Psoriatic arthritis

Classification according to ICD-10
M07 *	Arthritis psoriatica and arthritis in basic gastrointestinal diseases
M07.0 *	Distal interphalangeal arthritis psoriatic
M07.1 *	Arthritis mutilans
M07.2 *	Psoriatic spondylitis
M07.3 *	Other psoriatic arthritis
M09.0 *	Juvenile arthritis in psoriasis
L40.5 +	Psoriatic arthropathy
ICD-10 online (WHO version 2019)

Under psoriatic arthritis or Psoriasisarthropathie (Latin psoriatic arthritis or psoriatic arthropathy , and psoriatic arthritis ), short PSA , including arthritis in psoriasis called, an autoimmune inflammatory joint disease from the group of Spondyloarthritides understood that in some patients with the skin disease psoriasis (psoriasis) occurs and has some peculiarities compared to other rheumatic diseases .

Psoriatic arthritis is occasionally a diagnosis of exclusion , i.e. the assumption of the disease when other inflammatory joint diseases are not (convincingly) considered. This is especially the case if there are no skin changes in the sense of psoriasis, but psoriasis is known from a family history , for example .

Epidemiology

The prevalence of psoriatic arthritis is unknown despite numerous studies to this day. This is mainly due to the fact that there is no uniform evaluation standard for the reliable diagnosis of psoriatic arthritis.

The range is from 0.001% in a Japanese study to 0.42% in an Italian study. The German Society for Rheumatology eV gives the frequency as 0.05% to 0.3%, with an average of 0.2%. Both sexes are equally affected.

In 60% of cases, the skin symptoms precede the joint problems. 10% of psoriasis patients (up to 2% of the population) develop psoriatic arthritis.

The detailed causes of psoriatic arthritis are unknown, but it is an autoimmune disease. For as yet unexplained reasons, the immune system is activated against the body's own structures, and inflammation processes are set in motion in the joints. Medical research has yet to explain why between 1% and 48% of psoriasis sufferers develop psoriatic arthritis and others do not - and why the clinical picture progresses so differently from person to person. An influence of genetic factors is considered likely, but environmental factors such as bacterial infections or medication could also play a role.

Psoriatic arthritis shows an increased prevalence of the risk of diabetes mellitus and hypertension. On average, patients with psoriatic arthritis have a higher body mass index (BMI) compared to patients with psoriasis or rheumatoid arthritis or compared to the general population.

It can be assumed that psoriatic arthritis has an increased mortality compared to the general population.

clinic

All joints can be affected, but typically the end and middle joints on the hands and feet and large joints such as the knees and pelvic spine ( sacroiliac joints ). Often the disease is found in the joints of just one finger or toe ("infestation in the beam"). In contrast to rheumatoid arthritis, joint involvement is often asymmetrical, i.e. different joint regions are affected on the right and left halves of the body.

In addition, the soft tissues adjacent to the joints can also be affected, for example the tendons and tendon attachments, muscles and muscle attachments, bursa or ligaments.

The eponymous psoriasis of the skin or nails can also be present (see above).

laboratory

The disease is mostly "seronegative", which means that rheumatoid factors are usually missing . B. in rheumatoid arthritis are detectable. In contrast, ACPA (= antibodies against citrullinated proteins) are positive in up to 12% of cases. It also increases the likelihood that HLA-B27 is positive (up to 50% of cases).

treatment

Use is made of sulfasalazine , immunosuppressants (for. Example, methotrexate , leflunomide , cyclosporine A ) and a reserve agents in therapy resistance TNF blockers (eg. B. infliximab ), apremilast , ustekinumab and the IL-17A inhibitor Secukinumab .

literature

Wolfgang Miehle: Joint and spinal rheumatism. Eular Verlag, Basel 1987, ISBN 3-7177-0133-9 , p. 43.
Ludwig Heilmeyer , Wolfgang Müller: The rheumatic diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 309–351, here: pp. 331–333 ( special forms of chronic polyarthritis ).

Web links

Commons : Psoriatic Arthritis - Collection of Pictures, Videos, and Audio Files

Individual evidence

↑ Y. Alamanos, PV Voulgari, AA Drosos: Incidence and prevalence of psoriatic arthritis: a systematic review . In: J Rheumatol . tape 35 , no. 7 , 2008, p. 1354-1358 .
↑ ^a ^b ^c Eva-Maria Ziupa: Prevalence of psoriatic arthritis in dermatological patients with psoriasis . Ed .: Medical Faculty of the Eberhard Karls University of Tübingen. 2016.
↑ M. Catanoso, N. Pipitone et al.: Epidemiology of psoriatic arthritis. In: Reumatismo. Volume 64, No. 2, June 5, 2012, p. 66. PMID 22690382 .
↑ D. McGonagle, Z. Ash, L. Dickie, M. McDermott, SZ Aydin: The early phase of psoriatic arthritis. In: Annals of the rheumatic diseases. Volume 70, Suppl 1, March 2011, pp. I71-i76, doi: 10.1136 / ard.2010.144097 . PMID 21339224 (Review).

[1] Y. Alamanos, PV Voulgari, AA Drosos: Incidence and prevalence of psoriatic arthritis: a systematic review . In: J Rheumatol . tape 35 , no. 7 , 2008, p. 1354-1358 .

[:0-2] Eva-Maria Ziupa: Prevalence of psoriatic arthritis in dermatological patients with psoriasis . Ed .: Medical Faculty of the Eberhard Karls University of Tübingen. 2016.

[PMID22690382-3] M. Catanoso, N. Pipitone et al.: Epidemiology of psoriatic arthritis. In: Reumatismo. Volume 64, No. 2, June 5, 2012, p. 66. PMID 22690382 .

[PMID21339224-4] D. McGonagle, Z. Ash, L. Dickie, M. McDermott, SZ Aydin: The early phase of psoriatic arthritis. In: Annals of the rheumatic diseases. Volume 70, Suppl 1, March 2011, pp. I71-i76, doi: 10.1136 / ard.2010.144097 . PMID 21339224 (Review).