Добре дошли в сайта на д-р Севдалина Ламбова, дм, ревматолог




Psoriatic arthritis

             Psoriasis is hyperproliferation of epidermal keratinocytes combined with inflammation of the epidermis and dermis. It affects about 1 to 5% of the population worldwide and about 2% of Caucasians. A strong family history is characteristic. Lesions are either asymptomatic or pruritic and are most often localized on the scalp, extensor surfaces of the elbows and knees, sacrum, buttocks (commonly the gluteal cleft). The nails, eyebrows, axillae, umbilicus, and perianal region may also be affected. The most common skin rashes include erythema, papules and silvery scales. Nail lesions in psoriasis include mainly nail-pitting, spot lesions (“greasy spots”), onycholysis, subungual hyperkeratosis. Psoriatic arthritis (PsA) occurs in about 10 to 40% of patients with psoriasis. Psoriasis antedated the arthritis in over 70% of the cases, which is the most common clinical pattern. In over 20% of the cases, the psoriasis follow the arthritis. In these cases definite diagnosis may be established only in the course of follow-up. Presence of psoriasis in the family carries diagnostic value in these case. In 10% of the patients the psoriasis and arthritis develop simultaneously. PsA differs with heterogeneous clinical course. Several distinct clinical forms are recognized e. g., arthritis with predominant involvement of distal interphalangeal joints; symmetric polyarthritis (rheumatoid arthritis-like form); oligoarticular asymmetric arthritis, joint involvement; arthritis mutilans with osteolysis of phalanges, metacarpals and metatarsals is characteristic; axial involvement with asymmetric sacroiliitis and spondylitis. Enthesitis (inflammation of enthesis e. g., the insertion of tendon, ligaments or capsules into the bone) is a characteristic feature. Dactylitis (diffuse swelling of fingers and toes, that exceeds the contour of the joints) is another characteristic feature of PsA.


            Laboratory and instrumental methods

            There is no laboratory test, which facilitates the diagnosis of psoriasis or PsA, apart from the negative test for rheumatoid factor. Hyperuricemia occurs in over 10-20% of patients because of the increased epidermal cell’s turnover. Radiographs of patients with PsA have characteristic features such as presence of new bone formation near to the marginal erosions, periostitis, etc. Signs of assymetric sacroiliitis and paravertebral ossifications/


Syndesmophytes may be found.

            The treatment of PsA incudes nonsteroidal anti-inflammatory drugs, local or in selected cases systemic corticosteroids, disease-modifying antirheumatic drugs e. g., cytotoxic drugs (methotrexate, leflunomide, cyclosporine, etc.), biologic agents (anti-tumor necrosis factor alpha (TNF-α) blocking agents – etanercept, adalimumab, golimumab, infliximab; antibody against interleukin 12/23 - ustekinumab). The treatment should be defined by the attending rheumatologist according to the form of the disease and the disease activity in every individual case.


                                                                      Dr Sevdalina Lambova, MD, PhD