Psoriatic arthritis

 ICD9        = 696.0|

}} 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. Psoriatic arthritisis 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 Tendonitisand a sausage-like swelling of the digits known as dactilytis.

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 arthritisand 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 (M071): 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 (M072): 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 (M070): 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. NSAIDssuch as diclofenacand naproxenare usually the first line medication.

Other treatment options for this disease include joint injectionswith corticosteroids- this is only practical if a few joints are affected.

If acceptable control is not achieved using NSAIDs or joint injectionsthen second line treatments with immunosuppressantssuch as methotrexateare 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 drugs called Tumor necrosis factorinhibitors have come available, for example, infliximaband etanercept. These are becomingly increasingly commonly used but are usually reserved for the most severe cases.

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Psoriatic+arthritis Wikipedia article Psoriatic arthritis.