Psoriasis arthritis

Description:

Psoriasis arthritis (psoriasis arthropathy) - the chronic inflammatory disease of joints associated with psoriasis. The disease concerns to group of seronegative spondylarthrites and develops at 5-7% of patients with psoriasis.

Symptoms of Psoriasis arthritis:

At 70% of patients the articulate syndrome appears after development of skin displays of psoriasis, at 15-20% of patients damage of joints precedes damage of skin (sometimes for many years), at 10% of patients of damage of joints and skin begin at the same time. The beginning of psoriasis arthritis can be gradual (the general weakness, mialgiya, argralgiya) or acute (similar to gouty or septic arthritis with sharp joint pains and their expressed puffiness). 20% of patients can have an uncertain beginning, being shown only by arthralgias.
At the beginning of psoriasis arthritis distal, proximal interphalangeal joints of fingers of brushes, knee less often - metacarpal and metatarsophalangeal, shoulder joints most often are surprised. The affected joint pains are most expressed at rest, at night, early in the morning, decrease in the afternoon at the movements a little, are followed by morning constraint.
As a rule, joints are surprised in the form of mono - and an oligoarthritis. Involvement in a debut of a disease of joints exceptions for a pseudorheumatism - an interphalangeal joint of the I finger and a proximal interphalangeal joint of the V finger is peculiar to psoriasis arthritis. Damage of all joints of one finger of a brush is characteristic that is followed by a tendovaginitis of sgibatel, and the affected finger gets a sosiskoobrazny form. Most it is typical for fingers of feet. Skin over the affected joints has crimson and cyanotic coloring.

Allocate 5 clinical forms of psoriasis arthritis (Moll, Wright).

  1. Asymmetric oligoarthritis.
Psoriasis asymmetric oligoarthritis - the most frequent form of damage of joints at psoriasis (70% of all forms of psoriasis arthritis).
  2. Arthritis of distal interphalangeal joints.
Arthritises of distal interphalangeal joints - the most typical display of psoriasis arthritis, but usually seldom happens isolated, and is more often combined with damage of other joints.
  3. Symmetric revmatoidnopodobny arthritis.
Symmetric revmatoidnopodobny arthritis - this form is characterized by defeat of metacarpophalangeal and proximal interphalangeal joints of fingers of brushes. Unlike a rhematoid art iritis, chaotic deformation of joints is characteristic of this form of psoriasis arthritis, at the same time long axes of fingers are directed in different directions (the unidirectional elbow devitation of fingers of brushes is characteristic of a rhematoid art iritis).
  4. The Mutiliruyushchy (disfiguring) arthritis.
The Mutiliruyushchy (disfiguring) arthritis is characterized by heavy destructive arthritis of distal departments of extremities, first of all fingers of brushes and feet. At the same time ossifluence develops and fingers are shortened, deformed. Often this form of psoriasis arthritis is combined with damage of a backbone. The Mutiliruyushchy form is more often observed at patients with heavy skin displays of psoriasis.
  5. Psoriasis spondylitis.
The psoriasis spondylitis is observed at 40-45% of patients and socheratsya usually with peripheral arthritis. The clinical picture is very similar to clinic of a disease of Bekhterev (inflammatory pains in lumbar department of a backbone, consecutive transition of inflammatory process to chest, cervical departments, costovertebral joints, development of "a pose of the applicant"). However differences from Bekhterev's disease are possible - not always process consistently passes from lumbar department to upper parts of a backbone, mobility of a backbone is not always sharply limited, the asymptomatic current of a spondylitis is possible in general.
  Along with damage of joints muscular and fascial pains, damage of sternal and clavicular, acromial and clavicular joints, an achillobursitis, a subcalcaneal bursitis, damage of eyes (conjunctivitis, an iridocyclitis), very seldom an amyloidosis of kidneys can be observed.
The malignant form of psoriasis arthritis is observed very seldom and characterized by the following signs:

    * crushing psoriasis damage of skin, backbone joints;
    * gektichesky fever;
    * exhaustion of the patient;
    * generalized polyarthritis with sharply expressed pains and development of false ankyloses;
    * generalized lymphadenopathy;
    * damage of heart, kidneys, liver, nervous system, eyes.
Diagnostic criteria (on Mathies).
1. Defeat of distal interphalangeal joints of brushes and feet, in particular, thumbs of feet. Joints are painful, swelled up a little, skin over them cyanotic or crimson and cyanotic.
2. Simultaneous defeat metacarpophalangeal or metatarsophalangeal proximal and distal joints of the interphalanx same finger that causes its diffusion swelling ("finger sausage").
3. Early damage of a thumb of foot.
4. Talalgia (heel pain).
5. Existence of skin psoriasis plaques, damages of nails (symptom of "thimble", opacification of nail plates, their longitudinal and cross striation).
6. Psoriasis cases at relatives.
7. Negative reactions to the Russian Federation.
8. Radiological manifestations: ossifluence with raznoosevy shifts of bones, periosteal imposings, absence of circumarticular osteoporosis.
9. Radiological signs of juxtaspinal ossifications (calcification).
Clinical or radiological signs of a sacroileitis. The diagnosis of psoriasis arthritis is authentic with 3 criteria, and among them has to be surely the 5, 6 or 8 criteria. At identification of the Russian Federation 2 more criteria are necessary for confirmation of the diagnosis, and among these 5 criteria there shall be the 5th and 8th.

Reasons of Psoriasis arthritis:

The etiology and pathogeny of psoriasis arthritis are unknown. The greatest significance is attached to genetic and autoimmune mechanisms, and also environmental factors as which the infection acts. Participation of hereditary factors is confirmed by the fact that at 40% of close relatives of patients with psoriasis the articulate syndrome (Gladman), and also detection at the sick B13 B16, V17, V27, V38, V39, DR4, DR7 HLA types comes to light. Tell adjournment of immunoglobulins in skin about a role of immune mechanisms and in synovia of the affected joints, increase in the IgA and IgG level and identification in blood of the sick CEC, and also antibodies to components of skin and anti-nuclear antibodies in blood of patients, reduction of T-suppressor function of lymphocytes. In some cases deficit of T-helper function is found.
It is discussed, but the role of a viral, streptococcal infection in development of a disease is not proved finally.

Treatment of Psoriasis arthritis:

If you have a psoriasis arthritis which is followed by pain and constraint in joints it is important to discuss the program of treatment with the doctor. A fundamental step is timely treatment. Before psoriasis arthritis was considered as a disease of rather moderate degree, however at this stage need for use the basic, antirheumatic drugs modifying disease (BPRP) for prevention of a further erosion of joints and loss of functional activity increases.
Traditional methods of treatment of psoriasis arthritis. The purpose of treatment of psoriasis arthritis is reduction of an inflammation, the termination of an erosion and recovery of motive function of joints. At the same time treatment of injuries of skin and joints is carried out at the same time.
Earlier treatment of psoriasis arthritis is carried out with use of non-steroidal anti-inflammatory drugs (NSPVP), such as ibuprofen and Naproxenum. NSPVP possess long anesthetic and antiinflammatory effect. There is a set of versions NSPVP. Sometimes it is necessary to experience action several NSPVP before you define what of these drugs for you is safest and effective.
For treatment of psoriasis arthritis corticosteroids (steroids) are also used. These are the strong antiinflammatory drugs accepted at an acute pain and an inflammation orally or in the form of intra joint and intramuscular injections. (Effect of these drugs significantly differs from action of the steroids promoting increase of muscle bulk).
The basic antirheumatic drugs modifying disease (BPRP) slow down progressing of psoriasis arthritis. According to specialists, the termination of further development of a disease can prolong functional activity of patients with psoriasis arthritis. BPRP are the capital strong drugs conceding on the speed of action of NSPVP. Reception of BPRP is carried out under observation of the doctor for the purpose of the prevention of serious side reactions.
Exercises at psoriasis arthritis are how important?
Feasible, regular exercises can remove constraint of joints and weaken the pain caused by psoriasis arthritis. Specially developed program of the exercises directed to maintenance of range of movements in a combination with fortifying exercises, will help to achieve the following goals:
  * Mitigation of symptoms of psoriasis arthritis
  * Preservation of normal functional activity of joints
  * Increase in muscular flexibility and elasticity
  * Maintenance of optimum weight for the purpose of reduction of load of joints
  * Increase in endurance of cardiovascular system.