Developing an aerobic exercise intervention for patients with psoriasis to support lifestyle behaviour change and improve health outcomes.

BACKGROUND: Patients with psoriasis do not exercise to the extent recommended for cardiovascular health, which may contribute to the increased risk of cardiovascular disease (CVD) and metabolic syndrome observed in this patient group. We previously identified that patients with psoriasis have significant disease-specific barriers to exercise. Others have reported that individuals with psoriasis develop higher heart rates and systolic blood pressure during bouts of exercise, followed by a slower recovery than healthy control subjects. AIMS: We hypothesized that a bespoke, evidenced-based, exercise programme could be developed for patients with psoriasis. METHODS: We convened a multidisciplinary Working Group comprising key stakeholders, including patients with psoriasis, along with sports scientists and clinicians, to develop the programme. RESULTS: To allow for different levels of fitness, lifestyle and motivation a 10-week intervention comprising two group walking sessions per week each of 1 h duration [led by a sports scientist (RS)] was designed using the Mapometer website. Walking distance was validated by a Walkmeter application, which uses global positioning system technology. The volume of exercise per session was calculated so that participants could incrementally progress to heart-healthy levels of exercise over the course of the programme. Maps of 20 unique walking routes were developed. A GENEactiv Original accelerometer and Newfeel Onwalk 900 pedometer were selected as wearable devices. CONCLUSION: We developed an exercise programme which specifically removed barriers to exercise for those with psoriasis, in partnership with patients. Regular exercise may offer significant health benefits for patients with psoriasis, including reduced CVD risk and increased psychosocial functioning, and this programme merits further investigation.

Rare case of extensive streptococcal myositis.

A rare case of extensive streptococcal myositis is reported. A 46-year-old man was admitted following acute swollen right elbow joint associated with localised pain, erythema and hypoaesthesia. Multiple tense blisters subsequently developed around the affected elbow joint extending to the axilla. He was treated for suspected soft tissue infection and septic arthritis. Blood test investigations demonstrated raised creatine kinase (894 U/L) and inflammatory markers (white cell count 21.1×109/L; C reactive protein 370 mg/L). Emergency CT scan reported extensive myositis affecting the triceps, latissimus dorsi and pectoralis major muscle with no fascial involvement. He was escalated to intensive care unit and treated for infectious myositis. Further investigation revealed positive streptococcal antibody (anti-streptodornase B titre >1600 U/mL). He was managed conservatively with microbiologist specialist input and supportive care. The patient made good recovery after receiving 10 days of intravenous antibiotics and subsequently switched to oral antibiotics. He was discharged on day 30 of admission after receiving intensive inpatient physiotherapy.

Delayed-onset heparin-induced skin necrosis: a rare complication of perioperative heparin therapy.

An uncommon case of delayed-onset dalteparin-induced skin necrosis in an 83-year-old Caucasian female patient associated with heparin-induced thrombocytopaenia (HIT) presenting on day 30 following dalteparin therapy is reported. Investigations revealed mild thrombocytopaenia with normal protein C, protein S, coagulation screen and positive test for heparin-platelet factor-4 antibody. Clinical diagnosis of heparin-induced skin necrosis with HIT was made. Dalteparin injection was discontinued promptly and substituted with fondaparinux therapy. The patient achieved good recovery following cessation of dalteparin therapy and was subsequently discharged.