Psoriasis is a chronic, relapsing disease that manifests itself mainly in the form of rashes of profusely scaly plaques on the skin, but which can also be accompanied by damage to other organs, primarily damage to the joints, as well as bones, muscles, pancreas, lymph nodes, and kidneys. , various neurological and psychiatric symptoms. Therefore, modern scientists sometimes prefer the term: psoriatic disease.

For example, at the III International Symposium on Psoriasis in 1987, prof. Novotny from Czechoslovakia made a report entitled “Visceral psoriasis” and presented a classification in which forms such as psoriatic nephritis, endocrinopathic form of psoriasis, etc. were identified. And of course, in our time it is no longer possible to consider psoriasis only as a dermatosis limited to damage to the skin and nails. It follows that we must be critical of the definition of psoriasis made in most textbooks, where it is considered as an isolated lesion of the skin.

An autopsy study of the condition of the internal organs of patients with psoriasis revealed alterative changes in the walls of the main substance vessels, depolymerization of fibrillar structures of connective tissue, the appearance of perivascular cellular infiltrates and macrophage nodules in the myocardium, kidneys, etc. Reversible and irreversible changes in nerve cells have also been identified (Buharovich M.N. et al. - in the collection: Systemic dermatoses. - Gorky, 1990).

It should be emphasized that the etiology and pathogenesis of psoriasis remains poorly understood, and that the most likely causes of psoriasis are a complex relationship of genetic and many other influences. But this definition still says little about the pattern of articular and visceral lesions in psoriasis.

What psoriatic rashes on the skin look like, what psoriatic changes in the nails look like, what methods confirm the diagnosis of skin psoriasis, what purely morphological changes in the skin underlie the so-called “psoriatic triad”, how psoriasis progresses, what complications there are - you have studied all this in detail or you will study it in practical classes, and we will not touch on this issue in the lecture.

I’ll just say why you need this, at first glance, purely dermatological knowledge and diagnostic techniques. The fact is that a family doctor, local therapist, surgeon, or traumatologist in their practical work often has to meet with patients with psoriatic arthritis. And in order to recognize this form of joint damage, you need to be able to recognize the skin manifestations of psoriasis. By the way, the ability to diagnose psoriatic arthritis is provided for by the qualification characteristics of a general practitioner approved by the Ministry of Health.

Joint diseases are one of the most common types of human pathology, and there are up to 100 nosological forms. Apparently, at least 20 million people in the world suffer from these diseases. Among patients with various forms of chronic inflammatory diseases of the joints, rheumatoid arthritis undoubtedly ranks first in frequency at present. However, psoriatic arthritis, which, according to the modern classification, is classified as a group of rheumatoid diseases, also occupies an important place due to the incidence rate, resistance to therapy, the complexity of diagnosis and often unfavorable prognosis.

According to the All-Union Arthrological Center (Abasov E.M., Pavlov V.M., 1985), in patients with chronic monoarthritis, psoriatic arthritis is more common (7.1%) than ankylosing spondylitis - ankylosing spondylitis (5.3%), yersinia arthropathy (2.7), tuberculous synovitis (3.1) and other joint diseases. The actual incidence of psoriatic arthritis is undoubtedly much higher, since many patients, especially those with widespread skin rashes, are treated in dermatological hospitals and are not taken into account by statistics. In addition, psoriatic arthritis is often not recognized and not registered in a timely manner, since it can occur for a long time without characteristic skin rashes. And then, as many famous rheumatologists noted at the All-Union Conference in 1988, patients are mistakenly diagnosed with rheumatoid arthritis, infectious-allergic polyarthritis, etc.

It is believed that psoriatic arthritis develops on average in 7% (according to the American rheumatologist Rodnan G.P., 1973) or even in 13.5% of patients with psoriasis (according to Moscow rheumatologists). But psoriasis itself is a very common disease. Using mathematical analysis, it was found that the probability of developing psoriasis during one’s lifetime is 2.2% (Mordovtsev V.N. et al., 1985). Thus, the probability of developing psoriatic arthritis during a person's lifetime (up to 75 years) is approximately 0.1-0.15 (i.e. 100-150 per 100,000 population). This is a fairly high frequency: according to this calculation, in the city of Chelyabinsk with a population of 1 million people, one can expect from 1000 to 1500 patients with psoriatic arthritis. This calculation is confirmed by information from Erdes and Benevolenskaya, employees of the Institute of Rheumatology of the Academy of Medical Sciences, who in 1987 cited the figure of 0.1% as an indicator of the incidence of psoriatic arthritis among the population of Moscow.

Since today we will talk about joint diseases, we need to get acquainted with some general information.

Firstly, articular syndrome is a combination of joint(s) pain, swelling, stiffness and limited function. Joint swelling can be caused by intra-articular effusion (increased volume of synovial fluid), thickening of the synovial membrane of the joint, thickening of periarticular (extra-articular) soft tissues, intra-articular fatty growths, etc. Consequently, articular syndrome may be due to both intra-articular and periarticular changes.

The term arthritis(synovitis) refers to inflammatory lesions of the synovial membrane, accompanied by its hypertrophy and effusion into the joint.

The term arthrosis(or osteoarthritis) denotes degenerative damage to cartilage in the underlying bone, primary or secondary, accompanying inflammation and other factors.

Psoriatic arthritis belongs to the so-called seronegative arthritis: rheumatoid factor, as a rule, RF is not detected in patients with psoriatic arthritis - rheumatoid factor is antibodies to the Fc fragment of IgG, which are found in the blood serum of most patients with rheumatoid arthritis and some other diseases). But what kind of disease is psoriatic arthritis? Ailbert, who first described arthritis in a patient with psoriasis in 1882, believed that this was a random combination. However, it has now been proven that psoriatic arthritis is a special nosological form that naturally occurs in patients with psoriasis.

On etiology and pathogenesis There is no point in stopping at psoriatic arthritis, since it is simply not known, like the etiology and pathogenesis of psoriasis. Those interested can look at the collection “PSORIASIS” (M., 1980). There they will find various assumptions about the role of the CEC and cellular immunity, cyclic nucleotypes and lipid metabolism disorders, changes in the intestinal mucosa and nervous system, etc. The viral theory of the etiology of psoriasis will not be forgotten. But in the end it turns out that psoriasis is a multifactorial disease and the discovery of its pathogenesis is a matter of the future.

True, it is of interest that in patients with vulgar psoriasis and psoriatic erythroderma, HLA antigens B13 and B17 are found approximately 4 times more often than in the population. It is estimated that carriers of the B13 antigen have a risk of developing psoriasis almost 9 times greater than those who do not have this antigen (Erdes S. et al., 1986). But in patients with psoriatic arthritis, the frequency of detection of the HLA B27 antigen is 2-3 times higher than in the population: in patients with psoriatic arthritis, this antigen occurs in approximately 20-25%, and among the population in 7-10%. In patients with uncomplicated psoriasis (without symptoms of arthritis), the B27 antigen occurs with the same frequency as in healthy individuals, i.e. at 7-10%. The diagnostic significance of the HLA B27 antigen in psoriatic arthritis is due to the fact that it is found in 80-90% of patients with psoriatic arthritis with damage to the spine (“central arthritis”) and sacroiliac joints, but when only peripheral joints are affected, this antigen is found with such the same frequency as in healthy individuals (Brewerton et. al. 1974; Lambert et. al. 1976).

Medical statistics indicate that it is one of the most frequently diagnosed skin diseases and accounts for 1-2% of them. In many patients with a sufficiently long history of psoriasis, the joints are also involved in the pathological process; this condition is called psoriatic arthritis. In the past, this disease was considered a special variant, acquiring individual characteristics under the influence of skin pathology. However, recently, serious differences have been discovered between rheumatoid and psoriatic arthritis, which has made it possible to distinguish the latter as an independent nosological entity.

In this article we will look at the symptoms and treatment of psoriatic arthritis.

Epidemiology of psoriatic arthritis

Psoriatic arthritis is diagnosed in approximately 5-7% of people suffering from psoriasis. The onset of the disease, as a rule, occurs at the age of 20-50 years, in some cases it develops even in childhood. This pathology occurs with equal frequency in both men and women.

Causes and mechanisms of development of psoriatic arthritis

Psoriatic arthritis accompanies skin rashes in 5-7% of patients with psoriasis.

The etiology of psoriatic arthritis coincides with that of psoriasis itself and is not completely known today. Scientists believe that the basis for the excessive proliferation of epidermal cells observed in psoriasis is a disruption of their biochemical processes, which is associated with an imbalance between a number of biologically active substances: cAMP, cGMP, prostaglandins and others. Some authors believe that multiplying cells synthesize a special substance, namely epidermopoietin, which induces cell division, which leads to hyperplasia.

And yet, one of the leading theories of the occurrence of psoriasis and psoriatic arthritis is genetic. It has been proven that people who have a psoriatic process are carriers of certain antigens of the HLA system; in addition, almost every patient with psoriasis has a close relative with the same diagnosis. Individuals with this genotype feature are predisposed to psoriasis. When they are exposed to any unfavorable external factors, in particular stress, trauma, infectious agents, especially in combination with general or local disorders in the immune system, a malfunction occurs in the body, namely, a number of biochemical reactions characteristic of psoriasis are triggered.

Autoimmune disorders undoubtedly play a role in the pathogenesis of psoriasis and psoriatic arthritis, that is, the body produces antibodies to its own cells. Proof of this is the elevated levels of gammaglobulins, IgA, IgM and IgG, streptococcal antibodies, antibodies to skin antigens and other immunological indicators found in the blood.

Symptoms of psoriatic arthritis

In 68-75% of cases, arthritis develops in patients who have suffered from psoriasis for 2-10 years, less often it occurs simultaneously with the first skin manifestations, and sometimes articular syndrome even precedes the appearance of signs of skin pathology.

Arthritis usually debuts imperceptibly, gradually progressing, but in some cases the onset of the disease can be acute.

There are 5 types of joint damage in psoriatic arthritis:

1. Arthritis that affects the distal (those closest to the periphery) interphalangeal joints;
2. Monoligoarthritis (i.e., only 1-2-3 joints are affected);
3. Polyarthritis of the rheumatoid type;
4. Arthritis mutilans;
5. Spondyloarthritis (chronic inflammation of the spine, leading to decreased mobility in the joints of the lumbosacral region up to ankylosis).

Arthritis affecting the distal interphalangeal joints

The first type - inflammation of the distal interphalangeal joints of the feet and hands - is classic in psoriatic arthritis. At the beginning of the disease, one or more joints are affected; as it progresses, the rest are also involved in the process, and multiple lesions are observed. The skin over the affected joints is bluish or purplish. The joints are swollen (on palpation, this swelling is very dense), painful. The end joints change shape as the disease progresses, which, combined with the specific coloring of the skin over them, gives them a radish-like appearance. In addition, the pathological process with this type of arthritis usually involves the nails: they are dried out, peel, and break.

A pathognomonic sign (i.e., characteristic exclusively of this disease) of psoriatic arthritis is a wasp-shaped deformation of the fingers. It occurs when 3 - distal, proximal interphalangeal and metacarpophalangeal - joints of one finger are simultaneously affected, up to their ankylosis (complete fusion with an absolute absence of movements in them) and is called “axial” damage.

Mutilating form of arthritis

The mutilating form of arthritis, fortunately, is quite rare, occurring in only 5% of patients. This is a severe inflammation of the joints, leading to their rapid destruction, osteolysis. Externally, the fingers are shortened, curved, and look like a folding telescope - if desired, you can straighten them “manually” to their original length (so-called telescopic fingers). Examination reveals multiple subluxations and ankylosis of the affected joints. These changes are always asymmetrical and disordered - on the same hand, the axes of the fingers are shifted in different directions, there are both flexion and extension contractures of the joints.

The variants of joint damage described above, although they are classic for the disease we are describing, are found only in 5-10% of people suffering from psoriasis. In 7 out of 10 patients, inflammation of one or two large joints is detected - knee, ankle, hip. In 15% of patients, involvement in the pathological process of more than 3 joints, of absolutely any location, is diagnosed. Polyarthritis can be either asymmetrical or occur equally on both sides, reminiscent of the clinical picture of rheumatoid arthritis.

Spondyloarthritis

Sometimes, in 5% of cases, psoriatic arthritis occurs as ankylosing spondylitis (ankylosing spondylitis).

This pathology is often accompanied by eye damage - as a rule, iritis and episcleritis are diagnosed. If ulcerative lesions of the genital organs and oral mucosa are also detected, the patient is diagnosed with Reiter’s disease.

In the case of a malignant course of psoriatic arthritis, internal organs may also be involved in the pathological process. As a rule, this phenomenon is observed in young (under 35 years of age) men suffering from an atypical form of psoriasis. Patients complain of alternating sharp rises and sudden drops in temperature (the so-called hectic fever), accompanied by tremendous chills and severe sweating. They quickly lose weight, hair actively falls out, muscles atrophy, bedsores and trophic ulcers form on the skin, regional lymph nodes, especially the inguinal ones, increase in size. Damage to the heart occurs according to the following type: it is enlarged in size, the heart rate is increased; during auscultation (listening through a phonendoscope), a weakening of the first tone and systolic murmur are determined; The ECG also reveals diffuse changes in the myocardium. The liver is also affected and hepatolienal syndrome develops. In some cases, the kidneys are affected with the development of diffuse glomerulonephritis, and subsequently renal amyloidosis. With a particularly malignant course of psoriatic arthritis, the central nervous system is also involved in the pathological process - epileptic seizures and polyneuritis develop.

Diagnostically important signs of psoriatic arthritis. This:

• pain and swelling of the distal interphalangeal joints of the hands and feet;
• pain and swelling of 3 joints of the same finger - both hands and feet;
• asymmetric mono- or oligoarthritis;
• night or early morning deep pain in the sacral area;
• pain in the heel area;
• the presence of areas on the skin characteristic of psoriasis;
• Looking ahead, we note a negative rheumatoid factor, an increased ESR and characteristic changes on the x-ray of the affected joints.

Diagnosis of psoriatic arthritis

Based on complaints, medical and life history data (the presence of psoriasis in the patient being examined is especially important), and the results of an objective examination of the patient, the doctor will determine a preliminary diagnosis of psoriatic arthritis. To confirm it, you will need to conduct a number of laboratory and instrumental studies, namely:

• general blood test (the blood will respond to severe inflammation in the joints by increasing the ESR to 30 mm/h or more; an increase in the level of leukocytes, a decrease in hemoglobin and red blood cells can also be determined with a normal value of the color index (that is, normochromic anemia);
• blood test for rheumatoid tests, in particular, determination of rheumatoid factor (in this pathology it is negative, that is, it is not detected or absent in the blood) and C-reactive protein (it is detected in large quantities);
• biochemical blood test (increased content of gammaglobulins, determined by IgA, IgG or IgM);
• analysis of synovial (intra-articular) fluid taken by joint puncture (high cytosis is determined, that is, a large number of cells, with the presence of many neutrophils, the fluid viscosity is low, the mucin clot is loose);
• radiography of the affected joints and/or spine (at the initial stage of the disease, areas of osteoporosis and osteosclerosis (replacement of bone tissue with connective tissue) are identified in the image); at the stage of moderate lesions, narrowing of the joint spaces is visualized, both in the joints of the fingers and in the intervertebral joints, sacroilial joints (sacrum with the iliac bones) are also narrowed; at the late, advanced stage of the disease, there are no gaps between the articular surfaces in the affected joint, ankylosis is determined; in the mutilating type of joint damage, the articular surfaces and adjacent areas of the bone are completely destroyed).

In 1989, the Institute of Rheumatology of the Russian Academy of Medical Sciences developed diagnostic criteria, according to which the likelihood of psoriatic arthritis is determined by the number of points awarded during the testing process. The table of scores corresponding to certain criteria is presented below.

Diagnostic criterion	Point
Presence of psoriatic rashes on the skin	+5
Psoriasis of the nail plates	+2
Skin psoriasis diagnosed in a close relative	+1
Inflammation of the distal interphalangeal joints	+5
Axial joint damage	+5
Subluxations of the fingers of the upper extremities, directed in different directions	+4
Chronic asymmetric arthritis	+2
Blue or purplish coloration of the skin over the inflamed joints, mild pain	+5
Sausage shaped toes	+3
Skin and joint syndrome are determined simultaneously	+4
Pain and stiffness in the morning in the spine for the last 3 months	+1
Rheumatoid factor negative	+2
Bone destruction at the apex (acral osteolysis)	+5
Lack of mobility (ankylosis) of the distal interphalangeal joints of the hand or metatarsophalangeal joints of the feet	+5
Signs of sacroiliitis on a radiograph	+2
Bone growths along the edges of the joint spaces of the intervertebral joints: paravertebral ossifications	+4

Classic psoriatic arthritis is diagnosed if the score is 16 or more. With a score of 11-15, definite psoriatic arthritis is diagnosed. If the score is 8-10, psoriatic arthritis is probable, and if the score is 7 points or less, this diagnosis is rejected.

Differential diagnosis for psoriatic arthritis

Since this disease does not always occur in the classical form, one should be able to distinguish it from a number of other rheumatological diseases. Typically, differential diagnosis is carried out with:

• rheumatoid arthritis;
• ankylosing spondylitis;
• Reiter's disease;

Treatment of psoriatic arthritis

The patient will be prescribed injections of anti-inflammatory and painkillers.

Therapeutic measures should be aimed not only at treating articular syndrome, but also at influencing the skin psoriatic process.

Treatment of skin manifestations of the disease is usually carried out by a dermatologist, and therapeutic measures include ultraviolet irradiation, local use of hormonal ointments, systemic intake of vitamins, etc.

As for arthritis itself, drugs from the following pharmacological groups can be used to eliminate the inflammatory process in the joints:

1. intra-articularly (inside the joint) - Depo-Medrol, hydrocortisone, Kenalog, etc.
2. long-term course - meloxicam, celecoxib, nimesulide, diclofenac, indomethacin, piroxicam.
3. Basic drugs in the case of rheumatoid-like, polyarticular, mutilating forms of psoriatic arthritis: sulfasalazine, gold preparations (Tauredon, Crizanol), cytostatics (Methotrexate).
4. Systemic enzyme therapy drugs – Wobenzym, Phlogenzyme.

Efferent methods, such as plasmapheresis, can also be used as part of the complex treatment of arthritis.

Non-drug treatments for psoriatic arthritis may include:

• therapeutic exercises;
• physiotherapy (ultrasound with hydrocortisone on the area of ​​affected joints, paraffin baths);
• balneological treatment (hydrogen sulfide and radon baths);
• treatment at the resorts of Sochi, Talgi, Naftalan.

In the case of persistent synovitis (inflammation of the synovial membrane of the joint) that cannot be treated with drugs, as well as in cases of severe changes in the joints that impair the patient’s functional activity, surgical treatment may be recommended, but the results are not always good and long-term.

The criteria for the effectiveness of treatment are normalization or reduction in the severity of clinical syndromes of the disease: skin, joint and others; normalization of hematological indicators of process activity: ESR, leukocytes, C-reactive protein, immunoglobulins; slowing down the progression of the disease, determined on x-rays.

Prognosis for psoriatic arthritis

The course of the disease is unpredictable in most cases. Sometimes it is benign, and in some cases it is aggressive and in a short time the inflammation leads to destruction of the joint. The prognosis is determined individually, depending on the frequency and severity of exacerbations, the timeliness and adequacy of the prescribed treatment, and the duration of medication use.

Psoriatic arthritis is characterized by severe inflammation of the joints and surrounding tissues, with the presence of an inflammatory process and chronic skin disease. The disease can develop in patients who have suffered from psoriasis before. It happens that psoriatic arthritis appears several years after the first minor symptoms of psoriasis.

Causes of psoriatic arthritis

It is difficult to immediately determine the exact cause of the disease. Pathological symptoms are often caused by immune factors, as well as hereditary predisposition.

Many skin diseases, including psoriatic arthritis, occur due to a malfunction of the nervous system or psyche. It is not for nothing that experts call the pathology in question a psychosomatic illness.

Another possible cause of the disease is damage to the joint. Sometimes, symptoms appear against a background of a healthy condition, in the event of a fall or dislocation. Injuries of this kind can trigger the whole process.

In this video, a specialist from one of the Moscow clinics talks in detail about the first reasons for the appearance of this disease.

Who is at risk for psoriatic arthritis?

According to the theory, the risk group includes patients who have hereditary inclinations, that is, such a disease has already overtaken relatives.

According to statistics, people over 65 years of age are at risk. But don’t think that arthritis is a disease of old age. It affects pensioners, young people and even children. The appearance of pathological symptoms depends on the reasons that caused the change in the skin and joints.

It is estimated that millions of people suffer from psoriatic arthritis. Their numbers are gradually growing every year. According to experts, almost every third person living in this world could encounter the symptoms of the disease in question.

Main symptoms

Psoriatic arthritis is different from other diseases. The main symptoms are pain, swelling in the joint areas, redness and irritation of the white tissue. Both joints and other places are affected if not treated in a timely manner.

Activity level

Psoriatic arthritis is characterized by varying degrees of activity, both in the organs and in the joint structure as a whole. There are only three degrees.

First degree

Symptoms: Minor pain during movement. Stiffness in the morning (the duration of this process does not exceed half an hour). The general body temperature of a person is normal.

Manifestation: Manifestations of the exudative type are not present in the upper part of the articular region. Sometimes they are expressed, but minimally.

Second degree

Symptoms: Painful symptoms are present with the slightest movement, as well as at rest. Stiffness is present in the morning. It lasts about three hours.

Manifestation: In the affected joints there is constant, unstable exudative symptoms. Slight leukocytosis and manifestations of band shifts. As for body temperature, it is low-grade.

Third degree (maximum)

Symptoms: Unbearable pain during movement. At rest, pain is also present. Stiffness is present in the morning and lasts more than 3 hours. The area of ​​periarticular tissue is inflamed.

Manifestation: Body temperature is high. The occurrence of remission and inflammation cannot be ruled out. Pathology manifests itself in the form of vulgar psoriasis, but with complications.

In addition to the fact that various joints and skin are affected, the joints and tissues on the extremities of the arms and legs are susceptible to the disease to the maximum extent.

Clinical features of psoriatic arthritis

The clinical picture of the disease is quite varied. Starting with mono-oligoarthritis or isolated enthesitis, and ending with generalized joint damage, including striking visual extra-articular symptoms.

At the very beginning, the disease has quite clearly defined exudative signs, especially in places where the joints are most affected. The greatest activity of the inflammatory process is accompanied by poor mobility. This happens at first. After this, when insufficient quality treatment is used, everything gets worse and worse.

Is disability possible?

The prognosis for psoriatic arthritis depends on the correct approach during treatment. Depending on the approach of the specialists, the treatment can be completely successful. Otherwise, other methods and approaches will have to be taken.

Many patients with poor quality or self-treatment had complications, such as shortening or curvature of a bone or joint. Deformation of the limbs often appears, and after this the process is accompanied by fusion of the joints. A continuous painful spot develops on the surface of the skin. Due to the blocking of mobility and pain symptoms of the patient, disability occurs.

Forms of psoriatic arthritis

Today, several forms of the disease are diagnosed, which differ in their manifestations. They are diagnosed depending on the predominance of certain symptoms.

Symmetric – affects more than five joints. The disease manifests itself on both limbs symmetrically. This is where the name came from. The pathology is similar to rheumatoid arthritis, but is milder.

Spondylitis and sacroiliitis– characterized by damage to the spine and its parts. The hip joints and sacrum are slightly less likely to be damaged. Severe stiffness of patients in movement is noticed, but pain does not appear. For this reason, the disease cannot always be detected on time.

Asymmetric mono-oligoarthritis- This is one of the most common forms, which is characterized by damage to large joints in the area of ​​​​the toes or fingers. In appearance, the disease resembles simple psoriasis, but is complemented by all kinds of deformities.

Distal interphalangeal arthritis of the hands and feet– with this form, maximum damage occurs between the phalanges of the fingers. It occurs infrequently and is characterized by a large area of ​​tissue damage.

Arthritis mutilans– with this form, fingers, both hands and feet, are affected. Irreversible joint deformation is often observed. Accompanied by frequent subluxations and deformation of cartilage and bone tissue (distributed to the spine, arms and legs).

Mixed combinations of forms of the disease often appear. Sometimes pathology can change from one form to another.

Diagnostics

The symptoms of psoriasis and arthritis are impossible not to hear or not see. At this time, corresponding ulcers appear on the body in the form of a rash. It is worth noting that the rash, judging by its external signs, is significantly different from other diseases.

What tests need to be taken?

During diagnosis, the doctor prescribes tests that help more accurately determine the characteristics of the disease and make a diagnosis.

A blood test makes it possible to identify other diseases that occur in parallel with the pathology in question. The level of immunoglobulin and its groups is determined in the blood.

Additional laboratory tests: analysis of synovial fluid taken from the affected joint, analysis of stool and urine.

The main criteria for making an accurate diagnosis:

1. genetic transmission of the disease (by kinship);
2. X-ray signs of tissue destruction;
3. multiple lesions of articular tissues;
4. blood test results.

The presence of skin plaques characteristic only of psoriasis or psoriatic arthritis also gives a more accurate picture of the studies.

Why is an x-ray necessary?

A prerequisite for diagnostic actions is obtaining radiography results. Without x-rays it is simply impossible to make a correct diagnosis. It is important to review all possible affected areas and determine their severity, including deformation and destruction.

X-ray images make it possible to identify erosive processes, in which at the same time it is possible to detect changes of a proliferative nature, with a peculiar growth of bone tissue.

Treatment of psoriatic arthritis

When the first symptoms of the disease appear, it is important to know which doctor to contact. You should start with a therapist, who must then determine which specialist to contact.

This disease is treated by several specialists, including a dermatologist, rheumatologist, surgeon and orthopedist. Sometimes an immunologist also gets involved in the joint action.

Medications and therapy

There are different treatment methods, the main ones being drug therapy.
Modern drugs that have proven themselves well in practice:

• Ibuprofen.
• Indomethacin.
• Piroxicam.

In situations where the body does not respond well to medications, such as kidney failure, specialists are able to choose other medications, such as:

• Celecoxib.
• Nimesulide.
• Meloxicam.

Severe stiffness of the joints and nearby tissue can be eased by muscle relaxants:

• Mydocalm.
• Baclofen.
• Sirdalud.

Sometimes doctors prescribe steroid drugs, with their help you can quickly relieve pain symptoms and inflammation (glucocorticoids). In practice, Prednisone has performed well.

Physiotherapy and phototherapy

Effectively used during the treatment of psoriatic arthritis - physiotherapy. This method of treatment is more practical to use after the acute symptoms of the disease have been relieved and the condition has normalized. The patient's body temperature should also be normal.

Procedures:

1. use of ultrasound or high frequency;
2. treatment using therapeutic mud;
3. irradiation with ultraviolet radiation;
4. Balneotherapy;
5. reflexology;
6. the use of electrophoresis;
7. treatment using magnetic therapy methods;
8. therapy using laser technologies;
9. acupuncture and massage.

Selective phototherapy is well tolerated by many patients. A feature of this method is the use of a wavelength of 310-340 nm as part of the spectrum. After this treatment method, long-term remission occurs.

General phototherapy makes it possible not only to stop the spread of the disease in the affected areas of the skin, but also to prevent the appearance of pathological symptoms on a healthy surface.

The immediate side effects of phototherapy are the appearance of erythema, dry skin, and severe itching. Before the session, it is important to make sure that you are not allergic to ultraviolet radiation.

Treatment with folk remedies at home

Traditional medicine plays an important role in the treatment of psoriatic arthritis. But it is worth saying that traditional medicine also made a good contribution during the fight against this disease.

Baths with chamomile

Method of preparation: Take 200 chamomile heads, chop them and pour boiled water (3 l). Within two hours the infusion will be ready.

It can be added to water while bathing. If you heat a bath of water and add 3 liters of infusion to it, then it is enough to stay in the bath for 20 minutes for a healing effect. The frequency of such procedures is every other day, preferably before bedtime.

Celery root tincture

Method of preparation: Take 1 tbsp. a spoonful of washed raw materials (roots crushed in advance), the mass is poured with boiling water in the amount of 2 glasses. After this, the mixture should be left for 4 hours.

Celery leaves, honey and lemon juice

Method of preparation: Take 500 g of crushed celery leaves, mix them with 500 g of lemon pulp, grated together with the peel. The mixture must be thoroughly mixed. After this, take 500 g of heated honey and add it to the mixture. The resulting consistency is left in the refrigerator for 3-4 days.

Mainly used before eating - 2 teaspoons, 40 minutes before meals.

Nutrition and diet for this disease

Proper nutrition plays an important role, including the correct diet that a specialist has worked on. These methods can significantly reduce the symptoms of the disease.

Need to use more:

• fruits and berries (only when there is no allergy to them);
• vegetables and herbs (the diet should be reviewed by a doctor, as some plants cause allergies);
• dietary meat (chicken, turkey, rabbit);
• quail eggs.
• lactic acid products;

You should avoid fatty foods, mushrooms, and canned food. You don't need to eat a lot of salt or sugar. It is not recommended to eat sorrel and legumes. Smoking and drinking are contraindicated.

Rehabilitation and prevention

Regular exercise is used to relieve stiffness. If the system is correctly selected, then pain symptoms are also relieved, but this is effective only when all the main symptoms of the pathology have been relieved, including swelling and temperature.

Only professionals should work on an exercise program. Because if you select the wrong exercises, the symptoms may worsen.

Exercise goals:

• Reduced symptoms of psoriatic arthritis.
• Preserve the functionality and activity of joints.
• Increase muscle flexibility and elasticity.
• Maintain optimal body weight to reduce the load on joint tissue.
• Increase the endurance of the heart and blood vessels.

Psoriatic arthritis is difficult to get rid of with medications alone. For more effective recovery, it is better to carry out comprehensive treatment, including physical exercise and massage.

Help from a psychologist

Psoriatic arthritis can greatly affect aspects of life, which include: work, sports, dating and much more. In other words, after an illness, everything can change for the worse. At this time, it is important not to lose heart.

Often, patients feel like useless people in society and in life in general. To solve such problems, it is important to have the help of a psychologist who can provide the correct settings.

Quick page navigation

To date, literally tons of medical works and treatises and tons of popular literature have been written about psoriasis. There are not many effective methods for treating psoriasis, and even fewer that are reliably helpful.

For example, most symptoms of psoriasis regress when the climate changes to a maritime one. With moderate insolation, the plaques become faded, many of them disappear, and in some cases, psoriasis is cured. But there are forms in which tanning is contraindicated. In some cases, psoriasis is complicated by psoriatic arthritis, which occurs in 10% - 40% of patients.

The disease itself is common in the population in the region of 2-3%, and this means that at least one person in five hundred has some signs of psoriatic arthritis.

• It should not be confused with psoriatic, despite some similarities in the clinical picture.

The most important criterion for distinguishing them is the presence of a cutaneous form of psoriasis or its history in case of suspected psoriatic arthritis and specific signs of damage in rheumatoid arthritis, for example, seropositive forms in the presence of rheumatoid factor.

Psoriatic arthritis - what is it?

The most interesting thing is that there is no exact connection between the amount and duration of the cutaneous form of psoriasis and joint manifestations. Therefore, the definition of the type “psoriatic arthritis is joint damage as the next stage of rashes” is fundamentally incorrect.

There is a connection with rashes, but it is very conditional. Psoriasis can occur in the form of joint damage quite severely, but its skin manifestations can be insignificant, but still, complete joint damage without skin rashes is a rare occurrence.

The causes of psoriatic arthritis are just as hidden as the causes of psoriasis. There are many theories, ranging from metabolic to hereditary, but none of them can fully explain the cause of autoimmune inflammation.

risk factors (photo 1)

There are several risk factors that increase the likelihood of joint damage:

• Presence of nail lesions due to psoriasis. Nail plates are “transitional tissue” between the skin and joints, and if they are affected, the surface of the nail plate becomes covered with small pits, which are clearly visible in reflected light. The nails become like the surface of a thimble (see photo 1);
• Presence of skin rashes. And their severity and activity are not even as clear as the brightness of the meat - red around the edges and itchy skin - as evidenced by the length of the disease;
• Age. The most often affected is the “blooming period” - from 30 to 50 years. As for gender differences, men and women suffer equally often, but the disease manifests itself in different forms.

Symptoms of psoriatic arthritis by type

The main symptom of psoriatic arthritis of any localization is pain and limitation of movement. The pain intensifies with physical activity, but can also bother the patient at rest. Like all chronic diseases, psoriatic arthritis occurs with exacerbations and remissions.

During the period of remission, joint damage may not be detected at all, and a person may forget about the disease, deciding that everything has passed, but one morning he wakes up with old pains and realizes that the disease has not gone away.

How does psoriatic arthritis progress during exacerbation?

• Most often, the joints are affected asymmetrically, for example, in one person the index finger on the left hand, the small joints of the toes on the left, and the temporomandibular joint on the right may be simultaneously affected;
• Involvement of the joints of the axial skeleton, for example, the iliosacral joints and temporomandibular joints, may indicate an unfavorable course of the disease;
• During exacerbation, the color of the affected joints is bluish and purple. This is most noticeable on the fingers and toes, which become hot, swollen and painful;
• Often, when fingers are affected, all joints of the finger are affected, and pain begins in the middle of the palm. The entire finger loses its usual shape and swells evenly, resembling a purple-bluish “sausage”. This uniform inflammation of the tissue is called psoriatic dactylitis, or complete damage to the joints of the finger;

Types of psoriatic joint damage

You can identify several types of symptoms of psoriatic arthritis - joint damage due to psoriasis:

• Asymmetric arthritis, which affects several joints, including the joints of the hand, foot, wrist, and elbow.

In general, with psoriasis, damage to small joints is more typical than to large ones, but if large joints are involved, then this also does not happen alone.

Thus, isolated psoriatic arthritis of the knee joint is hardly possible; first of all, such a process must be differentiated with a specific lesion, primarily with tuberculous gonitis, as well as with gonococcal and chlamydial chronic infections.

• Symmetrical lesion involving axial joints.

As mentioned above, this form is more severe, and general symptoms may occur with it: malaise, mild low-grade fever, muscle pain.

A special type of axial lesion is psoriatic sacroiliitis, which can continue as an inflammatory lesion of small intervertebral joints. The outcome of such a disease can often be a sharp limitation of mobility in the back.

• Arthritis that affects only small joints.

Most often, these are the distal joints near the nail phalanges. As mentioned above, changes in the nails appear first, and then the joints are involved. Most often, this variant develops in men.

A special, rare form of the malignant course of the disease is arthritis mutilans, in which deformation and autoimmune inflammation are so pronounced that the hands become disfigured and deformed, lysis of bone tissue occurs with shortening of the phalanges.

If in arthritis there are nodules resembling rheumatoid ones, tophi, there is a connection with the course of a urogenital infection, rheumatoid factor is detected in the blood, and there is no skin evidence of psoriasis, then most likely we are talking about damage to the joints of another etiology (chlamydia, gout ).

Stages of psoriatic arthritis

There is no uniform classification of the stages of psoriatic arthritis. This is judged on the basis of the following data:

• whether or not there is concomitant damage to the axial joints, the presence of sacroiliitis;
• number of joints involved;
• is there a phenomenon of distal osteolysis (destruction of the phalanges);
• are there any systemic manifestations (amyloidosis, conjunctivitis, heart defects, uveitis, Raynaud's syndrome, polyneuritis, etc.);
• how pronounced the phase of disease activity is, or whether remission has developed.

Based on the overall picture, the stage of the disease is determined. An important criterion is an X-ray examination of the affected joints, which is divided into 4 stages, from mild osteoporosis to complete fusion of the joint space and the development of ankylosis.

Treatment of psoriatic arthritis, drugs

Treatment of psoriatic arthritis continues for many years as a chronic disease. If arthritis is accompanied by rashes (skin manifestations of psoriasis), then with the regression of these rashes the course of the joint syndrome improves.

One of the most reliable non-drug ways to influence articular syndrome is to normalize body weight and give up bad habits, first of all, giving up beer and weak alcoholic drinks.

NSAIDs, basic therapy and cytostatics

Treatment of exacerbations of psoriatic arthritis involves the administration of NSAIDs. Nimesulide (“Nise.” “Nimesil”) has proven itself well as an analgesic and anti-inflammatory agent.

In the event that there is intense autoimmune inflammation involving the axial joints, then the use of cytostatics, such as methotrexate according to a certain scheme together with folic acid, is indicated. Cyclosporine, colchicine, sulfasalazine, leflunomide, and gold preparations are also used.

Monoclonal antibodies

One of the modern and promising methods of treating psoriatic arthritis is the use of monoclonal antibodies, which can suppress the migration of leukocytes to the site of inflammation and prevent the formation of specific antibodies.

Antibodies that inhibit tumor necrosis factor (TNF-alpha) are used - infliximab, adalimumab.

Hormones

In modern treatment of psoriatic arthritis, hormones are rarely used, and all modern treatment regimens prefer to do without them. Their use, although it does not lead to the formation of Cushingoid syndrome, often transfers the course of psoriatic arthritis into a torpid phase, resistant to other drugs.

Of the indications for taking prednisolone, only the malignant course of the disease remains. Intra-articular administration of hormones to relieve local inflammation (Diprospan) is more widely used.

Treatment prognosis

If treatment for the symptoms of psoriatic arthritis is started in a timely manner (that is, before the appearance of radiological signs of severe arthritis), then there is a chance of stabilizing the condition and improving the quality of life.

Unfavorable signs of rapid deterioration of the condition are exudative inflammation, damage to more than 5 joints, including axial ones, the presence of sacroiliitis and systemic manifestations (carditis, amyloidosis, reactive hepatitis), and nail damage. In this case, hormones, basic drugs and cytostatics are used in therapy, and monoclonal antibodies remain reserve drugs.

The prognosis for life with psoriatic arthritis without systemic manifestations is favorable, but the quality of life in severe cases can be reduced, even leading to disability for various groups.

(psoriatic arthropathy) is an inflammatory joint disorder associated with the cutaneous form of psoriasis. Psoriatic arthritis is characterized by the presence of skin plaques, arthralgia, joint stiffness, spinal pain, myalgia, and subsequent deformation of the vertebrae and joints. Psoriatic arthropathy is diagnosed primarily by clinical and radiological signs. Treatment of psoriatic arthritis is carried out long-term and systemically with the help of anti-inflammatory, vascular drugs, chondroprotectors, physiotherapy, and rehabilitation measures. The progressive course of psoriatic arthritis leads to disability of the patient.

General information

Psoriatic arthritis accompanies the course of psoriasis in 5-7% of patients; Less commonly, the clinical manifestations of arthritis precede skin manifestations. The etiological factors of psoriatic arthritis are unknown. Among the causes are considered autoimmune and genetic mechanisms, environmental factors, in particular, infections. The hereditary theory of psoriatic arthritis is supported by the identification of articular syndrome in 40% of the closest relatives of patients with psoriasis. The inclusion of immune reactivity mechanisms in psoriatic arthritis is confirmed in laboratory tests. The participation of viral and bacterial agents in the development of psoriatic arthritis is assumed.

Factors predisposing to the occurrence of psoriatic arthropathy include the presence of confirmed psoriasis, hereditary tendency, and age from 30 to 50 years.

Classification of psoriatic arthritis

Symptoms of psoriatic arthritis

In the majority of patients (70%), articular syndrome develops following skin manifestations of psoriasis; in other cases (about 20%) it precedes skin lesions; in the remaining 10%, the appearance of skin and joint symptoms coincides in time. Psoriatic arthritis can develop gradually with general weakness, arthralgia, myalgia, or suddenly with acute arthritis with sharp pain and swelling of the joints. In the initial period, interest is noted in the interphalangeal joints of the fingers, metatarsal and metacarpophalangeal, knee, and shoulder joints.

Joint pain in psoriatic arthritis is worse at rest and at night; The characteristic morning stiffness and pain decrease during the day and with movement. Oligoarthritis with asymmetric joint involvement constitutes the most common clinical form of psoriatic arthritis. It is characterized by damage to no more than 4 joints of the feet and hands, “sausage-like” swelling of the fingers, the development of flexor tendovaginitis, and a purplish-bluish coloration of the skin over the joints. Arthritis affecting the distal interphalangeal joints is characterized by the most typical clinical picture of psoriatic arthritis.

Rheumatoid-like symmetrical arthritis involves 5 or more joints (interphalangeal, metacarpophalangeal); leads to random deformation of the joints and multidirectional long axes of the fingers. The mutilating form of psoriatic arthritis causes subluxation, irreversible deformation, and shortening of the toes and hands due to osteolysis of small bones. This variant of the course of psoriatic arthritis is often found in patients with severe skin symptoms and is combined with spondyloarthritis. Spondylitis is a form of psoriatic arthritis that affects various parts of the spine. Psoriatic spondylitis can be observed alone or in combination with damage to the joints of the extremities.

Various variants of the course of psoriatic arthritis can be accompanied by muscle and fascial pain, damage to the acromioclavicular and sternoclavicular joints, achilles bursitis, eye damage (iridocyclitis, conjunctivitis), and less commonly, renal amyloidosis. The malignant development of psoriatic arthritis includes severe lesions of the skin and spine, generalized polyarthritis and lymphadenopathy, hectic fever, cachexia, involvement of visceral organs, eyes, and nervous system.

Diagnosis of psoriatic arthritis

If psoriatic arthritis is suspected, the patient should consult a rheumatologist and dermatologist.

Specific criteria for the diagnosis of psoriatic arthritis are: involvement of the toes and hands with simultaneous damage to several joints; diffuse swelling and deformation of the fingers; damage to the first toes; Talalgia; psoriatic plaques on the skin and nail changes; cases of familial psoriasis; presence of radiological signs; manifestations of sacroiliitis; negative test for rheumatoid factor. A mandatory criterion is a psoriatic history of the patient or relatives.

In the peripheral blood of psoriatic arthritis, leukocytosis, hypochromic anemia, and an increase in ESR are detected; in venous blood - an increase in the level of sialic acids, seromucoid, fibrinogen, γ- and α2-globulins. Psoriatic arthritis is characterized by a negative result of a blood test for RF, detection of immunoglobulins in the synovial membranes and skin, an increase in the levels of IgA and IgG in the blood, and determination of the CEC. When examining synovial effusion, increased cytosis and neutrophilia, friability of the mucin clot, and low viscosity of the joint fluid are detected.

X-rays of joints in psoriatic arthritis reveal erosion of the articular surface of the affected bone, a decrease in the width of the joint space; signs of osteoporosis, osteolysis with multiaxial displacement of finger bones, ankylosis of joints, paravertebral calcification. If necessary, arthroscopy and diagnostic puncture of the joint are performed.

Treatment of psoriatic arthritis

There is no specific therapy for psoriatic arthritis, and therefore treatment is focused on reducing inflammation, pain and preventing loss of joint function. The main drugs for psoriatic arthritis are NSAIDs (diclofenac, piroxicam, indomethacin, ibuprofen). In case of poor tolerability, complications from the kidneys, gastrointestinal tract, exacerbation of skin psoriasis, it is advisable to prescribe selective COX-2 inhibitors (meloxicam, nimesulide, celecoxib). Severe joint stiffness is eliminated by prescribing muscle relaxants (tolperisone hydrochloride, baclofen, tizanidine).

Systemic therapy for psoriatic arthritis includes the use of glucocorticoids. To achieve a quick and pronounced effect (reduce pain, increase range of motion), intra-articular administration of glucocorticosteroids is possible. Basic drugs that modify the course of psoriatic arthritis include methotrexate, leflunomide, sulfasalazine, colchicine, mycophenolate mofetil, etc. Their mechanism of action is aimed at preventing damage to healthy joints. Basic drugs are used together with NSAIDs under tolerance control. In severe forms of psoriatic arthritis, immunosuppressive therapy is carried out with azathioprine, cyclosporine; monoclonal antibodies to TNF-α - infliximab, etanercept, electrophoresis, phonophoresis with glucocorticosteroids, dimethyl sulfoxide solution, exercise therapy. Severe deformities and ankylosis with irreversible dysfunction of the joints are indications for joint replacement.

Forecast and prevention of psoriatic arthritis

The course of psoriatic arthritis is chronic with a high probability of a disabling outcome. Modern methods of therapy make it possible to achieve remission and reduce the rate of disease progression. The prognosis is aggravated by the development of psoriatic arthritis in childhood and young age, severe cutaneous psoriasis, and polyarticular lesions.

Due to the lack of understanding of the etiology of psoriatic arthritis, it is impossible to prevent the disease. Secondary prevention measures include systematic anti-relapse therapy and medical supervision in order to preserve the functionality of the joints.