Psoriatic arthropathy: causes, treatment, disability, and prognosis
Psoriatic arthropathy: causes and treatment
Psoriatic arthropathy (arthropathic psoriasis) is a chronic inflammation of the joints developing on the background of the psoriasis.
Pathology refers to the group of seronegative arthritis and occurs in 5-7 percent of patients suffering from scaly ringworm.
The etiology and pathogenesis of violations
The causes and mechanism of development of psoriatic arthropathy is unknown until the end. It is believed that the importance in the manifestation of diseases are:
- autoimmune reactions;
- infectious diseases of various etiologies;
- constant stress;
- diseases of the digestive and endocrine system.
- separate pharmaceuticals (antimalaria funds, lithium salts, β-blockers).
According to the statistics of joint damage psoriasis occurs in 40% of the close relatives, this suggests that the basis of the disease involved genetic factors.
The discovery in the skin and in the synovial fluid of diseased joints of the immunoglobulin indicates that the pathology of the involved immune mechanisms.
I assume that the appearance of psoriatic arthropathy is associated with viruses and streptococcal infections, but it is still proven.
The clinical picture
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70% of patients with psoriasis first, there are changes in the skin and only then join joint damage.
Approximately 15-20% of cases in the pathological process involved joints and only after some time (sometimes many years) you can see the skin scaly lichen. 10% of patients with psoriasis of joint damage and skin commence simultaneously.
To begin arthropathic psoriasis may gradually. The patient in this case, there is a General weakness, muscle or joint pain.
In others there is an acute onset of disease, similar to gout or septic arthritis, characterized by sudden pain in the joints and their strengths pasty. 20% of patients, when it started, the disease cannot be determined, and it manifests itself only arthralgia.
The first in the pathological process involved the distal, Central interphalangeal joints of the upper extremities, knee and metacarpal — and metatarsophalangeal, shoulder joints.
Pain syndrome is especially pronounced alone, at night, in the morning immediately after waking up, in the afternoon during the movement the pain subsides. Morning stiffness occurs in the affected joints.
In most cases the disease occurs in the form of mono — and oligoarthritis.
Unlike rheumatoid arthritis in the early stages of psoriatic arthropathy affects the interphalangeal joints of the thumb and the proximal interphalangeal joint of the little finger.
Simultaneously in the pathological process involved all the joints of a finger, in addition to this there is tenosynovitis of the flexors, a sore thumb in the form to become similar to the «sausage». The skin over the joint becomes abnormal purple-cyanotic color. This is typically the case for the toes.
Clinical forms of the disease
Currently there are 5 clinical forms of psoriatic arthropathy:
- Asymmetric oligoarthritis. The most common joint involvement in psoriasis. Found in 70% of patients. The pathological process affects up to 4 joints on one side of the body or different joints on the left and right side of the body. May suffer major joints: hip, ankle, wrist and knee.
- Arthritis of the distal interphalangeal joints. One of the characteristic manifestations of the arthropathy. Usually found in conjunction with damage to other joints. More frequently diagnosed in men. In this form of the disease the nail plate usually thickens, it changes color, her dimples appear.
- Revmatoidnogo symmetric arthritis. The defeat of the same joints is observed in the left and right of the torso, at the same time suffer 5 or more joints. Deformed metacarpophalangeal and Central metalanguage joints of the upper extremities. This form of pathology is more common in women. Psoriasis accompanying arthritis symmetrical is hard.
- Mutiliruyuschego or as it is called destructive or disfiguring arthritis. Quite rare, can occur in patients with severe skin manifestations of scaly lichen. Over the years, the disease progresses, the result destroyed the small joints of the hands, particularly affecting the fingers, they are deformed and cease to perform their functions. Often destructive form of disease accompanied by lesions of the vertebral column.
- Psoriatic spondylitis. Found in 40% of patients and is often accompanied by peripheral arthritis. For this form of the disease characterized by back pain, may be accompanied by inflammation of the entire spine or just the cervical or lumbar spine, or inflammatory process may occur in the joints connecting the pelvis and the spine. In this form of the disease may be stiffness of the spine, although his mobility is limited not all patients, and someone generally there are no signs of spondylitis.
In complex lesions of the joints possible myofascial pain, inflammation of the sternum and acromioclavicular joint, bursitis of the foot and Achilles tendon, the defeat of organs of vision (conjunctivitis, anterior uveitis), and sometimes renal amyloidosis.
In rare cases, may develop a malignant form of psoriatic arthropathy, which is characterized by next signs:
- the depletion of the patient;
- the temperature of the hectic type;
- severe psoriatic lesions of the skin, joints of the spine;
- generalized polyarthritis with severe pain and formation of cicatricial ankylosis;
- generalized lymphadenopathy;
- with the defeat of organs of vision, heart, kidneys, liver, CNS and PNS.
Complications and consequences of disease
Psoriatic arthropathy may be accompanied by severe pain and hit all the new joints despite treatment.
In addition, the disease carries a number of threats:
- If the process involves the small joints of the fingers and toes, they are swollen. As a result, the person is difficult to perform various manipulations with your hands or because of the tumor difficult to find shoes.
- There is often enthesopathy, which is accompanied by pain and inflammation of the tendons. Usually suffers Achilles tendon. Because of the pain in the foot, the patient has difficulty in walking.
- With the involvement in the pathological process of the joints of the spine occur pain in the neck and back.
Psoriatic arthropathy frequently cause disability of the patient. The malignant form can lead to death
The doctor makes a diagnosis on the basis of clinical and laboratory data.
Of symptoms in psoriatic arthropathy doctors note:
- Damage of the distal interphalangeal joints of the upper and lower extremities, especially the I toes. Joints painful, swollen, the skin over them bluish or purple-bluish.
- The simultaneous failure of all the joints on one finger, with the result that they become like «sausages».
- The involvement in the pathological process in the beginning of the disease of the big toe.
- Metatarsal neuralgia, which is accompanied by pain.
- Cutaneous manifestations of psoriasis, nail changes (turbidity, the appearance of different lines, a symptom of «thimble»).
- Psoriasis in history.
The specialist may prescribe a number of tests and studies:
- An x-ray. It can be used to see changes characteristic of psoriatic arthropathy.
- Analysis of synovia. With a needle from the knee joint take synovial fluid and examine it for the presence of lactic acid. Rule out gout.
- Elevated erythrocyte sedimentation rate, hypochromia, leukocytosis.
- Negative rheumatoid factor.
That can be done.
Unfortunately, not a lot… to cure the disease Completely is not currently possible.
Therapy is aimed primarily at relief of pain, removal of the inflammatory process and prevent the loss of the joints of their functions.
The medication is prescribed:
- Nonsteroidal anti-inflammatory drugs. It is desirable to use a selective COX 2 inhibitors include drugs on the basis of Meloxicam. They are less likely to cause exacerbations of psoriasis.
- Glucocorticoids, for example, Diprospan.
- Pharmaceuticals or as they are called basic. Is Methotrexate and Sulfasalazine.
- Immunosuppressive drugs.
In malignant disease prescribe plasmapheresis and ultraviolet irradiation of blood.
In order to prevent
Primary prevention of psoriatic arthropathy to date does not exist, since no known causes of the disease.
To pause the development of the pathology, the patient should maintain normal your weight, lead an active lifestyle, avoid stress, viral and bacterial infections, balanced diet, take vitamin D.
In addition there are the following methods of prevention of the disease:
- Splinting. With tires the joint can be given a correct position, to control inflammation, reduce erosion of the joints.
- Hydrotherapy. Exercises performed in water, help to strengthen the joints and maintain their function.
- Cold and hot compresses. If they in turn apply to affected joints, they cropped the pain and removes the swelling.
You need to alternate exercise and rest, not to overload the joints, if necessary, to use auxiliary means for the movement, for example, canes, carts, they help to reduce the load on the joints.
Observance of all these rules will reduce the risk of disease progression and improve quality of life.