case_images: PMC11249543_01
case_images: Illustrating clinical progression (A) and therapeutic interventions (B) in this patient with spondyloarthritis and cutaneous manifestations. Each data point represents a medical consultation (MC), while the body surface area (BSA) delineates the extent of the patient's cutaneous involvement over time. Initially, prednisone was administered, with dosage adjustments tailored to symptom severity. Thalidomide (50 mg bid) and sulfasalazine (0.5g bid) were prescribed for arthritis management. Despite initial improvement in joint symptoms, the persistent and recurrent skin rash remained unresolved. Subsequent treatment with tumor necrosis factor (TNF)-alpha inhibitor (adalimumab) and interleukin (IL)-17A inhibitor (secukinumab) failed to alleviate symptoms. However, initiation of tofacitinib (5 mg bid) led to significant improvement, resulting in complete resolution of pustular lesions within 20 days. Follow-up assessments revealed sustained remission, indicating successful disease management.
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case_images: It is important to note that the patient developed widespread pustular eruptions on her limbs and joint symptoms following a urinary tract infection ( Figure 1A ), with urinalysis revealing elevated white blood cells and positive antibodies against Chlamydia trachomatis. D ), the refractory KB persisted. Due to the patient's long-term recurrent KB, we attempted to use tumor necrosis factor (TNF) -alpha inhibitor (adalimumab) and interleukin (IL) -17A inhibitor (secukinumab) ( Figure 1B ). Subsequently, a reduction of prednisone dosage to 20 mg qd, along with the addition of tofacitinib at 5 mg bid ( Figure 1B ), led to the resolution of pustular lesions on both palms and lower limbs after 20 days ( Figures 3E-H ).
case_images: Changes in sacroiliac joint MRI images before and after treatment with sulfasalazine combined with saliduridine in patients with reactive arthritis. Before treatment (A, B) Bilateral sacroiliac joints showed irregular patchy slightly low signal intensity on T1-weighted images and slightly high signal intensity on T2-weighted images, with high signal intensity on fat-suppressed T2-weighted images indicating bone marrow edema. Local cortical bone blurring and narrowing of the joint space were observed, and the articular cartilage was indistinct. After treatment (C, D) Bilateral sacroiliac joints showed a reduction in the extent of bone marrow edema compared to pre-treatment images. Local cortical bone blurring and narrowing of the joint space remained present, and the articular cartilage remained indistinct.
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case_images: Magnetic resonance imaging (MRI) confirmed bilateral sacroiliitis ( Figures 2A, B ), leading to a diagnosis of ReA.
case_images: Changes in vesicles and papules on the palmar (A, E), dorsal (B, F), and medial ankle (C, G) regions of both hands before and after 20 days of treatment with tofacitinib. Additionally, there was an improvement in the hyperkeratosis of the soles (D, H) compared to before treatment. Before treatment (A-D) The palmar, dorsal, and medial ankle regions exhibited vesicles and papules. Excessive hyperkeratosis was observed on the soles. After 20 days of treatment (E-H) A reduction in size or disappearance of vesicles and papules on the palmar, dorsal, and medial ankle regions was noted. Furthermore, there was an improvement in the hyperkeratosis of the soles.
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case_images: f3
case_images: During the recent exacerbation, the patient presented with numerous pustular eruptions on her palms, soles, and lower limbs, accompanied by itching ( Figures 3A-D ). Subsequently, a reduction of prednisone dosage to 20 mg qd, along with the addition of tofacitinib at 5 mg bid ( Figure 1B ), led to the resolution of pustular lesions on both palms and lower limbs after 20 days ( Figures 3E-H ).