Medical statistics show that psoriasis is one of the most frequently diagnosed skin diseases and 1-2% of them.Many patients with a sufficiently large experience of psoriasis in the pathological process involved and the joints, this condition is called psoriatic arthritis.In the past, this disease was considered a special variant of rheumatoid arthritis, skin diseases under the influence of the acquiring individual traits.Recently, however, significant differences were found between rheumatoid and psoriatic arthritis, which made it possible to allocate the latter as a separate disease entities.
This article describes the symptoms and treatment of psoriatic arthritis. Content
Psoriatic arthritis is diagnosed in about 5-7% of people with psoriasis.Onset is necessary, usually at the age of 20-50 years, in some cases, develop even in childhood.This pathology occurs with the same frequency in both men and women.
Etiology psoriatic arthritis coincides with that of the actual psoriasis and today finally known.Scientists believe that the basis of the excessive proliferation of epidermal cells observed in psoriasis, is a violation of the biochemical processes in them, which is associated with an imbalance between a number of biologically active substances: cAMP, cGMP, and other prostaglandins.Some authors believe that the proliferating cells synthesized a special substance, namely epidermopoetin which induces cell division that leads to hyperplasia.
And yet, one of the leading theories of psoriasis and psoriatic arthritis are genetic.It is proved that the person who says psoriatic process, are carriers of certain antigens HLA-system, in addition, virtually every patient with psoriasis has a close relative with the same diagnosis.Individuals with such a feature of the genotype are predisposed to psoriasis.When exposed to any adverse external factors, such as stress, trauma, infectious agents, especially in combination with general or local disturbances in the immune system, the body fails, namely it starts a series of biochemical reactions characteristic of psoriasis.
in the pathogenesis of psoriasis and psoriatic arthritis, no doubt, play the role of autoimmune disorders, that is, the body produces antibodies against its own cells.Evidence of this is found in elevated blood levels of gammaglobulin, IgA, IgM and IgG, streptococcal antibodies, antibodies to skin and other immunological parameters.
In 68-75% of cases, arthritis develops in patients with psoriasis for 2-10 years, at least it occurs simultaneously with the first skin manifestations, and sometimes even joint syndrome is preceded by the appearance of signs of skin pathology.
Debuts arthritis, usually unnoticed, gradually progressing, but in some cases the onset may be acute.
There are 5 types of joint damage in psoriatic arthritis:
first type - inflammation of the distal interphalangeal joints of the feet and hands - is a classic in psoriatic arthritis.At the beginning of the disease struck one or more joints, as it progresses, the process involved and the rest, they observed multiple lesions.The skin over the affected joints bluish or purple hue.Swollen joints (palpation the swelling is very dense), painful.End joints as the disease progresses change shape, which in combination with a specific color of the skin over them gives them a kind of garden radish.Furthermore, in the pathological process in this type of arthritis is usually involved nails they are withered, exfoliate, are broken.
pathognomonic signs (ie. E. Characteristic solely for this disease), psoriatic arthritis is "osiskoobraznaya defiguratsiya fingers.It occurs when the defeat of both 3 - distal, proximal interphalangeal and pyastnofalangovogo - one finger joints until they ankylosis (complete fusion with the absolute lack of movement in them) and is called "axial" defeat.
Mutiliruyuschaya form of arthritis fortunately quite rare, only 5% of patients.It is difficult runs inflammation of the joints, leading to their rapid destruction, osteolysis.Externally, the fingers are short, curved, have the form of a folding telescope - if you want you can straighten them "by hand" to the original length (so-called telescopic fingers).The examination revealed multiple subluxations and ankylosis of the affected joints.These changes are always asymmetrical and erratic - at one and the same hand axes fingers shifted in different directions, are available in both flexion and extension contractures of the joints.
above-described embodiments of joint damage, though are classical described for us the disease, but there is only 5-10% of people with psoriasis.In 7 out of 10 patients revealed inflammation of one or two large joints - knee, ankle, hip.In 15% of patients diagnosed with involvement in the pathological process of more than 3 joints, and absolutely any location.Polyarthritis may be both asymmetric and occur equally on 2 sides, this clinical picture resembling rheumatoid arthritis.
Sometimes, in 5% of cases, psoriatic arthritis proceeds as ankylosing spondylitis (ankylosing spondylitis).
This pathology is often accompanied by lesions of the eye - usually diagnosed conjunctivitis, iritis, episcleritis.If this is also found ulcerative lesions of genital and oral mucosa, the patient is put the diagnosis "Reiter's disease".
In the case of malignant course of psoriatic arthritis in the pathological process may involve internal organs.As a rule, there is the phenomenon of young (under 35 years) of men suffering from an atypical form of psoriasis.Patients complain of alternation of sharp ups and downs of sudden temperature (the so-called hectic fever), accompanied by shaking chills and severe sweating.They quickly lose weight, hair fall out actively, muscle atrophy, skin formed bedsores and trophic ulcers, regional lymph nodes, especially the groin, increasing in size.Cardiac proceeds as myocarditis: it increased in size, heart rate increased;auscultation (listening through phonendoscope) I determined the weakening tone, systolic murmur;ECG detected arrhythmias and diffuse myocardial changes.Amazed and liver - hepatitis develops and gepatolienalny syndrome.In some cases, to the development of kidney damage diffuse glomerulonephritis and subsequently renal amyloidosis.When a particularly malignant course of psoriatic arthritis in the pathological process involved and the central nervous system - developed encephalopathy, seizures, neuritis and polyneuritis.
Hiagnosticheski important signs of psoriatic arthritis.It:
On the basis of complaints, anamnesis of disease and life (especially important possession of the subject of psoriasis), the results of physical examination of the patient with the doctor to determine a preliminary diagnosis of psoriatic arthritis.To confirm it, need to hold a series of laboratory and instrumental investigations, namely:
In 1989, the Institute of Rheumatology diagnostic criteria have been developed according to which the likelihood of psoriatic arthritis is determined by the number of points accrued during the test.Table matching points defined criteria presented below.
Classic psoriatic arthritis exhibit, if the score is 16 or more.When the amount of points equal to 11-15, diagnosed with psoriatic arthritis defined.If the score is 8-10 - psoriatic arthritis is probable, and a value of 7 points or less rejected the diagnosis.
Since the disease is not always occurs in the classical form, should be able to distinguish it from many other rheumatic diseases.Typically, a differential diagnosis with:
Therapeutic activities should be directed not only to the treatment of articular syndrome, but also affect the process of psoriatic skin.
treatment of skin manifestations of the disease involved, as a rule, a dermatologist, and the remedial measures include ultraviolet irradiation, local application of hormonal ointments, systemic intake of vitamins and sedatives.
As for the arthritis, to eliminate inflammation in the joints can be used drugs following pharmacological groups:
in the complex treatment of arthritis can be used and efferent methods such as plasmapheresis.
From non-drug treatments for psoriatic arthritis can be recommended:
In the case of stubborn, untreatable drugs, synovitis (inflammation of the synovial membrane of the joint), as well as evolved gross changes in the joints, violating the functional activity of the patient, it may be recommended for surgerytreatment, but its results are not always good and long term.
criteria for the effectiveness of treatment is to normalize or decrease the severity of clinical disease syndromes: cutaneous, articular, and others;normalization of hematological parameters of activity of process: ESR, leukocytes, C-reactive protein, immunoglobulins;retardation of disease progression, detected on radiographs.
course of the disease in most cases unpredictable.Sometimes it is a benign, and in some cases - and aggressively in the short term inflammation leads to joint destruction.The forecast is determined individually, depending on the frequency and severity of exacerbations, timeliness and adequacy of the prescribed treatment, duration of medication.