Altered Muscle Metabolism in Pustular Psoriasis (Zumbusch Type) Demonstration by ³¹P Magnetic Resonance Spectroscopy

Abstract

We report a patient with pustular psoriasis (Zumbusch type) with diffuse muscle pain. Evaluation of skeletal muscle metabolism during rest, graded levels of exercise and recovery was performed using ³¹phosphor magnetic resonance spectroscopy (³¹P MRS). Our results underline the systemic character of severe pustular psoriasis. The clinical improvement after drug therapy (prednisolone and etretinate) correlated well with the measurable changes in vivo of several metabolites and indices important in muscle contraction, such as phosphocreatine (PCr), inorganic phosphate (P_i), intramuscular pH and the phosphorylation potential (PCr/P_i). Abnormal accumulation of sugar phosphates (phosphomonoester) as well as their slow resolution during recovery reflect profound alteration of metabolism in the sense of block in glycolysis. Our results show that ³¹P MRS is well suited to identify and measure subtle changes in the muscle metabolism occurring in pustular psoriasis.

In Vivo Measurement of Phosphorous Markers of Disease

“…Examples of markers of disease using 31 P MRS can be found throughout the literature in which the levels of 31 P metabolites and/or their fluxes are modified due to specific illnesses. In vivo 31 P spectral alterations in acquired and genetic pathological human muscle conditions such as dermatomyositis and polymyositis [72], muscle dystrophies [73][74][75][76], ischemia [77], sporadic inclusion body myositis [78], progressive supranuclear palsy [79], malignant hyperthermia [80], fibromyalgia [81], pustular psoriasis [82], retinitis pigmentosa [83], Parkinson disease [84], McArdle's syndrome [85], adenylsuccinate lyase deficiency [86], hypo-ß-lipoproteinae mia [87], and some mitochondrial myopathies (cytochrome bc1 deficiency [88], carriers of 11778 mtD-NA mutation [89], NARP syndrome [90], phosphofructokinase deficiency [91,92], Leber disease [93][94][95], and piruvate dehydrogenase complex deficiency [96] have been reported. The usual change found using 31 P MRS in these diseases is a reduction in the bioenergetics of the tissue.…”