miércoles, 20 de junio de 2018

Psoriatic Arthritis Prevention

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By Liji Thomas, MD

Psoriatic arthritis (PsA) is a painful joint condition that complicates the relapsing chronic skin disease psoriasis. It is considered to be an inflammatory joint disorder and is classified as part of the seronegative spondylarthropathies.

PsA affects between 5% and 25% of people with psoriasis. It is recommended that all psoriasis patients be evaluated at least once a year to detect the earliest signs of PsA. Symptoms such as joint pain, especially in women, heel pain, and clinically significant tiredness and stiffness as well as a general deterioration in physical functioning are important heralds of future PsA in patients who already have psoriasis. Heel pain predicts a fourfold risk of PsA while the risk is doubled in patients with pain, fatigue and stiffness.

The appearance of such warning symptoms frequently predates the appearance of clinical signs and symptoms suggestive of PsA by months or years. Early assessment might enable the patient to take preventive action against the deterioration of joint structure and function.

Risk Factors for Psoriatic Arthritis Prophylaxis

The presence of psoriasis is by far the highest risk factor for PsA, though in a few people the arthritis precedes the skin condition.

Being overweight or obese increases the risk of PsA, especially in adolescent-onset obesity. This is suspected to be due to inflammatory cytokines and especially adipokines released from fat cells, that are responsible for metabolic changes within the body which predispose to joint inflammation.

Psoriatic nail dystrophy is a risk factor for PsA and is present in 80% of these patients. In contrast, the severity of skin lesions does not predict PsA.

PsA occurs more often in patients who were diagnosed with psoriasis early in life, perhaps because of a highercumulative exposure to autoinflammatory processes. In most cases, the skin condition comes to light in late adolescence or early adult life or in middle age, rather than in childhood.

A family history of PsA in first-degree relatives such as parents or siblings increases the risk of PsA in individuals with psoriasis. There is an association with genes HLA Cw6 and HLA B27 with the IL23 receptor, but the genes responsible for this condition are not currently known.

The presence of a joint injury in the presence of other risk factors could act like a deep Koebner phenomenon and trigger progressive joint inflammation. Patients with psoriasis should probably take care not to engage in activities which could cause joint trauma, such as carpentry.

A history of certain infections such as streptococcal pharyngitis could be significant as some viral and bacterial infections may set off inflammation and result in PsA. HIV is also an established risk factor for PsA exacerbations. Regular HIV medication is important in achieving PsA control in such patients.

Stress is another risk factor associated with PsA, but it is a nonspecific linkage as stress worsens a wide variety of conditions.

Ways to Control Psoriatic Arthritis Prophylaxis Symptoms

People with psoriasis should adopt as many of the following tips as possible to avoid the development of joint damage due to PsA.

Look for and report symptoms such as:

Whole-body tiredness
Swollen, painful and tender tendons
‘Sausage digits’, or swelling over fingers and toes
Joint pain, stiffness, swelling and tenderness which is mono- or polyarticular
Reduced range of movement at the affected joints
Prolonged morning stiffness
Nail dystrophy
Eye changes such as redness and pain
Characteristic involvement of the DIP of the fingers and toes
Spinal symptoms
Pain and tenderness over the wrists, knees or ankles

Since such symptoms typically occur early, and since PsA occurs after the onset of psoriasis in 85% of people, they should be reported immediately.

Other self-help measures include:

Regular stress-relieving steps such as long walks, swimming, or quiet times to relax and recollect oneself
Weight control by eating appropriate food in adequate quantities and taking regular exercise
Going in for testing at least once a year so that early signs and symptoms can be identified early and PsA progression may be slowed. This is crucial because the condition can sometimes worsen very quickly and very seriously, causing extensive joint damage either spontaneously or after an injury.

Reviewed by Lois Zoppi, BA.