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Rheumatoid arthritis and psoriasis

23 Sep 18

Psoriatic arthritis and joint damage due to psoriasis

Psoriasis is a systemic disease that primarily affects the skin. However, it is possible that pathological reactions of the body may also spread to internal organs and joints. Psoriatic arthritis is a consequence of the development of inflammatory reactions in the cartilage and bone tissue of the articular surfaces, which also affects the ligaments and tendons.

After rheumatoid arthritis, psoriatic joint damage ranks second among all inflammatory changes in the musculoskeletal system. Arthritis is reported in 10-38% of patients with psoriasis and occurs more often in patients aged 26-54 years. After the first psoriatic plaques appear on the skin, changes in the joints occur approximately 10-15 years later. However, in some patients (10-15%) this systemic disease begins with impaired mobility.

According to ICD 10, psoriatic arthritis according to its clinical course is divided into the following types:

  • Arthritis of the distal interphalangeal joints, which predominantly affects these areas.
  • Oligoarthritis (less than five joints are involved) and polyarthritis (more than five joints are affected).
  • Mutilating articular psoriasis is accompanied by osteolysis (destruction of bone tissue) and shortening of the fingers.
  • Symmetrical polyarthritis, which in symptoms and signs resembles rheumatoid arthritis.
  • Spondyloarthritis is accompanied by inflammation and limited mobility of the spinal column.
  • Articular psoriasis can be of varying degrees of activity:

  • active (minimum, maximum, moderate);
  • inactive (remission phase).
  • Depending on the degree of preservation of functional abilities in arthritis, three degrees are distinguished:

  • performance is preserved;
  • performance is lost;
  • a person is unable to care for himself due to severe limitation of mobility.
  • Symptoms of psoriatic arthritis in most cases occur after cutaneous or visceral manifestations of the disease. But in a fifth of patients, psoriasis begins with changes in the joints.

    The onset of the disease is sometimes gradual, but can also be acute. However, as a rule, there are signs of psoriatic arthritis listed below:

  • change in the shape of joints;
  • the appearance of painful sensations that are more noticeable not when moving, but at night;
  • stiffness, more pronounced in the morning;
  • joint deformity;
  • sometimes there is a burgundy coloration of the skin in the area of ​​development of the pathological process;
  • with the osteolytic form of the disease, significant shortening of the fingers occurs;
  • Due to a violation of the density and elasticity of the ligaments, multidirectional dislocations often occur.
  • Most often, at the onset of the disease, changes are observed in small joints located on the hands and feet; less often, the elbow and knee joints are involved. Quite characteristic symptoms of joint psoriasis are signs of dactylitis, which is a consequence of inflammation of the flexor tendons and the cartilaginous surfaces themselves. This condition is accompanied by:

  • severe pain syndrome;
  • swelling of the entire affected finger;
  • limitation of mobility, which is associated not only with deformation, but also with pain when bending.
  • In approximately 40% of cases of psoriatic arthritis, the intervertebral joints are also affected. In this case, changes occur in the ligamentous apparatus, resulting in the formation of syndesmophytes and paravertebral ossifications. Mobility in these joints is rarely reduced, but pain and stiffness are quite common.

    Also, psoriasis with articular syndrome is characterized by damage to the area where the ligaments attach to the bones. In this case, inflammation occurs, and then destruction of the adjacent bone tissue. Favorite places for localizing these processes are:

  • the surface of the calcaneus at the site of attachment of the Achilles tendon;
  • calcaneal tubercle in the area of ​​attachment of the plantar aponeurosis;
  • tuberosity on the upper surface of the tibia;
  • in the area of ​​the humerus.
  • 80% of patients with psoriatic arthritis show signs of damage to the nail plates. First, small pits or grooves form on the surface, covering the entire nail. Subsequently, the color changes due to disruption of microcirculation, as well as as a result of accelerated division of skin cells in the nail bed area.

    Psoriatic arthritis and pregnancy have some relationship, because when carrying a child, a hormonal transformation of the entire body occurs. And since it is assumed, among other things, that the disease is of a hormonal nature, it is quite possible that an exacerbation will develop or even the first signs of joint damage will appear. In addition, increased arthritis symptoms during pregnancy are often associated with weight gain.

    Unfortunately, treatment of this group of patients is extremely difficult, since most drugs for systemic use are contraindicated for them. However, psoriasis does not affect reproductive function in any way and a woman with this disease in most cases is able to bear a baby. In the period before pregnancy, you should undergo a full examination by a dermatologist and, possibly, preventive treatment for psoriasis.

    Organ changes in psoriatic arthritis

    Damage to joints in psoriasis can be isolated or combined with damage to other organs and tissues. Systemic manifestations include:

  • generalized amyotrophy;
  • trophic disorders;
  • heart defects;
  • splenomegaly;
  • polyadenitis;
  • carditis;
  • amyloidosis of internal organs, joints and skin;
  • hepatitis;
  • ulcerative necrotic damage to the mucous membrane of the gastrointestinal tract;
  • cirrhosis of the liver;
  • diffuse glomerulonephritis;
  • polyneuritis;
  • nonspecific urethritis;
  • eye damage.
  • With psoriatic arthritis, both disability and the inability to care for oneself are usually the result of not only severe damage to the joints, but also changes in the function of internal organs.

    The leading factor in the development of the inflammatory process in the area of ​​internal organs is a violation of microcirculation in the vessels of the mucous membrane. Most often, angiopathy appears as a result of focal damage to the inner lining of blood vessels, spasm of the arteries and dilatation of capillaries. In addition, immune complexes can be deposited in the thickness of the vascular wall, as a result of which it becomes denser and its elasticity decreases.

    Diagnosis of psoriatic arthritis is largely based on the presence of a number of characteristic radiological signs of the disease:

  • periarticular osteoporosis;
  • narrowing of the joint space;
  • the presence of cystic clearings;
  • multiple patterns;
  • bone ankylosis;
  • ankylosis of joints;
  • the presence of paraspinal ossification;
  • sacroiliitis.
  • In addition to radiography, patients with suspected psoriatic arthritis are prescribed:

  • A blood test that reveals signs of inflammation and anemia, an increase in the level of sialic acids, fibrinogen, seromucoid and globulins. A very important difference from rheumatoid arthritis is a negative test for rheumatoid factor. The level of immunoglobulins of groups A and G also increases in the blood and circulating immune complexes are determined.
  • Quite often, synovial fluid obtained from joints is examined. In this case, increased cytosis and neutrophils are detected. The viscosity of the joint fluid is reduced, and the mucin clot is very loose.
  • The main criteria that allow us to make a correct diagnosis are:

  • finger joint involvement;
  • multiple asymmetric joint damage;
  • the presence of psoriatic skin plaques;
  • presence of characteristic radiological signs;
  • negative test for rheumatoid factor;
  • signs of sacroiliitis;
  • family history of psoriasis.
  • What causes psoriatic arthritis?

    The exact cause of joint psoriasis has not yet been established. However, heredity undoubtedly plays a leading role. Arthropathic psoriasis can also occur with the participation of the following factors:

  • trauma at the onset of the disease, which is mentioned by about a quarter of patients;
  • stress and emotional tension, which have a negative impact on the immune system;
  • significant physical activity;
  • systemic infections.
  • The following are involved in the development of the disease:

  • a genetic factor associated with mutation and the presence of certain histocompatibility antigens and a number of so-called “psoriasis” genes;
  • the immune factor is confirmed by an increase in the level of immune complexes and antibodies in the blood of patients, and a decrease in lymphokines;
  • The occurrence of arthritis in patients with a number of viral diseases, including HIV, after a streptococcal infection testifies in favor of an infectious nature;
  • In more than half of patients, signs of joint damage first appear after suffering a severe emotional shock.
  • To the question of whether psoriatic arthritis is curable, it is more correct to answer in the negative. However, modern advances in medicine help doctors prevent further progression of the process. In some cases, even partial restoration of joint function is possible.

    How to treat psoriatic arthritis in a particular patient should be decided by the doctor after a full examination and medical history.

    Drug therapy

    For joint damage and psoriasis, treatment is not specific, it is aimed at:

  • slowing down the progression of the disease;
  • elimination of acute symptoms;
  • normalization of the function of the musculoskeletal system;
  • reduction of inflammatory and immune reactions.
  • The use of medications is the leading method of treating psoriatic arthritis. For this purpose, various groups of active substances are used.

    Anti-inflammatory

    Non-steroidal drugs (ibuprofen, diclofenac) are taken to reduce the manifestations of inflammation, as well as pain and associated mobility limitations. At the same time, the swelling in the area of ​​the changes decreases.

    Glucocorticosteroids

    Hormonal medications can quickly eliminate the main symptoms of psoriatic arthritis. Since their systemic use poses a risk of developing negative reactions, they can be injected directly into the joint cavity.

    Methotrexate for psoriatic arthritis is the most commonly prescribed systemic drug. Despite this, there are still no definitive studies proving its effectiveness. The standard dose is 15-20 mg over a week. However, patients receiving such therapy should constantly monitor liver and kidney function. If significant deviations are detected, it is necessary to reduce the dose or completely discontinue the drug. When the spine is involved in the process and ankylosing spondylitis develops, methotrexate has low effectiveness.

    Sulfasalazine has anti-inflammatory and antibacterial effects and is often prescribed for rheumatoid arthritis. However, after recent clinical trials, this drug was approved for use in psoriasis. Sulfasalazine for psoriatic arthritis is usually prescribed in a dose of 2 g. It must be taken for a long time. But due to the presence of a large number of side effects, in particular from the intestines, as well as the lack of effectiveness in cases of damage to the spine, the question of prescribing this medicine should be decided on an individual basis.

    Tumor necrosis factor inhibitors

    In the treatment of psoriatic arthritis with drugs, the most effective drugs have been those that inhibit tumor growth (adalimumab, etanercept, infliximab). This therapy affects pathogenetic mechanisms, that is, it not only eliminates the symptoms of the disease, but also counters its main causes. The main inconvenience of this technique is the injection of the drug, but most patients are okay with this, as they feel a clear improvement in their condition.

    Cyclosporine for psoriatic lesions is taken 3 mg per day. This drug slows down the changes that occur in bone and cartilage tissue, which is confirmed by x-rays.

    Leflunomide has a positive effect on the course of the disease, reducing arthralgia and swelling in the joints, and also slows down bone destruction. This undoubtedly improves the patient's quality of life. Take it at a dose of 100-20 mg per day.

    Against the background of psoriasis, treatment of arthritis using physiotherapeutic procedures in some cases can be very effective. The most commonly used methods are:

    • laser irradiation of blood;
    • PUVA therapy;
    • magnetic therapy;
    • electrophoresis using glucocorticosteroids;
    • phonophoresis;
    • physical therapy.
    • Diet for psoriatic arthritis of the joints plays an important role in the treatment of the disease, as it helps to consolidate the results achieved through medication. A fairly significant condition for normalizing the condition is maintaining an alkaline environment in the body, since otherwise there is a high probability of developing an exacerbation of the disease.

      Nutrition for psoriatic arthritis must be carried out according to the following rules:

    • refusal of alcoholic products;
    • exclusion of possible allergens, which is carried out on an individual basis;
    • eating small portions;
    • refusal of smoked foods, preservatives, spicy and salty foods;
    • It is forbidden to eat citrus fruits;
    • limited intake of easily digestible carbohydrates;
    • increasing the volume of fermented milk products, cereals, vegetables, legumes;
    • replace butter with vegetable oil.
    • At the same time, the diet for psoriatic arthritis should be low-calorie, since excess weight increases the load on the joints. This leads to increased pain, as well as deformation and the appearance of other symptoms. Since most physical activity is contraindicated in case of serious intra-articular changes, patients’ only chance to eliminate excess weight is proper nutrition.

      Traditional methods of treatment

      Treatment of psoriatic arthritis with folk remedies should never be used as an independent technique. However, their use in addition to the main therapy in some cases makes a contribution.

      1. Lingonberry decoction is prepared from two small spoons of dry leaves and a glass of hot water. The freshly prepared solution should be cooled and drunk in small sips.
      2. Mix a few drops of turpentine, vegetable oil and one finely grated carrot. Apply a compress at night.
      3. Mix coltsfoot, St. John's wort and medicinal dandelion in equal proportions and make an infusion with a liter of boiling water. Take 50 ml daily.
      4. Birch buds are boiled for a quarter of an hour over low heat, cooled and taken 30 ml before eating.
      5. Surgical treatment for psoriatic arthritis is performed quite rarely when conservative medicine has not helped to cope with the disease. The surgical technique includes removal of diseased tissue from the joint in order to restore its function, prosthetics of large joints, and fixation in a given position.

        It is impossible to unequivocally answer the question of how to cure psoriatic arthritis, because this is determined taking into account individual characteristics. That is why, if you suspect the development of the disease, you should conduct a full examination as soon as possible. It must be remembered that if patients present late, there is a possibility that joint function will not be restored.

        Psoriatic arthritis

        This type of arthritis develops in 5-7 percent of psoriasis patients.

        Psoriatic arthritis is an inflammatory disease of the joints in patients with psoriasis. The appearance of skin changes usually precedes the development of joint damage, but in approximately 15% of patients, arthritis develops before skin damage.

        The cause of psoriatic arthritis is unknown. Arthritis often develops with clear skin lesions, but there is no clear connection between the severity and course of skin and joint manifestations. Provoking factors in the development of psoriatic arthritis are often stress and infectious diseases.

        In its course, psoriatic arthritis resembles rheumatoid arthritis. The distinctive symptoms are:

      6. asymmetrical joint damage;
      7. purplish-bluish coloration of the skin over the affected joint, pain and swelling of the joints;
      8. early damage to the big toe;
      9. heel pain;
      10. frequent damage to several joints on the fingers - the formation of the so-called “sausage finger”.
      11. With psoriatic arthritis, in most cases, skin manifestations of psoriasis are also found, which makes the diagnosis easier.

        The course of psoriatic arthritis is usually chronic with periods of exacerbation and improvement. Sometimes there are signs of damage to internal organs: eyes, myocardium, urinary tract.

        The diagnosis of psoriatic arthritis is made by a rheumatologist during examination and after consultation with a dermatologist. To confirm the diagnosis, the doctor will order a blood test from a vein to determine rheumatoid factor and rule out rheumatoid arthritis. It is also necessary to take an x-ray of the affected joints. If internal organs are damaged, consultations with other doctors may be necessary.

        Treatment of psoriatic arthritis should be comprehensive and carried out together with a dermatologist. If left untreated, psoriatic arthritis can severely deform the joint and lead to disability.

        Currently, there is no cure for psoriasis, but there are many techniques that can reduce the painful symptoms. Modern drugs make it possible to manage the disease, completely relieving the symptoms of the disease. However, this requires constant medical supervision and systematic treatment.

        Treatment for psoriatic arthritis is similar to treatment for rheumatoid arthritis. Anti-inflammatory drugs, corticosteroid hormones, and immunomodulators are used for treatment. If necessary, drugs are injected directly into the joint. In severe cases of psoriatic arthritis, blood purification - plasmapheresis - can be performed. This reduces inflammation and relieves symptoms of psoriasis.

        For patients with psoriatic arthritis, spa treatment is indicated outside of periods of exacerbation.

        Symptoms and prognosis for treatment of arthropathic psoriasis

        Arthropathic psoriasis (psoriatic arthritis) is a progressive joint damage that develops against the background of psoriasis and is chronic. The symptoms of this disease are in many ways reminiscent of rheumatoid arthritis, and the disease itself develops in every third patient with psoriasis between the ages of 20 and 50, 10-15 years after the appearance of the first plaques.

        The exact reason for the transition of the cutaneous form of psoriasis to the form that affects cartilage and joints is not fully understood, however, there is an assumption that such a transition may be associated with:

      12. adverse environmental influences;
      13. immune and genetic disorders.
      14. Thus, one of the main theories of the development of arthropathic psoriasis has become genetic, based on a family predisposition to the development of arthritis. And this theory has serious confirmation - up to 40% of cases of psoriasis are diagnosed in people who are close relatives.

        Let's look at how arthritis and psoriasis are related, and figure out what arthropathic psoriasis is, how joint damage manifests itself in psoriasis, and how they are treated.

        Predisposing factors

        It is quite natural that arthropathic psoriasis and cutaneous psoriasis are related to each other. However, not all patients suffering from ordinary psoriasis have joints affected.

        This is explained by the fact that the factors influencing the transition of the disease to the articular form are:

      15. joint injuries and bruises;
      16. tanning abuse;
      17. infections of a viral and streptococcal nature;
      18. hormonal imbalances;
      19. alcohol abuse;
      20. smoking;
      21. taking certain medications.
      22. The listed factors, both individually and together, aggravate the course of psoriasis, provoke the spread of the inflammatory process and are a trigger leading to the development of arthropathic psoriasis.

        Symptoms of the disease

        The onset of psoriasis arthritis can be either gradual or acute, accompanied by certain symptoms.

        The main symptom of the disease is pain, which manifests itself both during movement and at rest.

        As the disease progresses, the pain is accompanied by swelling and swelling of the joints, limited movement, which is most pronounced in the morning. Moreover, the last joints of the fingers, wrists, elbows and knee joints are most often affected.

        Over time, these symptoms are joined by:

      23. joint deformities;
      24. thickening of fingers;
      25. shortening of fingers.
      26. The skin in the area of ​​development of the pathological process is painful and hyperemic, however, occasionally it can acquire a bluish coloration.

        The disease can affect one or more joints, which makes psoriasis and rheumatoid arthritis similar to each other.

        In addition, in some cases, arthropathic psoriasis affects the internal organs, which is accompanied by:

      27. increased body temperature;
      28. chills;
      29. increased sweating;
      30. excruciating pain;
      31. the formation of trophic ulcers and the release of exudate;
      32. progressive weight loss;
      33. baldness;
      34. enlarged lymph nodes.
      35. Moreover, the spread of the disease to subcortical formations can lead to the appearance of delirium, seizures and symptoms of peripheral neuritis.

        Classification of the disease

        Depending on the clinical picture of the disease, arthropathic psoriasis is divided into:

      36. Symmetrical, characterized by a progressive course and manifested by symmetrical bilateral damage to one or more joints.
      37. Asymmetrical, affecting from one to three joints, not including symmetrical paired joints (in the vast majority of cases, the knee, phalanges of the fingers, and hip joint are affected).
      38. Distal interphalangeal, affecting the small joints of the fingers.
      39. Spondylosis affecting the hip joints and spine.
      40. Deforming, accompanied by deformation and gradual destruction of the small joints of the arms and legs, leading to a complete loss of their mobility.

      Diagnosis of psoriatic arthritis is made on the basis of a survey of the patient and his symptoms and, in particular, the plaques that accompany psoriasis. In addition, the patient is prescribed:

    • blood and joint fluid analysis;
    • X-ray examination;
    • additional examinations to distinguish the disease from rheumatoid arthritis.
    • Treatment of arthropathic psoriasis is a long and complex process aimed at stopping further progression of the disease, partially restoring the functions of damaged joints and improving the patient’s quality of life by achieving stable remission.

      The classic therapeutic regimen in this case involves the appointment of:

    • nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
    • injections of corticosteroids into the joint cavity, relieving inflammation and eliminating pain;
    • immunosuppressants that normalize the functions of the immune system and prevent further progression of the pathological process;
    • antidepressants and sedatives that normalize the psychological state, restore sleep, help fight depression;
    • cyclosporines, which slow down the destruction of bone tissue, stop the progression of the disease, relieve swelling and swelling of the joints and significantly improve the patient’s quality of life;
    • hormonal ointments and creams that relieve pain and relieve inflammation;
    • vitamin and mineral complexes that strengthen the immune system and normalize metabolic processes.
    • In addition, patients may be recommended the following physiotherapeutic procedures:

    • magnetic therapy;
    • laser therapy;
    • ultrasound and microcurrent therapy;
    • pressure chamber procedures;
    • electrophoresis with local glucocorticosteroids.
    • In addition, patients may be recommended physical therapy sessions and certain modes of physical activity.

      If these measures do not help and articular psoriasis continues to progress, patients are prescribed surgical treatment, which includes:

    • removal of affected bone and cartilage tissues in order to partially restore the functionality of the joint;
    • replacement of large joints with prostheses.
    • Diet for arthropathic psoriasis is no less important than conservative or surgical treatment. Proper and nutritious nutrition in this case allows you to consolidate the results achieved by therapy and prolong the state of remission.

      In the vast majority of cases, people suffering from this form of psoriasis are prescribed a dairy-plant diet with a main emphasis on fermented milk products, fruits, vegetables and cereals.

      The consumption of foods that lead to the development of allergic reactions (chicken meat and eggs, chocolate, citrus fruits, etc.) is prohibited by this diet.

      In addition, patients suffering from a disease such as joint psoriasis are recommended:

    • use vegetable fats instead of animal fats;
    • give up fatty meat, fish and poultry;
    • give up spicy, salty, pickled and smoked foods;
    • Avoid drinking alcohol, sweet carbonated drinks, and products containing artificial colors and flavors;
    • exclude sweets and any foods high in carbohydrates.

    Proper nutrition in this case allows overweight patients to lose extra pounds, thereby reducing the load on the joints, and eliminating allergens reduces the risk of worsening the course of the disease.

    Despite the fact that arthropathic psoriasis is an incurable disease, timely measures taken to stop its development in the vast majority of cases give excellent results - the disease moves to the stage of stable remission.

    Psoriatic arthritis: what is this disease, its symptoms and treatment

    Psoriatic arthritis (see photo) is a disease in which inflammation of the joints of the arms, legs or spine (arthritis) occurs, and which occurs against the background of psoriasis. In other words, this is a disease in which there are symptoms of both arthritis and psoriasis.

    Why is this happening? What signs of this disease do doctors look for first? What tests should be taken for this disease? You will find answers to all these questions in our article.

    Psoriasis is a fairly common skin disease: on average, 1 to 3% of the population suffers from it. And, unfortunately, many of these people run the risk of getting psoriatic arthritis in addition to psoriasis: the probability of this ranges from 10 to 40%!

    In what cases can this happen? Let's figure this out.

    Why does this disease occur?

    Both men and women suffer from psoriatic arthritis in approximately the same proportion, and the symptoms of the disease appear and gain strength in the period from 25 to 50 years.

    Scientists have long known that most skin diseases, including psoriasis, occur due to disruptions in the nervous system and psyche. It is not for nothing that many doctors call psoriasis a psychosomatic disease.

    Therefore, the first manifestations of psoriatic arthritis often occur against the background of acute or severe chronic nervous strain, stress, and fear. As a result, the human body reacts to such severe stress by developing a new disease “on top” of the old one - that is, psoriatic arthritis occurs, or, as doctors call this disease, psoriatic arthropathy.

    Another possible cause of this disease is joint injury. Sometimes, even against the background of almost complete physical health and without exacerbation of psoriasis, due to some unsuccessful movement, fall and similar troubles, one of the joints - the knee or one of the joints of the hand - gets injured. And then such an injury seems to trigger the disease process: subsequently the inflammation spreads to other joints (most often the small joints of the arms and legs), as if on its own.

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    There are various medications, the use of which can also trigger the occurrence of the disease. These include painkillers and antipyretics from the group of NSAIDs (non-steroidal anti-inflammatory drugs) - such as diclofinac, ibuprofen, naproxen.

    Another group of drugs that can contribute to the onset of the disease are drugs used for hypertension: atenolol, vasocordin, egilok and others.

    In addition, provoking factors include excessive alcohol consumption and smoking. However, various biological and hormonal processes in the body can also influence the manifestation of the disease. Thus, in women during menopause and after childbirth, the symptoms of the disease usually intensify and become more severe, while pregnancy, on the contrary, helps to reduce the manifestations of psoriatic arthritis.

    Another reason why this difficult disease can occur is infections, when the disease can appear after an inflammatory disease, most often of a viral nature. It appears that if a person has a weakened immune system, this may increase the risk of developing psoriatic arthropathy.

    This confirms the fact that those patients with psoriasis who have become infected with HIV infection (a disease in which the immune system almost does not work) are highly likely to develop this arthritis in addition.

    Recent research by scientists suggests that hereditary factors are of great importance in the development of the disease. So, if one of a person’s parents has arthritis, then the likelihood of his child getting this disease increases by 10-25%.

    In fact, when doctors talk about several very different theories of the occurrence of the disease, this means that, by and large, the main cause of the disease, unfortunately, has not yet been found.

    But, despite this, if you carefully monitor your health and, together with your doctor, can catch the onset of the disease in a timely manner, then with well-chosen treatment you can significantly mitigate its manifestations.

    The main signs of psoriatic arthritis are the appearance of pain and swelling in the joints. Moreover, a variety of joints can be affected - from intervertebral joints to large joints of the legs - for example, the knees. But most often this disease affects the small joints of the hand and foot, especially the interphalangeal joints of the fingers.

    Depending on the cause that caused the onset of the disease and other factors, inflammation in the joint can begin either acutely or gradually, sometimes even almost imperceptibly for the person himself. Moreover, at the initial stage of the disease there may not even be pain or restrictions in mobility in the joint.

    An important point: sometimes articular symptoms may precede the onset of psoriasis, and in other cases they may appear long after the onset of psoriatic skin changes.

    What especially important signs of psoriatic arthropathy will the doctor pay attention to during examination and questioning? First of all, he will note swelling of the affected joints with local redness of the skin and increased temperature in these areas, as well as pain when moving the affected joints. If the interphalangeal joints of the fingers are affected, the latter acquire a characteristic “sausage-like” appearance.

    In addition, this disease is characterized by the appearance of pain and difficulty in working the joints in the morning. Doctors call this symptom “morning stiffness” when the movement in the affected joints is reduced in the morning, and this condition continues for an hour. In other similar diseases (for example, osteoarthritis), joint pain and limited movement occur, on the contrary, in the late afternoon and during physical activity on the joint.

    Often, in order for a doctor to diagnose psoriatic arthritis, it is enough to see manifestations of psoriasis on the skin, make sure that other relatives have this disease, and also take an X-ray of the affected joints and conduct blood tests for rheumatoid factor (they are associated with this disease). will be negative).

    But since this disease affects a variety of joints, sometimes it can be difficult even for a doctor to make a diagnosis. But you can make his task easier if you can determine in what form the arthritis in psoriasis manifests itself.

    Types (forms) of the disease

    1st form: several small joints of the hands and feet are affected

    This is the most common form of the disease, accounting for about 70% of the total number of patients. With this form, as the name implies, mainly small joints are affected.

    Due to inflammation, the fingers become swollen, and over time, due to systemic osteolysis of bone tissue, the shape of the affected joints and the fingers themselves are modified - they can either be shortened or deformed.

    2nd form: a large number of symmetrical joints are affected

    This type of psoriatic arthritis occurs in 15% of cases of the disease.

    Inflammation usually occurs in a much larger number of joints than in the 1st form, but they occur symmetrically - that is, both identical joints on the right and left sides become inflamed.

    3rd form: the joints of the spine and pelvic bones are affected

    In this form of the disease, which occurs in 3-7% of cases, the intervertebral joints and joints of the pelvic bones are affected.

    The disease manifests itself unnoticed, gradually, in the form of usually mild pain in the back and lower back, as well as in the pelvic area.

    Sometimes inflammation in these areas can involve single joints in the arms or legs.

    4th form: characteristic psoriatic form

    The appearance of this type of disease is as follows.

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    The interphalangeal joints are mainly affected, but not just any of them, but those that are located further from the body (in medicine they are called distal joints).

    In all other respects, the symptoms of this form of the disease are similar to the most common form of the disease.

    5th form: severe arthritis

    This form is one of the most severe types of psoriatic arthropathy. Fortunately, it does not occur very often - in about 5% of cases.

    This form of the disease mainly affects the joints of the fingers and toes. It is characterized by all the symptoms of joint inflammation that are described above, but in this case the disease occurs in a particularly severe form.

    The pathological process in the joints is so strong that it causes irreversible deformation of the joint, subluxations and instability in the joints of the fingers and toes, severe limitation of mobility in these joints and contributes to the rapid disability of a person.

    Symptoms of the disease from other organs

    Sometimes psoriatic arthritis is not limited to skin rashes and joint inflammation, and then a person may experience painful symptoms in other organs. Most often, inflammation of the tissues of the eye (iritis) occurs, as well as ulcers in the mouth and skin.

    There are also especially severe, malignant forms of the disease, which occur mainly in men. With such a malignant course, in addition to multiple arthritis, severe fever occurs with general intoxication of the body, inflammation of the heart muscle (myocarditis), as well as inflammation of the kidneys in the form of glomerulonephritis and the nervous system (multiple inflammation of the nerves - polyneuritis).

    Therefore, if you suffer from psoriasis, if you experience incomprehensible and even not very severe pain in the spine and joints, be sure to consult a doctor. He will prescribe treatment that will help slow down the progression of the disease.

    Why do you need to take an x-ray for this disease?

    When examining your joints, your doctor will definitely suggest that you undergo an X-ray examination. Why is this necessary?

    The fact is that on an x-ray the doctor can see special, specific manifestations. First of all, these are signs of bone tissue resorption in the area of ​​​​the articular surfaces of bones (so-called osteolysis), as well as a special deposition of calcium in the area of ​​​​the spinal ligaments - if the intervertebral joints and ligaments are affected.

    Unfortunately, today there is no medicine that could cure psoriatic arthritis (as well as psoriasis) completely.

    But at the same time, if you see a doctor as early as possible and start receiving comprehensive treatment, you can slow down the development of this disease as much as possible and protect yourself from complications, which means reducing symptoms to a minimum and keeping joint pain to a minimum.

    Moreover, if symptoms of arthritis have already appeared, treating psoriasis alone is no longer enough - complex therapy is needed. Therefore, psoriatic arthritis should be treated jointly by a dermatologist and a rheumatologist.

    What treatments and cures for this disease currently exist? Let's briefly talk about the main ones.

    Medicines to treat psoriatic arthritis

    1. Nonsteroidal anti-inflammatory drugs (NSAIDs)

    These medications primarily help relieve pain in the affected joints. These include drugs such as diclofenac and methindol.

    2. Hormonal anti-inflammatory drugs - glucocorticoids

    This group includes medications such as prednisolone, dexamethasone, beclomethasone diapropionate and others. These drugs are also used to reduce inflammation in the joints - in cases where the effect of the previous group of drugs is not enough.

    Since glucocorticoids, when exposed to the entire body, have many side effects, including the possibility of increasing the symptoms of psoriasis, these medications are usually prescribed as intra-articular injections, when they are injected specifically into the area of ​​the inflamed joint.

    3. Basic anti-inflammatory drugs

    These include medications such as methotrixate, sulfasalazine, cyclosporine-A, and leflunomide. These drugs provide a good therapeutic effect and stop the development of psoriatic arthritis within 1-1.5 months after the start of treatment.

    If these drugs are not effective enough, drugs from the next group are prescribed.

    Bio-agents are special biological substances that suppress the action of a special protein - tumor necrosis factor, due to which inflammatory processes in the joint can be suppressed at the molecular level.

    This group includes the drugs Remicade and Humira (their other names are infliximab and adalimumab, respectively).

    Thanks to the use of such complex treatment under close medical supervision, it is usually possible to stop the progression of the disease and reduce the severity of its symptoms.

    Joint problems are a direct path to disability!

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    Outside of exacerbations, patients with psoriatic arthritis are recommended to undergo sanatorium-resort treatment.

    If sunbathing at resorts and contact with sea water does not provoke an exacerbation of the underlying disease - psoriasis, then this type of treatment can be very useful and lengthens periods of remission (absence of active symptoms of the disease).

    Therapeutic exercise and therapeutic exercises

    Exercise therapy, or physical therapy, is an important part of the treatment of psoriatic arthritis. In order for the joints to maintain flexibility and mobility for as long as possible, patients with psoriatic arthropathy are recommended to expand their usual motor mode, as well as regularly, two to three times a day for 15 minutes, perform the following exercises.

    Exercises for shoulder joints:

  • raise one arm at the shoulder in front of you, while relaxing the hand and making it hang freely; after that, begin to rotate your hand in front of you (i.e. in the frontal plane), first clockwise and then counterclockwise, until you feel heaviness in the hand; after that, change your hand and repeat the same procedure.
  • Exercises for elbow joints:

  • take a position in which your shoulder joints and shoulders themselves are motionless, and your arms hang freely; in this position, begin to freely make oscillatory movements in the elbow joint.
  • Exercises for hands:

  • first, clench and unclench your hands as quickly as possible; do this exercise at least several times;
  • then begin to rotate your hands at the wrist joint - first in one direction, then in the other direction;
  • after that, raise your hands with straightened fingers; in this position, start moving your fingers left, then right, and then back and forth.
  • Exercises for the hip joint:

  • start walking exclusively on straightened legs, resting your entire foot on the ground at once; the goal of this exercise is to make sure that only the pelvis works while walking;
  • move your hip (i.e. the entire leg) to the side as far as possible; ideally try to move it 90 degrees; after this, begin to make light oscillating movements to the side, while trying to move your leg a little further.
  • Exercises for knees:

  • these exercises are performed standing; shoulders should be straight;
  • bend and straighten your legs at the knee joints, as if your legs are a spring;
  • Bend your knees slightly and place your hands on your kneecaps; spread your legs slightly to the sides so that there is enough space, and begin to make wobbling movements in your knees in an inward direction; at the same time, the hands on the knees seem to help the knees move; then reverse the movement with your knees - outward.
  • with a small amplitude, making oscillatory movements, begin to pull your toes away from you and towards you;
  • alternately trample, as if shifting from foot to foot - first standing on the outside of the feet, then on the inside, then on the heels, and finally on the toes;
  • lift your leg at the knee and begin to make rotational movements with your foot at the ankle joint - first clockwise, then counterclockwise.
  • Treatment with folk remedies

    In folk medicine, there are many useful recipes that can improve the condition and reduce pain in psoriatic arthritis.

    Here are some of them:

  • take ginkgo biloba leaves and grind them as finely as possible (best in a coffee grinder); Take one teaspoon of this mixture 3 times a day.
  • take raw carrots and grind them on a fine grater; Add five drops of vegetable oil, or sunflower oil, to the resulting mass, as well as 5 drops of regular turpentine from the pharmacy. Mix the resulting mixture thoroughly and make a compress from it on the sore joint overnight; the next day, make a compress from aloe, and the next day - again a compress from carrots according to the same recipe.
  • in the spring, collect lilac buds: you will need to collect 2 cups of them; add this amount of buds to 0.5 liters of vodka, and leave to infuse in a dark place for ten days; after this, the medicine is ready: with the resulting infusion you need to wipe the affected joints, as well as the lower back; To obtain the effect, 10-12 procedures are usually sufficient.
  • ?Get the book “17 recipes for delicious and inexpensive dishes for the health of the spine and joints” for free and start getting better without effort!

    Joint damage due to illness

    Psoriatic joint damage has not been fully studied by scientists, so there are only theories about the origin of this disease. If arthritis develops against the background of skin lesions, the main cause is autoimmune mechanisms. Since in psoriasis the skin is affected by its own immune complexes, over the course of 10-15 years a lot of them accumulate, and not only epithelial cells, but also cartilage tissues begin to be attacked.

    Predisposing factors for activation of genetic predisposition:

  • Stressful situations, frequent nervous strain;

  • A separate group consists of patients with HIV infection and AIDS. In this category of people, the cause of the development of pathology may be common infections and colds, which disrupt the adequate immune response and lead to the formation of pathological immune complexes.

    Clinical symptoms and their severity depend on the degree of joint damage. The pathological process involves large and small joints, as well as the spine.

    Depending on the location, the symptoms will vary:

  • Damage to small hands. The disease leads to deformation of the fingers and changes in the nails. The terminal phalanges thicken, the nails become uneven, and the skin changes color.

  • In the later stages, there is destruction of the joints up to significant deformations of the limbs. This type of psoriasis is called destructive arthritis. In the photo, psoriasis of the joints looks like saber-shaped legs, walking resembles a rider's pose.

    Psoriasis requires careful diagnosis, since the prescription of treatment depends on the severity of the process and the number of affected joints. This information can only be obtained after a thorough examination of the patient.

    Treatment for joint psoriasis depends on whether skin manifestations exist or not. For skin symptoms, it is necessary to use local drugs, as well as systemic agents.

  • Ointments with glucocorticosteroids;

  • Among systemic drugs, it is necessary to use immunosuppressants, as they fight pathological immune complexes. Systemic glucocorticosteroids are used. To reduce general manifestations, it is necessary to use sedatives and antidepressants, since psoriasis causes significant complications on a person’s mental state. Fish oil, which is preferably taken in capsules, has a positive effect. Non-steroidal anti-inflammatory drugs are used to reduce pain.

    The first symptoms of joint psoriasis are not always noticeable, which is why the disease is diagnosed only in the later stages, which are the causes of complications:

    • Dactylitis – inflammation of the phalanges of the fingers. As a result, the fingers become like sausages and increase significantly in size. There is severe pain and the inability to perform small movements, as the function of the hand is impaired. Dactylitis can also affect the toes. As a result, there is severe pain when walking. It is difficult for such patients to find suitable shoes.

    Treatment of joint psoriasis with such symptoms requires an individual approach, and before prescribing therapy, it is necessary to carefully examine the patient. Prevention of the development of complications is early diagnosis and adequate treatment of psoriatic arthritis.

    Psoriatic arthritis is joint damage that develops against the background of psoriasis. The disease consists of two diseases - psoriasis and rheumatoid arthritis. They may precede each other's appearance or occur simultaneously.

    Psoriasis is a dermatological disease of a psychosomatic nature, occurring in 1% of the world's population.

    The probability of developing rheumatoid arthritis in patients with psoriasis is quite high and is 50%. In women, the disease occurs in a milder form , although the risk zone includes persons from 20 to 50 years of age, regardless of gender.

    The development of the disease is characterized by changes in epidermal cells, which arise as a result of disruption of chemical and biological processes. This leads to inflammatory foci in the lining of the joint and bone tissue and deformation of blood vessels.

    Experts do not have a consensus on the causes of the disease, but most of them believe that it is associated with psychosomatics, that is, disruptions in the nervous system and psyche lead to psoriatic arthritis.

    It has been reliably established that the development of such processes is associated with hereditary predisposition. If one of the parents suffered from an illness, then in 90 out of 100 cases the children will suffer from it.

    Disturbances in the human immune system of the autoimmune type also lead to the development of the disease.

    Factors influencing the development of psoriatic arthritis:

  • nervous disorders and stress;
  • past infections;
  • bruises and joint injuries;
  • metabolic disease;
  • surgical interventions;
  • connective tissue diseases;
  • neuroendocrine diseases;
  • alcohol and nicotine - this is especially true for the first, since alcohol reduces immunity and affects metabolism;
  • hormonal processes - women whose bodies are forced to constantly adapt due to menstrual cycles, menopause and pregnancy are at risk (if during menopause and after childbirth the symptoms of the disease intensify, then during pregnancy they decrease).
  • Symptoms and development of psoriatic arthritis are distinguished according to existing types:

  • Symmetrical arthritis. It is characterized by bilateral damage to one or more groups of joints. Usually occurs in a mild form.
  • Asymmetric arthritis. Affects 1 to 4 joints of varying sizes. It is characterized by swelling of the joints and impaired flexion-extension function.
  • Distal interphalangeal arthritis. Affects the small joints of the fingers and toes. Quite a rare species, found mainly in men.
  • Spondylosis or spondyloarthritis. Covers the joints of the spine and hip area.
  • Arthritis mutilans. It is the most severe type of disease. It is characterized by deformation and destruction of joint tissue, leading to loss of motor function and, in some cases, death.
  • Diagnosis of psoriatic arthritis is based on the person's medical history and physiological examination.

    Laboratory testing is not informative, since often all blood elements are normal, except for a slight increase in ESR and leukocytes.

    An X-ray of the joints is required, which gives a clear idea of ​​the development of the disease. The doctor makes a conclusion about the presence of the disease if the photo clearly shows affected areas, deformations of joints and bones, proliferation of bone osteophytes, and erosive tissue damage.

    The development of the disease is indicated by characteristic rashes, nail damage and other signs. It is also possible to carry out additional diagnostics in order to exclude diseases such as rheumatoid arthritis, osteoarthritis, Reiter's disease, gout, and ankylosing spondylitis, which have similar symptoms.

    In most cases, the symptoms of arthritis appear simultaneously with the symptoms of psoriasis. However, it can take 10 years from the appearance of a skin rash to inflammation of the joints.

    Signs of psoriatic arthritis:

    • increased pain during movement;
    • pronounced swelling of the joint;
    • arthralgia in the joints;
    • myalgia;
    • increased skin temperature and bluish discoloration in the painful area;
    • tendon inflammation.
    • In more severe forms of the disease, there is swelling of the fingers and toes, their shortening, disfigurement and bending in different directions.

      Due to weight loss, ulcers and damage to internal organs, after a while a person becomes incapacitated. In this condition, there is a high probability of death from hepatitis, glomerulonephritis, and encephalopathy.

      Psoriatic arthritis is very dangerous, so if the first symptoms of the disease occur, you should immediately consult a rheumatologist.

      Treatment of psoriatic arthritis is a complex and lengthy process, taking place in several stages.

      It is impossible to completely cure the disease, but the sooner comprehensive treatment is started, the faster the disease will go into remission.

      There is medication and folk treatment. It is advisable to combine both options, but this should only be done with the consent of an experienced specialist.

      The goal of drug treatment is to stop erosion, reduce inflammation and restore joint mobility.

      Using non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen, brufen, naproxen, butadione and other medications intended primarily to relieve inflammation and pain.

      Immunosuppressive therapy

      It is aimed at suppressing the division of pathological cells and normalizing immune processes.

      Hormone therapy

      Consists of using intra-articular injections of corticosteroids and glucocorticoids. They are used to relieve inflammation and in cases of acute unbearable pain. Despite the effectiveness of hormonal drugs, doctors try to use them as little as possible, as they have a negative effect on the body.

      Monoclonal antibodies

      The use of these antibodies is aimed at preventing relapses of the disease.

      Sedatives

      With the help of sedatives, and these include motherwort, valerian, antidepressants and other drugs aimed at improving mental health.

      Therapeutic techniques and means

      In modern medicine, hardware and physiotherapeutic techniques are also used. These include laser therapy, microcurrent and ultrasound treatment, and sessions in a pressure chamber.

      Surgical intervention cannot be ruled out. Surgeries are rarely performed, but sometimes they are necessary to remove affected areas of joint tissue and restore joint function.

      Through the use of comprehensive treatment, doctors are usually able to stop psoriatic arthritis. It all depends on the nature of the disease and the degree of its development.

      There are many traditional methods that actively act on both psoriasis and rheumatoid arthritis. First of all, they are used to relieve inflammation and pain.

    • Infuse 30 g of cinquefoil herb with 500 mg of water for 14 days. Take 1 tsp throughout the week. 3 times a day.
    • Finely chop 1 parsley and pour 2 cups of boiling water, then leave for 12 hours. Add lemon juice to the strained tincture. The finished product should be consumed 3 times a day, 50 ml.
    • For knee and elbow arthritis, you can make compresses from grated carrots (1 tbsp), pharmaceutical turpentine (1 tsp) and vegetable oil (0.5 tsp). An aloe compress (chop the leaves) can also be an excellent solution.
    • Grind the leaves of ginkgo biloba in a coffee grinder and eat the mixture 1 tsp. 3 times a day.
    • Birch buds (5 g), pour a glass of hot water and boil over low heat for 15 minutes. Cooled tincture, take half a glass before meals 4 times a day.
    • Psoriatic arthritis is a skin and joint disease associated with disorders of the psychosomatic system. It is characterized by damage to the joints against the background of progressive psoriasis, which makes it doubly dangerous.

      Most often, hereditarily predisposed people get sick, but people with weakened immunity, metabolic disorders and mental health disorders are also at risk.

      Psoriatic arthritis cannot be completely cured, but doctors have learned to stop its development using a set of medicinal techniques. It is important to know that the sooner you see a doctor, the more positive the outcome of the disease will be.

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