Psoriatic arthritis overview
|
Psoriatic arthritis Microchapters | |
|
Diagnosis | |
|---|---|
|
Treatment | |
|
Case Studies | |
|
Psoriatic arthritis overview On the Web | |
|
American Roentgen Ray Society Images of Psoriatic arthritis overview | |
|
Risk calculators and risk factors for Psoriatic arthritis overview | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
Psoriatic arthritis is a systemic, immune- mediated inflammatory arthritis, associated with psoriasis. The etiology is not clearly understood. It may be caused by complex interaction between genetic, immunologic and environmental mechanisms which act as triggers for the disease development. Both psoriatic arthritis and psoriasis have been shown to have strong familial predisposition. Psoriatic arthritis present with pain and stiffness in the affected joints. According to Moll and Wright criteria, joint involvement pattern in psoriatic arthritis include distal arthritis usually involving distal interphalangeal joints, asymmetric oligoarthritis, symmetric polyarthritis, arthritis mutilans, spondylitis, and sacroiliitis. Other symptoms include enthesitis (pain and tenderness at the insertion of tendons and ligaments to the bone), dactylitis ( sausage like finger or toe swelling), psoriatic skin plaques, nail changes (pitting, hyperkeratosis, and nail destruction). The pathophysiology of psoriatic arthritis consists of interactions between cytokines, dendritic cells, and T lymphocytes. Psoriatic arthritis must be differntiated from other inflammatory arthritides including rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, gout, pseudogout, osteoarthritis, arthritis associated with inflammatory bowel disease. The prevalence of psoriatic arthritis in general population ranges from 60 - 250 cases per 100,000 individuals and the prevalence of psoriatic arthritis among psoriasis patients is 11,000 per 100,000 individuals. The mainstay of therapy for psoriatic arthritis NSAIDs, conventional DMARDs (eg, methotrexate, sulfasalazine, cyclosporine) and biologic DMARDs (eg, TNF inhibitors), anti IL therapy (eg, secukinumab, ustekinumab). Other treatment options include physiotherapy, patient education about disease and joint preservation and surgery. Psoriatic arthritis is associated with a number of comorbid conditions due to circulating immunoglobulins, antibodies including metabolic syndrome, increased insulin resistance, atherosclerosis, stroke, hypertension, uveitis, osteoporosis and depression. Patients are monitored regularly for disease activity, drug efficacy, adverse effects and associated comorbid conditions.
Historical Perspective
In 1822, the association between psoriasis and psoriatic arthritis was noticed by Dr. Alibert. In 1948 after the discovery of rheumatoid factor, psoriatic arthritis was considered as a separate entity from rheumatoid arthritis by UK physician Wright.