- Psoriatic arthritis
Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of
inflammatory arthritis that, according to theNational Psoriasis Foundation , affects around 10-30% of people suffering from the chronic skin conditionpsoriasis . [Citation | publisher =National Psoriasis Foundation | title = About psoriatic arthritis | accessdate = 2008-08-31 | url = http://www.psoriasis.org/about/psa/] Psoriatic arthritis is said to be aseronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27. Treatment of psoriatic arthritis is similar to that ofrheumatoid arthritis . More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterised by pitting of the nails, or more extremely, loss of the nail itself (onycholysis ).Psoriatic arthritis can develop at any age, however on average it tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 50, but it can also affect children. Men and women are equally affected by this condition. In about one in seven cases the arthritis symptoms may occur before any skin involvement.
As well as causing joint inflammation, psoriatic arthritis can cause
tendinitis and a sausage-like swelling of the digits known asdactylitis . Radiology will give the appearance of "fluffy, new" bone.Types of psoriatic arthritis
There are five main types of psoriatic arthritis:
* Symmetric: This type accounts for around 50% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to
Rheumatoid arthritis and is disabling in around 50% of all cases.* Asymmetric: This type affects around 35% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves less than 3 joints.
* Arthritis mutilans (ICD10|M|07|1|m|05): Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage.
* Spondylitis (ICD10|M|07|2|m|05): This type is characterised by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis.
* Distal interphalangeal predominant (ICD10|M|07|0|m|05): This type of psoriatic arthritis is found in about 5% of patients, and is characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.
Treatments
The underlying process in psoriatic arthritis is
inflammation , therefore treatments are directed at reducing and controllinginflammation .NSAID s such asdiclofenac andnaproxen are usually the first line medication.Other treatment options for this disease include
joint injection s withcorticosteroid s - this is only practical if a few joints are affected.If acceptable control is not achieved using
NSAID s orjoint injection s then second line treatments withimmunosuppressant s such asmethotrexate orleflunomide are added to the treatment regimen. An advantage of immunosuppressive treatment is that it also treats the psoriasis in addition to thearthropathy .Recently, a new class of therapeutics developed using
recombinant DNA technology calledTumor necrosis factor-alpha inhibitors have come available, for example,infliximab ,etanercept , andadalimumab . These are becoming increasingly commonly used but are usually reserved for the most severe cases. As more is learned regarding the long-term safety of these biologic agents there is a trend toward earlier use to prevent irreversible joint destruction.References
External links
* [http://www.psoriasis.org National Psoriasis Foundation]
* [http://www.psorcurenow.org Psoriasis Cure Now nonprofit advocacy group]
* [http://www.nlm.nih.gov/medlineplus/ency/article/000413.htm National Institutes of Health entry on psoriatic arthritis]
* [http://www.emedicine.com/radio/topic578.htm Psoriatic Arthritis Emedicine Chapter by Noah Scheinfeld]
* [http://www.papaa.org The Psoriasis and Psoriatic Arthritis Alliance (PAPAA) - UK national charity]
Wikimedia Foundation. 2010.