银屑病性关节炎36例临床分析

目的:分析银屑病性关节炎的临床特征和疗效.方法: 对我院住院的36例银屑病性关节炎患者进行回顾性分析.结果:本组病例平均发病年龄36.5岁,男:女为3:1.以皮损为首发症状者22例(61.1％),皮损和关节炎同时发生者8例(22.2％),关节炎首发者3例(8.3％);各关节受累的频率依次为远端指/趾间关节、膝关节、踝关节、腕肘关节、肩关节和脊柱关节、髋关节.关节炎分类:仅远端指/趾间关节受累型10例(筋.8％);多关节炎型16例(44.4％);不对称少关节炎型5例(13.9％);脊椎炎型4例(11.1％);残毁性关节炎型1例(2.8％).所有患者依据病情给予阿维A、来氟米特、环孢素、甲氨蝶呤、雷公藤多苷等综合治疗,皮损和关节症状均获得一定缓解.结论:本病男性发病明显多于女性,非对称多关节炎和远端指(趾)关节易受累是本病的特点.合理联合用药可取得较好疗效.     

关节病型银屑病30例临床分析

目的:总结关节病型银屑病的临床特点.方法:对30例关节病型银屑病患者的临床资料进行回顾性分析.结果:本组病例的平均发病年龄为31.4岁,男:女为1:1.以皮损为首发者26例(86.6%);皮损和关节症状同时出现者2例(6.7%);以关节炎为首发者2例(6.7%).皮损类型为寻常型27例(90%).关节炎分类为对称性多关节炎型12例(40%);其次为远端指(趾)关节炎型7例(23.3%);非对称性关节炎型6例(20%);最后为残毁性关节炎型3例(10%);脊柱关节病变型2例(6.7%).经X线检查的26例患者中,23例阳性(88.5%).常见的改变有关节间隙变窄、骨质疏松、骨质吸收等.结论:各型银屑病皮损都可伴发关节炎病变.对称性多关节炎和远端指(趾)关节炎、非对称性少数关节炎是本病的主要特点.     

关节病型银屑病的临床特点与X线表现

目的：探讨银屑病性关节炎（ＰＡ）的临床特点与Ｘ线表现。方法：对３２例银屑病性关节炎的临床资料进行统计分析。结果：１８例皮损先于关节炎出现，４例皮损和关节症状同时发生，关节炎发先发育者１０例，２２例拌指趾甲损害不对称少关节炎型１４例；脊椎炎型２例，远端指（趾）关节炎型２例；对称多关节类型１３例；常跖胞疱病伴胸锁骨关节炎型１例，共３０例患者接受Ｘ线检查，２０例有ＰＡ的Ｘ线征。其中远端小关节受累１２例（     

关节病型银屑病37例临床分析

目的:探讨关节病型银屑病的临床特点。方法:对37例关节病型银屑病患者的临床资料进行回顾性分析。结果:本组病例平均发病年龄32.2岁,男:女为2.4:1。非对称性少数关节炎型最为常见,占45.9%(17例);其次为对称性多数关节炎型,占21.6%(8例),远端指(趾)关节炎型,占16.2%(6例),脊椎关节病型,占10.8%(4例)及残毁性关节炎型,占5.4%(2例)。各型银屑病皮损均可发生关节炎病变。膝关节最为常见(56.8%),其次为指(趾)关节(54.1%)及踝关节(35.1%)。在21例伴有甲病的患者中,19例患有远端指(趾)关节炎,占90.5%。3例患者尿蛋白检查阳性。X线检查常见的改变有关节间隙变窄,骨质疏松和骨质吸收等,亦可见关节骨性融合、骨刺形成和关节残毁性损害等不常见的改变。结论:非对称性多发性关节炎和远端指(趾)易受累是本病的特点,甲病变是远端指(趾)关节炎型的特征。一部分病人可伴有肾脏损害。非甾体类抗炎药、小剂量糖皮质激素、雷公藤多甙、氨苯砜、甲氨蝶呤等和中药的合理联合应用可取得一定疗效。     

指间关节病性银屑病14例临床分析

关节病性银屑病(PsA)又称银屑病性关节炎,远端指间关节受累、不对称性关节炎、附着点炎及指(趾)炎是PsA的经典表现[1].Moll-Wright分类标准将本病分为5种类型:①远端指(趾)间关节炎型(DIP);②非对称性少关节炎型(AO);③对称性多关节炎型(SP);④残毁性关节炎型(AM);⑤脊椎关节病型(SPON)[2].为探讨特定类型PsA的临床特点,本文对首发类型为DIP型PsA患者的临床资料进行归纳总结.     

雷公藤与助应素联合应用治疗银屑病性关节炎

<正> 临床资料12例银屑病性关节炎,男10例,女2例。年龄21～32岁,病期20天～2年(从出现关节症状算起)。受累关节为肘膝关节、指趾小关节、脊柱及髋关节。伴有不同程度红肿,自觉疼痛,活动受限。皮肤损害     

关节病性银屑病52例临床分析

目的：探讨关节病性银屑病的临床特点。方法：对52例关节病性银屑病患者的临床资料进行回顾性分析。结果：本组病例平均发病年龄31岁，男：女为3．7：1。以皮损为首发者45例，占87％；皮损和关节症状同时出现者2例，占4％；以关节炎为首发者5例，占10％。皮损类型为寻常性32例，占62％；红皮病性9例，占17％；急性泛发性脓疱性11例，占21％。关节炎分类为远端指(趾)关节炎23例，占44％；类风湿性关节炎样型11例，占21％；非对称性少数大关节炎10例，占19％，主要为强直性脊柱炎8例，占15％。接受x线检查的39例中，30例阳性，占77％。结论：本病男性发病多于女性．各型银屑病皮损都可伴发关节炎病变。非对称性多发性关节炎和远端指(趾)关节易受累是本病的特点。小剂量糖皮质激素、雷公藤多苷、甲氨蝶呤、非甾体类抗炎药、秋水仙碱、柳氮磺胺吡啶、阿维A等合理联合应用可取得较好疗效。     

银屑病性关节炎的关节症状

自 Moll 等报告银屑病性关节炎(PA)以来,本病虽已作为一个独立疾病,但诊断标准尚不明确,常难与其它疾病鉴别。作者汇总了日本国内报告的230例,并结合欧美的报告对 PA 的关节症状及慢性类风湿性关节炎(RA)因子的意义作了探讨。临床症状:Moll 等把 PA 分为5型:①少数指趾型(70%):最多见。指趾关节受累,为非对称性。②慢性类风湿性关节炎(PA)型(15%):为对称性多发性关节炎型,与 RA 类似。③DIP 型(5%):主要累及远端指(趾)间关节。④离断性关节炎型(5%):为有严重关节破坏型。⑤强直性脊椎炎(AS)型(5%)。日本国内     

关节病性银屑病29例临床分析

目的：探讨关节病性银屑病的临床特点及治疗。方法：对29例关节病性银屑病患者的临床资料进行回顾性分析。结果：本组病例平均发病年龄31．4岁，男18例、女11例，男：女为1．64：1。以皮损为首发者20例（69．0％），关节炎首发者6例（20．7％），皮损和关节炎同时发生者3例（10．3％）；皮损类型为寻常型27例（93．1％），脓疱型1例（3．4％），红皮病型1例（3．4％）；关节炎分类为非对称性少关节炎型10例（34．5％），远端指（趾）间关节炎型7例（24．1％），脊柱关节病型6例（20．7％），对称性多关节炎型4例（13．8％），残毁性关节炎型2例（6．9％）；25例患者接受关节X线检查，其中20例有阳性改变，表现为关节间隙变窄、骨质疏松、骨质吸收和骨刺形成。结论：本病男性多发，各型银屑病皮损都可并发关节炎病变。非对称性少关节炎和远端指（趾）关节易受累是本病的特点。甲氨蝶呤、来氟米特、阿维A、雷公藤多苷、沙利度胺、环孢素、吗替麦考酚酯、非甾体类抗炎药、小剂量糖皮质激素等合理联合用药可取得较好疗效。     

关节病性银屑病12例临床分析

关节病性银屑病(arthritic psoriasis，PA)是银屑病的特殊临床类型，临床上呈血清学阴性和关节非对称性受累的特点，通常累及脊柱、骶髂关节和远端指趾间关节。大多数患者表现为慢性进行性过程。目前，PA通常分为以下5种临床类型：④非对称性远端指趾骨间关节炎型；②残毁性关节炎型；⑧类风湿性关节炎样的对称性多关节炎型；④非对称性少关节炎型；⑤强     

Psoriatic arthritis: clinical spectrum and diagnostic procedures

Psoriatic arthritis presents with a broad clinical spectrum of symptoms. Symmetrical polyarthritis with joint pain and joint swelling is one pattern of clinical manifestations that often indicates erosive progressive disease. Unlike in rheumatoid arthritis, the distal interphalangeal joints are regularly involved. Sometimes, the disease focuses on the larger joints of the lower extremities; iliosacral and intervertebral joints and tendons can also be involved. Thus, inflammatory back pain as well as any other prolonged joint pain in a patient with psoriasis is suspicious of psoriatic arthritis. This article reviews the clinical spectrum and diagnostic procedures that can lead to the diagnosis of psoriatic arthritis.     

Psoriatic arthritis treated with oral zinc sulphate

Twenty-four patients suffering from psoriatic arthritis participated in a double blind cross-over trial of peroral zinc sulphate versus placebo (Trial I). Eleven patients continued an open trial of peroral zinc sulphate for an additional 24 weeks (Trial II). Remission was assessed by the disappearance of symptoms (overall condition, morning stiffness, functional capacity of the joints and joint pains), and signs (mobility and swelling of the joints). Reduction of joint pains as well as increase of mobility and decrease of swelling of several joints were observed. The clinical signs of reduced inflammation were accompanied biochemically by reduction of serum immunoglobulins and an increase of serum albumin. The need for analgesics was diminished. Severe side-effects and changes in the psoriatic skin involvement were not seen. Oral zinc sulphate seems to be valuable in the treatment of psoriatic arthritis.     

JOINT COMPLAINTS IN PSORIASIS PATIENTS

Four hundred and fifty-nine psoriasis patients seen at the Department of Dermatology, Bowman Gray School of Medicine of Wake Forest University, responded to a questionnaire concerning current or past joint complaints. Of these, 17% reported a previous diagnosis of psoriatic arthritis, and over 53% had a current or past history of arthralgias. Additional information on those patients reporting arthralgias focused on the cutaneous sites of involvement with psoriasis and which joints were most likely to be involved in patients with various types of arthritis. Previous treatments for skin involvement with psoriasis were more aggressive in those patients with a diagnosis of psoriatic arthritis. A significant proportion of patients presenting to dermatologists for treatment of psoriasis have joint complaints, and the percentage of patients with psoriatic arthritis is greater than generally appreciated by non-dermatologists.     

The diagnosis of early psoriatic arthritis in an outpatient dermatological centre for psoriasis

Background Most of the data currently available on early psoriatic arthritis (EPsA) derive from studies performed in rheumatological settings. However, in recent years, there has been an increase in the amount of data from dermatologic centres. Objectives To describe the prevalence, clinical, laboratory and imaging characteristics of psoriatic patients with EPsA seen at a dermatological outpatient psoriasis centre. Methods From January 2007 to May 2010, all patients with psoriasis who visited the psoriasis centre were asked about inflammatory joint involvement. A diagnosis of psoriatic arthritis was made on the basis of clinical, laboratory and imaging studies. The patients were diagnosed with early PsA (EPsA) if their inflammatory articular symptoms had been present for ≤1 year. Results We diagnosed EPsA in 33 patients. Joint involvement was polyarticular (>5 joints involved) in 20 patients (60.6%) and oligoarticular (≤5 joints involved) in the remaining 13 patients. Quality of life due to skin involvement and the degree of functional impairment due to joint inflammation were only mildly affected, as measured by DLQI and HAQ, respectively. A direct correlation between the number of tender joints (ACR 68) and HAQ was found (r = 0.36; P = 0.04). Imaging studies showed that in spite of the absence of radiologic findings of peripheral joint damage, ultrasonography and contrast enhanced ultrasonography showed signs of articular inflammation in all patients. Conclusions A diagnosis of EPsA can be correctly performed in a dermatologic outpatient facility. To do so, a close collaboration among dermatologists, rheumatologists and radiologists is necessary.     

Immunomodulating Drugs in the Management of Psoriatic Arthritis

Psoriatic arthritis is a chronic inflammatory arthropathy which can be distinguished from rheumatoid arthritis on the basis of differing patient demographics, genetic predisposition, histopathologic change, radiographic appearance, and clinical course. The cause of psoriatic arthritis remains unknown but appears to be autoimmune in nature as its pathogenesis is characterized by persistent synovial inflammation resulting in damage to the articular cartilage and osteolysis. Compared with rheumatoid arthritis, distinct lymphocyte subpopulations and pro-inflammatory cytokine levels appear to be present within the joint but the importance and therapeutic implications of these differences is uncertain. The clinical presentation of psoriatic arthritis is variable and overlapping patterns of joint involvement affecting both the appendicular and axial skeleton are seen. For patients with mild synovial disease and a favorable prognosis, the use of a nonsteroidal anti-inflammatory drug for symptomatic relief is often sufficient. However, the destructive potential of psoriatic arthritis is increasingly recognized and patients with more synovial disease and radiographic change at presentation appear to be at risk for greater morbidity and increased mortality. Immunomodulating therapy has the potential to suppress joint inflammation and preserve functional capacity but true disease modification has yet to be shown. The toxicity associated with presently available immunomodulatory agents makes careful patient selection and conscientious monitoring essential. The efficacy of methotrexate and sulfasalazine in patients with psoriatic arthritis is well defined while more anecdotal reports of benefit exist for other agents including the antimalarials, azathioprine, colchicine, cyclosporine, and the retinoids. For all treatment regimens, the magnitude of clinical improvement demonstrated to date has been rather small and quite subjective in character with few controlled studies of adequate size and duration having been reported. Emerging biologic therapies, such as those which target tumor necrosis factor, will hopefully provide future treatment options with greater efficacy and improved safety for patients with psoriatic arthritis.     

Adalimumab for treatment of moderate to severe psoriasis and psoriatic arthritis

Psoriasis and psoriatic arthritis are common diseases associated with considerable morbidity and disability. Their pathophysiology comprises similar processes leading to inflammation of skin, entheses, and joints. Although traditional systemic agents can be effective, their use may be limited by lack of efficacy and concerns regarding adverse effects. The objective of this study was to assess the efficacy and safety of adalimumab, a fully human antitumor necrosis factor (anti-TNF) monoclonal antibody, over 16 weeks. The present authors report their personal experience in 15 patients with severe plaque psoriasis and psoriatic arthritis, refractory to other treatments, in which a decisive regression of joint/skin involvement was obtained. Psoriasis and psoriatic arthritis are chronic inflammatory disorders resulting from a combination of genetic and environmental factors.     

Systemische Psoriasistherapie – der nächste Schritt

Adalimumab is the first fully human monoclonal antibody against TNFα and has been approved for treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Its efficacy for both joint and skin involvement has been confirmed in clinical trials. The recommended dose is 40 mg administered every other week subcutaneously. It may be combined with methotrexate and all topical psoriasis treatment modalities. User-friendly administration devices make self-injection possible. Patients should be evaluated for active/latent tuberculosis and serious infections prior to initiation of therapy. Adalimumab rapidly reduces joint symptoms within a few days. Adalimumab is used for the management of adult psoriatic arthritis patients who have had an inadequate response to disease-modifying antirheumatic drugs. Adalimumab is yet another biological for the treatment of psoriasis. Since the TNFα antagonists can be switched if one is ineffective, this agent broadens the therapeutic spectrum.     

Systemic psoriasis therapy - the next step. Adalimumab

Adalimumab is the first fully human monoclonal antibody against TNFalpha and has been approved for treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Its efficacy for both joint and skin involvement has been confirmed in clinical trials. The recommended dose is 40 mg administered every other week subcutaneously. It may be combined with methotrexate and all topical psoriasis treatment modalities. User-friendly administration devices make self-injection possible. Patients should be evaluated for active/latent tuberculosis and serious infections prior to initiation of therapy. Adalimumab rapidly reduces joint symptoms within a few days. Adalimumab is used for the management of adult psoriatic arthritis patients who have had an inadequate response to disease-modifying antirheumatic drugs. Adalimumab is yet another biological for the treatment of psoriasis. Since the TNFalpha antagonists can be switched if one is ineffective, this agent broadens the therapeutic spectrum.     

Anti-inflammatory efficacy of low-dose cyclosporin A in psoriatic arthritis. A prospective multicentre study

Summary Fifty-five patients with psoriatic arthritis were treated with a low dose of cyclosporin A (CyA) (mean dose 2.7 mg/kg per day) for a period of 6 months to investigate the efficacy of CyA on disease parameters. Significant improvement in the joint complaints and inflammation parameters was observed including a decrease in the number of painful (-46%) and swollen (-45%) joints, tenderness (Ritchie Index: -50%) and degree of swelling (-46%), patient's assessment of pain (-35%), the duration of morning joint stiffness (-37%), as well as a decrease in C-reactive protein (-52%). A 50% reduction of joint complaints required a total of 24 weeks, whereas a 50% reduction of skin involvement was achieved after 5–6 weeks of treatment. Four patients left the study due to adverse events: creatinine level increase in two patients, hypertension in one patient and gastroenteritis in the fourth patient. Joint scintigraphy in 18 patients indicated an improvement or stable condition in 61% of cases after a mean follow-up of approximately 8 months. The results of this prospective study show that low-dose CyA effectively improves not only skin lesions, but also joint complaints in psoriatic arthritis.