Department of Internal Medicine 'B', Assuta Ashdod Medical Center, Ashdod, Israel.
Rheumatology Unit, Assuta Ashdod Medical Center, Ashdod, Israel.
Clin Rheumatol. 2019 Sep;38(9):2367-2372. doi: 10.1007/s10067-019-04695-y. Epub 2019 Jul 22.
Streptococcus is well associated with a myriad of inflammatory diseases. Among others, this bacterium is linked to the triggering of psoriasis and to post-streptococcal reactive arthritis (PSRA), an arthritis which is typically confined to peripheral joints. Three patients who developed acute psoriatic spondyloarthritis (SpA) following a recent streptococcal infection are described in this article. We searched the existing literature for cases of axial involvement in PSRA and reviewed the association between streptococcal infection and psoriasis or psoriatic arthritis )PsA). In all patients, psoriatic SpA occurred within 7-10 days of a confirmed streptococcal infection. The main presenting syndrome was inflammatory back pain with evidence of acute axial spondyloarthritis on magnetic resonance imaging. One patient had guttate psoriasis, the second patient developed pustular psoriasis, and the third patient had exacerbation of pustular palmoplantar psoriasis. Two patients required treatment with tumor necrosis factor alpha (TNF-α) blockers. Axial involvement in PSRA is very rare. A potential association of streptococcal infection and development of PsA has been explored in several articles. However, to the best of our knowledge, acute psoriatic SpA as a manifestation of PSRA has yet to be described. Acute psoriatic SpA should be considered in the differential diagnosis of new-onset inflammatory back pain followed by psoriasis in young adults who had a recent throat infection. KEY POINTS: • Our case series describes three cases of acute psoriatic spondyloarthritis that occurred within 7--10 days of a confirmed streptococcal infection and progressed to full blown chronic disease. • Acute psoriatic spondyloarthritis as a manifestation of post streptococcal reactive arthritis should be considered in the differential diagnosis of new onset inflammatory back pain followed by psoriasis in young adults who had a recent throat infection.
链球菌与许多炎症性疾病密切相关。除其他外，这种细菌与触发银屑病和链球菌后反应性关节炎（PSRA）有关，PSRA 通常局限于外周关节。本文描述了 3 例最近链球菌感染后发生急性银屑病性脊柱关节炎（SpA）的患者。我们在现有文献中搜索了 PSRA 中轴受累的病例，并回顾了链球菌感染与银屑病或银屑病关节炎（PsA）之间的关联。在所有患者中，银屑病性 SpA 发生在确诊链球菌感染后 7-10 天内。主要表现为炎症性背痛，磁共振成像显示急性中轴性脊柱关节炎。1 例患者出现点滴状银屑病，第 2 例患者出现脓疱性银屑病，第 3 例患者出现掌跖脓疱性银屑病恶化。2 例患者需要接受肿瘤坏死因子-α（TNF-α）阻滞剂治疗。PSRA 的中轴受累非常罕见。已经有几篇文章探讨了链球菌感染与 PsA 发展之间的潜在关联。然而，据我们所知，急性银屑病性 SpA 作为 PSRA 的一种表现形式尚未被描述。在最近有喉咙感染的年轻成年人中，出现新的炎症性背痛和随后出现银屑病时，应考虑将急性银屑病性 SpA 作为新的鉴别诊断。关键点：•我们的病例系列描述了 3 例急性银屑病性脊柱关节炎，这些病例在确诊链球菌感染后 7-10 天内发生，并进展为慢性疾病。•急性银屑病性脊柱关节炎作为链球菌后反应性关节炎的一种表现形式，应在新出现的炎症性背痛和随后出现银屑病的年轻成年人中，作为最近喉咙感染后的鉴别诊断。
