Otar Yener Gulcin, Ekici Tekin Zahide, Yuksel Selcuk
Department of Pediatric Rheumatology, Pamukkale University School of Medicine, Denizli 20070, Turkey.
World J Clin Cases. 2019 Jan 6;7(1):69-72. doi: 10.12998/wjcc.v7.i1.69.
Diffuse fasciitis with psoriatic arthritis on magnetic resonance imaging (MRI) has not been previously described in childhood. Here we present the first case report of a pediatric patient developing fasciitis, beyond plantar fasciitis, with psoriatic arthritis.
An 11-year-old female was admitted with the complaints of psoriatic rash on the body associated with severe pain in the lower extremities and arthritis in the right knee. Psoriasis was confirmed by skin biopsy, she diagnosed with juvenile psoriatic arthritis. Diagnostic tests did not indicate any pathology except MRI. MRI of the femur and tibia revealed that high-signal inflammatory changes in the subdermal fascia. These findings led to a diagnosis of psoriatic fasciitis. Methotrexate was given for 3 mo but the patient showed no response to therapy; therefore, etanercept was added. However, there was no response to treatment. Etanercept was switched to adalimumab at the sixth month of therapy. Clinical improvement started with therapy of adalimumab within one month. Fasciitis finding in MRI disappeared at seventh months on adalimumab therapy. She has no complaint for two years with adalimumab.
The most effective imaging method is MRI and adalimumab may be the best choice of treatment for psoriatic fasciitis.
磁共振成像（MRI）显示的伴有银屑病关节炎的弥漫性筋膜炎在儿童中此前未见报道。在此，我们报告首例除足底筋膜炎外患有银屑病关节炎并发生筋膜炎的儿科患者。
一名11岁女性因身体出现银屑病皮疹、下肢剧痛及右膝关节炎入院。皮肤活检确诊为银屑病，她被诊断为青少年银屑病关节炎。除MRI外，诊断性检查未发现任何病变。股骨和胫骨的MRI显示皮下筋膜有高信号炎性改变。这些发现导致诊断为银屑病性筋膜炎。给予甲氨蝶呤治疗3个月，但患者对治疗无反应；因此，加用了依那西普。然而，治疗仍无反应。在治疗的第6个月，依那西普换为阿达木单抗。使用阿达木单抗治疗1个月后临床症状开始改善。在阿达木单抗治疗7个月时，MRI显示的筋膜炎表现消失。使用阿达木单抗治疗两年，她无任何不适。
最有效的成像方法是MRI，阿达木单抗可能是银屑病性筋膜炎的最佳治疗选择。
