Psoriatic arthritis
Psoriatic arthritis is a very common diagnosis that occurs with or without skin psoriasis. Psoriasis is an autoimmune skin disease that also attacks the joints and other organs. The clinical picture differs from that of rheumatoid arthritis: it attacks joints asymmetrically, and dactylitis occurs – inflammation not only of the joint but also of the periarticular (surrounding) tissues.
Psoriasis should be looked for not only in typical places such as the elbows and knees, but also on the scalp and feet, and it is not unusual to find it in the navel or the gluteal cleft. Arthritis can sometimes appear before psoriasis; the diagnosis is then very difficult, and only experienced rheumatologists will suspect psoriatic arthritis. Psoriatic arthritis is one of the seronegative arthritides. This means that rheumatoid factors are not positive, although the erythrocyte sedimentation rate and C-reactive protein may be raised. HLA typing more often shows the B27 and B35 loci, among others.
The radiological picture has its own specific features, so X-rays are important too; when the diagnosis remains uncertain, magnetic resonance imaging is needed. Joint ultrasound is a useful tool for diagnosis and monitoring, especially with the power Doppler technique, which shows microvascularisation – an important sign of active inflammation. Psoriatic arthritis must be treated both systemically and locally. We treat the psoriasis locally, while the joint disease is treated with medicines, above all methotrexate and leflunomide, and with biological medicines.
Non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac, etoricoxib and celecoxib are also indispensable. In milder cases with a calm, slow course, they are the only medicine needed. Therapeutic muds and petroleum derivatives (so-called ‘mastika’) have been used since ancient times, but with limited effect. Sun and sea also have a beneficial effect, but great caution is needed because of the damage caused by UV rays and its consequences.
As you can see, treatment is complex: alongside the rheumatologist and physiatrist, the patient's cooperation is needed so that flare-ups can be recognised early. Inflammatory bowel disease or gluten enteropathy (coeliac disease) is not uncommonly an underlying factor. Interestingly, the diagnostic criteria also include the fact that the risk increases if skin psoriasis has been recorded in the family or among relatives.
At Faktor Zdravlje Polyclinic we diagnose, treat and monitor psoriatic arthritis.
