Psoriatic Arthritis - diagnosis, causes, symptom, treatment of Psoriatic Arthritis
What is Psoriatic Arthritis?
Psoriasis is a chronic autoimmune skin disease that afflicts about 2% of Caucasians. Some 10% to 40% of patients with psoriasis develop a chronic inflammatory arthritis. Psoriatic arthritis (PSA) has a superficial resemblance to rheumatoid arthritis (RA), but is considered to be clinically and genetically distinct, with a different pathogenesis. The term psoriatic arthritis (psoriasis arthritique) was first used by the French dermatologist.
The pathogenesis of Psoriatic Arthritis involves an interplay of genetic, immunologic, and environmental factors. Although occasional pedigrees have been described with a Mendelian pattern of inheritance, most pedigrees cannot be explained on the basis of a single gene and are presumed to be inherited on a multifactorial basis. Seventy percent of monozygotic twins with psoriasis are concordant for the disease Psoriatic Arthritis.
Five clinical patterns of Psoriatic Arthritis
Psoriatic Arthritis is readily recognized on presentation as an oligoarticular arthritis with predominant involvement of distal interphalangeal (DIP) joints and flexor tenosynovitis; this is not the most common presentation. Five clinical patterns of PSA are recognized:
- Group 1: Predominant involvement of DIP joints.
- Group 2: Arthritis mutilans
- Group 3: Symmetric polyarthritis.
- Group 4: Oligoarticular arthritis.
- Group 5: Axial involvement.
Psoriatic Arthritis and Trauma
The observation that Psoriatic Arthritis is sometimes closely associated with trauma to the involved joint continues to be reported. Finger dactylitis and pitting edema over the dorsum of the hand has been reported after contusive trauma to the hand in a patient with long-standing psoriasis sine arthritis.
Sign and Symptom of Psoriatic Arthritis
There is a bimodality in age of onset of PSA. Patients with childhood onset, when followed into adulthood, have a stronger genetic component, a more frequent history of antecedent skin lesions, and fewer actively inflamed joints than the late-onset group.
Treatment of Psoriatic Arthritis
Patients with Psoriatic Arthritis have to bear the burden of two chronic and currently incurable diseases. Patients with PSA have a similar impairment in their quality of life as patients with RA and report more role limitations due to emotional problems and bodily pain. An important general principle in managing patients with chronic disease is the establishment of a productive dialogue that allows the patient to express fears and obtain enlightened answers. One can be optimistic that most patients with Psoriatic Arthritis will follow a relatively benign course without serious systemic complications; however, such a generalization is of little solace to patients in whom arthritis mutilans is developing.