Psoriatic arthritis symptoms and treatment with methotrexate

Shishkevich Vladimir, orthopedic Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Overview

Psoriatic arthritis (abbreviated as PsA) is a chronic inflammatory disease, combined with psoriasis and affecting the joints, and mostly small – interphalangeal, vertebral, sacroiliac, etc. Psoriatic arthritis code according to MKB-10: M07.0-M07.3 or L40.5.

Psoriasis usually affects no more than 2-3% of the population, while arthritis is found in 13-47% of cases, regardless of gender, in middle-aged people – 20-50 years, in children it is extremely rare. Disability and the most severe course of psoriatic disease are characteristic of young men. Pathology can be complicated by additional visceral lesions of the pancreas, lymphatic system, kidneys, and also cause various neurological and psychiatric symptoms.

Psoriatic arthritis is seronegative, since rheumatoid factor is not detected in patients, that is, it is not impossible to find antibodies in the blood serum of antibodies to the Fc fragment of immunoglobulin G, therefore, the disease is considered a special nosological form of arthritis associated with psoriasis.

Pathogenesis

The pathology is based on the pathological process – synovitis, manifested in the form of an increase in the volume and accumulation of effusion (biological fluid) in the joint cavities. Joint syndrome is a thickening of the synovial membrane of the joints, an increase in periarticular intermuscular joints and the growth of intraarticular adipose tissue.

Destructive changes in joints usually occur under the influence of tumor necrosis factor, extracellular protein TNF-α, which activates endothelial cells and stimulates the proliferation of fibroblasts. This results in the expression of matrix metalloproteinase, stimulation of the synthesis of collagenase and prostaglandin PGE2, activation of osteoclasts and regulation of the production of certain chemokines. An important role is also played by the formation of the interaction of immunocompetent cells with keratinocytes, synovial membrane cells, cytokines, impaired immunoregulation processes, and activation of inflammation and tissue destruction inducers.

Arthropathy and psoriatic disease as a whole cause alterative changes in the main substance of the vascular walls, depolymerization of the fibrillar components of the connective tissue, with the accumulation of perivascular cellular infiltrates, as well as reversible and irreversible changes in neurons.

Classification

Psoriasis arthritis is severe, common, and malignant. Depending on the location of the affected joints, these forms of psoriatic arthropathy are distinguished:

  • An isolated “central” form is a rather rare variant of pathogenesis (no more than 2-4%), can be combined with signs of peripheral arthritis, while inflammatory processes occur in the spine, sacroiliac joints, which resembles ankylosing spondylitis.
  • Distal form – pathology develops mainly in the distal interphalangeal joints of the limbs – in the feet and hands.
  • The asymmetric form of mono- or oligoarthritis is the most common pathology that differs in the localization of destructive processes in the knee, wrist, ankle, elbow joints and proximal interphalangeal joints of the upper and lower extremities. The defeat of the small joints of the hands and feet leads to a “sausage-like” deformation of the fingers caused by axial tenosynovitis of the interphalangeal joints.
  • The rheumatoid-like usually symmetrical form is a pathology in which the paired joints of those areas that are characteristic of rheumatoid arthritis are affected. The incidence is approximately 15-20% of cases, differs from rheumatoid arthritis in the absence of characteristic rheumatoid nodules.
  • A mutating form is observed in approximately 7% of patients and is characterized by the progression of contractures and ankyloses, osteolysis with a decrease in the size of the fingers on the hands and / or feet, causes the formation of “telescopic” deformations of the fingers and the bone itself, as well as the appearance of irreversible bone changes – subluxations and dislocations of different directionality. Sacroiliac joints and spine may also be involved in pathogenesis. The clinical picture is usually supplemented by weakness, digestive disorders and a persistent decrease in body temperature.

It is important to understand that the classifications are rather arbitrary, because different forms of arthritis are unstable and tend to move one into another.

Causes

Psoriatic arthritis is today regarded as a clinical manifestation of systemic psoriatic disease. Despite the fact that the cause of the development of psoriatic arthritis has not yet been elucidated, etiopathogenetic heterogeneity is noted. Researchers consider the etiology to be multifactorial and highlight a number of factors contributing to the onset and manifestation of the disease:

  • genetic;
  • immunological;
  • environmental (environmental).

Symptoms of Psoriatic Arthritis

Symptoms of peripheral arthritis include pain, swelling, and limited mobility of the joints. Most often, an asymmetric lesion of the joints of the feet is observed, later transforming into psoriasis axial polyarthritis with signs of dactylitis and sausage-like deformities of the fingers and feet, which acquire a crimson or purplish-cyanotic color. The pathological mobility of the phalanges and other joints, spondylitis lead to a significant violation of the functionality of the limbs, significantly reduce working capacity, quality of life and can even lead to functional insufficiency of the musculoskeletal system and, as a consequence, disability.

The clinical picture in addition to the manifestations of peripheral arthritis includes a triad of symptoms – dactylitis, enthesitis and spondylitis, which is characterized by:

  • acute or chronic inflammation of the tissues of the fingers, combined with pain, dense swelling, cyanosis of the skin of the fingers, limited flexion, dactylitis in psoriatic arthritis leads to deformation of the fingers and simultaneous damage to the flexors and extensors of the fingers, interphalangeal joints;
  • pain and swelling in the area of ​​the course of the tendons (enthesitis), as well as the limited function of the flexion of the fingers characteristic of tenosynovitis;
  • inflammatory pain arising from spondylitis – in the back and limiting the flexibility of different parts of the spine, its deformation and, as a result, a violation of posture.

Moreover, arthropathy in 75% occurs several years after the appearance of the first signs of psoriasis, which represents various rashes (vulgar, pustular, papular) and the appearance of abundantly scaly plaques in various parts of the skin, most often above the joints.

The course of the disease is persistent with a chronic nature, there are small and incomplete clinical remissions, frequent exacerbations, and parallelism is observed – the rash spreads and plaque formation occurs against the background of an exacerbation of the articular syndrome.

The malignant form of psoriatic arthritis is often accompanied by fever, metabolic disorders, lymphadenopathy, amyotrophy, anemia, intoxication, organic damage to internal organs (carditis, hepatitis, cirrhosis of the liver, diffuse glomerulonephritis, nonspecific urethritis, polyneuritis, conjunctivitis, and conjunctivitis). the cause of generalized amyloidosis and death.

Analyzes and diagnostics

For the diagnosis of psoriasis arthritis, it is necessary to comply with the CASPAR criteria, which determine the presence of signs of inflammatory processes in the joints – arthritis, spondylitis and enthesitis. To confirm the fears and exclude rheumatoid arthritis, reactive arthritis, ankylosing spondylitis, osteoarthritis, microcrystalline arthritis (gout), it is enough to perform 3 or more points:

  • the presence of radiological signs of marginal proliferation and proliferation of extraarticular bone structures of the hands and / or feet;
  • history of complaints or detection at the time of examination of signs of axial dactylitis – swelling and pain in the fingers;
  • negative rheumatoid factor test result (exception: latex test);
  • detection of point indentations, onycholysis, hyperkeratosis and other signs of psoriatic dystrophy of the nail plates;
  • detection of psoriasis during examination or information about data in a personal or family history.

Treating Psoriatic Arthritis

Treatment is usually prescribed conservative medication with the use of drugs such as:

  • NSAIDs – the most commonly used non-steroidal anti-inflammatory drugs are Diclofenac, Acetylsalicylic acid and Indomethacin;
  • glucocorticoid drugs in short courses, for example, methylprednisolone, β-metazone;
  • anti-psoriatic drugs – Neotigazone;
  • basic anti-inflammatory drugs – most often it is sulfasalazine or methotrexate, among targeted synthetic ones – the most popular are Apremilast and Tofacitinib.

In connection with new data on the involvement of tumor necrosis factor in pathogenesis, the first line of therapy may be drugs that inhibit its effect, of course, if patients have no contraindications to their use, for example, chronic heart failure, a history of serious infectious diseases or recurring infections, and also demyelinating diseases.

Psoriatic arthritis requires complex long-term treatment using various procedures and adjuvants, for example tar preparations, urea derivatives, keratolytics (salicylic acid, zinc pyrithione), lactic acid, etc.

In the fight against such a serious chronic illness, people may need psychological support. In addition, sessions of group psychotherapy, hypnotherapy and the use of various relaxation methods become quite effective and popular.

Treating Psoriatic Arthritis

The goal of therapy for psoriatic arthritis is to suppress the inflammatory process in the joints, achieve and maintain remission, and prevent the occurrence of destructive changes in the joints.

Treatment begins with the appointment of non-steroidal anti-inflammatory drugs in high doses for a long time (2-6 months), and with persisting pain, it continues for many months. From a large group of NSAIDs, those agents that have high therapeutic activity and minimal side effects should be used. These requirements are met by drugs – derivatives of aryl acetic acid (voltaren, diclofenac sodium, ortofen, etc.), prescribed at 150-200 mg / day, acyclofenac (aertal) 200 mg / day, derivatives of oxycam – piroxicam at a dose of 20-40 mg / day , meloxicam (movalis) at a dose of 7-15 mg / day, celebrex 100 mg 2 times a day, nimesulide 200 mg / day. Among the listed drugs, the least severity of side effects is characteristic of meloxicam and celebrex, it is due to the peculiarity of their mechanism of action on inflammatory mediators (selective suppression of the activity of the cyclooxygenase-2 enzyme). The appointment of NSAIDs in psoriatic arthritis requires caution, since these drugs are included in a number of medications that can provoke an exacerbation of psoriasis.

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A mandatory component of the anti-inflammatory treatment of psoriatic arthritis is local therapy in the form of intra-articular injections of glucocorticosteroids. Injections are carried out alternately in the affected joints until the signs of arthritis disappear. It should be noted that no more than 3 injections are allowed in the same joint during the year. For local treatment, preference is given to drugs with prolonged action (diprospan, depomedrol). The dose of the drug administered depends on the size of the joint (in the large joint – 1 ml, medium – 0,5 ml, small – 0,25 ml). Slow absorption of intra-articular glucocorticosteroids not only provides a pronounced local anti-inflammatory effect, but also has a resorptive effect, providing a reduction in symptoms of inflammation in other joints. In some cases, local glucocorticosteroid therapy allows for the remission of psoriatic arthritis.

The complex treatment of psoriatic arthritis includes basic agents that have the ability to slowly accumulate in the body, suppressing the immune component of inflammation. The arsenal of basic agents for treating psoriatic arthritis is similar to that for treating rheumatoid arthritis (gold preparations, salase derivatives and cytostatics).

In recent decades, salazo derivatives (sulfasalazine and salazopyridazine) have been used successfully to treat psoriatic arthritis. Treatment begins with 0,5 g / day for 1 week, and then the dose is increased by 0,5 g / day every week to a therapeutic component of 2-3 g / day. At this dose, the drug is taken until clinical and laboratory remission is achieved, then it is gradually reduced to maintenance (0,5-1,0 g / day). With sufficient effectiveness of therapy and good tolerability of the drug, treatment is continued for years.

Gold preparations (Tauredon) are administered intramuscularly 1 time per week. The first 2 weeks. administered at 10 mg / week. to assess drug tolerance. Further for 2 weeks. administered at 20 mg / week. With good tolerance, treatment is continued at 50 mg / week. until clinical and laboratory remission is achieved, which usually occurs not earlier than after 7-10 months. from the start of therapy. In a subsequent dose, the drug is gradually reduced by increasing the intervals between injections (1 time in 2 weeks, 1 time in 4 weeks). The total dose of tauredon is 2-3 g.

Further treatment can be continued with gold tablets (auranofin 3 mg 2-3 times a day), however oral gold preparations are less effective than parenteral ones. Cryotherapy should be continued without interruption for many years, provided it is effective and well tolerated.

Among cytotoxic drugs, methotrexate remains the drug of choice to date, since it has a beneficial effect on the articular and skin components of the disease. Methotrexate is prescribed in a dose of 7,5 to 15 mg / week. in 3 doses with an interval of 12 hours. Therapy with methotrexate can continue for 2 years. Its longer use is possible after the exclusion of signs of pulmonary fibrosis or hepatitis.

The use of any basic drugs should be carried out under the regular monitoring of blood and urine tests (once every 1-7 days, for salase derivatives – once a month) to timely detect side effects of treatment (cytopenia, nephropathy) and their correction.

A comparative assessment of the listed basic drugs in the treatment of psoriatic arthritis showed that gold preparations are most effective, followed by salase derivatives, and methotrexate is the last in this series. The best tolerance was sulfosalazine. Methotrexate and gold preparations were equal in terms of tolerance.

The appearance in the rheumatological practice of the immunosuppressant cyclosporin A, which has proven itself in the treatment of cutaneous psoriasis, inspired hope for its effectiveness in the treatment of articular syndrome. However, these hopes did not materialize. Cyclosporin A is prescribed in a daily dose of 2,5-3,0 mg / kg body weight under the control of serum creatinine during treatment.

Recently, there have been reports of the high effectiveness of genetically engineered anticytokine drugs (infliximab or remicade and etanercept) in the treatment of psoriatic arthritis. Against the background of treatment with infliximab, a pronounced positive dynamics of skin and joint manifestations is observed.

Aromatic retinoids (etretinate, acitretin) are highly effective in suppressing exacerbation of skin psoriasis, their effectiveness in treating psoriatic arthritis is much lower. When prescribing these drugs, generation II retinoids should be used (acitretin 30-50 mg / day at the beginning of treatment with a dose reduction to a maintenance dose of 10-50 mg / day in 2 doses with meals; treatment course from 1 to 4 months. ) under careful laboratory monitoring of blood biochemical parameters for the timely detection of side effects.

The use of aminoquinoline drugs for the treatment of psoriatic arthritis is not justified, since its effectiveness in suppressing the articular syndrome is doubtful, and the possibility of developing exfoliative dermatitis against its background is quite real.

The use of glucocorticosteroid hormonal drugs for the treatment of psoriatic arthritis is limited to prescribing short courses (up to 6-8 weeks) in small doses (5-7,5 mg / day in terms of prednisolone) in the absence of effect from other methods of treatment, since large doses of these drugs may develop a paradoxical reaction.

With a high degree of activity of psoriatic arthritis, extracorporeal methods of blood purification (ECMOK), most often plasmapheresis, which can be combined with ultraviolet or laser irradiation of autologous blood, are introduced into the treatment complex. Plasmapheresis sessions are carried out 1 time in 3 days, the course of treatment consists of 3-4 procedures. Such therapy increases the effectiveness of treatment, helps to increase the duration of remission and shorten the hospitalization of patients.

In the treatment of psoriatic arthritis, it is also advisable to use drugs that correct the rheological properties of blood (400 ml reopoliglyukin with the addition of 100-200 mg of pentoxifylline and 4 ml of no-shpa intravenously, drip at a rate of 40 drops / min once every 1 days; for a course of 2 -6 infusions; dipyridamole 8 mg (20 ml) in 4 ml of an isotonic sodium chloride solution intravenously every other day; for a course of 250-6 injections). It is advisable to alternate the administration of dipyridamole with reopoliglyukin. A good effect is observed during heparin therapy at 8 ME subcutaneously in the abdomen 5000 times a day for 4-2 weeks. with a subsequent dose reduction to 3 ME 5000 times a day for 2 weeks. with further cancellation. Correction of the rheological properties of blood is especially necessary in patients with a mutating version of the articular syndrome.

The treatment of psoriatic arthritis must be supplemented with physiotherapeutic methods. The most active of these is photochemotherapy or systemic PUVA therapy, which is a variant of artificial phototherapy. The method consists in the combined use of an oral psoralen photosensitizer 2 hours before the procedure, followed by irradiation with long-wave ultraviolet rays in the range of 320-400 nm, in the PUVA cabin. Photochemotherapy sessions are carried out with an interval of 2-3 days with a gradual increase in the dose of ultraviolet radiation by 0,5-1,5 J / cm2. The course of PUVA therapy is 20-30 procedures.

Physiotherapy methods such as magnetotherapy, transcutaneous laser therapy, electrophoretic and phonophoresis with a 50% solution of dimexide, glucocorticosteroids, etc. are also widely used. Physical therapy should be a mandatory component of treatment.

The development of gross deformations in the joints with the formation of ankylosis and severe dysfunction of the joints is an indication for surgical treatment (joint replacement).

Psoriatic arthritis

Psoriasis affects about 2% of the population. Inflammation of the joints or spine in this skin disease occurs in 20% of patients. The prevailing age of patients is 20-50 years. People of both sexes get sick equally often.

Psoriatic arthritis is included in the group of rheumatic diseases, since it has the features of rheumatoid arthritis and spondyloarthropathy (the so-called diseases in which the joints, sacroiliac joints, and spine become inflamed).

Etiology and mechanism of development

The causes of the disease are not fully understood. The most likely combination of several factors seems:

  • metabolic disorders;
  • infection, injury, or stress;
  • genetic predisposition.

A simplified diagram of the development of psoriatic arthritis is as follows: a person who has relatives suffering from psoriasis and is for some reason in a state of chronic stress, is injured or becomes infected with an infectious disease. The immune system, which is “held” for the time being, does not withstand the pressure of several damaging factors at once and fails.

At the initial stage of the disease, due to this malfunction, an active modification of skin cells begins. Later (but sometimes, on the contrary, earlier) a similar process starts in the joints – their cells also mutate. After some time, the immune system of an ill person begins to attack his own joints, since the modified cells appear to her to be foreign material. This triggers an autoimmune reaction, which is especially difficult for people who have, in addition, metabolic problems.

Clinic

The clinical picture of the disease is characterized by:

  1. Skin lesion.
  2. Joint Syndrome.
  3. Nail changes.
  4. Sacroileitis, spondylitis.
  5. Lack of extraarticular manifestations.

Most often, arthritis occurs in people who already have skin changes – psoriatic plaques. They look like flaky reddish spots that are located on the head, elbows, knees, around the nails and other parts of the body.

In about 1/4 of cases, inflammation of the joints and spine occurs before the appearance of plaques on the skin, sometimes long before them.

Joint syndrome usually begins with inflammation of one joint, then others begin to become inflamed. The features of joint damage in psoriatic arthritis include:

  1. Pandactylitis. All joints swell on the finger at once, which makes it red and looks like a sausage (“sausage-like finger”).
  2. The predominant lesion of the distal (those located at the base of the nails) interphalangeal joints. Around them a dense swelling appears, the skin above the joint acquires a crimson-cyanotic color (“radish finger configuration”).
  3. Asymmetry.

Arthritis is combined with changes in the nails: they become cloudy, streaked with longitudinal or transverse stripes, sometimes as if stuck with a thimble type (symptom of thimble).

In the most severe cases, patients develop a mutating lesion of the fingers. This term refers to the formation of subluxations of the fingers, in which they deviate to the side of their axis. A similar process occurs with rheumatoid arthritis: all fingers deviate in one direction, and symmetrically. With mutating psoriatic arthritis, no symmetry is observed: one finger can deviate up, the other down, the third out, etc.

The appearance of multidirectional asymmetric subluxations of the fingers is the “hallmark” of psoriatic arthritis.

In addition to finger damage, with psoriatic arthritis, the elbow, knee, ankle, and wrist joints are often inflamed. Without timely treatment, any of the inflamed large joints can become so deformed that its contracture will develop. With contracture, joint mobility is reduced to a minimum, and sometimes it is completely immobilized, freezing in one position. Most often – fixed in a slightly bent state, less often – completely straightened without the possibility of bending.

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Joint damage is accompanied by inflammation of the lumbosacral spine. It is characteristic that the lumbar pain of patients is practically not disturbing, and sacroileitis or spondylitis are detected only radiologically. Only a small percentage of patients experience morning stiffness, moderate pain in the sacrum at night.

Diagnostics

It is not difficult to establish a diagnosis of “classic” psoriatic arthritis in the presence of skin manifestations and characteristic articular symptoms. Problems arise only in cases when, against the background of cutaneous psoriasis, any other joint disease, for example, arthrosis, occurs. Such situations are classified as complicated, since there are no specific tests or analyzes to reliably confirm or refute the diagnosis of psoriatic arthritis.

The disease can occur both with absolutely normal blood tests, and, conversely, with “off-scale” inflammatory indicators. In the blood can be observed:

  • ESR acceleration;
  • an increase in the amount of uric acid;
  • increased levels of CRP, sialic acids, seromucoid;
  • the absence of a rheumatoid factor (if there is one, then the disease is regarded as a combination of rheumatoid and psoriatic arthritis).

Of the instrumental research methods for diagnosis, radiography is used. In the pictures of peripheral joints note:

  • lack of periarticular osteopenia (sparseness of bone tissue);
  • asymmetry of the lesion;
  • deformation of the proximal phalanges of the fingers as a cup-shaped (“pencil in a cap”);
  • asymmetric ankylosis (bone fusion).

On radiographs of the bones of the pelvis and lumbar spine are determined:

  • inflammation of the spine with the destruction of the vertebral bodies (spondylitis);
  • sacroileitis on the right or left (inflammation of the sacroiliac joints);
  • paravertebral ossification (areas of bone tissue) not associated with the vertebrae.

Diagnostic criteria to reliably establish a diagnosis based on clinical, laboratory and radiological data have not yet been developed.

Treatment

There are no specific drugs for the treatment of the disease. Therapy aims to:

  1. Stop the inflammatory process.
  2. Relieve pain.
  3. Improve joint function.

Non-steroidal anti-inflammatory drugs do pretty well on these tasks. Indomethacin is considered the most effective, but other non-selective NSAIDs (ibuprofen, diclofenac, ketonal), selective (nimesulide, meloxicam), and COX-2 inhibitors (celecoxib) are also used.

With prolonged use of NSAIDs, metabolism is impaired, which is already impaired in psoriasis. Therefore, drinking them for a long time is undesirable.

Steroid hormones are also used for treatment. It must be borne in mind that in patients with psoriatic arthritis, they sometimes do not improve, but worsen the condition of the skin and joints. Such a paradoxical reaction is observed in 15% of patients.

The use of cytostatics gives a more reliable result. These are immunosuppressants (cyclosporine, methotrexate) and anticytokine drugs (adalimumab, infliximab). Cytostatics help almost 70% of patients, affecting not only the course of the joint process, but also on the skin manifestations of the disease.

With a high activity of arthritis, the lack of effectiveness of drugs do plasmapheresis. This procedure allows you to quickly reduce the activity of inflammation and leads to a regression of psoriatic plaques.

Topical joint treatment includes:

  • applications of dimexide, bischofite;
  • intraarticular administration of hormones;
  • cryotherapy;
  • laser therapy.

A very beneficial effect on psoriasis patients is back massage. It should be soft, gentle, not traumatic. 10-12 massage sessions are carried out every other day, the courses are repeated 2-3 times a year.

Prediction and prevention of exacerbations

Adverse prognostic factors are the onset of the disease at a young age, the presence of severe skin psoriasis, damage to many joints, mutating lesions of the fingers.

To reduce the frequency of exacerbations of psoriasis and psoriatic arthritis, patients need to:

  • identify foci of infection in time and sanitize them (including carious teeth);
  • visit a psychotherapist to normalize the state of the nervous system;
  • monitor the function of the kidneys, liver, intestines;
  • follow a diet (abandon rich broths, dishes from mushrooms, fatty meat, legumes, sorrel, canned foods, pickles, spices, sauces, alcohol);
  • do physical education.

If a person is diagnosed with psoriatic arthritis, then he should not self-medicate. No matter how effective the alternative methods of treatment may seem, they cannot replace qualified medical care.

Psoriatic arthritis: effective drugs and folk remedies

Causes

Psoriasis arthritis is a complication of psoriasis, occurs in 10-30% of patients with such an autoimmune skin disease. Joint inflammation is an abnormal reaction of the immune system. The first signs of skin disease appear much earlier than the symptoms of arthritis.

What factors increase the risk?

In the appearance of psoriatic arthritis, an important role is assigned to such factors:

  • Psoriasis. Arthritis is closely associated with this skin disease. The most susceptible to inflammation of the joints are people who have manifestations of psoriasis on the nails.
  • Age. The risk group includes patients aged 30 to 50 years.
  • Наследственность.

An injury or infection can provoke the appearance of the disease.

Symptoms

The disease is manifested by exacerbations and remission. Symptoms are similar to rheumatoid arthritis. Joints in one or both halves of the body may be affected.

Symptoms of psoriatic arthritis:

  • dull pain in the affected joint;
  • stiffness, especially in the morning;
  • redness and swelling;
  • fever of the skin, a feeling of heat in the affected area;
  • muscle pain, which intensifies during movement;
  • discoloration of the skin of the limbs.

The first most often affected fingers and toes. They blush, swell, pain is felt. Symptoms of joint inflammation are accompanied by psoriatic plaques and acne.

Which doctor treats psoriatic arthritis?

At the first manifestations of the disease, it is worth visiting a rheumatologist. The patient should also be observed by a dermatologist or dermatovenerologist.

Diagnostics

The diagnosis of psoriatic polyarthritis is made by a rheumatologist after the examination. The doctor conducts a visual examination, palpates the joints for swelling or soreness.

To properly diagnose the disease, you need an additional examination. First of all, the doctor excludes the possibility of rheumatoid arthritis. Also, pathology is differentiated with osteoarthritis, Reiter or Ankylosing spondylitis, gout.

Diagnosis of psoriatic arthritis involves the following methods:

  • general blood analysis;
  • joint fluid analysis;
  • rheumatoid factor analysis;
  • x-rays of joints;
  • Ultrasound;
  • MRI.

On an x-ray, destruction of bone tissue, subluxation of small joints can be detected.

Treatment

The prognosis for recovery largely depends on the timeliness of diagnosis and treatment. Therapy is aimed at eliminating the joint syndrome and psoriatic skin manifestations.

The treatment is complex. Includes medications, physiotherapy, exercise therapy. The correct lifestyle and diet are important.

Medicines

Drug treatment involves the use of such funds:

  • NSAIDs. These are Diclofenac, Indomethacin, Piroxicam, Celecoxib. Therapy with these drugs is long.
  • Modifying anti-inflammatory drugs. Methotrexate has a good effect in psoriatic arthritis. The result is visible after several weeks of treatment.
  • Glucocorticoids. Medications are injected into the joint capsule. Kenalog or Hydrocortisone is used.
  • Cytostatics. Suitable azathioprine, cyclophosphamide.
  • Sedatives. This is Menovalen, Novo-Passit.
  • TNF-alpha inhibitors. Golimumab and Etanercept belong to them.

To eliminate psoriatic manifestations, hormonal ointments will be needed.

Together with medications, it is worth visiting an ultrasound, making applications with paraffin, and using plasmapheresis.

Surgery

The only way to surgical treatment of the affected joint is endoprosthetics. Metal prostheses are placed only with severe damage to the articular joint.

Folk methods

Treatment of psoriatic arthritis folk remedies:

  • juice, broth or tincture from celery roots;
  • hot pepper-based cream;
  • extract or ointment from a plant
  • aloe vera extract;
  • fish fat;
  • turmeric (not more than 1,5-2 g per day).

Folk remedies must be used for at least a month.

Lifestyle & Diet

It is important to lead a healthy lifestyle, do exercises every day, develop joints. To reduce the load on the joints, it is necessary to maintain a normal weight.

A diet for psoriatic arthritis is the key to the well-being of the patient. Its main goal is to maintain an optimal acid-base balance. Alkali-forming foods should occupy up to 70% of the diet. These are vegetables and fruits, as well as freshly squeezed juices.

Every day you need to drink up to 2 liters of mineral alkaline water, for example, Borjomi.

Boiled fish, poultry meat, cereals, skim milk, cheese, cottage cheese, vegetable and butter should occupy 30% of the diet.

Nutrition for psoriatic arthritis should be balanced. You can not overeat, you need to eat 5-6 times a day in small portions. Fried, greasy and spicy foods should be discarded. You can not drink alcohol and smoke, you should limit the intake of sugar and salt.

The list of prohibited fruits and vegetables includes plum, strawberries, strawberries, currants, cranberries, tomatoes, peppers, and eggplant. It is also worth excluding saturated fish and meat broths, beef, pork, seafood, caviar and fish (except fresh and boiled) from the diet.

Complications

With psoriatic arthritis of the joints, tendons, cartilage, mucous membranes of the eye, pleura and even the aorta can become inflamed. The consequences are:

  • dactylitis – inflammation of the fingers and toes;
  • conjunctivitis or uevit;
  • osteolysis – destruction of bone tissue;
  • spondylitis – inflammation of the articular joints between the vertebrae;
  • destruction and deformation of joints;
  • limitation of mobility;
  • mutating arthritis – a disease in which small bones are destroyed and the phalanges of the fingers are deformed;
  • cardiovascular diseases.

If psoriatic arthritis is diagnosed, is disability given or not? Yes, the patient can get a group. Psoriatic polyarthritis is an incurable disease. The disease can develop slowly or manifest itself suddenly with acute symptoms.

In the absence of therapy, serious complications are possible, including disability due to joint deformation. If the exacerbation lasts more than 4 months or the entire period of disability is 5 months per year, then the patient can apply for disability. The patient is assigned group III, with a severe course of the disease with impaired joint function – II or I.

Prevention

It is problematic to treat psoriatic polyarthritis, therefore it is easier to prevent its occurrence. The following recommendations must be observed:

  • reduce stress on the joints, especially on the fingers and toes;
  • give up hard physical work;
  • monitor weight, prevent obesity;
  • perform exercise therapy exercises, go swimming;
  • avoid hypothermia;
  • to refuse from bad habits;
  • observe the regime of work and rest.

Adhere to the advice necessary for patients with psoriasis and people who have patients with psoriatic arthritis in the family.

It is impossible to predict the forecast. The patient’s condition depends on the severity and frequency of the onset of exacerbations, as well as the timeliness of therapy.

Morozov Georgiy

Rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases. Specialization: diagnosis, treatment and prevention of diseases and deformations of the musculoskeletal system.

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