pathology: psoriatic arthritis

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Psoriatic arthritis (arthritis psoriatica, psoriasis arthropathia)

Definition

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-coloured shiny bran-like scales). Most common is recurrent moderately painful polyarthritis of the peripheral joints, only in 20% additionally or exclusively of the ISG 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 finger), possibly also monoarthritis of a large joint, usually 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 ISG and/or WS
  • Mutilating form: mutilating damage to one or more fingers or toes

In contrast to rheumatoid arthritis, IL-6 inhibition has not yet been successful in creating a therapeutic approach. On the contrary, inhibition of IL-6 leads to an overproduction of pro-inflammatory cytokines such as IL-17 and IL-23.

ICD M09

Diagnosis

  1. HLA-(mostly B27) positive
  2. In relapse, depending on extent: ESR, CRP elevated, uric acid, cholesterol elevated
  3. None typical for (RA) decalcification near the joint
  4. Typical acroosteolyses

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: Morbus Bechterew
  2. Peripheral type: Gout