to trauma. Some authors have called this reaction the “deep Koebner phenomenon”. It is assumed that the early, preclinical phase of psoriatic arthritis may be based on inflammation of the enthesis as a response to microtrauma, and explained by the proximity of the entheses and the articular membranes. Detection of early changes in entheses in psoriatic patients, including those who do not have complaints from the musculoskeletal system, is of great importance for the early diagnosis of psoriatic arthritis. In the literature review, the sources for the period 2010–2021 were studied, devoted to the role of the isomorphic reaction and microtraumatization in the pathogenesis of PA, as well as the role of various imaging methods for the early diagnosis of enthesitis in psoriatic patients.

Psoriasis is a chronic multi-factorial immune-mediated inflammatory disease of skin and joints. The variety of clinical forms of dermatosis is consistent with various pathogenetic features of the disease progress which have been significantly supplemented and reviewed recently. Knowledge of these mechanisms will improve and personalize the prescribed therapy.

This study places the emphasis on modern ideas about the formation of T cell memory, the role of melanocytes and innate lymphoid cells. Development mechanisms of guttate and paradoxical psoriasis with important distinguishing characteristics are described separately.

Today, knowledge of the molecular basis of the disease progression has led to the creation and introduction of a number of highly effective targeted drugs into clinical practice. Further developments related to the inhibition of resident memory cells, innate lymphoid cells, as well as the study of guttate psoriasis perpetuation and the occurrence of paradoxical psoriasis will significantly increase the effectiveness of the therapy.

Background. Psoriatic arthritis is a chronic inflammatory disease of joints, spine and enthesis, which develops in 6–40% of patients with psoriasis and has a significant impact on the quality of life of patients.

Aims. To determine the relationship between age of cutaneous manifestation of psoriasis and the timing of psoriatic arthritis diagnosis; to examine the possibility of prediction of timing of psoriatic arthritis diagnosis depending on age of cutaneous manifestation of psoriasis.

Materials and methods. Data of patients aged 18 years and older with psoriatic arthritis included in the psoriasis patient register were analysed. Inclusion criteria were: patient age 18 years and older; established diagnosis of psoriasis and psoriatic arthritis. Exclusion criteria were: psoriatic arthritis diagnosed before or simultaneously with cutaneous manifestation of psoriasis; the age of the cutaneous manifestation of psoriasis older than 70 years. The sample included 771 patients.

Spearman's correlation analysis was used to assess the correlation between age of cutaneous manifestation of psoriasis and period from skin psoriasis onset to psoriatic arthritis diagnosis.

The possibility of prediction of the period till psoriatic arthritis was diagnosed depending on age at cutaneous manifestation of psoriasis was established by means of quantile regression analysis.

Results. Mean age at cutaneous manifestation of psoriasis (±SD) was 26.0 ± 13.5 years. The period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis averaged 13.7 ± 10.3 years, its median [interquartile range] was 12 [6–19] years.

According to Spearman's correlation analysis, a moderate (close to strong) negative correlation between varibles was revealed (Spearman's correlation coefficient = –0.490, p < 0.0005).

In accordance to quantile regression analysis, lines of 5, 25, 50, 75 and 95% quantiles were obtained and the dependence of the period till the diagnosis of psoriatic arthritis on the age of onset of skin psoriasis was demonstrated. Based on the quantile equation obtained, a prognostic table for the period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis was compiled.

Conclusions. Statistically significant inverse relationship between age of cutaneous manifestation of psoriasis and period till psoriatic arthritis diagnosis was established: older age at skin psoriasis onset is associated with shorter period till psoriatic arthritis diagnosis. Based on established relationship, presented as an equation, table and graphically, prediction of period till psoriatic arthritis diagnosis is possible. These results can be used in the clinical practice of dermatovenereologists.

A 38-year-old female patient complained of lip augmentation. With a preliminary diagnosis of Rossolimo–Melkersson–Rosenthal syndrome (monosymptomatic form), chronic fissure of the lower lip, the patient was sent for examination in order to exclude tumor pathology and vascular malformation. According to the results of a comprehensive clinical and laboratory examination, it was found that lip enlargement is due to the formation of granulomas. Additional follow-up by a pulmonologist confirmed the presence of sarcoidosis of the lungs with involvement of the mediastinal lymph nodes. A comprehensive examination made it possible to verify the diagnosis of multisystem sarcoidosis in a patient with macrocheilitis. As a result of complex therapy using surgical methods and systemic glucocorticosteroids, a rapid dynamics of clinical symptoms was observed and remission was achieved. This clinical case demonstrates a combination of sarcoid lesions of the tissues of the mediastinal lymph nodes, lung parenchyma and lips. It was the presence of macrocheilitis that was the main reason for visiting a dermatovenereologist and was the reason for choosing the subsequent tactics of examination and treatment. As a result of complex therapy using surgical methods of treatment and systemic glucocorticosteroids, carried out entirely within the framework of the program of state guarantees of free medical care for citizens, a stable remission of the disease was achieved.

Lichen planus refers to dermatoses with frequent, often isolated, lesions of the oral mucosa. In the presence of rashes only on the oral mucosa, the diagnosis is difficult. At the same time, erosive-ulcerative forms of the disease present the greatest differential diagnostic difficulties. Cases that do not heal for a long time and are not amenable to treatment should be especially alert to the doctor due to the risk of malignancy.

The article describes a rare clinical case of squamous cell carcinoma of the oral mucosa in a 52-year-old patient with an erosive-ulcerative form of lichen planus of the oral cavity, characterized by a chronic long-term course, torpidity to therapy and simultaneous damage to the genital mucosa. The presented case emphasizes the importance of a thorough clinical examination, with a histological examination of the biopsy in order to monitor changes in the lesions.