Trauma-induced concomitant psoriatic arthritis and complex regional pain syndrome

Clin Rheumatol. 2019 Jul;38(7):1889-1895. doi: 10.1007/s10067-019-04612-3. Epub 2019 May 24.

Abstract

To report the simultaneous occurrence of psoriatic arthritis (PsA) and chronic regional pain syndrome type I (CRPS I) both triggered by intense walking in a male golfer with a history of scalp psoriasis. Sequential existence of these two conditions have been reported in the literature; however, to our knowledge, this is the first report of a simultaneous occurrence of PsA and CRPS I. This case illustrates the complex interplay between genetic predisposition and environmental risk factors with the central nervous and immune systems. As the pathogenesis of PsA has been better understood in recent years, we propose a mechanism that explains how the release of pro-inflammatory cytokines and neuropeptides following a traumatic event elicits a vicious cycle that is a common ground for the development of both PsA and CRPS I. Even unperceived trauma, such as intense walking, when directed to the synovio-entheseal complex, can precipitate the development of PsA and CRPS I in predisposed individuals.

Keywords: Complex regional pain syndrome; Neurogenic inflammation; Pro-inflammatory cytokines; Psoriatic arthritis; Synovio-entheseal complex; Trauma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Arthritis, Psoriatic / diagnosis*
  • Arthritis, Psoriatic / etiology*
  • Chronic Disease
  • Complex Regional Pain Syndromes / diagnosis*
  • Complex Regional Pain Syndromes / etiology*
  • Cytokines / physiology
  • Foot Injuries / complications*
  • Foot Injuries / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Neuropeptides / physiology

Substances

  • Cytokines
  • Neuropeptides