Psoriatic Arthritis Causes and Treatments

Psoriatic Arthritis Causes and TreatmentsPsoriatic arthritis is associated with some of the patients with psoriasis as a chronic, inflammatory arthritis, diseases involving the skin, joints, and refer to (toe) A and the eyes and so on. The incidence of approximately 1% of patients with psoriasis, the incidence over the age of 40-year-old, male and female incidence of approximately equal.

Cause
Cause of unknown etiology. May be related to genetic, immune, endocrine and metabolic abnormalities, infection, trauma and other relevant.

Pathology
Early synovial hyperemia, edema, inflammatory cell infiltration, followed by synovial cell hyperplasia, hypertrophy, the formation of villi, increased fibrous tissue, vascular wall thickening, stenosis, intra-articular fibrosis.

Diagnostics
1. Clinical performance of a majority of the slow onset.

2. Psoriatic arthritis often seen on the skin, the small number of psoriasis before or simultaneously with the emergence of symptoms and activity level of the same psoriatic lesions. Non-symmetrical arthritis, involving the limbs, large joints, spine and sacroiliac joints, joint swelling, pain, tenderness, morning stiffness, late joint deformities, stiffness, activities, obstacle.

3. The skin damage as a systemic, good hair on the scalp and extensor surfaces of the limbs, especially the elbow, knee position, red papules, plaques or small pustules on a silver-white scales cover to remove the scales and the following films, appear point-like bleeding.

4. Means (toe) A damage, a pasta-shaped depression, longitudinal Qiao, A Su-off and so on.

5. Fever, weight loss, some patients with inflammatory eye disease, inflammatory bowel disease and so on.

Laboratory Tests

1. Blood: mild anemia.

2. Activity period increased ESR. Rheumatoid factor-negative, IgG, IgA increased circulating immune complex-positive.

3. 50%-60% of patients positive for HLA-B27.

4. 10%-20% in patients with elevated serum uric acid.

5. synovial fluid examination revealed white blood cell count up to 1 x 109-15 x 109/L, with neutrophils mainly.

Warp the early detection of joint space can be widened, after the articular surface erosion, joint space narrowing; severe bone destruction, means (toe) may have distal bone Distal Osteolysis, bone thinning, variable tip, forming the first kind of pencil or pencil cap-like change; ligament osteophytes, osteoporosis, joint fusion, such as stiffness or subluxation.

A differential diagnosis of rheumatoid arthritis

1. In order to symmetric polyarthritis, with the metacarpophalangeal joints and proximal interphalangeal joint involvement mainly rheumatoid factor positive.

2. Ankylosing spondylitis: a good hair in young men, most patients appear first performance of Sacroiliac arthritis, X-ray showed that the spine showed bamboo-like change, and psoriatic spondylitis of the spine adjacent to the asymmetric ossification.

3. Reiter syndrome: a typical expression of arthritis, conjunctivitis, urinary tract and the triad of light can be associated with psoriasis-like skin rash, no nail changes.

4. Osteoarthritis: more common in the elderly, often involving a negative significant joints, no fever, anemia and other systemic symptoms, not the normal blood, X-ray showed bone hyperplasia, no bone erosion.

Treatment

There are many different treatment for arthritis can be used, including drug treatment, non-steroidal anti-inflammatory drugs: ease symptoms, are often used in enteric-coated aspirin, elimination of pain, piroxicam, ibuprofen and so on.

Antimalarials: For psoriatic arthritis, have a certain therapeutic effect, can cause retinal disease, medication should be regularly checked during the fundus.

Chloroquine 0.25-0.5g/d.
Hydroxychloroquine 0.2-0.4g/d.
Immunosuppressive drugs: generic drugs is difficult to control severe cases choose to apply for psoriasis and arthritis, skin Screenshot are effective, easy to relapse after drug withdrawal. Available methotrexate, Aza, cyclosporine A, etc.

Retinoic acid, trade names psoriasis Ling, 30mg/d, gradually increased to 60-70mg/d, or 6-8 weeks after symptoms improved gradually reduced to 30mg/d to maintain. Pairs of psoriatic lesions and arthritis are valid, pregnant and lactating women is disabled.

Other drugs such as sulfasalazine, triptolide are effective for psoriatic skin lesions and arthritis.

Physical therapy photochemical therapy, also known as psoralen ultraviolet A therapy. Oral 8 – methoxypsoralen 0.6mg/kg, 2 hours after exposure to ultraviolet, 2-3 times/week, with a total cumulative amount of no more than 500-600j/cm2. Surgical treatment of severe joint deformity were, line joints plasty, etc..

Joint functional exercise therapy prognosis is good, about 5% of severe joint deformity.

One Response to “Psoriatic Arthritis Causes and Treatments”

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