Psoriatic arthritis

Abstract

SummaryPsoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. It is characteristic that the rheumatoid factor in serum is absent. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also complex. Inflammation is caused by immunological reactions leading to release of kinins. Destructive changes in bones usually appear after a few months from the onset of clinical symptoms.Typically PsA involves joints of the axial skeleton with an asymmetrical pattern. The spectrum of symptoms include inflammatory changes in attachments of articular capsules, tendons, and ligaments to bone surface. The disease can have divers clinical course but usually manifests as oligoarthritis.Imaging plays an important role in the diagnosis of PsA. Classical radiography has been used for this purpose for over a hundred years. It allows to identify late stages of the disease, when bone tissue is affected. In the last 20 years many new imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance (MR), have been developed and became important diagnostic tools for evaluation of rheumatoid diseases. They enable the assessment and monitoring of early inflammatory changes. As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided.

Cartilage Degradation in Psoriatic Arthritis Is Associated With Increased Synovial Perfusion as Detected by Magnetic Resonance Imaging

“…However, previous research using DCE MRI has partially shown that PsA and RA can differ regarding the degree of their synovial enhancement, despite indistinguishable appearances on non-dynamic MRI (30,31). Also, the synovial involvement of PsA histologically differs from RA regarding the extent of inflammation, synovial thickness, and blood supply (31)(32)(33). These differences of synovial changes are potentially due to the different pathogenesis of both entities, with RA being primarily a synovial and PsA being an enthesealdriven disease (34,35).…”

A novel biomarker of MMP-cleaved prolargin is elevated in patients with psoriatic arthritis

“…Men and women are equally affected 4 . PsA typically affects the large joints, especially joints of the lower extremities, and distal joints of the fingers and toes, however it can also affect the spinal and sacroiliac joints of the pelvis 5 . The number of involved joints varies among patients—several or only 1–2 joint can be affected, which leads to diverse clinical features, resulting in difficulties when diagnosing patients 4 .…”

“…No specific diagnostic test is available for psoriatic arthritis 4 . Instead, the diagnosis is based on a combination of clinical criteria, blood tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to check for inflammation and x-rays or MRI scans for joint damage 3 , 5 . There is no cure for the PsA at the moment, and the treatment focuses on symptom relief and prevention of joint involvement 7 .…”

Predictive role of serum rheumatoid factor in different disease pattern of psoriasis and psoriatic arthritis

“…Disease Arthritis appears after skin lesions in most patients with PsA. Conversely, the arthritis precedes the skin lesions in 13 to 17% of patients [17].…”