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Psoriatic arthritis: symptoms and treatment

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Psoriatic arthritis: symptoms and treatment Psoriasis is a chronic disease that has a non-infectious nature, which is characterized mainly by the defeat of the skin and recurrent course. According to statistics, around 120 million people suffer from psoriasis worldwide, which makes the disease very relevant. Even more important is the problem that doctors in many countries are working hard to solve this problem, but they really can not do anything.

Currently, scientists do not know the exact cause of the disease (there are only hypotheses that have a different right to life). The fact that physicians cannot identify the factors causing the development of the disease predetermines the absence of methods that can help the patient once and for all. Psoriasis always worries patients throughout their lives, occasionally sharpening and retreating. Doctors do everything possible to ensure that the period of exacerbation of the disease delivers the patient a minimum of anxiety, and the symptoms subside as quickly as possible. Also, with the help of a special diet and following the recommendations of specialists, you can somewhat reduce the likelihood of exacerbation of the disease by prolonging the period of remission.

As mentioned above, in most cases the disease affects the patient's skin. However, this is not the only option for the course of the disease: it is possible that the nails, some organs, and joints can be damaged. It is about psoriatic arthritis and will be discussed.



Causes of Psoriatic Arthritis

Although the doctors did not establish the exact cause of the disease, over the years of study they have put forward several hypotheses explaining the development of psoriasis from different points of view.

  • Since the patient has too much keratinization of the upper layers of the epidermis during an illness, scientists are trying to figure out what can cause the skin to behave not quite adequately. A number of authors believe that some substances of the immune system penetrate the patient's epidermis and give him a false signal, according to which cells begin to divide rapidly. This leads to a significant increase in the number of layers, which subsequently die off and begin to peel off, causing corresponding symptoms.
  • According to another hypothesis, the defeat of the skin occurs due to the abnormal activity of one of the leukocyte fractions - T-lymphocytes. Normally, these cells are involved in the body's immune response to the invasion of pathogenic viruses and bacteria. In the case of psoriasis, this is a malfunction of these cells and an autoimmune lesion of the skin. However, again, the reason that forces your own body to give such an “order” is still unknown.
  • Hereditary predisposition increases the likelihood of developing psoriasis. This has been proven by observing patients with this disease and their children. If both parents suffer from this disease, then the chance that their child will also face this problem increases many times over. This suggests that there is a certain gene or set of genes that increase the likelihood of a patient developing a disease.
  • Endocrine disorders and the pathology of melanin-producing cells (skin pigment) can also cause the development of psoriasis, according to one theory. These disorders, among other things, can generally have a negative effect on the condition of the skin.
  • Infectious diseases (chickenpox, streptococcal sore throat , etc.) can lead to an exacerbation or development of psoriasis and psoriatic arthritis.
  • Neuropsychiatric stress and frequent stress also play a role in the activation of autoimmune processes in the patient's body.

Currently, the theory of the development of psoriasis, which is based on an imbalance in the patient's body of certain chemicals, has gained the most popularity. These are cyclic nucleotides and prostaglandins, normally involved in regulating the growth factors of the epidermis cells, and the pathological substance epidermopoietin, which is produced by rapidly proliferating cells and causes the epithelium to grow additional layers with even greater speed. But at the same time, doctors emphasize that this imbalance is not the root cause of the disease, but only the result of some kind of external influence that triggers the entire chain.

In psoriasis, doctors talk about the presence of a positive Kebner symptom - the appearance of pathological foci in a place where the integrity of the epidermis was compromised or simply irritated. For example, patients often have psoriatic manifestations on the skin in places exposed to gum from clothing, wearing jewelry and watches. In the case of arthritis, injury to the joint, surgery, and the presence of an old scar can serve as an impetus for joint damage.

Also contribute to the autoimmune disorders, which are observed with severe pathology. The content of immunoglobulins M, G, A in the blood is violated, antibodies to skin cells and synovial membranes of the joints are detected.

Some researchers argue that even in the absence of clinical manifestations of joint damage in patients with psoriasis, it cannot be said that only skin is affected. With the introduction of special radioisotopes into the body of such people, it was found that they accumulate in large numbers in the joints, indicating that the latter are asymptomatic.

Classification

In most cases (about 75%), joint damage in psoriasis occurs after the onset of dermatosis (skin lesions). However, from 12 to 25% of cases of psoriatic arthritis are characterized by the fact that the patient has never had any skin manifestations before, and the joints are the first organ affected by the disease. In this case, the diagnosis is somewhat difficult, because doctors may not think about psoriasis right away.

Doctors distinguish several clinical forms of the disease, depending on which joints are mainly affected.

  • Asymmetrical oligoarthritis is a lesion of the joint on one side only, which is almost the case with a lesion of the joints of another etiology. In the case of psoriasis, this form accounts for seven out of ten cases of the disease. Large joints (knee, hip, ankle) are often affected.
  • Arthritis of the distal interphalangeal joints - affects the patient's fingertips, which affects the fine motor skills of the hands. Often combined with lesions of other joints, rarely flows in isolation.
  • Symmetrical rheumatoid-like arthritis - large and small joints are damaged on both sides at once. Particularly affected are metacarpophalangeal joints and distal interphalangeal joints. In contrast to rheumatoid arthritis, during deformity, the fingers of patients are directed in different directions, and not into one.
  • Militant arthritis - a sharp deformation of the joints (disfigurement) occurs. The fingers and toes can be significantly shortened, and bone tissue is destroyed.
  • Psoriatic spondylitis - often combined with lesions of peripheral joints. It is characterized by the appearance of pain in the lumbar spine and their subsequent transition to the overlying departments (thoracic and cervical). The field is involved and the joints between the vertebrae and the ribs.



Symptoms of Psoriatic Arthritis

Psoriatic arthritis photo Although patients complain of pain in different joints, a number of common features can be found for all forms of the disease.

  • Palpation of the joint is painful.
  • There is some swelling that extends beyond the articulation.
  • The skin in the affected area becomes bluish or purple.
  • The swelling of the distal interphalangeal joints and their simultaneous coloring creates a pattern of "radish" deformity.
  • Often, patients are affected and the nail plate, which, when examined, alarms the doctor and makes you remember about psoriasis.
  • An axial lesion of the fingers and toes is a condition in which the patient has several interphalangeal joints that are simultaneously inflamed at once, and sometimes the metacarpophalangeal joints. The increase in all affected areas in size and the corresponding color cause a clinical picture of “sausage-like” deformity, when the finger is thickened throughout the length and has a purple tinge.

Symptoms of Malignant Psoriatic Arthritis

This variant of the course of the disease develops in the overwhelming majority of cases of males under the age of 35 years. In this case, the patient has a number of signs.

  • Extremely severe damage as a result of the progression of psoriasis of the skin and joints of the spine.
  • Fever (hectic type).
  • Exhausted patient condition - develops as a result of sudden changes in body temperature.
  • Generalized polyarthritis, accompanied by sharp pain in the affected joints. There is also a high probability of the formation of fibrous ankylosis and persistent impairment of mobility in the joint.
  • Swollen lymph nodes.
  • Damage to internal organs: kidney, heart, liver, eyes ( conjunctivitis and iridocyclitis), nervous system.

Diagnosis of Psoriatic Arthritis

To make a correct diagnosis, physicians resort to laboratory and instrumental research methods that provide fast and high-quality diagnostics.

Laboratory research

Unfortunately, laboratory tests that are specific to psoriatic joint damage have not yet been developed. Moreover, if the small joints of the hand are affected, then the patient may not notice a change in the laboratory values ​​at all.

  • Complete blood count - there can be found an increase in the erythrocyte sedimentation rate and an increase in the level of white blood cells. In the case of a malignant course of the disease, anemia is detected.
  • Test for the presence of rheumatoid factor - negative.
  • The study of synovial fluid obtained by puncture of the joint. Determined by the high content of cells, mainly neutrophils. Also, its viscosity is lower than normal. If the process is not pronounced, then minor deviations are noted in the synovial fluid, which simply indicate the presence of inflammation.

Instrumental diagnostics

  • X-ray examination is an affordable method that does not require many expenses for its implementation. In the cavity of the joints in the picture you can see proliferative changes, periostitis and other bone growths. Sometimes the disease in the pictures resembles rheumatoid arthritis due to the presence of marginal erosions of the epiphyses and signs of bone ankylosis of the joint. In the mutilated form, doctors discover major changes in the structure of the joint, a change in the shape of its slit. Bone bridges and ossification near the vertebrae are visible between the vertebrae in psoriatic spondyloarthritis.
  • Computed tomography is an accurate method for obtaining a layer-by-layer image of the patient's body. It is particularly well suited for the diagnosis of spinal lesions. The resulting images are characterized by increased clarity, they can see more elements in different projections.

Diagnostic criteria

There is a list of symptoms that doctors use to make a diagnosis. For diagnosis, you must have at least 3 criteria, one of which is necessarily the 5th, 6th or 8th.

  1. Damage to the distal joints between the phalanges of the toes and hands, in particular - the toes. The skin above them bluish or purple.
  2. Simultaneous defeat of several joints of one finger ("finger-sausage").
  3. Previously, a big toe on the foot.
  4. Pain in the heel area.
  5. The presence of psoriatic plaques on the skin.
  6. The presence of psoriasis in close relatives.
  7. Negative reaction to rheumatoid factor.
  8. Absence of periarticular osteoporosis, osteolysis with displaced bones and periosteal stacking in the pictures.
  9. The presence of signs of paravertebral ossification in radiographic images.

Treatment of Psoriatic Arthritis

If we compare the disease with rheumatoid arthritis, it becomes clear that the treatment of joint damage in psoriasis is simpler. This is primarily due to the fact that the patient may suffer from the same joints for decades. If we recall that in 70% of patients the disease proceeds in the form of oligoarthritis, the task is even simpler - to treat one charter is easier than a dozen. But do not forget about other forms of the disease in which the patient may even die (malignant course).

Doctors always carry out simultaneous treatment of joint damage and skin manifestations, since the effect in this case is achieved faster.

  • If the patient has a “winter” form of the disease, then the ultraviolet irradiation of the affected areas and joints shows itself very well. At the same time, regenerative processes are activated in the skin, and the patient quickly gets rid of the manifestations of the disease.
  • Locally, both on the joints and on the skin, it is recommended to use ointments. Salicylic ointment has traditionally been very common, but if necessary, hormonal drugs can also be used. Their local use prevents the development of side effects observed when taken orally, and the anti-inflammatory effect is really impressive.
  • Sedatives also contribute to the onset of remission of the disease. Doctors may prescribe a patient to take herbal substances like valerian or more potent drugs (seduxen, for example). It all depends on the severity of the clinical manifestations of the disease.
  • Vitamin therapy helps to normalize metabolic processes in the body and normalizes the immune system.
  • If the symptoms of the disease are not very pronounced, then doctors can use non-hormonal anti-inflammatory drugs.
  • If a sufficiently large joint is affected, and the clinical manifestations greatly reduce the patient’s quality of life, an emulsion with hydrocortisone can be injected into the intra-articular gap. This provides a direct effect on the affected tissues and prevents unwanted effects that are possible with the spread of hormones throughout the body.
  • In the most severe case, doctors use cyclophosphamide - a very powerful drug used in the treatment of rheumatoid arthritis. It helps to get rid of torpid inflammation of the synovial surfaces of the joint.
  • Ingestion of hormonal drugs is used internally if previous methods have not yielded the desired effect. It is impossible to abuse these substances and exceed the recommended doses, since the disease may turn into a malignant variant and not be amenable to further treatment.
  • Immunosuppressants - are also used in extreme cases, if hormonal preparations did not give the desired effect.
  • Methotrexate is a very serious drug that can be used for psoriatic lesions of the joints. Its reception is made according to a strict scheme, to deviate from which is highly undesirable.
  • Surgical intervention may be required if the patient has obstinate synovitis that is not retreated by conservative methods. Surgeons can also correct a gross deformity of the joint or eliminate ankylosis by surgery.

As you can see, the treatment of the disease is very serious, which confirms the inadmissibility of self-treatment. You can only aggravate the situation and provoke the development of other diseases in addition to arthritis. Appeal to experts - one correct option!


| 9 June 2013 | | 5,821 | Uncategorized
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John Doe: I complained 5 years ago and now it's you have PsA you just don't have the rash and you're still negative on every test other than the inflammation test

Ziv Benigoyev: people must understand that psoriasis is a mirror of your soul , you ignore your true self , you ignore your need for rest, your body becomes tired of this useless life you live, so it becomes ill and poisoned. and all this poison comes up to your skin. open your eyes see who you really are and how you can change to make life less stressful for you. remember money has no value when you are suffering

Darla: This is a very good video to communicate the seriousness of PsA. I think most people hear “arthritis” & think it’s something that a little ibuprofen/Advil will fix, which of course it is much more serious than that. I do think however, that a warning should have appeared before the mutilated hand was shown. I can handle seeing that but a lot of people cannot, especially without warning.

Gun_Point130: My wife kept going to her doctor and telling him that she bad joint pain and hip pain, and she could barely walk around the house, he just kept down playing it, gave her some low pain meds. So after 2years she went to Mexico to get check that same day they did x-rays and they told her she needed hip replacement and she had PA. She took the x-rays back home and showed her Dr. finally shortly after they said told her she had PA and will need hip replacement. The worst part is she's been almost completely immobile and i fear it's taken to the worst she can't get out of bed now, and 2 months later and many more x-rays and appointments she maybe finally going to get her replacement.. but again I'm thinking the rest of her bones and joints are just getting worst do to not getting good help early on.

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