Traditional medicine

Psoriatic arthritis prognosis for life. Psoriatic arthritis - symptoms, photos, treatment and medications

Medical statistics indicate that it is one of the most frequently diagnosed skin diseases and accounts for 1-2% of them. In many patients with a sufficiently long history of psoriasis, the joints are also involved in the pathological process; this condition is called psoriatic arthritis. In the past, this disease was considered a special variant, acquiring individual characteristics under the influence of skin pathology. However, recently, serious differences have been discovered between rheumatoid and psoriatic arthritis, which has made it possible to distinguish the latter as an independent nosological entity.

In this article we will look at the symptoms and treatment of psoriatic arthritis.

Epidemiology of psoriatic arthritis

Psoriatic arthritis is diagnosed in approximately 5-7% of people suffering from psoriasis. The onset of the disease, as a rule, occurs at the age of 20-50 years, in some cases it develops even in childhood. This pathology occurs with equal frequency in both men and women.

Causes and mechanisms of development of psoriatic arthritis

Psoriatic arthritis accompanies skin rashes in 5-7% of patients with psoriasis.

The etiology of psoriatic arthritis coincides with that of psoriasis itself and is not completely known today. Scientists believe that the basis for the excessive proliferation of epidermal cells observed in psoriasis is a disruption of their biochemical processes, which is associated with an imbalance between a number of biologically active substances: cAMP, cGMP, prostaglandins and others. Some authors believe that multiplying cells synthesize a special substance, namely epidermopoietin, which induces cell division, which leads to hyperplasia.

And yet, one of the leading theories of the occurrence of psoriasis and psoriatic arthritis is genetic. It has been proven that people who have a psoriatic process are carriers of certain antigens of the HLA system; in addition, almost every patient with psoriasis has a close relative with the same diagnosis. Individuals with this genotype feature are predisposed to psoriasis. When they are exposed to any unfavorable external factors, in particular stress, trauma, infectious agents, especially in combination with general or local disorders in the immune system, a malfunction occurs in the body, namely, a number of biochemical reactions characteristic of psoriasis are triggered.

Autoimmune disorders undoubtedly play a role in the pathogenesis of psoriasis and psoriatic arthritis, that is, the body produces antibodies to its own cells. Proof of this is the elevated levels of gammaglobulins, IgA, IgM and IgG, streptococcal antibodies, antibodies to skin antigens and other immunological indicators found in the blood.

Symptoms of psoriatic arthritis

In 68-75% of cases, arthritis develops in patients who have suffered from psoriasis for 2-10 years, less often it occurs simultaneously with the first skin manifestations, and sometimes articular syndrome even precedes the appearance of signs of skin pathology.

Arthritis usually debuts imperceptibly, gradually progressing, but in some cases the onset of the disease can be acute.

There are 5 types of joint damage in psoriatic arthritis:

Arthritis that affects the distal (those closest to the periphery) interphalangeal joints;
Monoligoarthritis (i.e., only 1-2-3 joints are affected);
Polyarthritis of the rheumatoid type;
Arthritis mutilans;
Spondyloarthritis (chronic inflammation of the spine, leading to decreased mobility in the joints of the lumbosacral region up to ankylosis).

Arthritis affecting the distal interphalangeal joints

The first type - inflammation of the distal interphalangeal joints of the feet and hands - is classic in psoriatic arthritis. At the beginning of the disease, one or more joints are affected; as it progresses, the rest are also involved in the process, and multiple lesions are observed. The skin over the affected joints is bluish or purplish. The joints are swollen (on palpation, this swelling is very dense), painful. The end joints change shape as the disease progresses, which, combined with the specific coloring of the skin over them, gives them a radish-like appearance. In addition, the pathological process with this type of arthritis usually involves the nails: they are dried out, peel, and break.

A pathognomonic sign (i.e., characteristic exclusively of a given disease) of psoriatic arthritis is a wasp-shaped deformation of the fingers. It occurs when 3 - distal, proximal interphalangeal and metacarpophalangeal - joints of one finger are simultaneously affected, up to their ankylosis (complete fusion with an absolute absence of movements in them) and is called “axial” damage.

Mutilating form of arthritis

The mutilating form of arthritis, fortunately, is quite rare, occurring in only 5% of patients. This is a severe inflammation of the joints, leading to their rapid destruction, osteolysis. Externally, the fingers are shortened, curved, and have the appearance of a folding telescope - if desired, you can straighten them “manually” to their original length (so-called telescopic fingers). Examination reveals multiple subluxations and ankylosis of the affected joints. These changes are always asymmetrical and disordered - on the same hand, the axes of the fingers are shifted in different directions, there are both flexion and extension contractures of the joints.

The variants of joint damage described above, although they are classic for the disease we are describing, are found only in 5-10% of people suffering from psoriasis. In 7 out of 10 patients, inflammation of one or two large joints is detected - knee, ankle, hip. In 15% of patients, involvement in the pathological process of more than 3 joints, of absolutely any location, is diagnosed. Polyarthritis can be either asymmetrical or occur equally on both sides, reminiscent of the clinical picture of rheumatoid arthritis.

Spondyloarthritis

Sometimes, in 5% of cases, psoriatic arthritis occurs as ankylosing spondylitis (ankylosing spondylitis).

This pathology is often accompanied by eye damage - as a rule, iritis and episcleritis are diagnosed. If ulcerative lesions of the genital organs and oral mucosa are also detected, the patient is diagnosed with Reiter’s disease.

In the case of a malignant course of psoriatic arthritis, internal organs may also be involved in the pathological process. As a rule, this phenomenon is observed in young (under 35 years of age) men suffering from an atypical form of psoriasis. Patients complain of alternating sharp rises and sudden drops in temperature (the so-called hectic fever), accompanied by tremendous chills and severe sweating. They quickly lose weight, hair actively falls out, muscles atrophy, bedsores and trophic ulcers form on the skin, regional lymph nodes, especially inguinal ones, increase in size. Damage to the heart occurs according to the following type: it is enlarged in size, the heart rate is increased; during auscultation (listening with a phonendoscope), a weakening of the first tone and systolic murmur are determined; The ECG also reveals diffuse changes in the myocardium. The liver is also affected and hepatolienal syndrome develops. In some cases, the kidneys are affected with the development of diffuse glomerulonephritis, and subsequently renal amyloidosis. With a particularly malignant course of psoriatic arthritis, the central nervous system is also involved in the pathological process - epileptic seizures and polyneuritis develop.

Diagnostically important signs of psoriatic arthritis. This:

pain and swelling of the distal interphalangeal joints of the hands and feet;
pain and swelling of 3 joints of the same finger - both hands and feet;
asymmetric mono- or oligoarthritis;
night or early morning deep pain in the sacral area;
pain in the heel area;
the presence of areas on the skin characteristic of psoriasis;
Looking ahead, we note a negative rheumatoid factor, an increased ESR and characteristic changes on the x-ray of the affected joints.

Diagnosis of psoriatic arthritis

Based on complaints, medical and life history data (the presence of psoriasis in the patient being examined is especially important), and the results of an objective examination of the patient, the doctor will determine a preliminary diagnosis of psoriatic arthritis. To confirm it, you will need to conduct a number of laboratory and instrumental studies, namely:

general blood test (the blood will respond to severe inflammation in the joints by increasing the ESR to 30 mm/h or more; an increase in the level of leukocytes, a decrease in hemoglobin and red blood cells can also be determined with a normal value of the color index (that is, normochromic anemia);
blood test for rheumatoid tests, in particular, determination of rheumatoid factor (in this pathology it is negative, that is, it is not detected or absent in the blood) and C-reactive protein (it is detected in large quantities);
biochemical blood test (increased content of gammaglobulins, determined by IgA, IgG or IgM);
analysis of synovial (intra-articular) fluid taken by joint puncture (high cytosis is determined, that is, a large number of cells, with the presence of many neutrophils, the fluid viscosity is low, the mucin clot is loose);
radiography of the affected joints and/or spine (at the initial stage of the disease, areas of osteoporosis and osteosclerosis (replacement of bone tissue with connective tissue) are identified in the image); at the stage of moderate lesions, narrowing of the joint spaces is visualized, both in the joints of the fingers and in the intervertebral joints, sacroilial joints (sacrum with the iliac bones) are also narrowed; at the late, advanced stage of the disease, there are no gaps between the articular surfaces in the affected joint, ankylosis is determined; in the mutilating type of joint damage, the articular surfaces and adjacent areas of the bone are completely destroyed).

In 1989, the Institute of Rheumatology of the Russian Academy of Medical Sciences developed diagnostic criteria, according to which the likelihood of psoriatic arthritis is determined by the number of points awarded during the testing process. The table of scores corresponding to certain criteria is presented below.

Diagnostic criterion	Point
Presence of psoriatic rashes on the skin	+5
Psoriasis of the nail plates	+2
Skin psoriasis diagnosed in a close relative	+1
Inflammation of the distal interphalangeal joints	+5
Axial joint damage	+5
Subluxations of the fingers of the upper extremities, directed in different directions	+4
Chronic asymmetric arthritis	+2
Blue or purplish coloration of the skin over the inflamed joints, mild pain	+5
Sausage shaped toes	+3
Skin and joint syndrome are determined simultaneously	+4
Pain and stiffness in the morning in the spine for the last 3 months	+1
Rheumatoid factor negative	+2
Bone destruction at the apex (acral osteolysis)	+5
Lack of mobility (ankylosis) of the distal interphalangeal joints of the hand or metatarsophalangeal joints of the feet	+5
Signs of sacroiliitis on a radiograph	+2
Bone growths along the edges of the joint spaces of the intervertebral joints: paravertebral ossifications	+4

Classic psoriatic arthritis is diagnosed if the score is 16 or more. With a score of 11-15, definite psoriatic arthritis is diagnosed. If the score is 8-10, psoriatic arthritis is probable, and if the score is 7 points or less, this diagnosis is rejected.

Differential diagnosis for psoriatic arthritis

Since this disease does not always occur in the classical form, one should be able to distinguish it from a number of other rheumatological diseases. Typically, differential diagnosis is carried out with:

rheumatoid arthritis;
ankylosing spondylitis;
Reiter's disease;

Treatment of psoriatic arthritis

The patient will be prescribed injections of anti-inflammatory and painkillers.

Therapeutic measures should be aimed not only at treating articular syndrome, but also at influencing the skin psoriatic process.

Treatment of skin manifestations of the disease is usually carried out by a dermatologist, and therapeutic measures include ultraviolet irradiation, local use of hormonal ointments, systemic intake of vitamins, etc.

As for arthritis itself, drugs from the following pharmacological groups can be used to eliminate the inflammatory process in the joints:

intra-articularly (inside the joint) - Depo-Medrol, hydrocortisone, Kenalog, etc.
long-term course - meloxicam, celecoxib, nimesulide, diclofenac, indomethacin, piroxicam.
Basic drugs in the case of rheumatoid-like, polyarticular, mutilating forms of psoriatic arthritis: sulfasalazine, gold preparations (Tauredon, Crizanol), cytostatics (Methotrexate).
Systemic enzyme therapy drugs – Wobenzym, Phlogenzyme.

Efferent methods, such as plasmapheresis, can also be used as part of the complex treatment of arthritis.

Non-drug treatments for psoriatic arthritis may include:

therapeutic exercises;
physiotherapy (ultrasound with hydrocortisone on the area of affected joints, paraffin baths);
balneological treatment (hydrogen sulfide and radon baths);
treatment at the resorts of Sochi, Talgi, Naftalan.

In the case of persistent synovitis (inflammation of the synovial membrane of the joint) that cannot be treated with drugs, as well as in cases of severe changes in the joints that impair the patient’s functional activity, surgical treatment may be recommended, but the results are not always good and long-term.

The criteria for the effectiveness of treatment are normalization or reduction in the severity of clinical syndromes of the disease: skin, joint and others; normalization of hematological indicators of process activity: ESR, leukocytes, C-reactive protein, immunoglobulins; slowing down the progression of the disease, determined on x-rays.

Prognosis for psoriatic arthritis

The course of the disease is unpredictable in most cases. Sometimes it is benign, and in some cases it is aggressive and in a short time the inflammation leads to destruction of the joint. The prognosis is determined individually, depending on the frequency and severity of exacerbations, the timeliness and adequacy of the prescribed treatment, and the duration of medication use.

As the name implies, psoriatic arthritis combines two diseases – rheumatoid arthritis and psoriasis. The inflammatory process affects human joints and is currently the most severe form of psoriasis. The prevalence of the disease among the world's population is low. According to experts, psoriatic arthritis, the symptoms of which can appear only in late stages, is common mainly among patients with psoriasis (from 7 to 47%). Ordinary people suffer from the inflammatory process much less frequently (the disease is recorded in 2-3% of the population).

The insidiousness of psoriatic arthritis is manifested in the fact that it can be absolutely painless. As a result, in the vast majority of cases the disease is detected too late, when adverse changes in the joints are already irreversible. This means that with a timely diagnosis of psoriatic arthritis, treatment should be prescribed as early as possible, which will avoid serious consequences and complications. Methods for early detection of the inflammatory process are standard: careful monitoring of the body, response to known symptoms, regular examination by a rheumatologist.

All standard preventive measures that are important for other orthopedic diseases have no effect in the case of psoriatic arthritis, since doctors do not know the exact cause of the inflammation. This means that the main way to combat the disease remains the so-called secondary prevention, which is aimed at slowing the spread of pathology and preserving the basic functions of the joints.

Unfortunately, no clinic in the world can still guarantee one hundred percent relief from this unpleasant disease. At this point in time, researchers are just beginning to understand the mechanisms of the body’s immune system. It is possible that in a few years an effective cure will be found, but for now, when diagnosed with psoriatic arthritis, treatment continues to rely on ineffective drugs that suppress the body’s overly strong immune reactions. Accordingly, sick people continue to suffer from the gradual destruction of soft tissues and joints. Many of the patients become disabled for life.

Psoriatic arthritis - symptoms and clinical picture

The most characteristic signs of inflammation are the appearance of red, flaky spots on the skin, changes in the pigmentation of nails on the toes and hands, and the formation of small scars resembling pockmarks. Psoriatic plaques are small in size, but they quickly spread throughout the body, and this process is accompanied by unpleasant itching and a constant feeling of discomfort. As mentioned above, when diagnosed with psoriatic arthritis, symptoms can appear very late, so every person needs to be regularly examined by a rheumatologist and monitor the condition of their body. An indirect sign of the presence of an inflammatory process is pain in the joints and their swelling, however, they are also characteristic of ordinary rheumatoid arthritis, therefore, in case of any unpleasant sensations, it is necessary to consult a specialist to eliminate the risk of severe complications.

Psoriatic arthritis - treatment and prognosis

There is no specific method for treating joint inflammation, so all efforts of doctors are aimed at restoring lost functions and relieving severe pain. The following groups of drugs are used for this:

non-steroidal anti-inflammatory drugs, in particular ibuprofen. Such drugs reduce joint stiffness, relieve pain, and suppress the development of inflammation. However, they have a negative effect on the intestines, kidneys, heart and gastric mucosa, so they should be taken with caution;
glucocorticoids - used in cases where psoriatic arthritis is accompanied by severe, sharp pain in the joints;
basic medications – reduce pain and inflammation, prevent the spread of the disease to other joints. Drugs in this group act very slowly, so the effect of their use becomes noticeable several weeks after the start of treatment;
immunosuppressive drugs - partly suppress the immune system, but relieve healthy tissues from the “attack” of our own body, which, in fact, happens with psoriatic arthritis. The most well-known immunosuppressive drugs are cyclosporine and azathioprine.

Surgical intervention is practically not used in the treatment of psoriatic arthritis. It is resorted to only in cases where the disease continues to spread, despite taking medications, and threatens to spread to healthy joints.

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The degree of activity characterizes the inflammatory process both in the joints and in other organs and systems and is determined according to the criteria proposed for rheumatoid arthritis.

I. The minimum degree of activity is manifested by minor pain when moving. There is no morning stiffness or its duration does not exceed 30 minutes. ESR is not increased (no more than 20 mm/h), body temperature is normal. Exudative manifestations in the joint area are absent or slightly pronounced. No other inflammatory symptoms are detected.

II. A moderate degree of activity involves pain at rest and with movement. Morning stiffness lasts up to 3 hours. Moderate, unstable exudative symptoms are detected in the joint area. ESR within 20-40 mm/h, significant leukocytosis and band shift. Body temperature is often subfebrile.

III. The maximum degree of activity is characterized by severe pain at rest and during movement. Morning stiffness lasts more than 3 hours. Severe exudative phenomena are observed in the area of periarticular tissues. ESR is above 40 mm/h. High body temperature. Significant increase in the level of biochemical laboratory parameters (sialic acids, SRV, fibrinogen, etc.). The development of remission of the inflammatory process is possible, especially with the monooligoarthritic variant of the articular syndrome and limited vulgar psoriasis.

Laboratory indicators. Laboratory changes when psoriatic arthritis are nonspecific and reflect the degree of activity of the inflammatory process. With a moderate and maximum degree of inflammatory activity, anemia, accelerated ESR, leukocytosis are determined, the appearance of SRV is noted, dysproteinemia with an increase in globulins due to α- and γ-fractions, etc. In 20% of patients, hyperuricemia is determined, which shows the severity of skin changes and almost never accompanied by clinical symptoms of gout. In 5-10% of cases of psoriatic arthritis, a positive test for RF is detected in small (not higher than 1/64) titers.

In patients with osteolytic variant of joint damage a violation of the aggregation properties of erythrocytes is detected, leading to an increase in blood viscosity and a decrease in hematocrit).

In case malignant form of psoriatic arthritis very pronounced deviations from the norm of nonspecific signs of inflammation and significant changes in immunological parameters are revealed: hypergammaglobulinemia above 30%, an increase in the concentration of immunoglobulins of classes A, G and E, circulating immune complexes, the appearance of nonspecific (antinuclear factor, rheumatoid factor) and specific (to the cells of the horn and granular layers of the epidermis) antibodies, etc. When examining the synovial fluid, high cytosis is detected (up to 15-20 x 104 / ml) with a predominance of neutrophils. The mucin clot is loose and disintegrating.

X-ray signs of psoriatic arthritis. The X-ray picture of psoriatic arthritis has a number of features. Thus, osteoporosis, characteristic of many joint diseases, in the case of psoriatic arthritis is detected only in the mutilating form. Psoriatic arthritis is characterized by the development of erosive changes in the area of the distal interphalangeal joints. Erosion, having formed at the edges of the joint, subsequently spreads to its center. In this case, the apices of the terminal and middle phalanges are worn down with simultaneous thinning of the diaphyses of the middle phalanges, and the second articular surface is deformed in the form of a concavity, which creates the radiological symptom “pencils in a glass”, or “cup and saucer”.

X-ray of fingers with psoriatic arthritis

Pathognomonic for psoriatic arthritis is the development of an erosive process with ankylosis in several joints of the same finger (“axial lesion”). Characteristic radiological signs are proliferative changes in the form of bone growths around bone erosions at the base and apex of the phalanges, as well as in the area of attachment of ligaments, tendons and joint capsules to the bones (periostitis). Osteolysis of the bones that make up the joint is a distinctive feature of the mutilating form of psoriatic arthritis. Not only the epiphyses are subject to resorption, but also the diaphyses of the bones of the joints involved in the pathological process. Sometimes the lesion affects not only all the joints of the hands and feet, but also the diaphyses of the bones of the forearm.

X-ray signs of psoriatic spondylitis appear in the form of vertebral and paravertebral asymmetrical rough ossifications, creating the “jug handle” symptom, ankylosis of the intervertebral joints. Sometimes X-ray changes in the spine do not differ from those characteristic of ankylosing spondylitis. Sacroiliitis in psoriatic arthritis is often asymmetrical (one-sided). If bilateral changes are noted, they usually have varying degrees of severity.

However, the development of sacroiliitis, similar to that of ankylosing spondylitis, is possible.

Radiologically, the stage of damage to peripheral joints is determined according to Steinbrocker, and the sacroiliac joints - according to Kellgren. If spondyloarthritis is present, its signs are indicated (syndesmophytes or paraspinal ossifications, ankylosis of intervertebral joints).

The degree of functional insufficiency of the joints and spine is assessed according to the principle accepted in domestic rheumatology. There are three degrees of joint dysfunction depending on the preservation or loss of the ability to carry out professional activities and self-care.

Various forms of psoriatic arthritis comprehensively reflect the main features of the pathological process, the degree of its severity, the degree of progression of osteochondral destruction, the presence and severity of systemic manifestations, the functional state of the musculoskeletal and other body systems.

The severe form is characterized by generalized arthritis, ankylosing spondylitis with severe spinal deformity, multiple erosive arthritis, lysis of the epiphyses of bones in two or more joints, functional failure of the joints of degree II or III, severe general (fever, exhaustion) and visceral manifestations with dysfunction of the affected organs, progressive course of exudative or atypical psoriasis, maximum degree of activity of the inflammatory process for three consecutive months or more. Diagnosis of this form requires the presence of at least two of the above symptoms.

The usual form is characterized by inflammatory changes in a limited number of joints, the presence of sacroiliitis and (or) damage to the overlying parts of the spine, but without its functional failure, destructive changes in single joints, a moderate or minimal degree of activity of the inflammatory process, a slowly progressive course, systemic manifestations without functional failure organs, limited or widespread vulgar psoriasis.

The malignant form develops exclusively in young men (under 35 years of age) with the presence of pustular or erythrodermic psoriasis. It is characterized by a particularly severe course with prolonged hectic fever, rapid loss of body weight to cachexia, generalized arthritis with a pronounced exudative component, spondyloarthritis, generalized lymphadenopathy and numerous visceritis. This form of psoriatic arthritis is difficult to treat, is characterized by a paradoxical reaction to anti-inflammatory therapy (including glucocorticosteroids) and an extremely unfavorable prognosis, often ending in death.

Psoriatic arthritis in combination with diffuse connective tissue diseases, rheumatism, Reiter's disease, gout. Combined forms of the disease are rare, but the rarest option is the combination of psoriatic arthritis with systemic lupus erythematosus.

Examples of clinical diagnoses:

Psoriatic arthritis, polyarthritic variant with systemic manifestations (renal amyloidosis, end-stage renal failure), severe form. Widespread psoriasis vulgaris, progressive stage. Activity III. Stage III. Functional joint insufficiency degree II.
Psoriatic arthritis, spondyloarthritic variant with systemic manifestations (aortitis, left-sided anterior uveitis), severe form. Palmoplantar pustular psoriasis, progressive stage. Activity III. Stage II B. Bilateral sacroiliitis stage IV, multiple syndesmophytosis. Functional insufficiency of joints of the III degree. Palmoplantar pustular psoriasis, progressive stage.
Psoriatic arthritis, distal variant, without systemic manifestations, usual form. Activity II. Stage III. Functional joint failure of the first degree. Limited vulgar psoriasis, stationary stage.

Diagnostics. Psoriatic arthritis has a number of distinctive features, which were grouped into diagnostic criteria by D. Mathies back in 1974 and remain relevant to this day.

Diagnostic criteria for psoriatic arthritis (Mathies D., 1974):

Damage to the distal interphalangeal joints of the fingers.
Simultaneous damage to the metacarpophalangeal (metatarsophalangeal), proximal and distal interphalangeal joints, “axial damage”.
Early damage to the joints of the feet, including the big toe.
Heel pain (subcalcaneal bursitis).
The presence of psoriatic plaques on the skin or changes in the nails typical of psoriasis (confirmed by a dermatologist).
Psoriasis in close relatives.
Negative reactions to the Russian Federation.
Characteristic radiological findings: osteolysis, periosteal overlays. Absence of epiphyseal osteoporosis.
Clinical (usually radiological) symptoms of unilateral sacroiliitis.
X-ray signs of spondylitis are rough paravertebral ossifications.

Diagnostic rule: the diagnosis is reliable if three criteria are present, one of which must be 5th, 6th or 8th. In the presence of the Russian Federation, five criteria are required, among which the 9th and 10th must be present.

Joint diseases
V.I. Mazurov

The development of arthritis is promoted not only by processes directly affecting the joints - degenerative diseases, injuries, congenital dysplasia, hereditary predisposition, surgery, etc.:

There are countless reasons, as they say... But not everyone knows that there is another type of arthritis - psoriatic.

Causes of psoriatic arthritis

The connection of this inflammatory joint disease to dermatosis is obvious from the name, as is the fact that treatment should be aimed at eradicating psoriasis.

Due to the fact that the etiology of psoriasis itself is controversial, psoriatic arthritis is one of the most mysterious, incomprehensible and intractable diseases.

Psoriasis is not an infectious disease; there are two main concepts of this disease.

In the first, the dermatous factor predominates:
- Due to the impaired function of the epidermis and keratinocytes, the proliferation (division) of skin cells increases.
In the second, decisive primary importance is given to autoimmune factors:
- activation of T-lymphocytes and their penetration into the skin, which causes inflammation and excessive division of the epidermis.

Viral factors in the pathology are also suspected, but they have not been proven.

The immune concept is supported by the fact that psoriasis responds well to treatment with drugs that suppress the immune system - immunosuppressants.

For this reason, psoriatic arthritis most closely resembles rheumatoid arthritis. It is also a chronic and virtually incurable disease.

Disease factors

Can trigger psoriatic arthritis

stress,
alcohol consumption,
accidentally acquired infection.

Any disease that occurs against the background of a chronic disease is intercurrent, that is, it accelerates the underlying disease.

Psoriatic arthritis usually follows psoriasis, but in some cases it can be the other way around:

First there are inflammatory symptoms in the joints, and then dermatic ones.

10 to 15% of psoriasis patients develop psoriatic arthritis.

Psoriasis is a dermatosis that cannot be confused with anything:

Areas of skin thicken and rise above the rest of the surface.
Red psoriatic plaques with silvery-white inclusions appear in the affected areas.
Scaly exfoliation of the skin is also characteristic, which is why the second name for this dermatitis is lichen planus.
A pustular form of the disease is possible with the formation of fluid-filled blisters protruding on the skin.
Sometimes in its most severe form, over 10% of the skin of the body is affected, including the scalp. The nails may also be affected.

In the photo on the right is a patient with psoriasis.

The disease causes a lot of physical and moral torment:

In addition to itching and discomfort associated with vigorous activity, wearing clothes, and self-care, depression, social phobia, and self-doubt also manifest themselves.

Psoriasis is fraught with complications such as:

diabetes, fungal infection, hypertension, hypothyroidism and other diseases.

Symptoms of psoriatic arthritis

Psoriatic arthritis mainly affects the small joints of the hands - the distal phalanges of the fingers, causing dalactitis - swelling in volume.
Possible damage to the big toe;
Severe damage to the knee, hip and vertebral joints also occurs, which sometimes leads to a complete inability to move independently.

When the patient becomes completely bedridden, the life prognosis sharply worsens: bedsores or pneumonia bring a tragic end closer

Other distinctive symptoms:

asymmetry of the lesion;
purplish-bluish color and pain in the joints;
possible heel pain;
in the late stage of PA, the muscles atrophy and the limbs become thinner.

How to treat psoriatic arthritis

Diagnosis and treatment of psoriatic arthritis are carried out by a rheumatologist. Treatment of PA can be symptomatic and basic.

Diagnostics of PA

To differentiate psoriatic arthritis from rheumatoid arthritis, it is necessary to take a blood test for rheumatoid factor.
Due to serious skin manifestations, a parallel examination by a dermatologist is necessary to determine the type of psoriasis and prescribe local treatment.
X-rays of the joints affected by arthritis and possibly the spine are taken.
Other laboratory tests may be needed.

Symptomatic treatment of psoriatic arthritis

For symptoms of pain, NSAIDs are traditionally used - non-steroidal anti-inflammatory drugs (naproxen, ibuprofen, meloxicam).
Along with the joints, the skin is also treated, so local NSAIDs (ointments, gels) can be beneficial by reducing skin eczema.
If the arthralgia is too severe, then prednisolone, a glucocorticosteroid drug (GCSP), is prescribed for a short course: it is administered intramuscularly or directly into the joint cavity, or oral administration (in tablet form) is also possible.

When taking both NSAIDs and GCSPs, you need to be careful and protect the gastric mucosa with protectors.

Long-term use of steroids can lead to joint deterioration.

Basic treatment of PA

Psoriatic arthritis, like rheumatoid arthritis, is treated with immunosuppressive drugs that reduce the activity of the immune system:
- sulfasalazine,
- methotrexate,
- cyclosporine,
- azathioprine.

The use of certain drugs that regulate immune activity leads to decreased immunity and an inability to resist simple viral infections.

Another treatment option is to directly target the inflammatory cytokine TNF-α by blocking it. For these purposes, three types of drugs, monoclonal bodies, are used:
- Infliximab, etanercept, adalimumab.
The newest drug for the treatment of psoriatic arthritis, the phosphodisterase inhibitor Otezla (apremilast), simultaneously treats skin and joint manifestations. It is used when it is impossible to use traditional immunosuppressants.
Also used in the treatment of psoriatic inflammatory joint disease, chrysotherapy (treatment with gold salts);
In particularly severe cases, psoriatic arthritis is treated by blood purification using plasmapheresis.

Treatment of psoriatic arthritis is often toxic, so it is necessary to choose the least harmful and at the same time effective method.

Phototherapy

To treat skin dermatosis, not only medicinal ointments are used, but also types of UV irradiation:

UV-B irradiation (phototherapy).
UV-A irradiation + chemical photosensitizers (photochemotherapy).

The next step, if phototherapy does not lead to anything, is systemic drug therapy (orally or by injection)

Psychotherapy

Due to cognitive behavioral disorders, patients with psoriasis need serious psychotherapy:

Psychotropic drugs (antidepressants, anxiolytics) reduce anxiety and depression and increase stress resistance.
Tricyclic antidepressants, such as amitriptyline, are also antihistamines that reduce itching.
Duloxetine and venlafaxine also relieve pain.

When choosing antidepressants for psoriasis, you need to be very careful, since some of them, for example, serotonergic ones, aggravate the disease.

Treatment of psoriatic arthritis at home

Many people are interested in how to treat psoriatic arthritis at home. Of course, it is impossible to cure such a complex disease solely at home. The main therapy is complex and is carried out in a clinic.

Psoriasis is prone to attacks, but it can also recede for a long time. It is good during such retreats (remissions) not to sit idly by, but to continue and even intensify the fight against the disease.

Therapeutic gymnastics

Psoriatic arthritis greatly weakens muscles, so it is important to maintain yourself with daily exercise.

It shouldn't be too tiring or stressful.
Aerobics, swimming and walking help a lot.

Nutrition for psoriatic arthritis

Nutrition should be rational, based on an alkaline diet:

less meat, fish products, eggs, milk, butter;
more plant foods (lemon, kiwi, pears, apples, asparagus, celery, parsley, seaweed, carrots, dried fruits, nuts, papaya, pineapple, etc.);
natural fresh juices

Traditional methods

The following herbal teas and infusions can slow down the development of the disease:
- lingonberry tea;
- dandelion tea;
- tea from the collection (blackberry, heather, birch leaves, coltsfoot)
- St. John's wort decoction.
Skin dermatosis and joint pain are best treated at home using baths:
- Chamomile, coniferous.
Compresses made from flaxseeds, wraps with burdock, cabbage, and coltsfoot leaves help well.

With long-term and proper treatment at the doctor and at home, and prevention of infections, it is possible, if not to defeat psoriatic arthritis, then to come to a peaceful agreement with it for a long time.

In the understanding of most people, psoriasis is a disease of the skin only. In fact, such a judgment is a fallacy. Undoubtedly, its main manifestation is represented by pathological changes in the skin in the form of redness and peeling. But psoriasis is based on immune disorders in the body. Therefore, very often this disease manifests itself in different clinical forms. One of them is psoriatic arthritis, which is an inflammatory disease of the joints. It will be discussed in this article.

Why does this happen

Scientists have found that the triggers for psoriasis are immune processes. Consequently, the problem does not arise in a specific area of the skin, but in the internal environment of the body. Against this background, there is a potential threat of damage to any tissue, in particular, hyaline cartilage and the synovium of large and small joints. Such an atypical course of psoriasis in the form of arthritis can be provoked by:

psycho-emotional factors and stress;
excessive exposure of the skin to sunlight and radiation;
infectious lesions of the skin and subcutaneous tissue;
immunodeficiency conditions, including HIV infection;
alcohol and tobacco abuse;
imbalance of blood hormonal balance;
traumatic injury (bruises, intra-articular fractures, ruptures and sprains, etc.);
the influence of certain medications.

All these factors cause an increase in immune imbalance in the body with the spread and generalization of psoriatic inflammation. First of all, tissues with a powerful microvasculature are affected. Joint elements are one of them.

Important to remember! Psoriatic arthritis occurs exclusively in patients with psoriasis. This means that in a person without signs of psoriatic rash, such a diagnosis cannot be made. The exception is cases of primary manifestation of psoriasis not from a skin lesion, but from an articular lesion. But these symptoms will definitely overlap each other!

How to suspect and identify a problem

The first symptoms of psoriatic arthritis may include pain, swelling, redness, decreased mobility, and deformity of certain joints. Depending on this, the disease has a different course, which determines its clinical type:

Asymmetric arthritis. It affects different joint groups on opposite sides. For example, the hip and hand joints on the left combined with inflammation of the knee joint on the right.
Symmetrical arthritis. It is characterized by the involvement of identical joints on both sides in the inflammatory process (for example, the ankle joints on the left and right).
Arthritis predominantly affecting small joint groups. This form of pathology is characterized by the greatest severity of inflammation in the joints of the hand or feet.
Psoriatic spondylosis is an inflammatory lesion of the spinal column.
Deforming form. Characterizes an extremely severe stage of the pathological process in the joints. Accompanied by their destruction and deformation.
Psoriatic polyarthritis and monoarthritis. In the first clinical variant of the disease, several articular groups are affected in an asymmetric or symmetrical manner. With monoarthritis, only one of the large joints is inflamed (knee, hip, ankle, shoulder, elbow).

Diagnosis of psoriatic arthritis is based on clinical, laboratory and instrumental data. The most indicative is the study of rheumatic tests (increased levels of C-reactive protein, sialic acids, seromucoid). Visual changes in the joints are determined during an x-ray examination. In case of inflammation of large joints, for the purpose of differential diagnosis, a puncture is performed to collect intra-articular fluid for analysis. By its nature and cellular composition, one can judge the approximate nature of the inflammation (exclude purulent process, gout, blood accumulation, etc.).

Important to remember! If patients with psoriasis develop symptoms of inflammation of any joints, this may be a signal of progression of the disease in the form of psoriatic arthritis. At the same time, the number of rashes may increase or signs of damage to internal organs may appear!

Although ICD-10 (the international classification of diseases, tenth revision) has a separate code for a disease such as psoriatic arthritis, such a diagnosis is extremely rarely made as an independent diagnosis.

Drug therapy

Treatment of psoriatic arthritis requires a comprehensive approach. This means that it should include medications in two directions: for the treatment of psoriasis and for the relief of inflammation in the joints. Some of them belong to the same pharmacological groups. They stop pathological processes in the skin and hyaline cartilage to the same extent.

The main directions of therapy are as follows.

Potent anti-inflammatory glucocorticoid therapy

Drugs in this group are among the basic ones in the treatment of psoriasis and arthritis of various origins. The tactics of using glucocorticoids is determined by the degree of inflammation activity:

Psoriatic polyarthritis with severe inflammatory changes in the joints in combination with or without exacerbation of psoriasis - treatment using pulse therapy with drugs based on methylprednisolone (Metypred, methylprednisolone, Cortinef), dexamethasone or prednisolone. Doses of these medications should be as high as possible to suppress inflammation.
Psoriatic arthritis with mild inflammatory changes in one or more joints of the limbs or spine. The use of hormones in moderate therapeutic doses by injection or tablet administration is indicated.

Treatment with non-steroidal anti-inflammatory drugs

Does not affect the course of psoriasis, but reduces inflammatory changes in the joints. Both older generation drugs (diclofenac, ortofen, nimesil) and selective new drugs (meloxicam, movalis, rheumoxicam) are used.

Use of cytostatics

Treatment with drugs of this group is used exclusively in the case of psoriatic polyarthritis occurring against the background of widespread psoriasis. The criterion for the need to use cytostatics is damage to internal organs. The most commonly used drug is called methotrexate.

Manipulation of affected joints

Treatment is represented by two types of influences:

Immobilization. Inflamed joints must be fixed in their normal anatomical position. Eliminating movements in them during the period of exacerbation of the process will significantly reduce the treatment time. Plaster splints and orthoses are suitable for immobilization.
Intra-articular administration of drugs. Short-acting or long-acting glucocorticoids (hydrocortisone, Kenalog, Dipospan) can be injected into large joints. Sometimes they resort to the introduction of cytostatics (methotrexate).

Exercise therapy and therapeutic exercises

Prescribed from the first days of illness. Its purpose is to ensure that, against the background of immobilization of the joint, the remaining segments of the limb continue to move. As the process stops, gradual development of the diseased joint begins.

Important to remember! With psoriatic arthritis, it is unacceptable to try to defeat the disease on your own, using only folk remedies. Refusal of timely comprehensive treatment will lead to the progression of the disease or its spread to several joints!

Possibilities of traditional medicine

Psoriatic arthritis, like any chronic disease, cannot always be successfully treated with medication. Patients who have lost hope of recovery are looking for any alternative methods that can be used to treat this disease. Usually folk treatment and alternative medicine come to the rescue. Of course, such methods have a right to life, but you should not rely only on them. It is best to combine drug treatment with folk remedies.

Here are some effective recipes:

Raw carrots as a compress on the affected joint. To prepare it, you need to finely grate one medium-sized carrot. Add five drops of turpentine and any vegetable oil to the carrot puree. After thorough mixing, the resulting mass is laid out on gauze, which is used to wrap the sore joint. The duration of the compress is about 8 hours (can be done overnight).
Aloe lotions. Prepared in a similar way to a carrot compress. The only difference is in the main ingredient: aloe is used instead of carrots. It is best to alternate with carrot compresses.
Tincture based on lilac buds. Raw materials are harvested in the spring. The required number of buds per serving of tincture is 2 cups. Fresh buds are poured into 500 g. alcohol For ten days, the infusion should be kept in a dark place. After this period, the product is ready for use. Used exclusively for external application in the form of rubbing on the skin in the area of the affected joints.

About the importance of proper nutrition

One of the theories of the origin of psoriasis, and therefore psoriatic arthritis, is intestinal. Therefore, appropriate nutrition is so important for the successful treatment of these diseases. A proper diet for psoriatic arthritis involves:

Exclusion of allergenic products: sweets, citrus fruits, chocolate, eggs.
Exclusion of irritating foods: marinades, seasonings, smoked meats, spices, alcoholic beverages.
The diet is based on vegetables, fruits and berries. But the diet excludes currants, strawberries, tomatoes, blueberries, plums, eggplants, and coconut.
Drinking a sufficient amount of purified or melt water (about 1.5 liters per day). Non-carbonated alkaline mineral waters (Borjomi, Essentuki) are also useful.
Dishes based on cereals: buckwheat, rice, pearl barley. It is best to season them with vegetable (olive, flaxseed, sunflower) or butter.
Meat products. Preference is given to dietary meats: chicken, turkey, rabbit. It is better to abstain from fish during an exacerbation.
Fermented milk products with low fat content.
Bread made from wholemeal flour and bran.
Cooking methods: fried and smoked foods are strictly prohibited. Products can be boiled, steamed, baked.

Features of the disease in childhood

The prevalence of psoriasis among children is significantly lower than among adults. The likelihood of psoriatic arthritis in a child is small, which is confirmed by statistical data. Among all patients with this diagnosis, no more than 6% are children under 16 years of age. People in this age group often have ordinary arthralgia (joint pain) against the background of psoriasis, which goes away without a trace. The peculiarity of the course of the disease in children is that most often it is generalized (like polyarthritis).

Prevention

It is very difficult to predict and prevent psoriatic arthritis. Prevention comes down to timely adequate treatment of classical forms of psoriasis, adherence to a dietary regimen (strict diet), giving up bad habits, proper hygienic skin care, and preventing injuries. The price for non-compliance with preventive measures is progression of the disease and even disability.

Psoriatic arthritis has much in common with arthritis of other origins. Its main difference is the mandatory presence of skin manifestations of psoriasis. This feature of the disease serves as the basis for diagnosis and selection of the optimal treatment method.

Description of the disease
Symptoms
Diagnostics
Treatment

According to medical statistics, in approximately 40% of people diagnosed with psoriatic arthritis, the pathological process extends to the spine, which is called psoriatic spondylitis. Moreover, most often it is combined with inflammation of the peripheral joints of the extremities.

Most often this happens when there is a change from one form of psoriasis to another, for example, vulgar psoriasis can change to exudative. And only in 5% of all cases is an isolated spinal lesion detected in psoriasis without the presence of psoriatic arthritis.

However, you should not think that with psoriasis a person’s back will necessarily suffer. Damage to the vertebrae will only occur if the course of psoriasis itself exceeds 10 years.

Description of the disease

The peculiarity of the disease is that the fibrous ring of the intervertebral discs is disrupted, where osteophytes and then syndesmophytes begin to form. In this case, an incorrect diagnosis is often made, and instead of spondylitis, the patient may be treated for spondylosis.

Most often, psoriatic spondylitis affects the sacroiliac part of the spine, the sternocostal and sternoclavicular joints. At the same time, the pathological changes with such spondylitis are practically no different from those changes that are detected with ankylosing spondylitis.

But still some differences exist. The thing is that with psoriatic lesions, the pathological process gradually covers all parts of the spine, which leads to the appearance of scoliosis, poor posture, and other skeletal disorders. And if there are no skin manifestations, and there is no arthritis of the joints of the extremities, then instead of a correct diagnosis, an erroneous diagnosis is made - ankylosing spondylitis.

Symptoms

The clinical picture of this type of spondylitis is similar to that of other spondyloarthritis. The main symptom is pain that occurs in any part of the back. In this case, painful sensations can last for several weeks or several months, sometimes even years. They are especially pronounced at night and in the morning immediately after waking up. The pain does not decrease with rest, but subsides slightly after prolonged physical activity.

Upon examination, the doctor may note a flattened lumbar back and a slight stoop. At the same time, Forestier syndrome is observed only in men, and even then in rare cases.

As for the severity of the pathological process in the spine, this indicator is closely related to the person’s age, the course of psoriasis, the patient’s gender and the degree of skin damage. In this case, it is the articular syndrome that is most often observed, and not the skin manifestation of the disease. Moreover, it can begin either from the peripheral joints or directly from the spine. If the back was affected from the very beginning of the disease, then the disease will occur with vivid symptoms and rapid progression. If it began with a cutaneous form, then the course of spondylitis will be benign.

As for gender, pronounced psoriatic spondyloarthritis with severe damage to the spinal column is characteristic only of young men. As for women, spondylitis is incredibly rare. Most often, inflammation is caused by such types of psoriasis as exudative, erythrodermic and pustular. It is these pathologies that give a high percentage of vertebral involvement in the pathological process.

Diagnostics

The disease is clearly visible on radiographs. In 50% of all cases there is neck deformity, osteoporosis of the vertebrae and calcification of the ligaments. Erosion of the intervertebral joints and deformation of the vertebral bodies may be detected. Scoliosis is usually detected in the thoracic region, and vertebral deformity is most common here. In the lumbar region, pathological changes in the vertebrae are detected less frequently, but here these changes are well expressed.

It is worth noting that at an early stage these pathologies cannot be identified, since they are simply invisible on an x-ray. In order for the disease to be detected at the very beginning, it is necessary to undergo tests such as CT or MRI. However, it often happens that a person turns to doctors too late, when pronounced changes have already occurred and medicine is powerless to do anything here.

Treatment

To date, no treatment has been developed that could help patients with this diagnosis. Drugs that belong to the group of anticytokines are used as drug therapy. The prescription of corticosteroids and cytostatics is also mandatory. As for anti-inflammatory therapy, it is carried out only according to strict indications and only according to an individual scheme. You can also add gymnastics to your treatment, which will help you maintain mobility for longer in case of psoriatic spondylitis.

Symptoms and treatment of psoriatic arthritis are two related concepts. The therapeutic regimen is developed taking into account the clinical picture and prevailing symptoms. The main goal of treatment is to improve the patient’s condition and prevent further progression of the disease.

Main symptoms

Signs of the disease are characterized by quite a wide variety. Psoriatic arthritis in children begins with skin manifestations of the disease. Erythematous papules appear, the characteristic feature of which are silvery scales. These signs are localized in the elbows, knees, groin and head. In adults, the disease begins with joint manifestations.

The first clinical signs of psoriatic arthritis appear gradually. Patients note a slight stiffness of movement, especially in the morning. With physical activity, the unpleasant sensations disappear without a trace. Over time, pain appears. At first it is quite insignificant and is characterized by a constant increase in intensity, especially at night.

Psoriatic polyarthritis is characterized by multiple joint lesions. The first signs are a change in their shape, which over time develops into deformation. The color of the skin over the affected joints is modified, the epidermis acquires a burgundy hue.

With psoriatic arthritis, the symptoms of the disease may differ depending on the type of disease. For example, the osteolytic form is characterized by shortening of the fingers.

The progression of the disease leads to a significant weakening of the ligamentous apparatus of the joints. As a result, there is a high probability of spontaneous dislocations.

Psoriatic polyarthritis begins with damage to the small joints on the phalanges of the fingers and toes. Over time, larger joints—the knee and elbow—are involved in the pathological process.

The transition of inflammation to the tendons and cartilaginous surfaces provokes the development of dactylitis. This condition leads to a significant deterioration in the patient's well-being. The main manifestations of dactylitis:

severe and constant pain;
severe tissue swelling in the area of the affected joint;
swelling spreading to the entire finger;
impaired joint mobility due to deformation and severe pain.

Involvement of the ligamentous apparatus of the spine in the pathological process leads to the development of complications. The consequences of this are manifested in the form of the formation of syndesmophytes and paravertebral ossifications. The condition is accompanied by severe pain and stiffness of movement.

The pathology gradually spreads to all joints. The inflammatory process involves not only tendons, but also bone tissue in the area of ligament attachment. This pathology is mainly localized in the area of the calcaneus and tubercle, the tuberosity of the upper surface of the tibia and humerus.

Psoriatic polyarthritis affects not only the joints and nearby tissues, but also the nail plates. The main manifestation is the appearance of pits or grooves on the surface of the bed. The nail changes color over time due to deterioration of blood supply.

Diagnostic criteria for the disease

Photo of psoriatic arthritis

Psoriatic arthritis (pictured) is characterized by pronounced clinical manifestations. However, it is almost impossible to trace a clear chronology. After all, each person reacts differently to diseases.

Carrying out additional examination of the patient will help confirm the diagnosis. For this purpose, laboratory and instrumental methods are used.

If psoriatic arthritis is suspected, diagnosis necessarily includes an x-ray. It can be used to determine the presence of specific signs of the disease.

Radiological signs of psoriatic polyarthritis include:

reduction of joint space space;
signs of osteoporosis;
the presence of numerous usurs;
manifestations of ankylosis of joints and bones;
development of sacroiliitis;
the occurrence of paraspinal ossification.

However, x-rays are not the only method for diagnosing the disease. The patient must undergo blood tests. A sign of the inflammatory process is an increase in the amount of seromucoid, fibrinogen, sialic acids and globulins. An increase in the level of immunoglobulins of groups A and G is observed in the blood, and circulating immune complexes appear. For the purpose of differential diagnosis with rheumatoid arthritis, the patient must undergo testing for the presence of rheumatoid factor.

If necessary, the attending physician may refer the patient to a joint puncture to obtain synovial fluid. Psoriatic polyarthritis is manifested by an increased level of neutrophils. The viscosity of the liquid is reduced, while the mucin clot is loose.

Conservative treatment of the disease

How to treat psoriatic arthritis? Unfortunately, there are no medications that can completely cure this unpleasant disease. The main goal of therapy is to improve the patient's condition by relieving symptoms and stabilizing the pathological process. Using an integrated approach, it is possible to prevent further progression of the disease, prevent the development of complications and achieve stable remission.

Treatment of arthritis includes the use of the following groups of medications:

NSAIDs. They have anti-inflammatory, analgesic and antipyretic effects. Help improve the patient's condition by eliminating the main signs of the disease (severe pain and inflammation). NSAIDs are used as symptomatic therapy because they do not affect the course of psoriatic polyarthritis. Most often, products based on Diclofenac or Ibuprofen are used. Depending on the clinical manifestations of psoriatic polyarthritis, it is prescribed in the form of ointment, gel, tablets or injections. The required form of administration of the drug, dosage and duration of treatment are determined by the doctor.
Glucocorticosteroids. Hormonal agents have strong anti-inflammatory and analgesic effects. They should be taken very carefully due to the high risk of complications. Glucocorticosteroids are prescribed when nonspecific anti-inflammatory drugs are ineffective. In some cases, intra-articular use of the drug is advisable. This will provide a quick and powerful therapeutic effect directly at the site of inflammation. The introduction of hormones into the joint capsule is possible only in a hospital setting, since this requires certain knowledge and skills. For this purpose, Dexamethasone and Prednisolone are used.
Basic anti-inflammatory drugs. The gold standard in the treatment of arthritis of various etiologies. With their help, it is possible to achieve remission during the course of the disease, but the therapeutic effect begins to appear only several months after the start of use. This group of drugs includes Methotrexate, Sulfasalazine, Leflunomide, Cyclosporine - A and others.
Bioagents. They have the ability to inhibit a specific protein - tumor necrosis factor. Thanks to this, inflammation is eliminated at the molecular level. These are Remicade, Humira and other drugs.

Treatment of a patient with psoriatic polyarthritis, especially if it is a child, should occur under medical supervision. If there is no positive result from the therapy, the specialist will be able to promptly adjust the prescriptions and select other medications.

Therapy of the disease using physical therapy

After relieving the acute inflammatory process, exercise therapy should be included in the complex treatment of psoriatic arthritis. Conducting classes is possible only after achieving stable remission and in agreement with the attending physician.

A physical therapy specialist will help you develop a suitable set of exercises. The level of physical activity and the necessary movements are selected taking into account the course of the disease, the presence of complications and the initial preparation of the patient.

With the help of exercise therapy, you can effectively get rid of excess weight, thereby reducing the load on sore joints. Regular exercise will strengthen the ligamentous apparatus and ensure flexibility and elasticity of muscle fibers. Relieves pain and morning stiffness. It will increase or at least maintain the same level of movement in the affected joints.

For psoriatic arthritis, the exercise therapy complex includes general strengthening exercises aimed at preserving the natural functions of the joints. Regular physical exercise will make the healing process much more successful.

Alternative therapy for the disease

Traditional methods of treating psoriasis arthritis can provide effective assistance in drug therapy of the disease.

First of all, the patient must strictly adhere to the diet. Frequent but small meals are recommended. When developing a daily menu, simple carbohydrates and animal fats should be excluded. Remove fried, spicy, smoked and salty foods. Dairy and vegetable products must be present in the daily diet. Fruits and vegetables play an important role, especially apples, blueberries, currants, rowan, sea buckthorn, and green beans. Psoriasis arthritis and alcohol are incompatible concepts. Therefore, you should avoid alcoholic beverages. Coffee and sweet soda are prohibited.

Old recipes based on medicinal herbs show good results:

Burdock root tincture. Chop the fresh plant and place it in a glass container. Pour in vodka so that the liquid covers the contents of the jar by 2-3 cm. Infuse the medicine for 3 weeks in a dry and dark place. The healing tincture can be used orally, 10-15 drops three times a day, 10-20 minutes before meals, or used as a rub on affected joints.
A decoction of lingonberry leaves. 2 tsp dry herbs, pour 200 ml of boiling water, put on fire and bring to a boil. The product must be boiled for 15 minutes, and after cooling, drink. The duration of treatment is several weeks and continues until the patient’s condition improves.
A decoction based on medicinal plants. Mix St. John's wort, coltsfoot, and dandelion in equal proportions. 1 - 2 tbsp. pour 200 ml of hot water into the mixture, leave and drink 0.5 cups twice a day.
Infusion of birch buds. It is very easy to prepare the product. You need to pour 5 g of kidneys into a glass of hot water and boil for 15 minutes over low heat. Wrap the container and leave the product for 1 hour. Drink the finished drink 50 ml 20 - 30 minutes before meals at least 3 - 4 times a day.

Traditional methods of therapy are most often absolutely safe, but they must also be agreed upon with the attending physician. This will allow you to quickly improve the patient’s condition and achieve remission, as well as prevent the development of complications.