Psoriasis vulgaris and arthritis psoriatica gravis mutilans.

A 33-year-old man with generalized vulgar psoriasis type I and psoriatic arthritis was admitted to the Naftalan Special Hospital on February 21, 2000. He was immobile and complained of severe pain in all his joints. Since the patient had suffered from the disease for 10 years without showing any improvement after different therapies, his cutaneous and joint lesions gradually worsened and eventually resulted in generalized psoriasis and mutilating arthritis. Nevertheless, the patient was discharged from our hospital in better condition. To avoid such severe consequences of psoriatic arthritis, we believe that patients with either type I or type II psoriasis should undergo locomotor system screening. It would significantly decrease the number of unrecognized and undiagnosed cases of psoriatic arthritis and allow their early treatment, and prevention of more severe forms. Administration of new therapeutic agents, e.g. Alefacept (IgG1 fusion protein), Etanercept (inhibitor of TNF activity), and Efalizumab (monoclonal antibody that blocks the leukocyte integrin CDIIa/CD18(LFA-1), could provide successful management of the disease in future.