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Acute onset of psoriatic spondyloarthritis as a new manifestation of post-streptococcal reactive arthritis: a case series

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Abstract

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.

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Author information

Author notes

  1. Amir Dagan and Shani Dahan contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine ‘B’, Assuta Ashdod Medical Center, Ashdod, Israel

    Amir Dagan, Shani Dahan, Asaf Shemer & Tamer Hellou

  2. Rheumatology Unit, Assuta Ashdod Medical Center, Ashdod, Israel

    Amir Dagan

  3. Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Amir Dagan

  4. Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Pnina Langevitz & Ora Shovman

  5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Pnina Langevitz, Yehuda Shoenfeld & Ora Shovman

  6. Hybrid Imaging Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Tima Davidson

  7. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Yehuda Shoenfeld & Ora Shovman

  8. Past Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel Aviv University, Tel Aviv, Israel

    Yehuda Shoenfeld

  9. I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

    Yehuda Shoenfeld

  10. Department of Internal Medicine ‘B’, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Ora Shovman

Authors
  1. Amir Dagan
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  2. Shani Dahan
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  3. Asaf Shemer
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  4. Pnina Langevitz
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  5. Tamer Hellou
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  6. Tima Davidson
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Corresponding author

Correspondence to Ora Shovman.

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We have been officially waived from the IRB committee approval, as this is a case series.

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Dagan, A., Dahan, S., Shemer, A. et al. Acute onset of psoriatic spondyloarthritis as a new manifestation of post-streptococcal reactive arthritis: a case series. Clin Rheumatol 38, 2367–2372 (2019). https://doi.org/10.1007/s10067-019-04695-y

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  • DOI: https://doi.org/10.1007/s10067-019-04695-y

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