Arthritis psoriatic

Psoriatic arthritis (psoriatic arthropathy, psoriatic spondylitis) is an inflammatory joint disease in patients with psoriasis.

Etiology, pathogenesis are unclear. Arthritis often develops with a clear lesion of the skin, but there is no complete paralpelism between the severity and the course of cutaneous and articular syndromes. Arthritis can often precede skin rashes or occur with single psoriatic plaques.

Symptoms, course. More common is a variant of the disease resembling rheumatoid arthritis. Distinctive features of psoriatic arthritis are: asymmetrical nature of joint damage, often the presence of a crimson-cyanotic skin color over the affected joint (with the involvement of the joints of the fingers often develop periarticular edema that captures the entire finger - "finger in the form of a sausage") , Often the presence of sakroileitis, and in some cases, the defeat of other parts of the spine (spondylitis), reminiscent of Bekhterev's disease. Much less common is a variant specific for this disease, occurring as a polyarthritis with a predominant lesion of the distal interphalangeal joints of the hands, rapidly progressing bone-cartilage destruction and the development of significant deformations-the so-called mutilating (disfiguring) arthritis.

The course of psoriatic arthritis is usually chronic with periods of exacerbations and subre-rests. In some patients arthritis is acute, transitory, imitating rheumatic or arthritic arthritis. In psoriatic arthritis, there are sometimes signs of damage to the internal organs: the eye (irites), the myocardium (myocarditis), the lower parts of the urinary tract (urethritis, etc.), and the development of amyloidosis. Changes in blood, according to laboratory studies, are nonspecific, rheumatoid factor in the blood is absent. X-ray changes in the joints resemble those of rheumatoid arthritis, but osteoplastic osteoporosis is less pronounced, and there is a tendency to develop periosteal reactions and small bone proliferates at the edges of the heads and distal phalanges of the fingers. For mutilating arthritis is characteristic development of osteolysis of phalanges, ankylosis and subluxations.

Treatment. Apply a variety of non-steroidal anti-inflammatory drugs (see Rheumatoid arthritis), carry out intra-articular corticosteroids. In the absence of a sufficient positive effect, a course of plasmapheresis is carried out, also krizanol (as in rheumatoid arthritis), and, in case of significant skin changes, methotrexate (5 mg per week or more).