| |
Psoriatic
Arthritis Types and Treatments
Psoriatic arthritis (or
arthropathic psoriasis) is a
type of inflammatory arthritis
that affects around 20% of
people suffering from the
chronic skin condition
psoriasis. It occurs more
commonly in patients with tissue
type HLA-B27. Treatment of
psoriatic arthritis is similar
to that of rheumatoid arthritis.
More than 80% of patients with
psoriatic arthritis will have
psoriatic nail lesions
characterised by pitting of the
nails, or more extremely, loss
of the nail itself (onycholysis).
Psoriatic arthritis is said to
be a sero-negative
spondyloarthropathy.
Psoriatic arthritis can develop
at any age, however on average
it tends to appear about 10
years after the first signs of
psoriasis. For the majority of
people this is between the ages
of 30 and 50, but it can also
affect children. Men and women
are equally affected by this
condition. In about one in seven
cases the arthritis symptoms may
occur before any skin
involvement.
As well as causing joint
inflammation, psoriatic
arthritis can cause tendonitis
and a sausage-like swelling of
the digits known as dactilytis.
Radiology will give the
appearance of "fluffy, new"
bone.
Types of psoriatic arthritis
There are five main types of
psoriatic arthritis:
* Symmetric: This type accounts
for around 50% of cases, and
affects joints on both sides of
the body simultaneously. This
type is most similar to
Rheumatoid arthritis and is
disabling in around 50% of all
cases.
* Asymmetric: This type affects
around 35% of patients and is
generally mild. This type does
not occur in the same joints on
both sides of the body and
usually only involves less than
3 joints.
* Arthritis mutilans
Affects less than 5% of patients
and is a severe, deforming and
destructive arthritis. This
condition can progress over
months or years causing severe
joint damage.
* Spondylitis This
type is characterised by
stiffness of the spine or neck,
but can also affect the hands
and feet, in a similar fashion
to symmetric arthritis.
* Distal interphalangeal
predominant This
type of psoriatic arthritis is
found in about 5% of patients,
and is characterised by
inflammation and stiffness in
the joints nearest to the ends
of the fingers and toes. Nail
changes are often marked.
Treatments
The underlying process in
psoriatic arthritis is
inflammation, therefore
treatments are directed at
reducing and controlling
inflammation. NSAIDs such as
diclofenac and naproxen are
usually the first line
medication.
Other treatment options for this
disease include joint injections
with corticosteroids - this is
only practical if a few joints
are affected.
If acceptable control is not
achieved using NSAIDs or joint
injections then second line
treatments with
immunosuppressants such as
methotrexate are added to the
treatment regimen. An advantage
of immunosuppressive treatment
is that it also treats the
psoriasis in addition to the
arthropathy.
Recently, a new class of
therapeutics developed using
recombinant DNA technology
called Tumor necrosis factor
inhibitors have come available,
for example, infliximab and
etanercept. These are becomingly
increasingly commonly used but
are usually reserved for the
most severe cases. As more is
learned regarding the long-term
safety of these biologic agents
there is a trend toward earlier
use to prevent irreversible
joint destruction. source
http://en.wikipedia.org/wiki/Psoriatic_arthritis
|
