(arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy)

By: Kenneth M. Lat

BSN-III

Psoriasis is a disease in which scaly red and white patches develop on the skin. Psoriasis is caused by the body's immune system going into overdrive to attack the skin. Some people with psoriasis can also develop psoriatic arthritis, when the immune system attacks the joints as well, causing inflammation. Like psoriasis, psoriatic arthritis symptoms flare and subside, vary from person to person, and even change locations in the same person over time. Psoriatic arthritis can affect any joint in the body, and it may affect just one joint, several joints or multiple joints. For example, it may affect one or both knees. Affected fingers and toes can resemble swollen sausages, a condition often referred to as dactylitis. Finger and toe nails also may be affected.

 Asymmetric
Symmetric Arthritis

mutilans Spondylitis Distal interphalangeal predominant

 UNKNOWN

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 Pain,

swelling, or stiffness in one or more joints. Joints that are red or warm to the touch. Sausage-like swelling in the fingers or toes, known as dactylitis. Pain in and around the feet and ankles, especially tendinitis in the Achilles tendon or Plantar fasciitis in the sole of the foot. Changes to the nails, such as pitting or separation from the nail bed. Pain in the area of the Sacrum (the lower back, above the tailbone).

 CD8

+ T cells(a predominately activated, clonally expanded memory T cells)

psoriatic

synovium is characterised by hypervascularity and morphologically tortuous vessels.

(VEGF) and (TGF)=over-expressed in psoruiatic tissue + (TNF)

bone

changes of psoriatic arthritis

 Cytokine

interaction with the receptor activator of nuclear factor kappa B (RANKL) leads to osteoclast proliferation and activation, contributing to erosions and osteolysis. This is manifested clinically by the radiological changes of arthritis mutilans, including pencil-in-cup deformities, as well as new-bone formation of periostitis. Additional cytokines may play a key role in the synovitis. Interleukin 23 has been identified as playing a role in the skin lesions of psoriasis. It remains to be determined whether it contributes to the risk of arthritis.

 There

is no definitive test to diagnose psoriatic arthritis. that contribute to a diagnosis of psoriatic arthritis include:

Factors

 1.)

Non-steroidal anti-inflammatory drugs 2.) disease modifying anti-rheumatic drugs 3.) anti-tumor necrosis factor agents 4.) For swollen joints, corticosteroid injections can be useful. Surgery can be helpful to repair or replace badly damaged joints. 5.) Proper exercise is very important to improve overall health and keep joints flexible.

 6.)

Walking is an excellent way to get exercise. A walking aid or shoe inserts will help to avoid undue stress on feet, ankles, or knees affected by arthritis 7.) An exercise bike provides another good option, as well as yoga and stretching exercises to help with relaxation. 8.) Some people with arthritis find it easier to move in water. If this is the case, swimming or walking laps in the pool offers activity without stressing joints.