Psoriasis of the joints

Psoriasis of the joints is an inflammatory process that develops as a result of psoriatic skin lesions with the appearance of red spots and light flaky scales. Some experts believe that psoriasis of joints is the fusion of two pathologies, such as rheumatoid arthritis and psoriasis.

This disease has an autoimmune mechanism of development: disorders of immune defense lead to self-destruction of cellular structures, to stratification of excess tissues and to the development of inflammatory reactions in the joints.

Epidemiology

Psoriasis of joints with the same frequency can be found in male and female patients.

Of the total number of patients with psoriasis, joint damage occurs in about 20% of cases.

Psoriasis of the joints a person can get sick in both young and old age, however the greatest number of patients belong to the age category of about 40 years.

The role of heredity in the development of the disease is not proven, but it should not be ruled out. It is noted that approximately 40% of patients with joint psoriasis have or have direct relatives who have suffered from dermatological or joint pathologies.

[1], [2], [3], [4], [5]

Causes of the psoriasis of the joints

It is proved that psoriasis of joints, like ordinary psoriasis, appears as a result of stress and excessive nervous tension. Many experts talk about psoriasis, as a psychosomatic disease.

In addition, arthritis can occur on the background of psoriasis and joint trauma - especially if the injury is received during a period of exacerbation of the disease.

The main reasons for the development of psoriasis of the joints on the background of skin psoriasis are as follows:

• long-term treatment with non-steroidal anti-inflammatory drugs;
• reception of high doses of vasocordin, atenolol, egilok;
• alcohol and smoking abuse;
• severe infectious (especially viral) diseases;
• adverse heredity.

[6], [7], [8]

Risk factors

• Injuries to extremities and joints.
• Influence of large doses of radiation.
• Infectious diseases (viral and streptococcal infection).
• AIDS.
• Treatment of certain types of medication.
• Strong or sudden emotional stress, excessive mental stress.
• Regular intake of alcohol, drug addiction and smoking.
• Severe hormonal stress.
• Genetic factor.

[9], [10]

Pathogenesis

Psoriasis of the joints is a pathology, which is accompanied, first of all, by the growth and consolidation of the epidermis, and this process has not been fully studied yet. Presumably, the growth can be explained by the failure of biological and chemical reactions in the epidermal cells due to imbalance between cAMP, cGMP and prostaglandins. Biological and chemical changes are not initial, but arise as a result of an incorrect functioning of the immune system - again, after the negative influences of any external factors.

Many scientists associate psoriasis with peripheral arthritis and psoriatic spondyloarthritis. However, the underlying disease is still skin psoriasis. Outside provoking factors, it is especially necessary to distinguish infectious diseases, traumas, and psychoemotional stresses.

From infectious diseases, streptococcal angina, scarlet fever, influenza, shingles, chickenpox, hepatitis A have a stimulating effect. Nevertheless, there is no specific provoking agent of psoriasis of the joints.

The role of injuries and joint injuries in the development of psoriasis of the joints is also not unimportant. A characteristic of Kebner is the development of psoriatic manifestations in areas with postoperative scars, violations of the integrity of the skin.

A large number of patients independently indicate that the disease started after a sharp or strong psychoemotional stress, or a long-term stressful state. Such patients are often diagnosed with thermoregulatory disorders, impaired sweat gland function, vascular pathology, as well as disorders of metabolic processes.

Of great importance is the autoimmune version of the development of psoriasis of the joints. Confirmation of this version are some diagnostic features: patients have hypergammaglobulinemia, imbalance between immunoglobulins A, G, M, the presence of antibodies to dermatoantigens, as well as an increased amount of streptococcal antibodies.

How does psoriasis affect joints?

Psoriasis of the joints is characterized by the development of the chronic form of synovitis, which has signs of rheumatoid arthritis. Different synovitis due to the presence of weakly expressed cell proliferation reactions, as well as mainly fibrotic changes.

In psoriasis of joints, painful changes affect the superficial areas of the synovial membrane; Fibrinous deposits with significant penetration of neutrophils in them are detected. Infiltrates - lymphoid and plasma cell - are poorly expressed.

The painful process also extends to the epiphysis of bones, articular cartilage, in which erosion develops. In advanced cases, bone destruction takes place, which reaches the metaepiphyseal part and further along the bone. Because of such processes, many scientists attribute psoriasis of joints to the number of neurogenic arthropathies.

Against the background of these reactions, recovery processes also take place: they are manifested by the formation of periostitis, dense osteophytes, calcification of ligaments.

[11], [12], [13], [14], [15], [16], [17], [18], [19],

Symptoms of the psoriasis of the joints

According to the clinical picture, joint psoriasis is often similar to rheumatoid arthritis. However, there are a number of typical signs for psoriasis of the joints:

• heel pain;
• lack of symmetry of joint damage;
• tenderness of the joints on the thumb of the lower limb;
• crimson skin at the site of joint damage, swelling and pain;
• often the defeat of more than one joint of the fingers.

Other signs are known, which, however, are not typical.

The first signs of psoriasis of the joints can reveal themselves in the form of pain and edema of the spine or some articulations. There is morning stiffness. Psoriasis can manifest as inflammatory changes in the internal organs as well - in the urinary system, cardiovascular system, lungs.

The defeat of the joints with psoriasis can seize the area of the ankle, knees and fingers. More often than not one suffers, but several joints. Joints ache, swell (swell), become pinkish and hot when palpating. Psoriasis on the joints of the fingers can take place with a marked swelling, when the affected fingers become like "sausages".

In patients with psoriasis joints, there is often an inflammatory process in the tendons (medical term - tendonitis), as well as in cartilaginous tissue (chondritis). Pain in the joints with psoriasis is permanent, but intensified after loads - walking, squats, climbing the stairs.

Psoriasis and joint arthritis are always closely related. In the period of exacerbation of psoriasis - the main disease - the symptoms of arthritis always worsen. Most often, such exacerbations occur in the off-season or in the winter: in the summer the disease recedes.

Psoriasis of the knee joint is observed somewhat less often than the lesion of the fingers. However, this type of disease can be difficult, with severe deformation and limited mobility in the knee area. It becomes difficult for the patient not only to climb, but also to descend the stairs. Ultimately, the severe course of the disease can lead to a complete absence of joint motor activity.

Stages

1. Active stage, which, in turn, is divided into minimal, moderate and maximum.
2. Inactive stage (it is the stage of remission).

[20]

Forms

Five types of psoriasis of joints are known: they need to be known, since different types of disease require a different approach to treatment.

• Symmetrical joint psoriasis - for this species is characterized by a symmetrical lesion of the joints (i.e., mostly paired joints are affected). Such a pathology is usually characterized by the increase and aggravation of symptoms, provoking a complete loss of efficiency in half of patients with this diagnosis.
• Asymmetric psoriasis of the joints is characterized by unilateral involvement of 3 or more joints. For example, the knee, the hip joint, and also the phalanges of the fingers can be affected simultaneously.
• Psoriasis of the joints with the predominant involvement of distally located interphalangeal joints in the process - this type is characterized by the defeat of the small joints of the fingers of the upper and lower extremities.
• Spondylosis is a psoriasis of the joints with a predominant spinal injury, more often in the neck or lower back.
• Deforming psoriasis of the joints is one of the most complex varieties of psoriasis of the joints, which causes curvature and destruction of small joints of the limbs. This species is often combined with spondylosis, but is generally less common than other types of disease.

Complications and consequences

Psoriasis of joints in the absence of treatment or with improper treatment may be complicated by development:

• erosion with subsequent restriction of mobility of the joint;
• complete immobilization of the joint with further attribution of disability.

Some patients with time, there is a mutilating arthritis. This complication, which is characterized by the gradual destruction of small joints (for example, interphalangeal finger joints of the upper and lower extremities). The logical and difficult outcome of the mutilating arthritis is disability.

Psoriasis of the joints with a high degree of probability can lead to the development of the following problems:

• dactylitis - inflammation of the joints of the fingers;
• plantar fasciitis (the so-called heel spur);
• Spondylitis is an inflammatory process in the spine.

Sometimes a secondary synovitis of the knee joint develops on the background of psoriasis. Its development is facilitated by autoimmune reactions, metabolic disorders, damage to the synovial membrane or articular cartilage. The essence of synovitis is that the articular fluid under the influence of certain factors changes its density and structure, which becomes the cause of the development of the pathological process.

[21], [22], [23],

Diagnostics of the psoriasis of the joints

• Analyzes for psoriasis of the joints are of little informative, as there are no specific laboratory tests for this disease. In many patients, the disease does not affect the overall picture of the blood. With significant exudative intraarticular processes, ESR can increase. Occasionally, a small leukocytosis and anemic processes were observed, which were aggravated with an aggressive-malignant form of the disease.
• Instrumental diagnosis of psoriasis of joints is usually represented by radiography of the bone system, namely, joints and the spinal column. X-ray signs of psoriasis of the joints are quite typical. They are, first of all, erosive and proliferative disorders (osteophytes) in the joints. Sometimes on the radiographic image, symptoms of rheumatoid arthritis can be observed, so it is very important for proper treatment to distinguish in time these two diseases.

In psoriatic spondyloarthritis, the appearance of dense intervertebral bone membranes, vertebral bone growths. However, such signs do not happen so often, and the x-ray picture can resemble the usual ankylosing spondylitis.

[24], [25], [26], [27]

Differential diagnosis

Differential diagnosis of psoriasis of joints is carried out:

1. with rheumatoid arthritis;
2. with deforming osteoarthrosis;
3. with Bekhterev's disease;
4. with Reuter's disease.

Diagnosis of joint psoriasis is often based on the presence of the following symptoms:

• defeat of small joints on the fingers of the limbs;
• defeat of three joints of one finger;
• pain in the heel;
• diagnosed psoriasis of the skin and (or) nail plates;
• diagnosed psoriasis in direct relatives of the patient;
• characteristic spinal cord injury - ossification.

Of the listed symptoms, the presence of signs 4 and 5 in combination with the radiologically proven osteolytic process and bony outgrowths is sometimes sufficient for diagnosis.

[28], [29], [30], [31], [32], [33],

Treatment of the psoriasis of the joints

Psoriasis of joints is subject to treatment, the main task of which is to remove the inflammatory reaction, to prevent the development (aggravation) of erosion, to restore the usefulness of movements in the joint. Simultaneously, systemic treatment of psoriasis should be carried out.

For the treatment of psoriasis of joints, the following drugs are used:

• anti-inflammatory drugs (diclofenac, ibuprofen, nimesulide);
• corticosteroids (prednisolone, dexamethasone);
• chondroprotectors (chondroitin with glucosamine, hyaluronic acid, diacerein);
• immunosuppressors (azathioprine, leflunomide);
• inhibitors of TNF-alpha (adalimumab, infliximab).

	Dose and method of administration	Side effects	Special instructions
Diclofenac	Take 25-50 mg to 3 times a day.	Pain in the abdomen, indigestion, stomach ulcer.	Do not combine diclofenac treatment with alcohol.

	Dose and method of administration	Side effects	Special instructions
Prednisolone	Dosage is set individually, on average - from 5 to 60 mg per day.	Swelling, muscle weakness, digestive disorders.	The drug should be taken at the same time every day.

	Dose and method of administration	Side effects	Special instructions
Chondroitin with glucosamine (chondroitin complex)	1 tablet three times a day, for 3 weeks. Then 1 tablet twice a day for 2-3 months.	Pain in the abdomen, dizziness, weakness.	The drug is not prescribed for children.

	Dose and method of administration	Side effects	Special instructions
Azathioprine	Take 1-2.5 mg per kg per day, for 1-2 intake. Duration of treatment is at least 3 months.	Myelodepression, dyspepsia, erosion and ulcers of the digestive system.	Treatment is carried out under the control of a picture of blood.

Nonsteroidal anti-inflammatory drugs eliminate pain, relieve inflammation, swelling. In this case, prescription drugs such as diclofenac or nimesulide are more pronounced than, for example, ibuprofen.

Immunosuppressors cause processes, with psoriasis of joints suppressing immunity, failure in which leads to attack of own cells in the body.

TNF-alpha inhibitors inhibit the effect of the necrosis factor, which is the catalyst for many inflammatory reactions.

In addition, with psoriasis joints are often prescribed methotrexate - an antirheumatic drug that inhibits the destruction of joints. This drug is used for a long time, since its effect becomes noticeable only after a long therapeutic course.

Take psoriasis joints and vitamins: it is proven that vitamin D can alleviate the symptoms of joint damage. One of the most common vitamin preparations for psoriasis of joints is Alfa D3 Teva (alfacalcidol), which is taken 1 μg daily, for a long time.

Physiotherapeutic treatment

The treatment regimen for psoriasis of joints can include a number of physiotherapeutic procedures, which creates an additional positive effect in the treatment. The most commonly used procedures are:

• laser treatment of blood;
• PUVA-therapy;
• magnetotherapy;
• electrophoresis with glucocorticosteroids;
• phonophoresis;
• LFK and gymnastics.

Most procedures are prescribed in the subacute period or period of remission of the disease, to prevent relapse.

Alternative treatment

Treatment of psoriasis of joints by alternative methods is one of the auxiliary options of therapy, which is used only in combination with other medical measures appointed by a doctor.

• Insist leaves of cranberries (2 tsp for 250 ml of boiling water), drink during the day in small sips.
• Apply compresses on the basis of 2-3 drops of turpentine, one crushed carrot and 1 tsp. Sunflower oil. The mass is spread over a cotton napkin, applied to the diseased joint, and covered with polyethylene film on top. It is desirable to put the compress at night.
• Insist equal parts of plants such as mother-and-stepmother, dandelion flowers and St. John's wort, in 1 liter of boiling water. Drink about ¼ cup three times a day.
• Prepare juice from one beet, 1 apple and two carrots, add half a teaspoon of grated ginger, mix and drink. You should drink at least 2 similar servings per day.

Herbal Treatment

• For psoriasis of joints, it is appropriate to use rhizome of aira, leaves and fruits of hawthorn, elderberry, strawberry, currant, blueberry, violet, chamomile, lily of the valley, fennel and chicory seeds.
• Also prepare a fifteen-minute decoction from the birch buds, cool and drink 50 ml before meals, daily.

• You can pour the flowers of elderberry (1 tsp), birch leaves (4 tsp), willow bark (5 tsp), 500 ml of boiling water, insist and filter. Drink 100 ml 4 times a day before meals.
• It is useful to brew for 2 tsp. Birch leaves, nettle and flower violets in 500 ml of water, insist for at least half an hour. Drink 100 ml 4 times a day before meals.
• It is good to drink during the day instead of tea infusion of leaves of black currant and hips.

Homeopathy

Homeopathic preparations are considered safe and such that they can not cause any serious side effects. They do not develop addiction, they are not toxic and do not accumulate in the body.

In psoriasis of joints, the main goal of homeopathic treatment is the elimination of the inflammatory process and pain, restoration of joint mobility, prevention of its destruction and curvature.

For the treatment of psoriasis of joints, you can take homeopathic mono-drugs:

• Graphite 6 three pellets once every three days, in the morning;
• Apis 6 (Apis mellifica) on a single granule once every three days at night.

They take the funds listed on different days.

In addition, the use of complex drugs is indicated:

• Diskus-compositum - 1 ampoule intramuscularly, from 1 to 3 times a week, for 4-6 weeks;
• Psorinochel - 10 drops three times a day for 15 minutes before meals, for 4-8 weeks.

Homeopathy is most often used in complex treatment, using all possible medical measures: this is the only way to cope with a complex disease and achieve a stable remission.

Operative treatment

In the overwhelming majority of cases, patients with psoriasis of the joints do not undergo surgical intervention - this is simply not necessary. The operation is prescribed only when no conservative methods bring relief to the patient.

One of the options for surgical intervention is the procedure for restoring the operability of the affected joint - sinovectomy.

In severe and neglected situations, arthroplasty of the joint is performed, or cartilage endoprosthetics is an operative intervention, during which the replacement of affected tissues with artificial ones is performed.

For many patients, surgical treatment allows to restore the function of the joint, eliminate pain and deformity. Sometimes practice the fixation of the cartilage of the wrist and ankle, as well as the fingers of the limbs.

Prevention

Specific preventive measures to prevent the development of psoriasis joints. However, there are a number of general recommendations, compliance with which will eliminate many of the negative factors that could contribute to the development of the disease.

• It is necessary to protect joints, avoid overloads and injuries.
• We must abandon bad habits: do not abuse alcohol, do not smoke, do not eat fast food, give up plenty of salt and sugar in the diet.
• It is important to monitor the body weight, not to admit obesity: excess weight exacerbates the load on the musculoskeletal system.
• Do not hypothermia joints.
• Regular rest at sea resorts, as well as periodic use of medicinal mineral waters are encouraged.

[34], [35], [36], [37], [38], [39]

Forecast

Completely cure psoriasis of joints is unlikely to succeed, but it is possible to bring the disease out in a stable period of remission. At present, all the relevant drugs and methods are available for this purpose.

[40], [41]