Psoriatic arthritis is chronic inflammatory arthritis that affects 5 to 42 percent of people with psoriasis.As of now, the cause and pathogenesis of psoriatic arthritis are unknown. There are indirect evidence that infections, trauma, increased cellular immunity to streptococci, decreased suppressor cell activation, immune complexes, complement activation, adhesion molecules, dendritic cells, keratinocytes, and abnormal fibroblast and polyamorphonuclear leukocyte function may play a role.
Polyarthritis has developed in patients with psoriasis and hepatitis treated with interferon. Most studies have observed an increased frequency of HLA-B17, CW6, DQ2 and /or B27 in patients with psoriatic spondyltis.
Fulminat disease should make one suspect human immunodeficiency virus disease.
Clinical Manifestation
Three major types of psoriatic arthritis are generally recognized
- Asymmetric inflammatory arthritis
- Symmetric arthritis
- Psoriatic spondylitis.
Asymmetric Inflammatory Arthritis
47 percent of patients have an asymmetric inflammatory arthritis. Disease appears equally in men and women. Psoriasis tends to precede the arthritis by years, although many patients complain of morning stiffness.
The proximal interphalangeal and distal interphalangeal joints are commonly involved with characteristic sausage-shaped digits , while knees, hops, ankles, temporomandibular joints, and writs are less frequently involved.
Most patients have onychondystrophy (onycholysis, ridging and pitting of nails), the course of which does not parallel that of the synovitis. The prognosis is good, with only one-fourth of the patients developing progressive destructive disease; one-third develop inflammatory ocular complication (conjunctivitis, iritis, epiiscleritis).
Symmetric Arthritis
5 percent of patients develop symmetric arthritis resembling rheumatoid arthritis. This disease occurs twice as frequently in women. Psoriasis and inflammatory arthritis usually develop simultaneously; most patients experience morning stiffness. The DIP, PIP, metacarpophalangeal (MCP), metatarsophalangesl (MTP), sternoclavicular, and, in articular, large peripheral joints are involved.
Practically all patients have onychodystrophy, which helps distinguish them from patients with rheumatoid arthritis.
Over half of the patients in this group go on to develop destructive arthritis, including arthritis mutilans. Eye complications are uncommon. Subcutanous nodules are not present, but one-fourth of patients have rheumatoid factors. Unilateral upper limb edema has been described.
Psoriatic Spondylitis
23 percent of the patients have psoriatic “spondylitis,” with or without peripheral joint involvement. Psoriasis tends to precede the arthritis by a few years, and low back pain with morning stiffness is common. Psoriatic spondyltis is more common in men. About half the patients in this group have spondylitis and the other half have sacroiliitis.
The back disease is usually slowly progressive, with little clinical deterioration as compared with ankylosing spondylitis; the peripheral disease also tends not to be destructive except for the occasional patient with arthritis mutilans. Enthesopathy, i.e, inflammation of tendons and ligamentous attachments to bone, is characteristic, viz., of the tendo onychodystrophy, but few have inflammatory ocular complications. Gut inflammation occurs n 30 percent (no gut inflammation was noted in patients with only peripheral arthritis).
The pathology of Psoriatic Arthritis is similar to that seen in rheumatoid arthritis: synovial hyperplasia, early polymorphonuclear infiltration and later mononuclear cell infiltration, cartilage erosion, and pannus formation.
Skin lesions have more CD45RO+ cells in psoriasis. Fibrosis of the joint capsule and marrow is prominent in many patients.
Popularity: 1% [?]
Related posts:
- Klippel-Feil Syndrome-Overview and Clinical Presentation
- How To Approach A Patient With Musculoskeletal Problems
- Clinical History of A Patient With Musculoskeletal Disorders
About Dr Arun Pal Singh
