Keywords
anti-jo-1
inflammatory myopathy
antisynthetase syndrome
secukinumab
Categories
How to Cite
Abstract
Background: Psoriatic arthritis is a chronic inflammatory musculoskeletal disease associated with psoriasis and characterized by heterogeneous clinical manifestations. Idiopathic inflammatory myopathies and antisynthetase syndrome are distinct autoimmune entities that may rarely coexist with psoriasis or psoriatic arthritis, creating diagnostic and therapeutic challenges. Case presentation: We present the case of a 42-year-old woman initially diagnosed with psoriatic arthritis after presenting with recurrent knee arthritis accompanied by mild effusion and biopsy-confirmed psoriasis vulgaris localized to the left elbow. The patient fulfilled the CASPAR classification criteria and was initially treated with conventional disease-modifying antirheumatic drugs without satisfactory response. Subsequent treatment with secukinumab also failed to achieve disease control. Despite medical recommendations, the patient continued intermittent intramuscular corticosteroid administration prescribed elsewhere for symptomatic relief. Several months later, she was reevaluated because of persistent musculoskeletal complaints and progressive muscle weakness. Physical examination revealed severe proximal muscle weakness, including inability to rise from a prone position. Laboratory investigations demonstrated markedly elevated creatine phosphokinase levels exceeding 3000 U/L. Myositis-specific antibody testing revealed strongly positive anti-Jo-1 antibodies. The diagnosis was revised to inflammatory myopathy compatible with antisynthetase syndrome overlap, and treatment with systemic corticosteroids and azathioprine was initiated. Conclusions: This case highlights the importance of continuous diagnostic reassessment in patients with presumed refractory psoriatic arthritis. Fulfillment of classification criteria should not preclude consideration of additional autoimmune diseases when atypical manifestations emerge. The temporal association with secukinumab also raises the possibility of biologic-related unmasking or triggering of inflammatory myopathy, although causality cannot be established.
References
1. Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665–2673.
2. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370:263–271.
3. Kronzer VL, Kimbrough BA, Crowson CS, et al. Incidence, prevalence, and mortality of dermatomyositis: a population-based cohort study. Arthritis Care Res (Hoboken). 2023;75:348–355.
4. Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003;362:971–982.
5. Bohan A, Peter J. Polymyositis and dermatomyositis. N Engl J Med. 1975;292:344–347.
6. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20:1475.
7. Chu D, Yang W, Niu J. Concurrence of dermatomyositis and psoriasis: a case report and literature review. Front Immunol. 2024;15:1345646.
8. Xu Z, Xu B, Zhao B, et al. Treatment of refractory psoriasis with dermatomyositis using upadacitinib. Clin Exp Rheumatol. 2024;42:458–459.
9. Schreiber C, Khamlong M, Raza N, et al. Overlap of psoriatic arthritis and dermatomyositis. J Investig Med High Impact Case Rep. 2021;9:23247096211057702.
10. Markovic A, Schuster V, Simon JC, et al. Erythematous scaling lesions of the face, dorsal fingers, elbows, and knees together with symmetrical muscle weakness in a child. Clin Case Rep. 2019;7:1347–1349.
11. Xing Y, Xie J, Jiang S, et al. Co-existence of juvenile dermatomyositis and psoriasis vulgaris with fungal infection: a case report and literature review. J Cosmet Dermatol. 2019;18:1560–1563.
12. Kato Y, Yamamoto T. Development of psoriasis with relapse of dermatomyositis-associated interstitial lung disease. Int J Rheum Dis. 2017;20:660–661.
13. Inkeles MS, No D, Wu JJ. Clinical improvement of a patient with both amyopathic dermatomyositis and psoriasis following treatment with cyclosporine. Dermatol Online J. 2017;23.
14. Montoya CL, Gonzalez ML, Ospina FE, et al. A rare case of amyopathic juvenile dermatomyositis associated with psoriasis successfully treated with ustekinumab. J Clin Rheumatol. 2017;23:129–130.
15. Akiyama M, Ueno T, Kanzaki A, et al. Association of psoriasis with Hashimoto's thyroiditis, Sjögren's syndrome and dermatomyositis. J Dermatol. 2016;43:711–712.
16. Machado NP, Camargo CZ, Oliveira AC, et al. Association of anti-glomerular basement membrane antibody disease with dermatomyositis and psoriasis: case report. Sao Paulo Med J. 2010;128:306–308.
17. Gran JT, Gunnarsson R, Mørk NJ. A man with erythrodermia, muscle weakness and weight loss. Tidsskr Nor Laegeforen. 2009;129:2240–2241.
18. Pavlović MD, Zecević RD, Zolotarevski L. Psoriasis in a patient with dermatomyositis. Vojnosanit Pregl. 2004;61:557–559.
19. Kim NN, Lio PA, Morgan GA, et al. Double trouble: therapeutic challenges in patients with both juvenile dermatomyositis and psoriasis. Arch Dermatol. 2011;147:831–835.
20. Mahler M, Miller FW, Fritzler MJ. Idiopathic inflammatory myopathies and the anti-synthetase syndrome: a comprehensive review. Autoimmun Rev. 2014;13:367–371.
21. Perna DL, Callen JP, Schadt CR. Association of treatment with secukinumab with exacerbation of dermatomyositis in a patient with psoriasis. JAMA Dermatol. 2022;158:454–456.
22. Dicaro D, Bowen C, Dalton SR. Dermatomyositis associated with anti-tumor necrosis factor therapy in a patient with psoriasis. J Am Acad Dermatol. 2014;70:e64–e65.
23. Cabezas-Rodríguez I, Morante-Bolado I, Brandy-García A, et al. Anti-MDA5 dermatomyositis mimicking psoriatic arthritis. Reumatol Clin (Engl Ed). 2018;14:224–226.
24. Haroon M, Devlin J. Gottron's papule in amyopathic dermatomyositis mimicking psoriasis. Clin Rheumatol. 2009;28:1245–1246.
25. Sontheimer RD. Dermatomyositis: an overview of recent progress with emphasis on dermatologic aspects. Dermatol Clin. 2002;20:387–408.
26. Mitsuya J, Hara H, Hattori A, et al. Vesicle formation in dermatomyositis associated with colon carcinoma. Clin Exp Dermatol. 2009;34:e221–e222.
27. Fujimoto N, Honda S, Wakabayashi M, et al. Anti-MDA-5 antibody-positive bullous dermatomyositis with palmar papules complicating rapidly progressive interstitial lung disease. Mod Rheumatol. 2016;26:614–616.
28. White SW, Tesar JT. Dermatomyositis and dermatitis herpetiformis. Arch Dermatol. 1982;118:599–601.
29. Kalovidouris AE, Miller FW, Lawley TJ. Polymyositis/dermatomyositis associated with dermatitis herpetiformis. Arthritis Rheum. 1989;32:1179–1181.
30. Barrows-Wade L, Jordon RE, Arnett FC Jr. Linear IgA bullous dermatosis associated with dermatomyositis. Arch Dermatol. 1992;128:413–414.
31. Glover M, Leigh I. Dermatomyositis pemphigoides: a case with coexistent dermatomyositis and bullous pemphigoid. J Am Acad Dermatol. 1992;27:849–852.
32. Tsukada Y, Kawase MK, Murashima A, et al. Bullous pemphigoid associated with dermatomyositis successfully controlled with minocycline. Clin Exp Dermatol. 2003;28:563–564.
33. Narbutt J, Torzecka JD, Sysa-Jedrzejowska A, et al. Pemphigus foliaceus in an 11-year-old boy with dermatomyositis. Br J Dermatol. 2003;148:838–839.
34. Yanagi T, Kato N, Yamane N, et al. Bullous pemphigoid associated with dermatomyositis and colon carcinoma. Clin Exp Dermatol. 2007;32:291–294.
35. Ahmad T, Nabih A. Dermatomyositis followed by pemphigus foliaceus: a case report and possible mechanism. Rheumatol Rep. 2009;1:e11.
36. Black M, Marshman G. Dermatomyositis and pemphigus vulgaris: association or coincidence? Australas J Dermatol. 2011;52:e11–e14.
37. Thongprasom K, Prasongtanskul S, Fongkhum A, et al. Pemphigus, discoid lupus erythematosus, and dermatomyositis during an 8-year follow-up period: a case report. J Oral Sci. 2013;55:255–258.
38. Fujimoto N, Takayama S, Hamaguchi Y, et al. Pemphigus foliaceus associated with anti-NXP2 autoantibody-positive dermatomyositis. Acta Derm Venereol. 2014;94:478–479.
39. Garcia B, Dabouz F, Pascal L, et al. Amyopathic dermatomyositis with anti-MDA5 antibodies associated with bullous pemphigoid, Sjögren syndrome and gastric MALT lymphoma. Ann Dermatol Venereol. 2017;144:629–633.
40. Chan LS, Vanderlugt CJ, Hashimoto T, et al. Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol. 1998;110:103–109.
41. Cruellas MG, Viana Vdos S, Levy-Neto M, et al. Myositis-specific and myositis-associated autoantibody profiles and their clinical associations in patients with polymyositis and dermatomyositis. Clinics (Sao Paulo). 2013;68:909–914.
42. Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76:1955–1964.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Krasimir Kraev, Vesela Hristeva, Ivaylo Sokolov, Gergana Miteva-Ilieva, Stanislava Popova-Belova, Ivan Yanakiev, Sanie Dzhambazova, Maria Uchikova, Yordanka Basheva-Kraeva, Mariela Geneva-Popova (Author)