Cure for psoriatic arthritis of the joints. Sulfasalazine for rheumatoid arthritis: application and reviews

Psoriatic arthritis is a common chronic joint disease associated with a skin disease called psoriasis. Treatment options for patients have changed significantly over the past decade. To prevent joint deformity, each affected person should know how to treat psoriatic arthritis. Clinical researches allow us to understand the true value of NSAIDs for arthritis of the joints. Biological agents and tumor necrosis factor inhibitors are widely used. The treatment strategy is individual. Gradually, new agents are introduced into the pharmaceutical market, helping to provide a better future prospect for the patient.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Psoriatic arthritis cannot be cured. Medications can help prevent acute attacks of arthritis and slow the progression of the disease. Non-steroidal anti-inflammatory drugs are effective tool for many patients. NSAIDs inhibit pain, relieve swelling and morning stiffness, and improve joint range of motion in psoriatic arthritis. A non-exhaustive list includes (in parentheses active substance):

• Clinoril (sulindac);
• Clitoris (piroxicam);
• Indocin (indomethacin);
• Mobis (meloxicam);
• Motrin, Advil (ibuprofen);
• Doc, Anaprox, Naprelan, Naprosin (naproxen sodium);
• Relafen (nabumeton);
• Voltaren, Artrodoc (diclofenac).

Which NSAIDs can be used will be decided by the doctor, each case is individual and requires a special approach. Acetaminophen and Tylenol may be added to the list of drugs to relieve pain and inflammation. These medicines are available without a prescription. Stronger NSAIDs are available by prescription. Some drugs, when taken in high doses or over a long period of time, cause problems in the gastrointestinal tract, including ulcers and bleeding.

COX-2 and PDE4 inhibitors against joint inflammation

As numerous studies show, COX-2 inhibitors are less problematic for the stomach than NSAIDs. For example, Celecoxib (Celebrex) is also an NSAID, but a different type that has a stronger effect and a lower risk of side effects in psoriatic arthritis. It is available by prescription only. COX-2 inhibitors reduce pain and inflammation with less stomach damage, but they cause heart problems. They have many risks, so before using them, you should discuss the drug with your doctor, take into account all the pros and cons.

A new treatment option for psoriatic arthritis is PDE4 inhibitors. Ampremilast is currently one of the the best drugs with this type of arthritis. A new oral remedy regulates the complex processes of inflammation within the immune cell, which leads to the removal of swelling and reduction of pain. The drug inhibits an enzyme known as phosphodiesterase 4, or PDE4. PDE4 controls most of the inflammatory actions in cells that affect the level of inflammation associated with psoriatic arthritis. Ampremilast should be taken continuously to maintain the improvement achieved.

Therapy of the disease with basic anti-inflammatory drugs

DMARDs are prescribed to slow potential joint damage caused by psoriatic arthritis. Unlike NSAIDs, they take longer to take effect. Some antirheumatic drugs that reduce pain and inflammation in psoriatic arthritis, but which cause many side effects when treated:

• Methotrexate;
• Sulfasalazine;
• Cyclosporine;
• Leflunomide.

Methotrexate is an immunosuppressive drug approved for the treatment of psoriatic arthritis. It is effective in relieving symptoms and preventing joint destruction. Methotrexate in small doses is generally well tolerated. However, the drug has a number of side effects, and exaggeration of the dose of the drug threatens to damage the liver. A patient taking Methotrexate should carefully follow the doctor's instructions.

Sulfasalazine, a sulfa drug designed to treat inflammatory diseases intestine, sometimes used for psoriatic arthritis. The use of the drug is not recommended for patients suffering from porphyria, impaired metabolism, diseases of the urinary tract. The doctor may require regular blood tests while the patient is on sulfasalazine, which is required to treat psoriatic arthritis. This is necessary to monitor the number of leukocytes and liver enzymes. Possible side effects: nausea, rash, headache, abdominal pain, vomiting, fever and dizziness.

If these drugs do not bring the desired result, the doctor prescribes biologics. This new type BPVP. They block a protein that causes inflammatory process in the joints. These biological products include:

• Adalimumab;
• Certolizumab;
• etanercept;
• Golimumab;
• infliximab;
• Ustekinumab.

These medicines are expensive and have side effects (dizziness, nausea, vomiting, abdominal pain). They reduce the immune system's response to the body's defense against an infectious or viral disease.

What is Provailen and how does it work?

Provailen is a powerful homeopathic immune system modulator used for rheumatoid and psoriatic arthritis. It is a natural remedy developed on herbs, medicinal mushrooms, vitamins and minerals. Advantages:

• quickly relieves pain;
• reduces inflammation and swelling;
• stops the progression of the disease;
• improves adrenal function.

It also provides fast healing. Due to this, cartilage tissue damaged by psoriatic arthritis is gradually restored. In fact, Provailen is superior to many drugs that actually poison the body and are the cause of many diseases. This remedy has been successfully used against various kinds arthritis for many decades, only a few know about it. Provailen returns patients to a fulfilling life.

Dietary nutrition in case of illness

Diet in psoriatic arthritis plays an important role in reducing inflammation. By adjusting the diet, you can keep all manifestations of arthritis under control. Talk to your doctor before making major changes to your eating habits. There are 3 dietary approaches:

1. Weight loss. Researchers have found that a high body mass index (BMI) is associated with an increased risk of developing psoriasis and psoriatic arthritis, as well as increased disease severity. Eliminate foods that promote weight gain from your diet.
2. The use of anti-inflammatory foods. Most people respond positively to dietary changes designed to combat chronic inflammation. To reduce inflammation, include flax seeds in your diet, olive oil, pumpkin seeds, walnuts, lean fish, fresh fruits and vegetables (blueberries, mangoes, figs, squash, carrots, cabbage, broccoli), omega-3 fatty acids.
3. A gluten-free diet for psoriatic arthritis will significantly improve the patient's condition. It completely excludes from the diet products containing a complex protein compound - gluten. You can eat rice, corn, poultry, meat, fish, legumes and most dairy products, vegetables and fruits.

According to the National Psoriasis Foundation (NPF), there is little scientific evidence that diet affects the symptoms of the disease. However, many people claim that avoiding certain foods can help manage the intensity of arthritis. Avoid fatty red meat, processed foods, refined sugar, nightshade vegetables (tomatoes, peppers, potatoes), and high-fat dairy products.

Psoriasis arthritis is an inflammatory disease that requires the right approach to treatment and nutrition. Here are some recommendations that should be followed in this disease:

1. Eat fish at least twice a week. For example, tuna, mackerel, herring, trout.
2. Choose lean meats and skinless poultry. Cook them without adding saturated fats or trans fats.
3. Use low fat dairy products.
4. Limit your intake of foods containing partially hydrogenated vegetable oils. They contain trans fats.
5. Limit your alcohol intake.
6. Limit the amount of processed foods and fast food.

In addition, it is necessary to include vitamins in the diet. Studies have not shown a direct relationship between vitamins and biologically active additives with psoriatic joint disease. However, doctors note that they help clear the skin and relieve pain. Dietary supplements are sold in capsules, tablets, powders, and liquids. Glucosamine can help build and repair cartilage and possibly reduce inflammation. Chondroitin increases the elasticity of cartilage and inhibits its destruction.

Organization of the therapeutic process at home

You can protect the joints from destruction and inflammation with the help of folk remedies. Herbs used for baths have proven themselves to be successful. Chamomile, nettle, linden, calamus root, willow bark and string have amazing properties. Take a bath with the addition of one of the listed herbs should be 15-30 minutes, preferably every day. Treatment of psoriatic arthritis with folk remedies is less expensive than drugs. Here are a few effective recipes:

1. Flaxseed compress. After preparing the cotton cloth, heat the flax seeds in a frying pan. Then pour the raw material into the fabric and wrap the sore joints. Procedures are performed daily at bedtime.
2. Lingonberry tea. Two teaspoons of crushed lingonberry leaves are poured into a glass of boiling water. After 15 minutes of infusion, tea is drunk in small sips. If desired, add honey.
3. An infusion of burdock root. 300 grams of chopped grass is poured with vodka so that its level is 3 cm higher than the leaves. The medicine is infused in a dark, warm place for 3 weeks. With the resulting remedy, it is necessary to rub the joints affected by the disease daily.

In addition to the treatment of folk remedies, be sure to get plenty of rest, eat well and avoid heavy stress on the joints.

Psoriatic arthritis is an inflammation of the joints of an autoimmune nature that accompanies psoriasis or acts as an independent form of the disease. This disease affects young and middle-aged patients, regardless of gender, manifests itself several years after the onset of skin psoriatic lesions, sometimes preceding it. It is diagnosed in approximately 40% of patients with psoriasis. Psoriatic arthritis rarely occurs in children under 12 years of age.

The pathology affects one or more large joints, most often it can be knee, ankle, as well as small interphalangeal joints. Inflammation can be unilateral or bilateral. Psoriasis and associated arthritis are often disabling and require ongoing treatment.

Causes of appearance and development

Psoriasis is an autoimmune disease, in half of the cases it has hereditary causes. Psoriasis develops along the path of proliferation of epidermal cells due to biochemical disorders, which leads to aseptic inflammatory phenomena.

The appearance of psoriatic lesions is influenced by provoking factors:

• Previous infectious diseases: streptococcal tonsillitis, hepatitis, chicken pox, shingles, influenza and others.
• Psycho-emotional stress. Psoriasis is considered one of the psychosomatic diseases, the beginning of which is nervous tension, mental disorders, severe stress. In this case, arthritis joins as a secondary symptom complex against the background of developed psoriasis.
• Injuries, most often bruises. In the presence of moderate psoriasis, even small bruises can cause the development of arthritis, which, as the disease progresses, will affect healthy joints.
• Treatment with certain drugs can trigger the development of psoriasis and subsequent arthritis, for example, a group of non-steroidal anti-inflammatory drugs, drugs to reduce blood pressure and others.
• Systemic connective tissue diseases.
• Scars in the area of ​​the joints, on soft tissues and skin, after surgical treatment.
• Metabolic disorders and pathologically increased activity of cells that produce melanin.
• Cardiovascular diseases.

Classification

The classification of psoriatic arthritis depends on the severity of the course of the disease, the localization of pathological changes and the severity of symptoms.

Psoriatic arthritis manifests itself in several varieties:

1. Asymmetric arthritis, affecting one or more joints. The hip, ankle, knee, elbow, and phalanxes of the extremities are usually affected. The joints are edematous, their flexion-extension is disturbed.
2. Symmetric arthritis. Bilateral damage to one or more groups of joints, with a milder course, however, in 50% of cases this form progresses to the loss of the patient's ability to work, resulting in disability.
3. Distal arthritis of the phalanges of the extremities. It affects the hands and feet.
4. Deforming or mutilating arthritis. Severe form of psoriatic lesions affecting the fingers of the extremities, with irreversible changes.
5. Psoriatic spondylitis, sacroiliitis. Forms of arthritis that affect the spine and hip joints.

Stands out separately juvenile psoriatic arthritis - a type of disease that occurs in children with psoriasis.

It is not uncommon for patients with psoriasis to have multiple types of arthritis.

Depending on the number of affected joint groups, psoriatic arthritis is divided into three forms:

• 1-2 groups - monoarthritis;
• 2-4 groups - oligoarthritis;
• 5 or more groups - polyarthritis.

Despite the fact that gender does not affect the incidence of psoriasis, certain types of arthritis may be more common in women or men, for example, men are more likely to suffer from spinal pathologies, women - peripheral polyarthritis.

The course of the disease falls into four stages of development:

1. Light.
2. Moderate.
3. Heavy.
4. Malignant psoriatic arthritis - this type is very difficult to treat and occurs in combination with psoriatic erythroderma.

Psoriatic arthritis is primarily characterized by joint pain. The pain is accompanied by the following symptoms, the presence of which can preliminarily establish a diagnosis:

• The joint is edematous, the edema extends to the adjacent tissues.
• Pain is felt on palpation of the diseased organ.
• The periarticular area is cyanotic, sometimes the skin becomes purple. Interphalangeal joints with such symptoms resemble radishes in shape and color.
• The skin over the diseased area has a higher temperature.
• Often there is a psoriasis lesion of the nails.
• The fingers of the extremities are thickened, often seem shortened.
• Due to a violation of the elasticity and density of the ligaments, dislocations may form.
• When the intervertebral joints are affected, ossificates are formed, leading to stiffness and pain of movement.

The malignant form also has a number of symptoms:

1. Vertebral joints and skin are always affected.
2. There is fever, exhaustion, increased fatigue.
3. The joints are limited in mobility, the pain is intense.
4. Enlarged lymph nodes.
5. Psoriasis also affects other organs: the liver, kidneys, eyes, nervous and cardiovascular systems.

Malignant arthritis in psoriasis develops only in male patients, quickly leads to disability. The consequences are very serious, up to death. The lethal outcome is often due to encephalopathy, glomerulonephritis and severe hepatitis.

Psoriatic arthritis is currently considered an incurable disease. Mild types of the disease do not greatly change the quality of life and allow you to maintain capacity, with appropriate treatment. Systemic complications worsen the prognosis, to the point of disability.

Diagnostics

First of all, the diagnosis of psoriatic arthritis is based on a physical examination and the patient's history, since typical symptoms - joint pain, specific skin and nail lesions - almost immediately make it possible to make a diagnosis.

The doctor of the Moscow Doctor clinic tells more about the disease, symptoms and diagnosis:

Laboratory tests for psoriasis usually show the norm, with the exception of exacerbations - during such periods it increases ESR blood, leukocytes. Rheumatoid factor is not present. Joint puncture and tests synovial fluid show signs of inflammation - an increase in leukocytes and neutrophils.

X-ray required, the picture shows the following radiological signs:

1. presence of osteophytes.
2. Erosion of the bones.
3. Ingrown and deformed bones in the articular region, deformity of the joints.
4. No signs of osteoporosis.

Based on the results of the research, differential diagnosis is carried out with rheumatoid arthritis, Reiter's and Bechterew's diseases, osteoarthritis, gouty arthritis.

This disease is treated continuously throughout life, the goal of treatment is to prevent joint deformity, reduce the severity of symptoms and maintain the patient's quality of life.

Malignant psoriasis requires urgent treatment in stationary conditions to avoid rapid death.

Treatment of psoriatic arthritis includes prescribing courses of medications, physiotherapy, exercise therapy, and an appropriate diet. In case of severe joint deformity and inflammation that is poorly treatable, surgery is recommended - the affected capsule or part of the joint is excised. In severe cases, arthroplasty, cartilage prosthetics, fixation of cartilage and connective tissue in the area of ​​the fingers, wrist and ankle can be used.

How to treat psoriatic arthritis conservatively

Treatment includes the appointment of courses of the following drugs:

• Non-steroidal anti-inflammatory drugs that relieve pain, swelling. They are usually prescribed in tablet form. Among the recommended ones are indomethacin, voltaren, brufen, butadione.
• Corticosteroids to relieve acute pain. These drugs are injected into the joint. The use of hydrocortisone, prednisolone derivatives, kenalog is recommended. Long treatment these means is undesirable, since there is a possibility of the transition of the disease to a malignant form.

• Immunosuppressants. These are substances that suppress the formation of pathological cells, reduce the severity of autoimmune processes. These include methotrexate, azathioprine, cyclophosphamide, sulfasalazine. These drugs are used as basic therapy for psoriasis and arthritis for six months to a year. They are prescribed for treatment in severe cases, since methotrexate, sulfasalazine and other analogues have a fairly serious list of contraindications and side effects.
• Gold preparations are prescribed for the low effectiveness of immunosuppressants, these include krizanol; as well as second-line agents, antimalarial drugs - delagil and plaquenil - are recommended.
• Monoclonal antibodies are prescribed for stable preservation of treatment results and prevention of relapses, these are adalimumab, infliximab.
• Vitamins of group B, injectable, accelerating the treatment and restoration of tissues, as well as vitamin A, folic acid and mineral complexes.
• Sedatives such as valerian, motherwort infusion, antidepressants. Against the background of their admission, clinical manifestations are reduced.
• External preparations, ointments with NSAIDs and corticosteroids (prednisolone).
• Chondroprotectors for bone tissue restoration. These are chondroitin sulfate, glycosamine sulfate, hyaluronic acid and others.

A rheumatologist also talks about the disease and methods of its treatment. the highest category Ilya Maslakov:

Physiotherapy uses treatment with the following methods:

1. Ultrasound.
2. Laser combined with magnetotherapy.
3. Microcurrents.
4. Pressure chamber.
5. Balneotherapy.

Therapeutic gymnastics is carried out during the period of subsiding of acute phenomena and is aimed at reducing the severity of symptoms, maintaining the full functioning of the articular structures, ligaments and muscles. Physical therapy exercises also maintain an optimal weight, which reduces the burden on diseased limbs and the heart.

A set of exercises is prescribed by a doctor, the patient can do them at home or in the clinic under the supervision of an instructor.

The goal of a psoriatic arthritis diet is to preserve joint function and reduce the rate of disease progression. Recommended frequent appointments food in small portions. Nutrition for psoriatic arthritis should include dairy and vegetable products, dietary meat, eggs. You need to limit carbohydrates and animal fats. Among the necessary products are fruits and vegetables, with the exception of nightshade, citrus, legumes, sorrel. Spicy, fried foods, red meat, salted fish are excluded from the menu.

During periods of exacerbation, sweets are removed from the diet. You should drink liquid no more than 1 liter per day, food is prepared without salt.

You also need to give up negative habits and follow all the recommendations of the doctor.

Alternative methods of treatment are used to maintain remission and reduce symptoms, but it should be remembered that at home, psoriasis and psoriatic arthritis cannot be cured with these remedies alone, this is fraught with serious consequences for the patient.

For the treatment of edema and pain, the following folk recipes are used:

• Infusion of cinquefoil. The grass of the cinquefoil is poured with vodka in the ratio of 30 g per 0.5 liter, infused for two weeks. This infusion is taken orally, for 8 weeks, 3 times a day, 1 teaspoon before meals. Treatment gives its results in 2-3 weeks.
• Parsley infusion. Parsley with the root is passed through a meat grinder and poured with boiling water, infused for 12 hours. Lemon juice is poured into the strained infusion. You need to drink 70 ml, 3 times a day.
• Compress of carrots and turpentine. 1 tablespoon of grated carrots is mixed with half a teaspoon of vegetable oil and 1 teaspoon of white turpentine. This ointment is applied to the affected area, closed with a film. You can alternate every other day with a compress, where slightly beaten aloe leaves are used instead of carrots.

Arthritis, which arose on the basis of psoriasis, does not have a one-time course of treatment, but, with a change in lifestyle and compliance with all prescribed recommendations, the patient can increase remission periods and live at the usual level.

Zhukovsky L.S. shared with Internet users about folk methods of treatment, as well as about his history of combating this pathology:

How to treat psoriatic arthritis according to doctors?

Unfortunately, today psoriatic arthritis is considered an incurable disease. However, its manifestations can and should be fought - this will significantly improve the quality of life of the patient. This opinion is shared by the vast majority of doctors. Proper treatment of psoriatic arthritis is the key to a calm and comfortable life for every person who is faced with such an unpleasant disease.

If a few years ago this pathology was classified as relatively moderate, today in the fight against it, experts recommend using not only basic, but antirheumatic drugs aimed at modifying the course of the disease. This approach helps to prevent the occurrence of joint erosion and the loss of their functional activity, at the same time, psoriasis is treated.

What traditional methods are used by doctors in the fight against psoriatic arthritis?

The main goals set by traditional medicine- suppression of the inflammatory process, prevention of erosions and preservation (restoration) of the motor function of the joint. Moreover, the treatment of affected joints and skin areas is carried out simultaneously.

In the early stages of the development of the disease, the use of non-steroidal anti-inflammatory drugs (hereinafter referred to as NSAIDs) gives a good effect. This class of drugs is widely represented in the pharmacological market. For every person medicine should be selected individually with the obligatory participation of the attending physician. NSAIDs give a long-lasting analgesic and strong anti-inflammatory effect. The most popular drugs are naproxen and ibuprofen.

Are steroids used for psoriatic arthritis?

Yes, corticosteroids (or steroids) are actively used by doctors in the treatment of this disease. They have a good anti-inflammatory effect, and also help patients get rid of acute pain. Steroids are used orally, as well as in the form of intramuscular or intraarticular injections.

One of the most effective drugs in this group is prednisolone. It has been in service with doctors all over the world for many years. It is actively used in the fight against various rheumatic diseases, including psoriatic arthritis. However, we must not forget that long-term use of corticosteroids can lead to joint erosion and debilitation. Therefore, they are used only in critical situations.

Other Traditional Medicine Methods

Relatively recently, basic antirheumatic drugs have been used in the treatment of psoriatic arthritis, which contribute to the modification of the course of the disease, slowing down its progression. Medicines of this group are slightly inferior in terms of the speed of action of NSAIDs, therefore they are used mainly for the prevention of severe adverse reactions. The traditional DMARD is methotrexate. Also today, new drugs are increasingly being used, such as Remicade, Humira and Enbrel.

What is the role of exercise therapy in the treatment of psoriatic arthritis?

Regular performance of special exercises allows the patient to get rid of stiffness in the joints and pain. The level of physical activity is determined by a professional instructor. The most effective combination of general strengthening exercises, and those that are aimed at maintaining the normal functioning of the joints. Thus, physical therapy allows you to achieve the following results:

• Symptoms become less pronounced;
• It remains at the same level or improves the functioning of the joints;
• Muscle fibers become more flexible and elastic;
• Optimal body weight is maintained, which reduces the load on the joints;
• The risk of developing complications from the CCC is reduced.

Alternative methods of disease control

Is it possible to treat psoriatic arthritis with folk remedies? This is the question that worries many patients. Not a single expert can answer it unambiguously. Why? Self-medication is most often not effective, and sometimes even worsens the patient's condition. Nevertheless, some techniques are still able to speed up the treatment process or at least “pacify” unpleasant symptoms.

In order not to harm your health, it is better to consult a doctor before starting treatment at home. Experts recommend taking herbal aromatic baths. They help relieve fatigue, unload the nervous system, speed up metabolic processes and even ease the feeling of pain.

Diet for psoriatic arthritis

A properly composed diet helps to slow down the progression of the disease, and also allows you to maintain the functional activity of the affected joints.

It does not mean starvation and torture of the body. On the contrary, nutrition should be regular and complete. There are only a few guidelines to follow. The diet must include:

• The maximum amount of dairy and vegetable food with a minimum intake of animal fats;
• All kinds of berries, fruits and vegetables (fresh).

A patient with this disease should completely abandon the use of alcoholic beverages, as they provoke the development of exacerbations.

Prevention

Prevention of PA, first of all, implies the observance of the correct, healthy lifestyle life. This includes periodic physical activity of moderate severity, and a balanced diet, and the rejection of bad habits.

In addition, it is necessary to periodically see a doctor in order not to earn a lot of unpleasant, intractable chronic sores, which after a while will lead to the development of more serious pathologies, including psoriatic arthritis.

Now you know almost everything about how to treat psoriatic arthritis and how it can be avoided. Be healthy!

Psoriatic arthritis according to mcb 10.

Definition

Psoriatic arthritis is an inflammatory disease of the bones associated with skin disease. Psoriasis is a chronic non-infectious pathology that mainly affects the skin.

Code M07 in the International Classification of Diseases (ICD-10) belongs to psoriatic arthritis. At the same time, psoriatic arthritis is a secondary disease, against the background of a formed skin disease. The disease affects more often middle-aged women, due to their emotional background.

Reasons for development

According to numerous studies, the main cause of psoriasis and psoriatic arthritis is the psychosomatic status of the patient. Emotional instability, overexcitability, fear, constant nervous strain cause the development of psoriasis. Also, severe stress (death of a loved one, accident, divorce, etc.) can serve as a catalyst for the onset of an illness.

Other causes of psoriatic arthritis include:

• Injuries (industrial, domestic, sports).
• Reception of some medicines(anti-inflammatory drugs - ibuprofen, diclofenac, antihypertensive drugs - egilok, atenolol).
• Infectious diseases of various etiologies (viruses, bacteria)
• Endocrine diseases, as well as hormonal changes in the body (hypothyroidism, diabetes pregnancy, menopause)
• Alcohol abuse, drug addiction, obesity.
• Heredity (genetic failure leads to the transmission of the disease from parents to children).
• Surgical intervention, soft tissue scars.

Clinical picture of the disease

In most patients (about 65-70%), joint damage occurs after skin lesions in some patients, in other cases, either arthritis precedes psoriasis, or these diseases appear simultaneously. In most cases, the clinic is typical of arthritis, the onset can also be gradual or abrupt.

Articular manifestations of psoriatic arthritis include:

• Soreness of varying intensity, expressed at night and at rest.
• Morning stiffness, better or better in the afternoon.
• Simultaneous damage to several joints of the fingers and toes.
• Signs of inflammation: swelling and hyperemia of the fingers, violation of their function.

Extra-articular manifestations of psoriatic arthritis:

• Common manifestations in the acute phase of the disease: fatigue, apathy, depression, sleep disturbances, decreased appetite, subfebrile condition.
• Manifestations of psoriasis: the presence of a monomorphic rash in the form of plaques, which are covered with white scales. Usually localization of formations on the affected joints. A feature of the disease is a tendency to exudation, resistance to therapy.
• Damage to the nail plate, fragility, thinning.
• Shortening of the fingers in length.
• Systemic manifestations (damage to the lymph nodes, hepatopathy, Raynaud's syndrome)
• Kidney damage (glomerulonephritis)
• Damage to the organs of vision (uveitis, blepharitis, etc.)
• Defeat nervous system(polyneuropathy)

There are the following forms of psoriatic arthritis according to microbial 10, different in clinic and pathogenesis:

1. Classical form: the disease first affects the distal interphalangeal joints of the hands and feet. Manifested characteristic features arthritis with damage to the nail plate and skin.
2. Mutilating form: a more severe form of the disease, which is characterized by displacement of the small bones of the upper and lower extremities, leading to shortening of the fingers (like a "lorgnette"). In the acute phase of the process, the general condition of the patient worsens.
3. Symmetrical polyarthritis, which has a course similar to rheumatoid arthritis, is characterized by a symmetrical lesion of various joints in the body, but without the formation of rheumatoid nodules and the presence of rheumatoid factor in laboratory parameters.
4. Asymmetric periarticular arthritis: the most common variant of psoriatic arthritis, with a "sausage-like" lesion more often than the distal interphalangeal joints of the hands, their deformation and dysfunction.
5. Monooligoarthritic form: large joints (knee, wrist) are affected, the disease develops slowly and can affect all joints of the body.
6. Ankylosing spondylitis is considered as a manifestation of generalized enthesopathy.
7. Juvenile psoriatic arthritis has a similar clinical picture with juvenile rheumatoid foma and is characterized by lesions in children and adolescents under 16 years of age.
8. The malignant form is characterized by a rapid increase in the clinic and deterioration of the condition. It most often affects men under the age of 35.

Despite the similarity of the external manifestations of all forms of the disease, with a thorough examination and competent diagnosis, a rheumatologist can easily make the correct diagnosis.

Diagnosis of psoriatic arthritis

At the first signs of skin and joint diseases, you should consult a general practitioner. The specialist, after examination, will give a referral to a rheumatologist and dermatovenereologist for additional diagnostics and a more accurate diagnosis.

Diagnosis of the disease includes several stages:

1) Examination of specialists (taking an anamnesis, examination). At this stage, they search for the cause of the disease, note its manifestations, the severity of the process, and then proceed to another stage of the examination.

2) Laboratory diagnostics.

• General analysis of blood and urine (typical for the disease are an increase in the number of leukocytes and ESR)
• Biochemical blood test (increased levels of inflammatory markers: sialic acids, seromucoid, while rheumatic tests are negative)
• Analysis of synovial fluid during joint puncture (signs of inflammation: cytosis, viscosity and cloudy color of the fluid).

3) Instrumental research:

On the radiograph, the affected joints are eroded, the articular surfaces are narrowed. The presence of osteoporosis and osteolysis with displacement of the fingers is also characteristic. In more advanced cases, bone fusion is determined - ankylosis and calcification.

For more exact definition stages, forms of the disease, additional research methods are carried out: MRI, ultrasound, which will more accurately determine the location of the lesion, determine the stage and deformity of the joints.

Thus, for the diagnosis of psoriatic arthritis according to mkd10, at least three criteria are necessary:

• Skin manifestations in the form of psoriasis.
• The hereditary nature of the disease (cases of transmission of the disease).
• Characteristic clinical and radiological manifestations of the disease.

Basic principles of treatment of psoriatic arthritis

MCD-10 involves the complex treatment of psoriatic arthritis. The fight against a chronic disease is a long process that requires patience and the strict implementation of all medical recommendations. Currently, methods of dealing with the disease consist of several approaches:

1) Drug therapy (prescription of tablets or injectable drugs):

• Non-hormonal anti-inflammatory drugs (Nimesulide, Diclofenac, Meloxicam) reduce the inflammatory process.
• Cytostatic agents (Methotrexate, Sulfasalazine) are prescribed for a long period of time (up to 2 years), help to slow down the development of the pathological process.
• Hormonal drugs (glucocorticoids) are rarely used due to the threat of exacerbation of psoriasis
• Immunosuppressants (Etanercept, Adalimumab) are expensive drugs that can reduce the activity of processes in both psoriasis and arthritis.
• Sedatives (Persen, Afobazol) for stress and neurotic conditions.
• Immunomodulators (Immunal, Likopid) as a component complex therapy arthritis, helps restore the body's defenses.
• Multivitamin preparations (Alfavit, Vitrum) with the aim of strengthening the body's defenses and preventing hypovitaminosis.

2) Local treatment is the application of ointments, gels to the affected joints (fluorocort, sinalar). You can also use salicylic ointment, although hormonal agents are more efficient.

3) Physiotherapy is carried out during the period of remission of inflammation and is the use of paraffin baths, various therapeutic baths, ultrasound treatment and mineral waters. Also, with this disease, massage of the affected joints is indicated during the period of subsiding of the inflammatory process.

4) Therapeutic and recreational physical education includes a set of exercises aimed at improving motor functions in the affected joints.

Let's look at a few exercises:

Clench into fists and unclench (3 sets of 10 times, perform quickly)

We perform rotation in the wrist joint (10 times in one direction, 10 times in the other, 3 sets)

We bend the brush with straightened fingers first to the right and to the left, then back and forth (3 sets of 10 times each exercise)

Making oscillatory movements, pull the sock towards you (back and forth, 3 sets of 10 times)

Kneading from foot to foot (from toe to heel, from the outer edge to the inner, 3 sets of 10 times each exercise)

We perform rotation in the ankle joint (10 times in one direction, 10 times in the other, 3 sets).

5) Surgical treatment is carried out in advanced cases, when conservative treatment no results are needed for a long time with damage to large joints (knee, hip). Then endoprosthesis is performed (replacement of the affected joint with an artificial implant).

Diet for psoriatic arthritis

Dietary compliance plays an important role in the treatment and duration of remission in psoriatic arthritis. If you are sick, you should give preference to alkaline foods and limit foods that cause high acidity.

Decreased acidity can be achieved by eating fresh vegetables and fruits, limiting fatty, canned, spicy and fried foods.

The use of the following products is allowed, even during an exacerbation:

• Fruits, vegetables (kiwi, citrus fruits, peaches, pumpkin, cabbage, carrots, etc.).
• Dried fruits (dried apricots, dates).
• Oil (sesame, almond).
• Low-fat varieties of meat and fish (cod, hake, beef, turkey).
• Low-fat dairy products (natural yogurt, cottage cheese)
• Freshly squeezed juices (very useful juice from carrots and celery);
• Nuts in small quantities.
• Kashi (buckwheat, oatmeal).
• Herbal teas and fruit drinks

It is necessary to exclude the following products, especially during the period of exacerbation of psoriatic arthritis:

Prediction and prevention of psoriatic arthritis

Currently, there is no specific prevention of psoriatic arthritis. However, if you follow the recommendations of a specialist, attend preventive appointments, take prescribed medications, do gymnastics and massage, you can keep the disease in remission for a long time. Thus, a gradual dysfunction of the affected joints and a gradual loss of ability to work can occur.

A disease such as "psoriasis" in the majority is associated with lesions of the skin: the formation of plaques, papules, peeling, and not many people know that this pathology also affects the musculoskeletal system with the development of psoriatic arthritis.

Inflammation in the joints, ligaments in psoriasis develops in 5-8% of all patients. Usually, articular pathology (in 70-75% of cases) occurs after the development of skin changes. There is a possibility of the simultaneous debut of arthralgia and the formation of skin plaques (in 5-10% of patients), or joint damage may precede skin symptoms(in 15-20% of cases).

With psoriasis, both the joints of the limbs and the articular joints of the central skeleton: the spine and pelvic bones can be affected. Both isolated and combined lesions of several articular areas can be observed.

Manifestations of articular changes are very diverse: from minor asymptomatic changes in one or two phalanges of the foot or hand, to severe disabling pathologies involving large joints and deformities of the spinal column.

Until the end, a clear idea of ​​the causes and mechanisms of development of psoriatic arthritis has not been formed. There are assumptions about the leading role of heredity, autoimmune mechanisms, certain risk factors (stress, infection, hypothermia) can become a trigger in the development of the disease

genetic predisposition

Geneticists have identified certain "psoriasis genes" - HLA B17, B13, B16, B33, B40. There is an increase in the frequency of HLA B27 in individuals suffering from this type of arthritis.

The risk of disease in a family where there is already a patient suffering from this pathology increases many times over. The probability of getting sick to a child whose parents both suffer from psoriasis is 50/50. If only one parent is sick with this disease, in 25% of cases the child can inherit this pathology.

immune mechanisms

Autoimmune disorders are present in this pathology, as evidenced by the deposition of immune complexes, a large amount of IgA, IgG immunoglobulins in the skin and synovial fluid of the joints affected by the disease.

Sometimes, with articular pathology, there is a decrease in the T-suppressor function of lymphocytes, a deficiency of protective T-helpers.

Infiltrates are observed in the skin of the affected foci immune cells and deposits of immunoglobulins, increased concentrations of pro-inflammatory cytokines: TNF-alpha, IL-6, IL-8, IL-5, IL-10, G-MSF

Provoking factors

Factors that can provoke and "start" the disease include:

• acute and chronic stress;
• functional disorders of the nervous system;
• emotional overload;
• focal infections (streptococcal, viral, staphylococcal);
• atherosclerosis;
• diabetes;
• violations of carbohydrate, fat metabolism;
• liver pathology;
• taking certain medications: glucocorticosteroids, lithium salts, beta-blockers;
• period of minimum solar activity: autumn-winter-spring.

Clinical picture

Psoriatic arthritis affects both men and women more often between the ages of 30 and 45. Individual cases of the disease can occur in a wider age range: from 9 years to 71 years. Some authors identify a high frequency of cases among men, but according to many sources, the gender structure of the disease is homogeneous.

The articular lesion debuts in most cases already against the background of existing skin manifestations of psoriasis, but it can appear simultaneously with it, or even precede psoriatic rashes.

The onset of the disease can be gradual: the patient begins to feel unmotivated fatigue, general weakness, and mild pain in muscles and joints. At the same time, in some patients, the onset of the disease is acute, manifested by a pronounced articular syndrome similar to gouty or septic arthritis.

Most often at the beginning of the disease, the joints of the fingers, knees, and less often the shoulders and feet suffer. The pains are maximal at rest, at night, in the mornings, they may be accompanied by morning stiffness, with movements during the day they decrease somewhat, “walk around”.

With articular manifestations of psoriasis, patients can only be disturbed by one joint, then the disease is called monoarthritis, several (3-5 joints) - oligoarthritis, more than five - polyarthritis.

Often, small joints of the hand or foot with psoriatic lesions become inflamed with involvement of the ligamentous apparatus and tendons, damage to the flexor muscles and sausage-like deformity of the fingers, as well as discoloration of the skin. The skin over the inflamed joints has a purple-blue color.

Sometimes there may be an isolated lesion of the joints of the spine - spondylitis of psoriatic origin. It manifests as a pain syndrome lumbar, sequentially, the thoracic, cervical region, costovertebral joints. Patients suffer from pain, it is poorly relieved by NSAIDs, and over time, a "beggar's posture" develops, which is characteristic of Bechterew's disease, with which it is sometimes mistakenly confused. It happens that the disease is asymptomatic, without pain, gradually causing a violation of posture and deformation of the spinal column.

In addition to the articular syndrome, patients may experience the following changes:

• muscle pain;
• skin lesions;
• eye diseases (iridocyclitis, conjunctivitis);
• kidney pathology (amyloidosis);
• inflammatory changes in tendons, ligaments.

For psoriatic lesions, a gradual increase in the number of affected joints over time is characteristic: the disease can debut with monoarthritis, and then progress and cover an increasing area of ​​pathological changes. With the development of polyarticular changes, the frequency of exacerbations increases and the duration of remissions decreases - the condition steadily worsens without appropriate therapy.

Disease classification

There are several clinical forms of psoriatic arthritis:

1. The asymmetric form is the most common of all types of the disease. Occurs in 70% of cases. With this lesion, only one side of the joint is involved in the inflammatory process. Asymmetric sacroiliitis or spondylitis often occurs.
2. Arthritis of the distal interphalangeal joints.
3. Symmetrical form - articular inflammation is observed on both sides, the hands suffer more often than others.
4. The mutilating (disfiguring) form is a severe, destructive, irreversible inflammatory articular process, in which there is a complete destruction of the heads of the bones, melting of the bone tissue, deformation and shortening of the fingers, and dysfunction of the organ.
5. Psoriatic spondylitis - damage to the joints of the spine is accompanied by combined inflammation of the peripheral joints of the extremities.
6. The malignant form is rare and manifests itself in the form of the following symptoms:

• severe damage to the joints, spine, skin;
• an increase in body temperature to high numbers (39-40⁰С), with sharp drops in rises and sudden declines;
• exhaustion of the patient up to cachexia;
• generalized articular syndrome with the development of polyarthritis, severe pain, fibrous ankylosis;
• an increase in lymph nodes of a common nature;
• damage to the heart, kidneys, liver, eyes, nervous system.

Depending on the stage of the disease, articular psoriatic changes are classified into:

1. Progressive - exacerbation of a sluggish process, the maximum severity of the clinical manifestation.
2. Stationary - episodes of remission, attenuation, when pain, swelling and dysfunction of the joints do not bother the patient, periods of calm of the disease can last from several weeks to many months.
3. Regressive - the reverse development of the disease under the influence of adequate therapy. Exacerbations, if they happen, they do not reach such intensity as the previous ones, and happen less and less.

How to suspect pathology

To establish the correct diagnosis of psoriatic arthritis help:

• careful history taking and clinical symptoms;
• laboratory signs;
• instrumental research methods.

History and clinical manifestations

An experienced doctor in a number of cases, based on the appearance of the patient and a thorough questioning, can make a presumably correct diagnosis, which can be confirmed by laboratory and instrumental research methods.

Psoriatic arthritis in the presence of clinical symptoms confirming joint inflammation is indicated by:

1. Identified cases of psoriasis in relatives.
2. The presence of psoriatic plaques and other changes in the patient's skin, damage to the nail plates, damage to the scalp like seborrhea.
3. Nails can exfoliate, pathologically change according to the type of thimble-like piercing, sometimes the nail plate can be hypertrophied like a ridge.
4. The joints of the feet and hands can be swollen, painful, the skin tone above them is cyanotic, with a purple tint, such fingers are figuratively called sausage-shaped deformed.
5. Negative tests for RF.
6. Clinical, radiological signs of sacroiliitis.
7. Pain in the heels.

If there are at least several of the criteria described above that allow us to make an assumption about the disease, the data should be supplemented by laboratory and instrumental research methods.

Laboratory data

In psoriatic arthritis, the following changes can be observed in the analyzes:

• KLA: ESR acceleration, leukocyte content is much higher than normal, anemic changes;
• BAC: all indicators indicating joint inflammation increase (seromucoid, fibrinogen, sialic acids, PSA);
• blood on the RF: the result is negative;
• a blood test for histocompatibility antigens: the presence of the HLA B27 antigen;
• examination of the joint fluid: a lot of leukocytes, neutrophilia, reduced viscosity, a lot of mucin.

instrumental data

Assistance in making a diagnosis is instrumental method examinations like x-rays.

X-ray examination: more often take pictures of the joints of the feet, hands, sacroiliac region and sternoclavicular joint.

In these areas, osteolysis with bone displacements in different axes, periosteal changes, signs of calcification can be visualized on the film.

Additional methods can be ultrasound, MRI of the joints.

How to treat pathology

Treatment of arthropathy against the background of psoriasis should be carried out in a complex manner. It includes not only the relief of pain and the removal of symptoms of joint inflammation, but also the treatment of the underlying disease, skin manifestations in general.

Goal of therapy: to get expressed clinical effect, relieve exacerbation, and also prevent the progression of the disease, as long as possible to maintain a state of remission.

An integrated approach to therapy includes medication, physiotherapy, and diet. Sometimes in severe cases of psoriatic arthritis, according to the recommendations of the surgeon, surgical methods– synovectomy, endoprosthesis replacement of modified and ankylosed joints.

Medications for internal use

Tablets, injections, infusions - these dosage forms used in the treatment of arthropathy on the background of psoriasis.

The following groups of drugs are used:

1. Immunosuppressants (Methotrexate, Azathioprine, Cyclosporine A).
2. Tumor necrosis factor inhibitors (Etanercept, Infliximab).
3. Delagil, placvinil.
4. Preparations of gold.
5. Glucocorticosteroids (Prednisolone, Medrol).
6. NSAIDs (Indomethacin, Dicloberl, No-shnpa).

These drugs contribute to the relief of inflammatory processes, reduce the body's immunological aggression directed against its own tissues, and, with an adequate dosage, provide a long-term remission.

Medications for external use

Allow to relieve pain, reduce swelling and normalize blood circulation in the area of ​​the affected joint ointments, creams and gels of the following composition:

1. Hormonal ointments (Advantan, Sinaflan, Betamethasone).
2. External means with NSAIDs (Indomethacin ointment, Ultrafastin).
3. Antifungals (Ketoconazole, Nizoral).
4. Salicylic ointment.

Physiotherapy

Physiotherapeutic methods are indicated only in the stage of regression of the disease, after the relief of acute inflammatory phenomena and in the absence of contraindications from other organs and systems of the patient.

Physiotherapy is not indicated for oncological diseases, severe decompensated cardiac, respiratory failure, individual intolerance.

A good effect is brought by physiotherapy courses, which include the use of procedures for 7-10 days:

• electrophoresis with hydrocortisone;
• laser therapy;
• amplipulse therapy;
• iontophoresis;
• common baths with sea salt, peat oxide.

Therapeutic exercise under the guidance of a specialist doctor helps patients maintain the function of the affected joint and improve their work if there are certain disorders in the volume of active and passive movements that have arisen as a result of the disease.

Permissible physical activity during exercise therapy is determined by the doctor, based on the severity clinical manifestations diseases and the degree of activity of arthritis. In the remission stage, daily walks in the fresh air for at least 30 minutes at an average pace, gymnastic exercises for the fingers, squats, gymnastics, cycling are shown.

How to eat with psoriatic arthritis

Patients should be aware of some nutritional features that allow them to "keep the disease in check."

Restriction in the use of fatty, fried, spicy foods, sweets, coffee, strong tea, complete absence alcohol, will allow you to be in remission for a longer time and avoid deterioration in well-being, even without conducting maintenance courses of drug therapy.

It is advisable both in the phase of exacerbation and in the period of calm of the disease to use foods enriched with protein, unsaturated fatty acids, fiber. And consume carbohydrates and fats in limited quantities.

You should say “yes” to fermented milk products, vegetables, both raw and boiled, sea lean fish, boiled dietary meat, fruits, soy, buckwheat, rice and corn porridge.

Svetlana Ognevaya, a well-known Russian dermatologist-phytotherapeutist, is of the opinion that in order to create an optimal long-term remission in psoriatic arthritis, it is necessary to eat foods that create an alkaline environment in the body.

Alkaline-forming foods should be 80% of the patient's diet. Such products include vegetables and juices from vegetables, most fruits, with the exception of citrus fruits, pomegranates, white meat, seafood, milk, alkaline mineral waters.

It is important not to overeat, eat fractionally, but often (at least 5-6 times a day). Alcohol is not recommended to be consumed even in minimal quantities, as well as sweets. If you really want something sweet, let it be a banana or a baked apple with honey.

Non-traditional ways of treating the disease

Despite the fact that medicine is confidently making leaps and bounds, new drugs are being created, it is not possible to cure psoriasis 100% and get rid of arthritic manifestations against its background today.

Quite a lot of people among patients prefer to be treated unconventional ways, while many of them, after undergoing treatment with folk remedies, note an improvement in well-being. Doctors do not prohibit traditional medicine methods, but before starting treatment, it is strongly recommended to consult a doctor.

Methods of therapy methods "from the people" include:

1. Ingestion of the following mixture for a month: black radish juice - 200 ml, honey - 200 g, table salt - 10 g, vodka - 100 ml. 1 teaspoon 2 times a day after meals.
2. Apply to diseased joints a compress soaked in ammonia, honey and iodine, taken equally.
3. Collect red clover flowers, pour vodka, insist for at least ten days, then strain, pour into an orange glass container, cork with a plastic stopper. Rub the diseased joints twice a day, morning and evening.
4. Grind fresh burdock root, burdock root 1: 1 through a meat grinder, apply as a slurry for 30 minutes to places where pain is localized.
5. At night, rub a mixture of fresh leaves of a three-year-old agave, honey, burdock roots, taken 1: 1, into the joints. Wash off in the morning.

Apitherapy in the treatment of psoriatic arthritis

Treatment with bees and bee products (royal jelly, propolis, bee bread, honey) is extremely popular and has a beneficial effect on the body in many ailments, including psoriatic changes in the joints.

The most desperate patients decide to have sessions when the bees sting the skin directly over the inflamed focus. It is allowed to release up to 10 bees at a time on a medium-sized joint area. Bee venom has an anti-inflammatory, antioxidant, immunosuppressive effect, improves blood circulation in the focus area.

Alcohol tinctures or water infusions are made from propolis. Patients use them internally or externally in the form of rubbing and poultices.

Perga, royal jelly, beeswax, propolis is part of many cosmetic creams produced by the industry and sold through the pharmacy chain.

Apilak is a biogenic stimulant based on bee products that strengthens the immune system and is used in many conditions accompanied by immunodeficiency and immune disorders, including various manifestations of the psoriatic process.

Does hair fall out with psoriatic arthritis?

Psoriatic changes in the body, manifested as an isolated articular syndrome, are possible, but are extremely rare. As a rule, violations are also manifested by skin changes, including plaques that affect hairy part head with the development of dermatitis and seborrheic manifestations.

On the scalp, lesions grow - plaques, spots, peeling occurs. Skin changes often occur in the forehead, behind the ears, on adjacent areas of skin bordering the hair.

The deplorable condition of the skin of the hair cannot but affect their appearance. Hair fades, breaks and falls out. There may even be areas of limited focal alopecia - alopecia areata. Less common is diffuse alopecia - hair loss throughout the head evenly.

It is important to understand that a late visit to the doctor with articular changes that have appeared threatens with the loss of joint function and the development of disability. In the late, advanced stages, patients may lose self-care skills and become disabled.

At the slightest change in the musculoskeletal system, the appearance of non-specific symptoms, such as pain, a feeling of stiffness in the joints, discoloration of the skin over them, you should consult a doctor. Especially if these disorders occur against the background of psoriatic rashes. The treatment of psoriatic arthritis is carried out by a rheumatologist in close conjunction with a dermatovenereologist.

The sooner the disease is diagnosed and the course of treatment is started, the more likely it is to maintain the health and function of the joints, to prevent the progression and deterioration of general well-being.

The treatment of psoriatic arthritis is not an easy process, which combines measures to improve the functioning of the joints, get rid of the skin manifestations of psoriasis, and general tonic. You can significantly improve your well-being with the help of medicines and folk methods.

In the initial stage of the disease is quite justified folk treatment psoriatic arthritis. It consists in following a diet to reduce the manifestations of psoriasis and means to relieve pain and inflammation in the joints. Patients are advised to eat fractionally, but often avoid the following foods:

• chocolate and alcohol;
• strong coffee and tea;
• animal fats;
• smoked and spicy food.

Cold compresses can be used to relieve swelling from the joint and reduce pain. The most popular of them is a frozen decoction of chamomile.

Warm compresses and wraps normalize motor functions:

1. Grate a large raw carrot.
2. Mix equal proportions of aloe and lemon juice. Add carrot pulp.
3. Heat water, pour into a plastic bottle.
4. Apply a healing mixture to the diseased joint, cover with cling film, put a bottle of hot water or a heating pad on top.
5. The procedure lasts 15-20 minutes and should be repeated twice a day for a week.

On the early stages you can combine traditional methods with the use of pharmaceutical products. First of all - non-steroidal anti-inflammatory drugs.

How to treat psoriatic arthritis at home?

If the disease progresses rapidly, it is very important to relieve inflammation of the joint. It is almost impossible to do this without the use of medications. To date, the most common way to treat arthritis at home is the use of special ointments. One of the most effective is Arava. The use of Arava in psoriatic arthritis is also justified by the fact that the drug not only eliminates swelling of the joint and resumes its motor activity, but also relieves pain at the same time. Also, this medicine reduces skin irritation and prevents peeling.

Treatment can be supplemented with Sulfasalazine. It is a strong antimicrobial antiseptic that is often prescribed for psoriasis.

In advanced cases, doctors recommend treatment of psoriatic arthritis with Methotrexate. This drug is commonly used in the treatment of cancer, it stops the growth of tumor cells. In psoriatic arthritis, its action is directed to stop tissue necrosis and preserve the integrity of the joint. Using Methotrexate, you can slow down the deformation of tissues and prolong motor activity for a fairly long period. The drug is effective in the complex therapy of psoriasis, it is often supplemented with Pyrogenal. Both those and other tablets are released in the pharmacy strictly according to the doctor's prescription.

Often, therapy for psoriatic arthritis also includes the use of corticosteroids and other synthetic analogs of adrenal hormones. This allows you to reduce pain and relieve inflammation of the joint. Recently, agents acting at the molecular level have also become popular. These are the so-called bio-agents, Remicade and Humir preparations.

Psoriatic arthritis - inflammation of the joints against the background of an already existing skin disease. Psoriasis can occur at any age (usually after the age of 20) and is chronic. Periods of exacerbation are replaced by periods of remission. This pathology is not contagious, it mainly affects the skin, but patients may experience problems with self-esteem, social isolation and stress due to psoriatic plaques. They are unpleasant reddish spots with small dry scales. Plaques can be located on any part of the body (both on the scalp, face, and on the arms and legs), causing severe itching.

In addition to plaques, the manifestations of psoriasis are exfoliating nails, resulting ulcers, cracks and blisters on the skin. Psoriasis is often complicated by arthritis. Inflamed joints of the hands, spine, knees, elbows, hip joints. Arthritis can be either unilateral or symmetrical bilateral. The nature of the disease is autoimmune. The immune system takes cells related to the body as foreign and attacks them. If arthritis is left untreated, in almost all cases it leads to complete destruction of tissues, deformities of the joints, affects organs (eyes, lungs, kidneys, intestines), and as a result, disability occurs.

Treatment of psoriatic arthritis is carried out by two doctors - a dermatologist and a rheumatologist.

Main the reasons leading to psoriatic arthritis:

• - hereditary predisposition;
• - strong emotional upheavals, stress;
• - joint injuries;
• - alcohol consumption in large quantities;
• - infectious diseases.

Symptoms that indicate the development of psoriatic arthritis:

• - the appearance of pain in the area affected by arthritis of the joint (mainly in the morning);
• - puffiness;
• - a change in the color of the skin from red to cyanotic;
• - movement becomes difficult;
• - if the disease has progressed strongly, then a deformity of the joint is formed.

In order to correctly diagnose psoriatic arthritis, the attending physician refers the patient to an x-ray. As additional studies - blood tests and joint fluid.

Treatment of psoriatic arthritis

Treatment for psoriatic arthritis is aimed at eliminating pain the patient to enable him to fully move and work. In addition, it is necessary to influence the inflammatory process in the cartilage, stop its destruction and restore the ability of the joint to move.

There is no universal cure for psoriatic arthritis. Doctors recommend a course of medications, physiotherapy exercises (to maintain muscle tone), ointments and creams, physiotherapy, diet, traditional medicine methods. In the early stages, it is much easier and faster to remove the period of exacerbation and have a positive effect on joint recovery than with an advanced form of arthritis, when without surgical intervention not enough.

Traditional medicine methods do not allow self-treatment. Each prescription should be discussed with the attending physician, who will establish the absence of contraindications for use, the safety of the method, advise the necessary dosage and course of treatment.

Compresses, rubbing, baths

1. A compress of raw grated carrots, five drops of vegetable oil and five drops of turpentine has an antimicrobial and tonic effect, penetrates deep into the skin and nourishes connective tissue cells. It is necessary to apply a compress before going to bed, alternating it with an aloe vera compress.


2. Aloe compress with oil and turpentine is made according to the same recipe as carrot. Aloe has excellent healing properties, positively affecting joints affected by psoriatic arthritis.
3. A powerful anti-inflammatory and analgesic effect gives a tincture of lilac buds. They are collected in the spring in the amount of two glasses, mixed with half a liter of alcohol and insisted in a dark place for ten days. Tincture is rubbed with diseased joints (arms, legs, spine). A course of ten to twelve applications.

Together with the tincture for arthritis, you can apply a wrap of lilac leaves. Steamed fresh leaves are applied to the joints, fixed and insulated. After just a few applications, pain is noticeably reduced and mobility is increased.

AT summer period you can make your own tincture from fresh burdock root. They are dug up, cleaned, crushed and poured with vodka (the liquid level should be 2-3 centimeters higher than the crushed roots). The mixture is infused in a dark place for three weeks. Periodically, the container with tincture must be shaken. ready mix used for rubbing and for oral administration (half an hour before meals three times a day, one tablespoon). Burdock has antiseptic, analgesic properties, has a positive effect on the condition of the skin and joints.

One of the most effective remedies for psoriatic arthritis is a decoction of birch buds. They contain almost all known vitamins, promote wound healing, have antiseptic and analgesic properties. Five grams of the kidneys must be poured with a glass of boiling water and boiled over low heat for fifteen minutes. After that, the broth should be poured into a thermos and insisted for one hour. The entire volume is designed for a four-time intake in one day (fifty grams each).

In summer, one of the most affordable and effective recipes is the use of wood lice grass. It is collected and stuffed fresh into shoes, which are then put on bare feet and worn from morning to evening.

Marsh cinquefoil ointment penetrates deep into the skin, warms up, anesthetizes and helps to restore cartilage tissue. To make it you will need: a tube of cream, one tablespoon of cinquefoil tincture (sold in a pharmacy), three drops of liquid vitamin E, a teaspoon of honey, a teaspoon of red pepper tincture. All ingredients must be mixed thoroughly. Apply the ointment several times a day, store the rest in the refrigerator.
With constant use, wraps from cabbage leaves, burdock or coltsfoot help well. Plants are used fresh, the leaves are heated before use and many small cuts are made on the surface. To improve the effect, smear with honey. The compress is insulated and left overnight.

A compress of crushed chalk and kefir is also made at night, be sure to insulate it with a woolen cloth or cotton wool.
Baths with pine needles have a positive effect on the skin, well-being and joints. The collected needles are poured with boiling water, insisted and poured into a warm bath, which takes fifteen to twenty minutes.

In addition to rubbing, compresses and baths, traditional medicine recommends dieting. A systematic approach to the treatment of psoriatic arthritis is the key to a successful fight against exacerbations.

Permitted foodstuffs: juices from fruits and vegetables, fish, chicken, rice, cereals (oats, millet, rye, barley), bran, vegetables.

With caution and separately from other products, it is allowed to eat: apples, melons, bananas, grapefruit.

But you will have to completely exclude from the diet: alcohol, citrus fruits, pomegranates, avocados, raspberries, strawberries, strawberries, salmon, salted fish, sushi, battered dishes, red meat, tomatoes and ketchups, legumes, corn.

Traditional medicine methods have a minimum of contraindications and side effects, unlike many medical preparations. A properly selected course of treatment with folk remedies will not only save money, but also significantly alleviate the symptoms of psoriatic arthritis, gradually minimizing them.

Psoriatic arthritis

In the understanding of most people, psoriasis is a disease of only the skin. 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 lesion of the joints. It will be discussed in this article.

Why does it happen

Scientists have found that the triggers of psoriasis are immune processes. Therefore, the problem does not occur on 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 synovial membrane of large and small joints. To provoke such an atypical course of psoriasis in the form of arthritis is capable of:

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

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

Important to remember! Psoriatic arthritis occurs exclusively in patients with psoriasis. This means that in a person without signs of a psoriatic rash, such a diagnosis cannot be established. The exception is cases of primary manifestation of psoriasis not from a skin lesion, but from an articular one. But these symptoms are sure to build up on top of each other!

How to suspect and identify a problem

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

1. Asymmetric arthritis. It affects different articular groups from opposite sides. For example, the hip and hand joints on the left, combined with inflammation of the knee joint on the right.
2. Symmetric 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).
3. Arthritis with a primary lesion of small articular groups. This form of pathology is characterized by the greatest severity of inflammation in the joints of the hand or feet.
4. Psoriatic spondylosis is an inflammatory lesion of the spinal column.
5. deforming form. It characterizes an extremely difficult stage of the pathological process in the joints. Accompanied by their destruction and deformation.
6. Psoriatic polyarthritis and monoarthritis. In the first clinical variant of the disease, several articular groups are affected according to an asymmetric or symmetrical type. 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. With inflammation of large joints with the aim of differential diagnosis a puncture is performed with intra-articular fluid sampling for analysis. By her nature and cellular composition one can judge the approximate nature of inflammation (exclude purulent process, gout, accumulation of blood, etc.).

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

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

Damage to the small joints of the hand in psoriatic arthritis

Medical therapy

The treatment of psoriatic arthritis involves an integrated approach. This means that it should include drugs 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 equally stop pathological processes in the skin and hyaline cartilage.

The main directions of therapy are as follows.

Powerful anti-inflammatory therapy with glucocorticoids

The drugs of this group are one of the basic 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 exacerbation of psoriasis or without it - treatment according to the method of pulse therapy with drugs based on methylprednisolone (metipred, methylprednisolone, cortinef), dexamethasone or prednisolone. Doses of these drugs should be as high as possible to suppress inflammation.
• Psoriatic arthritis with moderate inflammatory changes in one or more joints of the limbs or spine. The use of hormones in medium therapeutic doses by injection or tablet administration is shown.

Treatment with non-steroidal anti-inflammatory drugs

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

Use of cytostatics

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

Manipulations on the affected joints

Treatment is represented by two types of effects:

• Immobilization. Inflamed joints are subject to fixation in a normal anatomical position. The exclusion of movements in them for the period of exacerbation of the process will significantly reduce the duration of treatment. 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

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

Important to remember! With psoriatic arthritis, it is unacceptable to try to defeat the disease on your own, using only folk remedies. Failure to timely complex 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, can not always be successfully treated with medication. Patients who have lost hope of recovery are looking for any alternative methods which can be used to treat this disease. Usually, alternative treatment and alternative medicine come to the rescue. Of course, such techniques have the right to life, but you should not rely only on them. Best to combine drug treatment with folk remedies.

Here are some effective recipes:

1. Raw carrots as a compress on the affected joint. To prepare it, one medium-sized carrot needs to be finely grated. 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 wraps the diseased joint. The duration of the compress is about 8 hours (it is possible at night).
2. Lotions from aloe. Prepared by analogy with a carrot compress. The difference is only in the main ingredient: aloe is used instead of carrots. It is best to alternate with carrot compresses.
3. Tincture based on lilac buds. Raw materials are harvested in the spring. The required number of kidneys per serving of tincture is 2 cups. Fresh kidneys are poured 500 gr. alcohol. Within ten days, the infusion should be in a dark place. After this period, the product is ready for use. It is used exclusively for external application in the form of rubbing on the skin in the area of ​​the affected joints.

On the importance of proper nutrition

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

• Exclusion of allergenic foods: sweets, citrus fruits, chocolate, eggs.
• Exclusion of irritating foods: marinades, seasonings, smoked meats, spices, alcoholic beverages.
• The basis of the diet are vegetables, fruits and berries. But the diet excludes currants, strawberries, tomatoes, blueberries, plums, eggplant, coconut.
• The use of 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, barley. It is best to fill them with vegetable (olive, linseed, sunflower) or butter.
• Meat products. Preference is given to dietary meats: chicken, turkey, rabbit. It is better to refrain from fish at the time of exacerbation.
• Sour-milk products of low fat content.
• Bread made from wholemeal flour and bran.
• Ways of cooking: fried and smoked dishes are strictly prohibited. Products can be boiled, steamed, baked.

Proper nutrition is the key to successful treatment and prevention of psoriatic arthritis

Features of the disease in childhood

The prevalence of psoriasis among children is much lower than in 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. In persons of this age group, against the background of psoriasis, there are often ordinary arthralgias (joint pains), which pass without a trace. The peculiarity of the course of the disease in children is such that most often it is of a generalized nature (like polyarthritis).

Prevention

Predicting and preventing psoriatic arthritis is very difficult. 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. Price for non-compliance preventive measures- progression of the disease and even disability.

Psoriatic arthritis has much in common with arthritis of a different origin. 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 method of treatment.

With psoriasis, red spots appear on the skin, covered with white or grayish scaly scales. Psoriasis usually first appears between the ages of 14 and 45, and is equally common in men and women.

Related news

Psoriatic arthritis develops in approximately 10% of patients with psoriasis. Often it occurs several or even many years after the first onset of psoriasis symptoms, but it can also appear before skin symptoms develop.

What causes psoriatic arthritis?

The exact cause is unknown, but it is believed that the development of the disease is due to the interaction of immune, genetic and environmental factors. Up to 40% of patients with psoriatic arthritis have a family history of psoriasis or arthritis.

Symptoms

Symptoms of psoriasis include skin changes: red, scaly patches on the skin, pockmarked scarring, and changes in pigmentation around fingernails and toenails. The patches (medical term "psoriatic plaques") can be very small. Very often they occur on the scalp at the hairline, on the lower leg just below the knee, or on the forearm in front of the elbow, but they can also be widely distributed throughout the body (on the trunk, on the head and on the limbs). Often their appearance is accompanied by itching and discomfort for the patient.

Pain and swelling of the joints, most often the last joints of the fingers and toes, as well as the wrists, elbows and knees. In some cases, only one joint may be affected, but several joints may be involved in the inflammatory process, so that clinical picture reminiscent of rheumatoid arthritis. The sacroiliac joints and spine can also be affected by the inflammatory process. It is because of this that psoriatic arthritis belongs to a group of diseases known as spondyloarthrosis. Psoriatic arthritis develops over a long period of time, but it can also occur suddenly.

Diagnostics

The doctor will ask about your symptoms and perform an examination. Since the symptoms of arthritis are similar, the doctor may prescribe an additional examination:

• X-ray examination
• Blood analysis
• Joint fluid analysis.

If the patient has skin manifestations of psoriasis, then an accurate diagnosis can be made almost immediately. In other cases, a thorough examination is required, and sometimes the diagnosis is confirmed with the appearance of skin lesions.

Management of patients with psoriatic arthritis

Your doctor may involve other specialists in developing the best program to control and treat your condition. In general, a healthy lifestyle and overall good body condition play an important role in your condition.

The main goals of treatment include reducing joint pain and inflammation, controlling the skin manifestations of psoriasis, and slowing (or preventing) joint damage. Therapy is complex and includes the use of external medicines, drugs for oral administration and other methods of treatment.

Psoriasis requires careful skin care. You should use mild cosmetics, soap, avoid exposure to any irritating household chemicals.

Depending on the severity of the disease, the severity of the pain, the doctor will help you choose a comprehensive treatment program for the disease, which will include correctly selected exercise(the instructor of physiotherapy exercises will recommend a set of suitable exercises), the regime of work and rest and medicines. There are different groups of drugs that control psoriasis and improve the condition and appearance of the skin. In arthritis, drugs from the NSAID group are most often prescribed to reduce pain, inflammation, and joint stiffness. Such drugs act quickly enough and are not addictive. In severe cases of arthritis, it is possible to use corticosteroids and immunomodulatory drugs.

In patients with psoriatic arthritis, chronic fatigue and depression are often noted. The doctor will help to cope with such psychological problems, as well as give recommendations, the observance of which will help you improve the quality of life of the patient.

Promises of "instant cure", "miraculous relief" sound very attractive to patients chronic disease. Most products advertised in this way, whether drugs, supplements, or devices, are harmless but useless. Usually, such remedies are expensive, and their effectiveness is not proven or questionable. Before taking any remedy, be sure to consult your doctor.

How to treat psoriatic arthritis?

Victor M.

Recipe number 1 If you have a swollen joint, make compresses from raw pureed carrots. For 1 st. add a spoonful of grated carrots 5 drops of sunflower oil and 5 drops of pharmacy turpentine. Do the procedure after 1 day. The next day, put compresses from aloe leaves.
Recipe number 2 If you are prone to joint swelling, drink burdock leaf juice annually. Take 1 tbsp. spoon 3 times a day 40 minutes before meals and eat 1 teaspoon of honey (if there is no blood sugar and allergies to bee products). Juice can be prepared for 3-4 days. Make juice only from fresh leaves, store it in the refrigerator. At the same time take mummy. Take 1 tbsp. spoon in the morning an hour before meals. Prepare the solution as follows: 2 gmummies per 200 ml of boiled water. 10 days to drink - 5 days break. Drink 2-3 months.
Recipe number 3 With psoriatic arthritis, the small joints of the legs often hurt. Very good results are obtained by the grass woodlice, or medium chickweed. This grass grows in every garden, in the fields like a weed. If you are in the country, stuff this grass into your shoes like insoles. Put on directly on bare feet, and in the evening rinse with warm water. The effect is amazing! Try it.
Recipe No. 4 For psoriatic arthritis, a month after the main course of treatment, according to my method, it is necessary to make a tincture of pine nuts. Method of preparation: crush the nuts together with the shell, pour into a bottle of 0.5. Vodka should be 6 cm more. Insist 3 weeks. Then strain. Take 1 tbsp. l. 3 times a day half an hour before meals.
Recipe number 5 With psoriatic arthritis, as well as arthrosis, squeeze the juice from 1 kg of celery roots, add 2 cups of honey and mix well. Keep refrigerated. Take 1 tbsp. l. 3 times a day half an hour before meals. The course is 1 month, a month break. Repeat in a month.
Recipe No. 6 Crush marshmallow root (2 tablespoons), place in an enamel pan, pour 200 g of hot boiled water, close the lid and boil in a water bath for 30 minutes. Refrigerate 10 minutes. Squeeze out the raw materials and bring to 200 ml with boiled water. Keep only two days. Take 1/3 cup 3 times a day after meals.
Recipe No. 7 500 g of celery root with herbs, 500 g of lemons with peel. Add 500 g of honey. Mix and refrigerate for 3 days. Take 1 tbsp. l. 3 times a day 30 minutes before meals. The joints will become mobile, the fingers dexterous.
Recipe number 8 Dry ginnkgo leaves, grind in a coffee grinder. Take 1 tsp. 3 times a day with meals.
Recipe No. 9 Philinnik (kirkazon) 50 g per 1 bucket of water, 30 min. boil. Take externally in the form of baths. Internally: 1 tbsp. l. brew 1 cup boiling water, leave for 1 hour, take ¼ 3 times a day.
Recipe number 10 In the spring, collect lilac buds. 2 cups of kidneys pour 0.5 liters of vodka. Put in a dark place to infuse for 10 days. With this infusion, rub sore joints, lower back. Enough 10-15 procedures.

Dasha Buldakova

You need to start with yourself and accept the fact that the disease is not curable, despite the entire arsenal of drugs. Stop rushing about in search of "the most miraculous remedy." So far there is no such thing. But I did not deceive you by calling the article "How to treat psoriatic arthritis". Because only your brain can cure you.
* Each patient has his own psoriasis, and it proceeds in its own way. Of course, there is an official classification, where the symptoms are beautifully described, but none of them contains information about what kind of lifestyle one should lead in this case. Surely, having told the doctor about what is bothering you, in response you will not hear anything that you yourself do not know. Don't focus on it and don't get upset. Remember - you are your own best doctor, just listen to yourself more often.
* Do not be nervous, especially over trifles, because this can lead to an aggravation. Try to learn to pass by yourself all the information that does not concern you personally.
* Always get good sleep and get plenty of rest.
* After you have been diagnosed and treated, be sure to consult with several doctors and listen to their opinion. Rheumatologists are very fond of prescribing cytostatics and hormones, like “vitamins”. Remember that these are far from harmless drugs, they greatly "plant" the liver, and you still need it. Without it, for many years you will not shave with such an insidious disease.
* Therefore, try to independently identify those factors that cause an exacerbation of the disease in you personally, and exclude them. No doctor will do this for you, because he simply does not understand that this is possible. It doesn't matter what it is: cold, smells, food, etc. These factors are known only to you.
* Now you also need to use cosmetics and household chemicals minimally, since they contain substances that can exacerbate the disease.
* Changing your lifestyle, do not forget that you have friends, and therefore do not limit communication with them. Although sometimes you really want to close yourself in your shell and not come out of there. But you can’t, it will lead to depression and exacerbate the disease.
* Psoriatic arthritis does not like drugs, so if the exacerbation could not be avoided, then first of all remove all unnecessary drugs, leave yourself 3-4 vital ones.
* And finally, the most important thing is diet. The most famous for Pegano and raw-mono diet. Many adhere to them, and for most they work well, but again, everyone is individual. This may not help you. But it is known for sure that it is necessary to completely and forever exclude alcohol, tobacco, chocolate, all nightshade (peppers, potatoes, tomatoes, eggplants), as well as products containing preservatives.
As for the rest of the products, everything here is also relative and depends on how your body tolerates them. This can only be learned by trial and error, listening to yourself.
As practice shows, the treatment of psoriatic arthritis by 50% depends on the positive mood of the patient, and on their adherence to a healthy lifestyle. Although, of course, it is so difficult to avoid bouts of despair, but they always pass, you just need patience!

anti-inflammatory drugs and chondroprotectors in combination with physiotherapy

sys-tav.ru

Symptoms of the disease

In many cases of psoriatic arthritis, the skin manifestations of psoriasis are observed, which allows the doctor to quickly make a diagnosis. The course of the disease is usually chronic, with periodic improvements and exacerbations. .

Sometimes there are signs of damage to internal organs: the heart, eyes, urinary tract. In many patients, the acute development of the disease is not accompanied by morning stiffness.

The main symptoms of psoriatic arthritis are:

• asymmetric joint damage;
• cyanotic-purple color of the skin and swelling over the affected joint, soreness of the zone;
• spinal injury;
• the formation of "looseness" of the finger and the acquisition of the appearance of a sausage;
• psoriasis of the nails and/or skin.

When psoriatic arthritis is actively developing, the symptoms become especially pronounced. Initially, the signs of the disease are reduced to increasing joint pain and swelling in this area. Further, the joints lose their mobility. It is especially difficult to return their function to them in the morning: you will need to stretch the numb place. To what extent psoriatic arthritis can develop - the photo will demonstrate clearly.

Forms of psoriatic arthritis

In medicine, five forms of psoriatic arthritis are distinguished, for the treatment of each of which the appropriate therapy is selected. The disease is classified depending on the joints in which the inflammatory process occurs. To consider the division of psoriatic arthritis into types is rather conditional. Over time, one form of the disease can be replaced by another, or a combination of forms is observed.

Types of psoriatic arthritis:

Traditional Treatments for Psoriatic Arthritis

To prevent severe joint deformity and disability, psoriatic arthritis must be treated constantly. For this, the patient must be observed by a doctor and undergo systematic therapy. The sooner the treatment of the disease is prescribed, the greater the hope for the preservation of functions. joints and internal organs. Timely therapy is an opportunity for the patient to prolong the active years of life.

Medical therapy

Psoriatic arthritis can be cured by reducing inflammation, stopping erosion, and restoring joint motor function. In this case, the therapy of damage to the skin and joints is carried out simultaneously.

If necessary, drugs are injected directly into the joint. In severe cases, plasmapheresis is prescribed - blood purification. This will reduce the phenomenon of inflammation and relieve the symptoms of the disease.

The following remedies are used to treat psoriatic arthritis:

• anti-inflammatory drugs;
• corticosteroid hormones;
• chondroprotectors - drugs for restoring bone structure;
• immunomodulators.

Among non-steroidal anti-inflammatory drugs, the use of diclofenac sodium, nimesulide, ibuprofen is common. Of the glucocorticosteroid drugs, dexamethasone, prednisolone are used. Since the use of chondroprotectors, it has also become known how to treat psoriatic arthritis. These are drugs: chondroitin sulfate, hyaluronic acid, glycosamine sulfate, sodium hyaluronate, diacerein.

In the treatment of psoriatic arthritis, Alpha D3 TEVA is used to alleviate the symptoms of bone and joint damage. Smoothes the course of the disease and the use of the enzyme bromelain, as well as moderate doses of lecithin, together with omega-3 polyunsaturated fatty acids.

Exercise therapy and gymnastics

The most important component in the treatment of psoriatic arthritis is exercise therapy. The patient can choose to attend classes. It can be visits to the clinic or doing a set of exercises at home.

Exercise therapy is usually carried out in 10 sessions. The level of physical activity is set by the instructor for each individual case. Regular exercise will help relieve joint pain and stiffness.

The greatest effect is given by a combination of general strengthening exercises and a set of exercises aimed at maintaining normal physiological functions joints. In the remission stage, it will be useful to conduct a daily warm-up and a general increase in the physical activity of the body. Therapeutic physical education and gymnastics allow you to achieve the following results:

• reduction in the severity of symptoms;
• maintaining at the same level, or improving the functioning of the joints;
• making muscle fibers more flexible and elastic;
• maintaining optimal weight (reduces stress on the joints);
• reducing the risk of developing complications of the cardiovascular system.

Surgical treatment

Most patients with psoriatic arthritis surgical treatment not required. But, there are times when the previous methods do not give a positive effect.

Such patients should not despair - doctors know how to treat psoriatic arthritis through surgical procedures. These include synovectomy - an operation to restore the functions of the joint and extract the affected tissues.

In cases of severe damage, arthroplasty or cartilage prosthetics is used - an operation to replace the diseased connective tissue with an artificial one. This leads to the restoration of the function of the affected area and the mitigation of pain, improvement appearance joint. In some cases, surgical fixation of the carpal or ankle cartilage, connective tissues of the fingers is performed.

Treatment with folk remedies

Folk methods have been used since ancient times for the treatment of various skin diseases. Psoriatic arthritis is also no exception. A feature of the treatment of the disease with the gifts of nature is that plant components have a positive effect on both psoriasis and arthritis. influence the disease folk methods can be combined with medications, which increases the chances of an early remission.

Diet for psoriatic arthritis

A diet is prescribed for psoriatic arthritis in order to maintain the full functional functioning of the joints. Follow the diet prescribed by the doctor should be strictly.

This is the only way to significantly slow down the rate of progression of psoriatic arthritis and significantly alleviate the patient's condition. Meals are recommended by nutritionists to be carried out in small portions, without overeating.

In psoriatic arthritis, preference is given to dairy and vegetable foods. Limit the intake of carbohydrates and animal fats, and increase the amount of food rich in vitamins. It has been noted that apples, plums, asparagus, sorrel, blueberries, black currants, mountain ash and sea buckthorn are very useful for patients with psoriatic arthritis. From the daily diet, patients exclude fried, fatty and spicy foods.

In addition, a complete rejection of any bad habits and timely treatment infectious diseases. The patient is prescribed a strict diet for psoriatic arthritis lasting a week with a second course not earlier than a couple of months later. Violation of the prescribed diet threatens with a new period of exacerbation and a decrease in the former, active lifestyle of a person.

You should not eat citrus fruits, berries, red meat for psoriatic arthritis. Salted fish, peas, legumes, and vegetables belonging to the nightshade family are categorically contraindicated.

Traditional medicine recipes

Psoriatic arthritis can be treated with burdock root. To do this, the fresh roots of the plant are cut into small pieces. The components are transferred to a suitable container, and pour vodka on top so that the liquid covers the contents by 3 cm.

Then the blank is placed in a dark place and infused for 3 weeks. Tincture is used for rubbing or ingestion: 3 times a day 30 minutes before meals.

Recommends traditional medicine for the treatment of psoriatic arthritis and lingonberry remedy. For this, a decoction is prepared from the leaves of the plant. Put 2 teaspoons of herbs in a container and pour one glass of hot water. The contents are brought to a boil and boiled over low heat for fifteen minutes. When the broth is ready and completely cooled, it must be drunk in small sips.

With the diagnosis of psoriatic arthritis, the treatment of folk remedies involves the use of a recipe based on fresh carrots. A grated vegetable is mixed with 5 drops of vegetable oil and pharmacy turpentine. All ingredients are mixed and applied as a compress at night. The carrot-oil compress the next evening is replaced by the application of an aloe leaf. The alternation occurs 10 times.

In the treatment of psoriatic arthritis, decoctions based on such herbs are actively used:

• Hypericum perforatum;
• coltsfoot;
• medicinal dandelion.

The recipe on birch buds demonstrates, in general, the approach to preparing medicinal decoctions for psoriatic arthritis. Initially, 5 g of kidneys are taken, poured with a glass of boiling water and the mixture is brought to 100 ° C over low heat. After 15 minutes of boiling, the container is wrapped for an hour. Take the remedy for 0.25 cups before meals 4 times a day. AT traditional medicine this recipe is recommended quite often.

Psoriatic arthritis - dangerous disease, which must be treated as quickly as possible. If you start the disease, it can turn into extremely unpleasant consequences. But when choosing methods, do not forget that first of all you need to ask for the advice of a specialist: only a doctor knows how to do the right thing in your situation.

mirsustava.ru

What is psoriatic arthritis?

Psoriatic arthritis is an inflammation that occurs in the joints due to a disease that a person has called psoriasis. Psoriasis affects both males and females equally. If in the past doctors considered psoriatic arthritis to be a type of rheumatoid arthritis, now it has been isolated as a separate disease.

Psoriatic arthritis does not always develop against the background of the corresponding disease, but only in 30% of cases. Most often, this form of joint inflammation affects people who are aged 30 to 50 years.

There are several types of the disease:

Arthritis psoriatic asymmetric. Several joints are involved in the pathological process, most often up to three. In this case, both large and small bone elements can be affected. A similar paired joint does not suffer.

Symmetrical arthritis affects paired joints, actively progresses and often leads to disability. Its course resembles rheumatoid arthritis.

Arthritis psoriatic, affecting the interphalangeal distal joints. First of all, the small joints of the fingers, located near the nails, suffer. This applies to both the upper and lower extremities. It is often confused in the initial stages with osteoarthritis.

Spondylosis, when the disease is more affected by the spine in one or more of its departments.

The most severe form of the disease is deforming arthritis. The joints are destroyed, and the person becomes disabled due to the inability to perform the simplest actions.

Symptoms of psoriatic arthritis

The most striking symptom of psoriatic arthritis is pain.

It can occur in various joints, but there are certain symptoms that make it possible to suspect this particular disease:

The joint swells, this puffiness goes beyond its area and somewhat spreads to nearby tissues.

If the joint is palpated, the person will experience pain.

The affected area is bluish in color. Sometimes it can be purple.

The affected distal interphalangeal joints, with a combination of all of the above signs, are somewhat reminiscent of the shape and color of a radish.

Often the nail plates are affected, which allows a more accurate diagnosis, as it suggests psoriasis.

The fingers thicken, sometimes it happens symmetrically on both the upper and lower extremities.

Fingers can be shortened in size.

Since the density and elasticity of the ligaments are disturbed, dislocations of different directions can form.

If the intervertebral joints are affected, which occurs in 40% of cases, then ossifications are formed, this causes pain and stiffness of movements.

The skin at the site of the lesion will have a higher temperature than the general body temperature.

Doctors also distinguish a malignant form of psoriatic arthritis. Most often, this pathology affects men at a young age (up to 35 years and earlier).

It has its own specific symptoms:

The joints of the spine and skin are always affected.

Feverish state.

Loss of energy and exhaustion.

Violation of joint mobility, polyarthritis with severe pain.

Enlarged lymph nodes.

The disease affects most organs: eyes, liver, kidneys, heart and nervous systems.

There are several reasons for the development of the disease. Among them, the most likely are:

Disorders in the work of the nervous system. That is why psoriasis belongs to the category of psychosomatic diseases. The impetus can be constant nervous tension, which is expressed in mental health disorders. Often the strongest stressful situation (death of a loved one, divorce, etc.) becomes a provoking factor. Arthritis occurs as a secondary disease, against the background of existing problems with the skin.

Trauma can also be a contributing factor. Against the background of existing psoriasis, inflammation can occur even in a slightly injured joint. In the future, the disease will gradually cover more and more new areas.

Taking certain medications can trigger the development of the disease. These include popular anti-inflammatory nonsteroidal drugs (ibuprofen, naproxen, diclofenac), as well as drugs to lower blood pressure (egilol, vasocardin, and others).

unhealthy lifestyle and bad habits are a secondary factor in the onset of the disease.

The symptoms of psoriatic arthritis can worsen significantly during menopause among women. The reason becomes hormonal disbalance in the body. Pregnancy, on the contrary, significantly reduces the signs of the disease.

Transferred infectious diseases and weakened by them immunity. These include streptococcal tonsillitis, chicken pox and other diseases.

The hereditary factor plays an important role in the development of pathology. It is worth paying more attention to your joints for those people whose close relatives suffered from psoriatic arthritis. This criterion has been carefully studied in many studies, and it was found that if both parents suffered from psoriasis, then the child is more likely to also be affected by this type of arthritis.

Increased activity of T-lymphocytes, which are involved in the body's immune response to pathological changes and violations.

Violations in the work of the endocrine gland, as well as the pathological activity of cells responsible for the production of melanin.

Even an old scar on the soft tissues and on the skin, as well as surgical intervention, can be the impetus for the onset of inflammation in the joints.

Many scientists argue that even if a person does not have symptoms that indicate psoriatic arthritis, this does not mean that his joints are healthy.

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October 29 is World Psoriasis Day every year. This year, the main goal is to inform patients with psoriasis and their relatives with articular syndrome on the early detection of psoriatic arthritis in order to timely identify and treat psoriatic arthritis, other rheumatic diseases. Considering the urgency of this problem, in the Vitebsk region from October 12 to October 27, 2017, a republican medical and educational action " Early detection psoriatic arthritis in risk groups.

Psoriasis, or psoriasis, is one of the most common chronic inflammatory skin diseases; occupies a leading place in the structure of skin pathology and affects from 0.1 to 5% of the population of different countries.

In the Republic of Belarus, in the structure of dermatovenereological diagnoses, psoriasis accounts for 3.6% of the total pathology. The disease is characterized by polygenic inheritance, men and women get sick equally often. In the presence of psoriasis in the father, the risk of developing the disease in a child is 8%, 41% in the presence of psoriasis in the mother. Unlike most non-contagious skin diseases, psoriasis is common among indigenous people of the Far North; a high frequency of joint damage was noted in patients in Yakutia. In the Republic of Belarus, the prevalence of psoriasis among the population ranges from 3 to 4.5%.

Currently, there is an increase in severe, refractory to pharmacotherapy, sometimes disabling forms of dermatosis in the form of arthropathic psoriasis, pustular psoriasis and psoriatic erythroderma, which significantly affects the quality of life of patients, leads to mental and social maladjustment, to permanent disability, determining not only medical but also the social significance of this problem.

Psoriatic arthropathy (PsA) has specific pathogenetic, clinical and therapeutic characteristics.

The incidence of psoriatic arthritis is 6 cases per 100,000 population. The exact prevalence of this nosology is unknown. According to different authors, the development of psoriatic arthritis in patients with psoriasis occurs in 5-30% of cases. More often, arthritis develops against the background of psoriatic skin lesions, however, in 15-25% of patients it may be the first symptom of the disease. There is also no correlation between the severity of articular and skin syndromes.

The peak incidence of psoriatic arthropathy falls on the age group of 20-40 years. The gender distribution is equal, however, axial forms are still more common in men, while multiple joint involvement is more common in the female population.

Studies show that in 19-41% of patients with a disease experience of more than 5 years, more than five joints are involved in the pathological process. The same figure increases to 58% after 10 years of the course of the disease. It is believed that more early therapy antirheumatic drugs (biological drugs, cytostatic therapy, NSAIDs) allows you to restrain the aggressive development of the pathological process.

Indicators of PsA severity and prognostic criteria for the activity and progression of the process include: involvement of five or more joints in the process; the nature of the damage during x-ray examination; ESR and CRP levels clearly correlate with activity clinical course PsA; low level ESR can be considered as a positive protective prognostic sign.

PsA is an example of a joint disease associated with chronic T-cell autoimmune skin inflammation. A key link in the pathogenesis of PsA. As with other forms of psoriasis, a high degree of hereditary predisposition should be considered.

The immunological mechanisms of PsA are similar to those in other forms of psoriasis: association with activated T cells (CD8+), which play a key role in the synthesis of pro-inflammatory cytokines - IL-2, IFNy, TNFa. A certain importance is also attached to the negative impact of exogenous environmental factors. All of the above mechanisms lead to the predominant localization of inflammation in the periarticular formations, followed by the formation of areas of fibrosis, restructuring / lysis of bone structures and synovitis.

There is no single classification for PsA. The most commonly used clinical classification of PsA, developed by J. Moll and V. Wright:

• asymmetric oligoarthritis or monoarthritis (often occurring);
• arthritis of the distal interphalangeal joints (specific PsA);
• symmetrical rheumatoid-like arthritis with negative RF serology (common);
• mutilating arthritis (specific PsA);
• psoriatic spondylitis.

It is also customary to distinguish two subgroups of PsA. The first - with the prevailing clinic of involvement in the pathological process of the axial joints with / without the development of the clinic of peripheral arthritis. The axial form is relatively resistant to treatment with drugs such as sulfasalazine and methotrexate. In patients with axial PsA, as a rule, the resulting clinic of peripheral joint lesions is more malignant. The second subgroup is a peripheral form of joint damage in PsA with no signs of involvement in the process of axial joints (Psoriasis: objectification of the choice rational therapy: method, manual / A, M. Lukyanov. - Minsk: DoctorDesign, 2011.-p. 35-40).

In the Vitebsk region, 1,400 patients with psoriasis are registered with dermatovenereologists, and 86 patients with psoriatic arthritis. The main goal in the management of patients with psoriasis and psoriatic arthritis is to reduce the frequency of relapses of this disease in patients, prevent the risk of developing complications of this disease, and improve the quality of life of these patients. This is achieved through dynamic dispensary observation for patients (2-4 times a year, more often if necessary), the use of new modern methods treatment of patients, carrying out rehabilitation measures.

Immunobiological agents are the most modern treatment option for psoriasis and psoriatic arthritis.

These are biological preparations of narrowly targeted action (reduction advanced level TNF-alpha, blocking the biological activity of IL-12 and IL-23), which selectively affect certain mechanisms without affecting other components of the immune system. Modern immunobiological preparations are well tolerated and convenient for use. Four drugs for immunobiological therapy are available in Belarus: Infliximab (Remicade), Ustekinumab (Stelara) for parenteral administration, Adalimumab (Humira), Etanercept (Enbrel) - preparations for subcutaneous administration. Immunobiological therapy is indicated for patients with moderate to severe psoriasis, especially in the presence of joint damage, with the ineffectiveness of other previous therapy.

Systemic therapy. Currently, methotrexate is the most commonly used drug for the treatment of psoriasis and PsA. The drug belongs to the pharmacotherapeutic group of folic acid antagonists, which requires the mandatory appointment of the latter while taking the drug.

Currently, in addition to tablet forms of the drug, there is the possibility of parenteral use of methotorexate, which has a higher bioavailability and is convenient to use.

Before starting therapy with methotrexate, it is necessary to determine the presence of indications and the absence of contraindications to the appointment of the drug.

Indications for the appointment of methotrexate in patients with psoriasis and

1. Severe forms of psoriasis:

• chronic plaque psoriasis (more than 20% involvement of body surface area or disability, social exclusion);
• pustular forms of psoriasis;
• psoriatic erythroderma;
• psoriatic arthropathy;
• severe forms of psoriatic onychodystrophy.

1. psoriasis resistant to local therapy, photochemotherapy and/or acitretin.

Treatment is carried out under the supervision of a dermatologist and a rheumatologist.

Phototherapy (narrow-wavelength 311 nm UVB phototherapy) of psoriasis is a method of light therapy for psoriasis using medium-wave radiation of narrow-spectrum ultraviolet rays (UVB - rays with a maximum emission at a wavelength of 311 nm). It has a selective effect on skin structures, reduces the proliferation of keratinocytes, and has an immunomodulatory effect. By your high therapeutic effect comparable to PUVA therapy, but causes fewer side effects and complications. The phototherapy method can be used for the entire skin covering, and locally on individual lesions.

Good results have been achieved with the use of methods such as plasmapheresis, ozone therapy in the complex therapy of psoriasis ( intravenous administration ozonized solutions, mesotherapy with ozone of psoriatic plaques, topical use of ozonated oil), UV blood, laser therapy.

Medical rehabilitation. In the medical rehabilitation of patients with psoriasis and PsA, physiotherapeutic methods of treatment, hydrotherapy (baths with Naftalan oil emulsion, tar baths), mud therapy (wraps with Saki and sapropel mud), infrared sauna, flax seed gel wraps are used. Non-traditional methods of treatment are also used (apitherapy, hirudotherapy, acupuncture, treatment with a bee hive biofield, Nordic walking), methods of psychotherapeutic correction.

Thus, for the treatment of psoriasis, psoriatic arthritis and the prevention of exacerbations, many effective modern methods have recently been developed and implemented that can significantly improve the quality of life of patients, and sometimes even make them forget about the disease for many years.

And about. Chief Physician of ME "VOKTSDiK" V.V. Salarev

Sulfasalazine en reviews for rheumatoid arthritis

How can rheumatoid arthritis be treated?

To date, few studies have been published directly addressing these methods in the treatment of psoriatic arthritis. However, there has been extensive research into the value and usefulness of such treatments in the management of arthritis in general and rheumatoid arthritis in particular, from which it is possible to extrapolate data regarding their value and usefulness in psoriatic arthritis.

The key role of the rheumatologist and specialists in the department of rheumatology is to determine the need for such adjuvant therapy.

Treatment of psoriasis prior to the development of psoriatic arthritis depends on the severity of skin lesions. Patients with moderate skin disease are treated with systemic agents (methotrexate, cyclosporine, and acitretin) as well as UV therapy.

After a complete cure of psoriasis, there is no residual damage, so dermatologists usually treat until clear skin is restored, after which they stop therapy until new plaques appear.

Many intermittent and combination therapy strategies have been developed that are based on the assessment of the severity of skin damage in order to achieve optimal results.

When considering treatment options for arthritis when it develops, it is important to consider early tolerability and efficacy. systemic drugs used in psoriasis.

The question of how and how to treat rheumatoid arthritis is asked by every person who had to face this difficult disease. With this disease, as a rule, mixed symptoms are observed, therefore, in order to avoid serious consequences, proper treatment should be considered as soon as possible.

The modern approach involves the use of drugs of two types:

• basic.

• anti-inflammatory drugs;
• basic.

How to take Sulfasalazine for arthritis? The drug is taken orally (orally) only before meals. The tablet should be taken with a glass of water (250 mg) without chewing. Do not take pills with alcohol or citrus juices (this is not a total ban, but it is not recommended to do so).

The standard treatment regimen involves the use of 500 mg of the drug once a day for the first week. For the second week, a different dosage is prescribed - 500 mg twice a day. For the third week, a dosage of 500 mg three times a day is prescribed.

The therapeutic dosage of the drug can be from 1.5 to 3 grams per day.

The duration of treatment for severe forms disease can be 6 or more months. All this time, the patient should be closely monitored, as serious side effects and liver and / or kidney disorders are possible.

More detailed instructions on the use of Sulfasalazine in various types of arthritis can be obtained from your doctor. Including the doctor determines the duration and dosage of treatment. To the menu

How to replace Sulfasalazine in arthritis?

How to replace the drug Sulfasalazine in the treatment of various types of arthritis? To that medication there is a fairly impressive list of analogues. The most preferred analogue is Mesacol tablets (about the same efficiency and cost).

Other analogues of Sulfasalazine for arthritis:

1. Tablets enteric Salazopyrin En-Tabs.
2. Enteric tablets Asacol.
3. Tablets and granules of prolonged action Pentas.
4. Salofalk (suspension, enteric tablets, long-acting gastroresistant granules).
5. Enteric tablets Samezil.

It is forbidden to independently replace Sulfasalazine even with the most suitable (literally identical in composition) analogues. This should be done by the attending physician.

In addition, you cannot replace Sulfasalazine on your own with its direct analogue (Sulfasalazine EH): these drugs are somewhat different from each other. to the menu.

Review of tablets Sulfasalazine (video)

Possible side effects

Sulfasalazine for rheumatoid arthritis: application reviews

Methotrexate is a drug used for rheumatoid arthritis and other serious pathologies of the musculoskeletal system and the endocrine system.

The remedy gets a lot positive feedback due to its complex action, but it also has contraindications and some side effects.

psoranet

Psoriasis? Let's heal together!

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Catalog section Psoriatic arthritis focuses on symptoms, medications, diagnosis, treatment, and other related issues. to psoriatic arthritis (PA). Today's forum member Vertushka shares his experience of relieving symptoms and alleviating the condition of PA.

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