Psoriatic arthritis

"The evolution is episodic "in outbreaks" and there may be times when the patient is asymptomatic".

DR. ENRIQUE ORNILLA LARAUNDOGOITIA
SPECIALIST. RHEUMATOLOGY SERVICE

Psoriatic arthritis is a joint inflammation associated with a skin disease called psoriasis. In most cases, the arthritis appears years after the skin lesions.

It is included in the spondyloarthropathies, a group of rheumatic diseases that have common clinical, radiological and genetic characteristics.

Analytically, they present a common genetic marker, the so-called histocompatibility antigen HLA B27, although it is not present in all cases.

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What are the symptoms of psoriatic arthritis?

Clinically, it usually manifests itself in 70% of the cases as arthritis of the final joints of the fingers, generally asymmetric (one hand), and also of other joints of the extremities.

In 15% of the cases, it appears as arthritis of several articulations (polyarthritis) symmetrical (in both sides), similar to the rheumatoid arthritis.other less frequent forms of presentation are the arthritis of the distal articulations of the fingers (as the only affectation), associated with injuries in the nails (5%) and the mutilating arthritis (5%), with destruction of the bones and articulations of the fingers and of the feet.

The most common symptoms are:

  • Arthritis of the final joints the fingers of one hand.
  • Arthritis of the joints of the lower extremities.
  • Dactilitis or "sausage fingers", which is the inflammation of the whole finger due to the inflammation of the tendon sheaths of the flexor muscles.
  • Morning stiffness in the hands.
  • Conjunctivitis or uveitis.

Do you have any of these symptoms?

You may have psoriatic arthritis

What are the causes of psoriatic arthritis?

The cause of psoriatic arthritis is unknown, although it is probably multifactorial, with genetic, immune and environmental factors.

There are data in the literature suggesting a tendency towards familial aggregation, although, for the moment, there are no definitive arguments.

Likewise, these diseases have been associated with microbial agents.

What is the prognosis of psoriatic arthritis?

The prognosis is variable and unpredictable ranging from mild forms of monoarthritis with a very good prognosis to forms with destructive polyarticular involvement with a much worse prognosis.

The polyarticular form (more than 5 joints affected), family history of psoriatic arthritis, the onset at an early age and the widespread skin form can predict worse evolution.

How is psoriatic arthritis diagnosed?

The diagnosis of psoriatic arthritis is primarily clinical. Its diagnosis is not easy, because sometimes the skin manifestations (psoriasis) and the joints do not coexist. Sometimes the skin lesion is subsequent to the joint.

It can also establish the diagnosis of psoriatic arthritis in patients without psoriasis but with a family history of psoriasis.

The laboratory studies not specific. You can see an increase in inflammatory agents (sedimentation rate, C-reactive protein ...), moderate anemia and elevated uric acid.

In the x-rays may appear increased soft tissue and osteoporosis. If it evolves, alterations in the joint space, erosions or bone proliferations may appear.

The involvement of the distal interphalangeal joints (up to the nails) and deformities are the hallmarks of this disease.

How is psoriatic arthritis treated?

The treatment and monitoring of this disease is carried out in a joint and multidisciplinary way with other services.

The treatment is based on the combination of symptomatic treatment with NSAIDs (non-steroidal anti-inflammatory drugs) with the disease modifier/braker treatment with immunosuppressants (methotrexate, sulfasalazine, leflunomide...).

If there is no response to these drugs or if drug intolerance or toxicity appears, treatment with anti-TNF drugs (infliximab, etanercept, adalimumab, golimumab, certolizumab) should be initiated.

Rest during periods of joint flare/swelling and physiotherapeutic treatment is also important.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM

Rheumatology Service Specialists

The Rheumatology Service has a multidisciplinary team highly specialized in the diagnosis and treatment of rheumatological diseases, from osteoarthritis, arthritis or osteoporosis to autoimmune or inflammatory diseases.

In addition, we have doctors specialized in assisting pregnant women with autoimmune diseases, in order to guarantee the maximum safety of the fetus.

Organized in specialized units

  • Inflammatory arthropathies.
  • Degenerative arthropathies.
  • Microcrystalline arthropathies.
  • Bone pathology.
  • Systemic autoimmune diseases.
  • Autoinflammatory diseases.
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