Psoriatic arthritis (PR)

This rheumatism is associated in 90% of cases with skin or nail psoriasis (or familial).

But there is no parallelism between skin and joint disorders that are totally independent of each other.

Symptoms

Psoriatic arthritis is an Ankylosing spondylitis (AS)  because there is an involvement of enthesitis very often associated with synovial involvement. Clinically, this is manifested by inflammatory spinal pain but rather beginner cervical, talalgia, sternal pain, fingerlings (fingers or toes in sausage) and arthritis of the joints of the members more frequent than in ankylosing spondylitis ( SPA).

Diagnostic

An inflammatory syndrome is quite common on the blood test, there are no known autoantibodies. The genetic terrain is variable: HLA B 16-17 or 27. X-rays, normal at the beginning, will show in severe forms lesions of ankylosis of entheses and destruction of arthritis of the limbs. But again, the evolution by successive pushes is capricious and variable from one patient to another with risk of stiffness of the spine and deformities of the hands and feet.


Treatment

Psoriatic arthritis does not cure. The new drugs nevertheless make it possible to circumscribe most of the cutaneous and articular symptoms and to prevent erosion of the joints.


 Medical treatment


NSAIDs
In mild psoriatic arthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used to combat inflammation and pain. Note that these drugs do not stop joint erosion and have no effect on skin damage.
Background treatments
If more than one joint is affected, treatment with bottom-line is usually used. By intervening in certain processes of the immune system, they can slow the evolution of arthritis and prevent erosion of the joints. They act mainly on inflammation of the joints of the hands, elbows, knees and feet, as well as on tendonitis. Many background treatments also work well on skin symptoms (psoriasis), but are unfortunately almost ineffective for inflammation of the spine.
Biotherapy
Biotherapies are a new generation of background treatments used in severe forms of psoriatic arthritis (and when conventional background treatments are ineffective). These are complex protein substances made using costly technologies from genetically modified animal or plant organisms. Biotherapies are targeted in certain immune processes. In the case of psoriatic arthritis (and other forms of spondyloarthritis), they have an anti-inflammatory effect on the joints, tendons, spine and skin. Biotherapies are generally well tolerated.
Cortisone
Cortisone preparations are effective anti-inflammatories. They are injected directly into affected joints or tendon insertions (eg, in the elbow or heel). As part of a long-term treatment, cortisone is prescribed in tablet form. It often causes side effects such as osteoporosis, hypertension, high eye pressure, skin atrophy or diabetes.

Other measures
Mobilization
Sports and physical activities help prevent stiffening of the joints and preserve muscle mass. Heat, cold and ultrasound treatments are used to relax muscles and combat pain and inflammation. Targeted physiotherapy can strengthen periarticular structures, especially around the knee, hip and spine.
Food
As part of a varied diet, fish fats (omega-3 fatty acids) have a beneficial effect on joint inflammation. In contrast, alcohol can strengthen joint and skin symptoms.
Skin treatment
The range of dermatological treatments ranges from ointments and lotions applied locally to special biotherapies. In addition, certain products prescribed by the rheumatologist also act on the cutaneous symptoms of the disease. In addition, it is possible to treat the skin by exposing it to certain ultraviolet rays (puvatherapy).


Surgery

Surgery may be necessary in case of severe inflammations no longer responding to drug treatments and joints destroyed. The surgeon can remove the inflamed joint capsule (synovectomy) or place a joint prosthesis. In rare cases, it is necessary to block the spine in the region of cervical vertebrae affected.

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