Cyclical psoriatic arthritis responding to anti-oestrogen therapy
H. P. STEVENS
Department of Dermatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorL. S. OSTLERE
Department of Dermatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorC.M. BLACK
Department of Rheumatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorH. S. JACOBS
Department of Reproductive Endocrinology, Middlesex Hospital, Mortimer Street, London W1N 8AA, U.K.
Search for more papers by this authorM. H. A. RUSTIN
Department of Dermatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorH. P. STEVENS
Department of Dermatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorL. S. OSTLERE
Department of Dermatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorC.M. BLACK
Department of Rheumatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorH. S. JACOBS
Department of Reproductive Endocrinology, Middlesex Hospital, Mortimer Street, London W1N 8AA, U.K.
Search for more papers by this authorM. H. A. RUSTIN
Department of Dermatology, The Royal Free Hospital and School of Medicine, Pond Street. London NW3 2QG, U.K.
Search for more papers by this authorSummary
We report a patient with severe psoriatic arthritis in whom the severity of both the arthritis and psoriasis fluctuated with the menstrual cycle. These features failed to improve with standard therapy, but there was a prompt response to treatment which suppressed oestrogen secretion. Such treatment should be considered in patients with disabling cyclical changes in psoriatic arthritis.
References
- 1 Rudge SR, Kowanko IC, Drury PL. Menstrual cyclicity of finger joint size and grip strength in patients with rheumatoid arthritis. Ann Rheum Dis 1983; 42: 425–30.
- 2 Farber EM, Nall ML. The natural historyof psoriasis in 5.600 patients. Dermatologica 1974; 148: 1–18.
- 3 McHugh NJ, Laurent MR. The effect of pregnancy on the onset of psoriatic arthritis. Br J Rheumatol 1989; 28: 50–2.
- 4 HH Roenigk (ed). Psoriasis. New York : Marcel Dekker, 1990.
- 5
Stephens CJM,
Black MM.
Autoimmune progesterone dermatitis.
Br J Dermatol
1989; 121(Suppl. 34): 64.
10.1111/j.1365-2133.1989.tb05972.x Google Scholar
- 6 Krause PJ, Ingardia CJ, Pontius LT et al. Host defence during pregnancy: neutrophil chemotaxis and adherence. Am J Obstet Gynecol 1987; 157: 274–80.
- 7 Hempel KH, Fenandez LA, Persellin RH. Effect of pregnancy sera on isolated lysosomes. Nature 1970; 225: 955–6.
- 8 Froelich CJ, Goodwin JS, Bankhurst AD, Williams RC Jr. Pregnancy, a temporary fetal graft of suppressor cells in autoimmune disease. Am J Med 1980; 69: 329–31.
- 9 Persellin RH, Rhodes J. Inhibition of human monocyte Fc receptor and HLA-DR antigen expression by pregnancy alpha-2 glycoprotein. Clin Exp Immunol 1981; 46: 350–4.
- 10 Stimson WH. Studies on the immunosuppressive properties of a pregnancy-associated alpha-macroglobulin. Clin Exp Immunol 1976; 25: 199–206.
- 11 Ungar A, Kay A, Griffin AJ, Panayi GS. Disease activity and pregnancy-associated α2-glycoprotein in rheumatoid arthritis during pregnancy. Br Med J 1983; 286: 750–2.
- 12 Bijlsma JWJ, Huber-Bruning O, Thijssen JHH. Effect of oestrogen treatment on clinical and laboratory manifestations of rheumatoid arthritis. Ann Rheum Dis 1987: 46: 777–9.
- 13 Jungers P, Liote F, Pelissier C et al. Ľhormonomodulation dans le lupus érythémateux disséminé: résultats préliminaires avec le danazol et ľacétate de cyprotérone. Ann Med Interne (Paris) 1986; 137: 313–19 (Fre) (Eng Abstr).
- 14 Sturgess AD, Evans DT, Mackay IR, Riglar A. Effects of the oestrogen antagonist tamoxifen on disease indices in systemic lupus erythematosus. J Clin Lab Immunol 1984; 13: 11–14.
- 15 Vidaller A, Llorente L, Larrea F et al. T cell dysregulation in patients with hyperprolactinemia: effect of bromocriptine treatment. Clin Immunol Immunopathol 1986; 38: 337–43.
- 16 Bravo G, Zazueta B, Lavalle C. An acute remission of Reiter's syndrome in male patients treated with bromocriptine. J Rheumatol 1992; 19: 747–50.
- 17 Weber G. Frey H. Treatment of psoriatic arthritis with bromocriptine. J Am Acad Dermatol 1987; 16: 388–9.
