Joint psoriasis

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 the joints is a fusion of two pathologies, such as rheumatoid arthritis and psoriasis.

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

Epidemiology

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

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

A person can get joint psoriasis both at a young and an old age, but the largest number of patients belong to the age category of about 40 years.

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

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Causes psoriasis of the joints

It has been proven that psoriasis of the joints, like regular psoriasis, appears as a result of stress and excessive nervous tension. Many specialists speak of psoriasis as a psychosomatic disease.

In addition, arthritis can occur against the background of psoriasis and joint trauma, especially if the trauma occurs during an exacerbation of the disease.

The main reasons for the possible development of joint psoriasis against the background of skin psoriasis are the following:

• long-term treatment with nonsteroidal anti-inflammatory drugs;
• taking high doses of vazocordin, atenolol, egilok;
• alcohol and smoking abuse;
• severe infectious (especially viral) diseases;
• unfavorable heredity.

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Risk factors

• Injuries to limbs and joints.
• The effects of high doses of radiation.
• Infectious diseases (viral and streptococcal infections).
• AIDS.
• Treatment with certain types of medications.
• Strong or sudden emotional stress, excessive mental strain.
• Regular alcohol consumption, drug addiction and smoking.
• Severe hormonal stress.
• Genetic factor.

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Pathogenesis

Joint psoriasis is a pathology that is accompanied, first of all, by the proliferation and thickening of the epidermis, and this process has not yet been fully studied. Presumably, the proliferation can be explained by a failure of biological and chemical reactions in epidermal cells due to an imbalance between cAMP, cGMP and prostaglandins. Biological and chemical changes are not initial, but occur as a result of improper functioning of the immune system - again, after the negative influences of some external factors.

Many scientists associate psoriasis with peripheral arthritis and psoriatic spondylitis. However, the underlying disease is still skin psoriasis. Among external provoking factors, infectious diseases, injuries, and psycho-emotional stress should be especially highlighted.

Of the infectious diseases, streptococcal sore throat, scarlet fever, flu, shingles, chickenpox, and hepatitis A have a stimulating effect. However, there is no specific trigger for joint psoriasis.

The role of trauma and joint damage in the development of joint psoriasis is also important. The Koebner sign is characteristic - 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 began after a sharp or strong psycho-emotional stress, or a long-term stressful state. Such patients are often diagnosed with thermoregulation disorders, sweat gland dysfunction, vascular pathologies, and metabolic disorders.

The autoimmune version of the development of joint psoriasis is also of great importance. This version is confirmed by some diagnostic features: patients have hypergammaglobulinemia, an imbalance between immunoglobulins A, G, M, the presence of antibodies to dermatoantigens, as well as an increased number of streptococcal antibodies.

How does psoriasis affect joints?

Psoriasis of the joints is characterized by the development of a chronic form of synovitis, which has signs of rheumatoid arthritis. Synovitis is differentiated by the presence of weakly expressed reactions of cell proliferation, as well as by predominantly fibrous changes.

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

The disease process also spreads to the epiphysis of bones, articular cartilage, where erosions develop. In advanced cases, bone destruction occurs, which reaches the metaepiphyseal part and further along the bone. Due to such processes, many scientists classify joint psoriasis as a neurogenic arthropathy.

Against the background of the listed reactions, recovery processes also take place: they are manifested by the formation of periostitis, dense osteophytes, and ligament calcifications.

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Symptoms psoriasis of the joints

The clinical picture of joint psoriasis often resembles rheumatoid arthritis. However, there are a number of typical signs of joint psoriasis:

• heel pain;
• lack of symmetry of joint damage;
• pain in the joints of the big toe of the lower limb;
• purple skin at the site of the affected joint, swelling and pain;
• Often more than one finger joint is affected.

Other signs are also known, but they are not typical.

The first signs of joint psoriasis may manifest themselves in the form of pain and swelling of the spine or some joints. Morning stiffness is present. Psoriasis may manifest itself in inflammatory changes in internal organs - in the urinary system, cardiovascular system, lungs.

Joint damage in psoriasis can affect the ankle, knees and fingers. Most often, not one, but several joints are affected. Joints hurt, swell (puff up), become pinkish and hot to the touch. Psoriasis on the joints of the fingers can occur with pronounced swelling, when the affected fingers become like "sausages".

Patients with joint psoriasis often develop an inflammatory process in the tendons (medical term - tendinitis), as well as in the cartilage tissue (chondritis). Joint pain in psoriasis is constant, but intensifies after exercise - walking, squatting, climbing stairs.

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

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

Stages

1. The active stage, which, in turn, is subdivided into minimal, moderate and maximal.
2. Inactive stage (also known as remission stage).

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Forms

There are five known types of joint psoriasis: it is important to know them, since different types of the disease require different approaches to treatment.

• Symmetrical psoriasis of the joints - this type is characterized by symmetrical damage to the joints (that is, mainly paired joints are affected). Such pathology is usually characterized by an increase and worsening of symptoms, causing a complete loss of working capacity in half of patients with this diagnosis.
• Asymmetrical psoriasis of the joints – characterized by unilateral damage to 3 or more joints. For example, the knee, hip joint, and phalanges of the fingers can be affected at the same time.
• Psoriasis of the joints with predominant involvement of the distally located interphalangeal joints in the process - this type is characterized by damage to the small joints of the fingers of the upper and lower extremities.
• Spondylosis is a psoriasis of the joints with predominant damage to the spine, most often in the neck or lower back area.
• Deforming psoriasis of the joints is one of the most complex types of psoriasis of the joints, which causes curvature and destruction of small joints of the limbs. This type is often combined with spondylosis, but in general is less common than other types of the disease.

Complications and consequences

Psoriasis of the joints, if left untreated or treated incorrectly, can be complicated by the development of:

• erosions with subsequent limitation of joint mobility;
• complete immobilization of the joint with subsequent assignment of disability.

Some patients eventually develop arthritis mutilans. This is a complication characterized by the gradual destruction of small joints (for example, the interphalangeal finger joints of the upper and lower extremities). The logical and severe outcome of arthritis mutilans is disability.

Psoriasis of the joints is highly likely to lead to the development of the following problems:

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

Sometimes secondary synovitis of the knee joint develops against 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 synovial fluid, under the influence of certain factors, changes its density and structure, which causes the development of the pathological process.

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Diagnostics psoriasis of the joints

• Tests for joint psoriasis are of little information, since there are no specific laboratory tests for this disease. In many patients, the disease does not affect the overall blood picture. With significant exudative intra-articular processes, ESR may increase. Occasionally, slight leukocytosis and anemic processes were observed, which worsened with an aggressive-malignant form of the disease.
• Instrumental diagnostics of joint psoriasis is usually represented by X-rays of the skeletal system, namely, joints and the spine. X-ray signs of joint psoriasis are quite characteristic. They are, first of all, erosive and proliferative disorders (osteophytes) in the joints. Sometimes, symptoms of rheumatoid arthritis can be observed on the X-ray image, so it is very important to distinguish between these two diseases in a timely manner for proper treatment.

In psoriatic spondylitis, dense bone intervertebral membranes and vertebral bone growths are observed. However, such signs are not so common, and the radiographic picture may resemble common ankylosing spondylitis.

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Differential diagnosis

Differential diagnostics of joint psoriasis is carried out:

1. with rheumatoid arthritis;
2. with deforming osteoarthritis;
3. with Bechterew's disease;
4. with Reiter's disease.

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

• damage to small joints on the fingers;
• damage to three joints of one finger;
• pain in the heel area;
• diagnosed psoriasis of the skin and/or nail plates;
• diagnosed psoriasis in the patient's immediate relatives;
• A characteristic lesion of the spine is ossification.

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

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Treatment psoriasis of the joints

Joint psoriasis is subject to treatment, the main task of which is to relieve the inflammatory reaction, prevent the development (worsening) of erosion, and restore the full range of motion in the joint. At the same time, systemic treatment of psoriasis should be carried out.

The following medications are used to treat joint psoriasis:

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

	Dosage and method of administration	Side effects	Special instructions
Diclofenac	Take 25-50 mg up to 3 times a day.	Abdominal pain, dyspepsia, stomach ulcer.	Treatment with diclofenac should not be combined with alcohol consumption.

	Dosage and method of administration	Side effects	Special instructions
Prednisolone	The dosage is determined individually, on average – from 5 to 60 mg per day.	Swelling, muscle weakness, digestive disorders.	It is advisable to take the drug at the same time every day.

	Dosage 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.	Abdominal pain, dizziness, weakness.	The drug is not prescribed to children.

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

Nonsteroidal anti-inflammatory drugs eliminate pain, reduce inflammation, and swelling. At the same time, prescription drugs such as diclofenac or nimesulide act more strongly than, for example, ibuprofen.

Immunosuppressants cause processes that suppress the immune system in psoriasis of the joints, a failure of which leads to an attack on the body's own cells.

TNF-alpha inhibitors suppress the effects of tumor necrosis factor, which is a catalyst for many inflammatory reactions.

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

Vitamins are also taken for joint psoriasis: it has been proven that vitamin D can alleviate the symptoms of joint damage. One of the most common vitamin preparations for joint psoriasis is Alpha D3 Teva (alfacalcidol), which is taken 1 mcg daily for a long time.

Physiotherapy treatment

The treatment regimen for joint psoriasis may include a number of physiotherapeutic procedures, which creates an additional positive effect in treatment. The following procedures are most often used:

• laser blood treatment;
• PUVA therapy;
• magnetic therapy;
• electrophoresis with glucocorticosteroids;
• phonophoresis;
• Physical therapy and gymnastics.

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

Folk remedies

Treatment of joint psoriasis using folk methods is one of the auxiliary treatment options, which is used only in combination with other treatment measures prescribed by a doctor.

• Infuse lingonberry leaves (2 tsp per 250 ml of boiling water) and drink in small sips throughout the day.
• Apply compresses based on 2-3 drops of turpentine, one chopped carrot and 1 teaspoon of sunflower oil. Spread the mixture over a cotton napkin, apply to the sore joint, and cover with polyethylene film on top. It is advisable to apply the compress overnight.
• Infuse equal parts of such plants as coltsfoot, dandelion flowers and St. John's wort in 1 liter of boiling water. Drink ¼ cup three times a day.
• Prepare juice from one beetroot, one apple and two carrots, add half a teaspoon of grated ginger, mix and drink. You should drink at least 2 such portions per day.

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Herbal treatment

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

• You can pour 500 ml of boiling water over elder flowers (1 tsp), birch leaves (4 tsp), willow bark (5 tsp), let it brew and filter. Drink 100 ml 4 times a day before meals.
• It is useful to brew 2 teaspoons of birch leaves, nettle and violet flowers in 500 ml of water, leave for at least half an hour. Drink 100 ml 4 times a day before meals.
• It is good to drink an infusion of blackcurrant leaves and rose hips during the day instead of tea.

Homeopathy

Homeopathic medicines are considered safe and cannot cause any serious side effects. They do not cause addiction, are not toxic and do not accumulate in the body.

In case of joint psoriasis, the main goal of homeopathic treatment is to eliminate the inflammatory process and pain, restore joint mobility, and prevent its destruction and curvature.

To treat joint psoriasis, you can take homeopathic mono-remedies:

• Graphite 6, three granules once every three days, in the morning;
• Apis 6 (Apis mellifica) one granule once every three days at night.

The listed medications are taken on different days.

In addition, the use of complex drugs is indicated:

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

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

Surgical treatment

In the vast majority of cases, patients with joint psoriasis do not undergo surgical intervention - there is simply no need for it. Surgery is prescribed only when no conservative methods bring relief to the patient.

One of the surgical intervention options is a procedure to restore the functionality of the affected joint – synovectomy.

In severe and advanced situations, joint arthroplasty or cartilage endoprosthetics is performed - a surgical intervention during which the affected tissues are replaced with artificial ones.

For many patients, surgical treatment allows restoring joint function, eliminating pain and deformation. Sometimes, surgical fixation of the cartilage of the wrist and ankle, as well as the fingers of the extremities, is practiced.

Prevention

There are no specific preventive measures to prevent the development of joint psoriasis. However, there are a number of general recommendations, the observance of which will eliminate many negative factors that could contribute to the development of the disease.

• It is necessary to protect joints, avoid overloads and injuries.
• You need to give up bad habits: do not abuse alcohol, do not smoke, do not eat fast food, and do not include large amounts of salt and sugar in your diet.
• It is important to monitor your body weight and avoid obesity: excess weight increases the load on the musculoskeletal system.
• Avoid allowing joints to become too cold.
• Regular vacations at seaside resorts are encouraged, as well as periodic use of medicinal mineral waters.

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Forecast

It is unlikely that psoriasis of the joints will be cured completely, but it is quite possible to bring the disease into a stable period of remission. Currently, all the appropriate drugs and methods are available for this.

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