yogabook / pathologie / psoriatic arthritis

psoriatic arthritis (Arthritis Psoriatica, Psoriasis Arthropathia)

Definition of

is usually (90%) associated with HLA-B27, but also with HLA-CW17 and others. Only 5-10% of psoriatics develop P.A., then usually (but not always, sometimes vice versa) first arthritis and then the skin symptoms of psoriasis on the extensor sides of the extremities (scaly papules with silver-colored shiny bran-like scales). Most common is recurrent moderately painful polyarthritis of the peripheral joints, only in 20% additionally or exclusively of the SI joints and/or the spine. Bone changes are possible, sometimes severe. Remissions of the joint symptoms usually occur with remissions of the skin symptoms. M:W 1:1.
A distinction is made:

• Oligoarthritic form (70%) with emphasis on the DIP of individual toes and fingers, also affecting other joints of the affected ray (sausage fingers), possibly also monoarthritis of a large joint, usually the knee joint. The affection is asymmetrical
• Polyarthritic form with emphasis on the finger and toe joints, only a few of the other joints are affected
• Symmetrical form: usually all finger and toe joints are affected, which is similar to RA
• Rarely: Spondylitis psoriatica: affection of the SI joint and/or spine
• mutilating form: mutilating damage to one or more fingers or toes

ICD M09

Diagnosis

1. HLA-(mostly B27) positive
2. during relapse, depending on the extent: ESR, CRP elevated, uric acid, cholesterol elevated
3. No decalcification near the joint( typical forRA)
4. Typical acroosteolysis

Symptoms

1. peripheral type (the actual PsA), inflammatory joint involvement:
2. Central type (psoriatic spondylitis)

Therapy

1. NSAIDs, if not sufficiently effective: additionally the basic therapeutic agents

DD

1. central type: ankylosing spondylitis
2. peripheral type: gout