PSORIATIC ARTRITIS
Psoriasis is a non-contagious skin disease with rash, which is characterized by redness, peeling and scaling of the skin. It is usually seen on elbows, knees, scalp, forehead and face. Psoriatic arthritis is a condition of inflammation in various joints that occurs in patients who have or will have some form of psoriasis.
Figure 1: Psoriasis skin lesion
WHAT CAUSES PSORIATIC ARTHRITIS?
The reel cause of psoriatic arthritis is unknown. It is thought that genetics, immune system and environmental factors may initiate it. Patients with the disease usually have a history of psoriasis or psoriasis rheumatism in their first-degree relatives. It is associated with some genes. However, it is thought that not only genetics, but also infections may have a role in the emergence or exacerbation of the disease by activating the immune system.
WHO DEVELOPS PSORIATIC ATHRITIS?
The age of onset of the disease is 30-55. The onset of the disease is not expected after the age of 65. Although not very common, it can also be seen in children (juvenile psoriatic arthritis). Psoriasis rheumatism may develop in approximately 20-30% of psoriasis patients. When the skin findings and the time of emergence of rheumatism are evaluated; approximately 70% of patients have skin findings before rheumatism. Around 20%, skin and joint findings begin together. In 10% of patients, joint disease precedes skin manifestations.
WHICH JOINTS DOES PSORIATIC ARTHRIT AFFECT?
The first form of psoriatic arthritis involves the distal inter phalangeal joint closest to the fingernails. Psoriasis changes in the nails (thimble nail) often accompany the disease.
The second form causes severe destructive damage to the joints (Arthritismutilans). It holds the root joints of the hands and feet. It is often accompanied by inflammation of the pelvis and spine junction joint inflammation (sacroiliitis), which we call the sacroiliac joint. The frequency of this form of the disease is less.
The third form presents with symmetrical involvement of the small joints of the foot and hand, and the hand and ankle. It is often similar to another rheumatic disease called rheumatoid arthritis.
The fourth form is the type in which two-four joints are held asymmetrically.
In the fifth form, the spine is mainly affected.
Spinal involvement is more common in individuals with peripheral joint involvement and HLA B27 genetic test positive. This type of psoriasis rheumatism causes inflammation of the spine and sacroiliac joints, resulting in pain and stiffness. In most of these patients, the first complaint at presentation is inflammatory low back pain.
The most important features of this type of low back pain are;
- Insidious onset
- Three months or longer
- Onset with rest (especially in the second half of the night or towards the morning);
- Decrease in movement
- Morning stiffness lasting longer than half an hour,
- Good response to non-steroidal anti-inflammatory (NSAID) drugs (such as ibuprofen, diclofenak sodium)
The number of joints affected may vary at the onset of the disease and during follow-up. At the beginning of the disease, the joint rheumatism type in which several joints are involved is seen, while more and different regions may be involved in the later periods. Several forms can also be seen together.
Figure 2: Joints Involved in Psoriatic Arthritis
WHAT ARE OTHER REGIONS AFFECTED IN PSORIATIC ARTHRITIS?
Pitting on the nail; pits appear on the nail surface. This is the nail sign of psoriasis.
Dactylitis; swelling in the whole finger is a rheumatic joint involvement also called sausage finger.
Enthesitis; It is the occurrence of tenderness and pain at the points where tendons and ligaments attach to the bone around the heel, sole of the foot, front of the knee, elbow.
It can also affect the eyes, cardiovascular system and kidneys.
Figure 3: Pitting on Nail Dactylitis
HOW IS PSORIATIC ARTHRITIS DIAGNOSED?
As in most diseases, the patient's history is required to diagnose psoriasis rheumatism. In addition to the personal history, joint findings and skin lesions in relatives help the diagnosis.
On examination, tenderness and range of motion of painful or swollen joints are checked.
In the diagnosis process, X-Ray films and MR (magnetic resonance) are used. Many lesions specific to psoriasis rheumatism and non-psoriasis can be detected in hand and foot radiographs. In arthritis mutilans, which has a destructive form, the sign of pencil in cup can be seen. New bone formations can be seen at the edge of various bones. Symmetrical or mostly asymmetrical sacroilitis may be seen on spinal MR imaging. New bone formations-syndesmophytes- can be seen around the vertebrae. New bone formations-enthesitis- may be seen at the attachment site of the Achilles tendon or the tendon of the sole of the foot.
Figure 4: Artritis Mutilans Pencil in Cup
There is no specific blood test for psoriasis rheumatism. Elevated Erythrocyte Sedimentation rate (ESH) or CRP tests may inform the presence of an inflammatory process. Anemia may accompany.
As a result; the diagnosis of psoriasis rheumatism may not always be easy. It is necessary to identify and differentiate other rheumatic diseases that can be confused with psoriasis rheumatism.
HOW IS PSORIATIC ARTHRITIS TREATED?
Treatment of psoriatic arthritis varies from patient to patient and the area of the joint involved.
Pain medications (ibuprofen, diclofenac, naproxen, etc.) to relieve pain and inflammation in the joint can be taken while protecting the stomach. In single joint involvement, cortisone injection can be made into the joint. In order to control the disease in the long term and to prevent damage to the joint; rheumatic drugs that change the course of the disease can be used. Biological drugs can be used in patients who do not respond to these drugs. Physical therapy methods are used at every stage of the disease to prevent joint damage and reduce pain. It is recommended to use a splint to prevent strain on the joints of the hands.