Medicine for psoriatic arthritis of the joints. Psoriatic arthritis - treatment with therapeutic methods and at home. How to suspect pathology

Most people associate a disease such as “psoriasis” with damage to the skin: the formation of plaques, papules, peeling, and not many people know that this pathology also affects the osteoarticular system with the development of psoriatic arthritis.

Inflammation in the joints and ligaments during psoriasis develops in 5-8% of all patients. Typically, joint pathology (in 70-75% of cases) occurs after the development of skin changes. There is a possibility of 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).

Psoriasis can affect both the joints of the limbs and the joints of the central skeleton: the spine and pelvic bones. 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 deformation of the spinal column.

Until now, a clear understanding of the causes and mechanisms of development of psoriatic arthritis has not been formed. There are assumptions about the leading role of heredity and 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 the disease in a family that already has a patient suffering from this pathology increases many times over. A child whose parents both suffer from psoriasis has a 50/50 chance of getting the disease. 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 number of immunoglobulins IgA, IgG in the skin and synovial fluid of the joints affected by the disease.

Sometimes, with articular pathology, a decrease in the T-suppressor function of lymphocytes and a deficiency of protective T-helper cells occurs.

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

Provoking factors

Factors that can provoke and “trigger” the disease include:

acute and chronic stress;
functional disorders of the nervous system;
emotional overload;
focal infections (streptococcal, viral, staphylococcal);
atherosclerosis;
diabetes;
disorders of carbohydrate and 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 30-45 years. Individual cases of the disease can occur in a wider age range: from 9 years to 71 years. Some authors highlight a higher incidence of the disease among men, but according to many sources, the gender structure of the disease is homogeneous.

In most cases, joint damage debuts 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 the muscles and joints. At the same time, in some patients the onset of the disease is acute, manifested by a sharply expressed articular syndrome, similar to gouty or septic arthritis.

The joints most often affected at the onset of the disease are the joints of the fingers, knees, and less commonly, the shoulders and feet. The pain is maximum at rest, at night, in the morning, it can be accompanied by morning stiffness; when moving during the day, it decreases somewhat and “paces.”

With articular manifestations of psoriasis, patients may be bothered by only 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 the involvement of the ligaments and tendons, damage to the flexor muscles and sausage-shaped deformation of the fingers, as well as changes in the color of the skin. The skin over the inflamed joints has a purplish-blue color.

Sometimes isolated damage to the joints of the spine may occur - spondylitis of psoriatic origin. It manifests itself as pain in the lumbar region; the thoracic, cervical, and costovertebral joints can subsequently be involved in the inflammatory process. Patients suffer from pain, it is poorly relieved by NSAIDs, and over time they develop a “suppliant pose”, characteristic of ankylosing spondylitis, with which it is sometimes mistakenly confused. It happens that the disease is asymptomatic, without pain, gradually causing poor posture and deformation of the spinal column.

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

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

Psoriatic lesions are characterized by a gradual increase in the number of affected joints over time: the disease can debut with monoarthritis, and then progress and cover an increasingly larger area of pathological changes. With the development of polyarticular changes, the frequency of exacerbations increases and the duration of remissions decreases - the condition without appropriate therapy steadily worsens.

Classification of the disease

There are several clinical forms of psoriatic arthritis:

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

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

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

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

How to suspect pathology

Help to establish the correct diagnosis of psoriatic arthritis:

careful collection of medical history and clinical symptoms;
laboratory signs;
instrumental research methods.

History and clinical manifestations

In some cases, an experienced doctor, based on the patient’s appearance and careful 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:

Identified cases of psoriasis in relatives.
The presence of psoriatic plaques and other changes in the patient’s skin, damage to the nail plates, damage to the scalp like seborrhea.
The nails may become exfoliated, pathologically change like a thimble-like wear, and sometimes the nail plate can hypertrophy like a ridge.
The joints of the feet and hands can be swollen, painful, the skin over them is bluish, with a purplish tint; such fingers are figuratively called sausage-shaped deformed.
Negative tests for Russian Federation.
Clinical, radiological signs of sacroiliitis.
Heel pain.

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 with laboratory and instrumental research methods

Laboratory data

With psoriatic arthritis, the following changes may be observed in the tests:

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

Instrumental data

An instrumental examination method such as x-rays helps in making a diagnosis.

X-ray examination: most often, images are taken of the joints of the feet, hands, sacroiliac area and sternoclavicular joint.

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

Additional methods can include ultrasound and MRI of joints.

How to treat pathology

Treatment of arthropathy due to psoriasis should be carried out comprehensively. It includes not only relief of pain and symptoms of joint inflammation, but also treatment of the underlying disease and skin manifestations in general.

The goal of therapy: to obtain a pronounced clinical effect, relieve exacerbation, and also prevent progression of the disease, maintaining a state of remission for as long as possible.

An integrated approach to therapy includes treatment with medications, physical therapy, and diet. Sometimes, in severe cases of psoriatic arthritis, according to the surgeon’s recommendations, surgical methods are indicated - synovectomy, endoprosthetics of modified and ankylosed joints.

Medicines for internal use

Tablets, injections, infusions - these dosage forms are used in the treatment of arthropathy due to psoriasis.

The following groups of drugs are used:

Immunosuppressants (Methotrexate, Azathioprine, Cyclosporine A).
Tumor necrosis factor inhibitors (Etanercept, Infliximab).
Delagil, Plaquinil.
Gold preparations.
Glucocorticosteroids (Prednisolone, Medrol).
NSAIDs (Indomethacin, Dicloberl, No-shpa).

These drugs help relieve inflammatory processes, reduce the body's immunological aggression directed against its own tissues, and with adequate dosage, provide long-term remission.

Medicines for external use

Ointments, creams and gels of the following composition allow you to relieve pain, reduce swelling and normalize blood circulation in the area of the affected joint:

Hormonal ointments (Advantan, Sinaflan, Betamethasone).
External agents with NSAIDs (Indomethacin ointment, Ultrafastin).
Antifungal agents (Ketoconazole, Nizoral).
Salicylic ointment.

Physiotherapy

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

Physiotherapy is not indicated for cancer, severe decompensated heart failure, respiratory failure, or individual intolerance.

Physiotherapy courses, which include the use of procedures for 7-10 days, bring good results:

electrophoresis with hydrocortisone;
laser therapy;
amplipulse therapy;
iontophoresis;
general baths with sea salt, peat oxidate.

Therapeutic exercise under the guidance of a specialist helps patients maintain the function of the affected joint and improve their functioning if there are certain disturbances in the range 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 of the clinical manifestations of the disease and the degree of arthritis activity. 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, and cycling are recommended.

How to eat with psoriatic arthritis

Patients should be aware of certain dietary habits that will help them “keep the disease under control.”

Limiting the consumption of fatty, fried, spicy foods, sweets, coffee, strong tea, and a complete absence of alcohol will allow you to stay in remission for a longer period and avoid deterioration of your health, even without maintenance courses of drug therapy.

It is advisable, both during the acute phase and during the lull of the disease, to consume foods enriched with protein, unsaturated fatty acids, and fiber. And consume carbohydrates and fats in limited quantities.

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

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

Alkaline-forming foods should make up 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 to avoid overeating, to eat small meals, but often (at least 5-6 times a day). Alcohol is not recommended to be consumed even in minimal quantities, as are sweets. If you really want something sweet, let it be a banana or a baked apple with honey.

Unconventional methods of treating the disease

Despite the fact that medicine is confidently moving forward by leaps and bounds, new drugs are being created, it is not possible to cure psoriasis 100% and get rid of the arthritic manifestations associated with it.

Quite a lot of patients prefer to be treated in unconventional ways, while many of them, after undergoing courses of treatment with folk remedies, note improvements in their well-being. Doctors do not prohibit traditional medicine methods, but before starting treatment they strongly recommend consulting with a doctor.

Methods of therapy using methods “from the people” include:

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.
Apply a compress soaked in ammonia, honey and iodine, taken equally, to the sore joints.
Collect red clover flowers, add vodka, leave for at least ten days, then strain, pour into an orange glass container, and seal with a plastic stopper. Rub the joints affected by the disease twice a day, morning and evening.
Grind fresh burdock root, burdock root 1:1 through a meat grinder, apply in the form of a paste for 30 minutes to the places where the pain is localized.
At night, rub a mixture of fresh leaves of three-year-old agave, honey, and 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, beebread, honey) is extremely popular and has a beneficial effect on the body for many ailments, including psoriatic joint changes.

The most desperate patients decide to conduct sessions where bees directly sting the skin over the inflamed area. A single release of up to 10 bees per medium-sized joint area is allowed. Bee venom has an anti-inflammatory, antioxidant, immunosuppressive effect, and improves blood circulation in the affected area.

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

Bee bread, royal jelly, beeswax, and propolis are included in many cosmetic creams produced by industry and sold through the pharmacy chain.

Apilak is a biogenic stimulant based on bee products that strengthens the immune system and is used for 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 in isolation by articular syndrome, are possible, but extremely rare. As a rule, disorders are also manifested by skin changes, including plaques affecting the scalp with the development of dermatitis and seborrheic manifestations.

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

The deplorable condition of the hair's skin cannot but affect its appearance. Hair becomes dull, breaks and falls out. There may even be areas of limited focal baldness - alopecia areata. Less common is diffuse alopecia - hair loss evenly over the entire head.

It is important to understand that late consultation with a doctor if joint changes have appeared can result in loss of joint function and the development of disability. In later, advanced stages, patients may lose self-care skills and become disabled.

If there is the slightest change in the musculoskeletal system, or the appearance of nonspecific symptoms, such as pain, a feeling of stiffness in the joints, changes in the color 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 collaboration with a dermatovenerologist.

The sooner the disease is diagnosed and a course of treatment is started, the greater the chances of maintaining the health and function of the joints, and preventing progression and deterioration of overall well-being.

Treatment of psoriatic arthritis involves treating both skin damage and joint pain. Many lotions and creams are made for skin affected by psoriasis. In this article we will look at medications for psoriatic arthritis.

PUVA therapy stands for psoralen (a naturally occurring coumarin class compound) combined with ultraviolet light (UVA). This may be beneficial for skin lesions. PUVA therapy uses external creams - preparations that are rubbed onto the skin lesions and affected joints. After applying the cream, the area of skin is placed under a lamp that emits a special ultraviolet light. The light triggers chemicals in the treatment cream, which treats the rash and may, in some cases, also contribute to joint pain. ?

Treatment for arthritis symptoms depends on which joints are affected and the severity of the disease.

The first medications most doctors prescribe are nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and ibuprofen are NSAIDs, as are many painkillers. Other medications, known as disease-modifying antirheumatic drugs (DMARDs), are used by patients with high levels of pain or particularly “bad” arthritis. These drugs work in different ways to regulate the immune system and thereby control arthritis.

One of the most commonly used disease-modifying drugs to treat psoriatic arthritis is methotrexate. DMARDs such as methotrexate not only control symptoms but also slow the progression of the disease. This is what makes them “disease modifying”. Methotrexate can control the symptoms of poor skin and also helps arthritis symptoms. For some patients, it may be necessary to combine methotrexate with another drug (eg, infliximab) to achieve the desired results (reduction in joint pain, swelling, and stiffness).

Infliximab is a type of disease-modifying drug in a class called antitumor factor (TNF). Anti-TNF agents are a special type of antibody called human monoclonal antibodies. They specifically target (and inhibit) tumor necrosis factor. Tumor necrosis factor (TNF) promotes the inflammatory response, which in turn causes many of the clinical problems associated with autoimmune disorders such as rheumatoid arthritis. .

Oral psoriatic arthritis medications (tablets taken by mouth) are under investigation and may be available in the future for the treatment of psoriatic arthritis. These include ustekinumab, apremilast and tofacitinib. Each of these medications works slightly differently to regulate the immune system.

Doctors sometimes prescribe a combination of medications. Cortisone injections into sore joints may also help relieve pain. Surgery may be necessary in rare cases of uncontrollable pain or loss of joint function.

In addition to drug treatment, your doctor will ask you to see a physical therapist to maximize the strength and mobility of your joints.

Physical therapy

Treating psoriatic arthritis with quality care, physical therapy can help manage your condition along with the use of prescribed medications. Physical therapy cannot cure your disease, but it can help manage your pain and prevent joint destruction due to the disease process. Physical therapy will focus on the effects of psoriatic arthritis on your joints, rather than on the skin damage that is part of the disease. .

During your first visit, your physical therapist will take a detailed history from you. They will want to know when your arthritis started bothering you, what joints you have pain in, how often they bother you, your pain level, and what activities irritate or relieve your pain. They will also ask about associated skin lesions, as well as any family history you may have of the disease. And about any previous or current treatments you are undergoing, including what medications you are taking. Finally, they will ask about your work and recreational activities and will want to know if your arthritis limits you in any of these activities.

If your arthritis has affected any joints in your lower extremities, your physical therapist will want to look at how you walk to see if your arthritis is affecting your gait. They will also evaluate your overall posture and alignment to determine if you have any bad habits or poor alignment due to illness. They will advise you on proper posture and walking techniques and discuss the use of a walking aid if necessary. For example, a cane if they see a need to relieve stress from your joints.

Your physical therapist will then evaluate and measure range of motion in any arthritic joints. The strength of the muscles surrounding these joints will also be determined. For any joints that have a reduced range of motion or are at risk of losing their range of motion, your therapist will prescribe range of motion exercises. Stretches will be prescribed for any muscles around the joints that are considered tight and pulling down the area. Strengthening exercises will be prescribed for any weak muscles that your therapist determines are at risk of losing strength during illness. .

In some cases of psoriatic arthritis, electrotherapy, such as transcutaneous nerve stimulation, may be useful in reducing joint pain. Your physical therapist may also use your hands for techniques such as massage to the muscles surrounding your joints or mobilizations to encourage increased range of motion in your joints. Often the use of heat can be very soothing for your joints, so it can be used in combination with other therapeutic treatments. If you feel that the heat is soothing to your joints, your therapist will encourage you to use the heat at home.

Unfortunately, your psoriatic arthritis will not go away. However, there are many treatment options to help you cope with this disease. Along with the advice of your doctor, your physical therapist and any other health care professionals who are involved in your treatment, you should find a management program that will work for you. See above for medications for psoriatic arthritis.

The drug Sulfasalazine is an antimicrobial, anti-inflammatory, immunosuppressive agent. According to its chemical structure, the drug is a combination of sulfapyridine (relieves inflammation due to good absorption) and 5-aminosalicylic acid (characterized by low ability to be absorbed by the intestines).

The drug consists of 500 mg of sulfasalazine, excipients: starch, propylene glycol, magnesium stearate, silicon dioxide, povidone, hypromelose.

When is the remedy prescribed?

Sulfasalazine is effective for diseases of the musculoskeletal system and gastrointestinal tract of humans. The doctor recommends it for:

Crohn's disease,
juvenile and rheumatoid arthritis,
nonspecific ulcerative colitis,
pierce.

The use of the drug to prevent exacerbation of these pathological conditions is also justified.

A distinctive feature of the drug is poor absorption in the digestive tract and accumulation in the pleural, peritoneal, and joint fluid.

Synovial fluid is found in the joint cavity and acts as a lubricant. In other words, Sulfasalazine for arthritis has a beneficial effect precisely in the affected area.

The best result can be achieved if you start treatment with the drug at the very beginning of the development of the disease, avoiding exacerbation.

Method of application, dosage regimen

Sulfasalazine is produced in tablet form. One contains 500 mg of active substance. Begin treatment with 1 tablet per day. Gradually the volume of the product should be increased. After a month, the average daily dose will be from 4 to 6 tablets.

The drug is taken before meals with a sufficient volume of purified water without gas. It is not advisable to drink tea or other liquids. It is also forbidden to chew the tablet. The exact dosage is prescribed by a rheumatologist, based on the patient’s condition, his tests, and the degree of neglect of the pathology.

Treatment of rheumatoid arthritis assumes that Sulfasalazine will be taken for a long time, although the patient will notice a significant improvement after a month of therapy. In general, the course of treatment can last up to six months:

Adult patients are advised to take 1 tablet per day in the first week of therapy. During the second week, take 2 tablets per day, and in subsequent times drink 3 tablets per day. The daily dose can reach 3 g of Sulfasalazine (6 tablets);
Children over 6 years of age are given the drug in an amount of 30 to 50 mg per kilogram of weight per day. This dose is divided into 2-4 doses. Children over 16 years of age can take a maximum of 4 tablets per day.

Throughout the entire period of treatment for rheumatoid arthritis, you should be observed by a doctor in order to assess intermediate results and identify side effects of the drug. It is necessary to monitor the level of liver enzymes, urine and blood levels.

For Crohn's disease, ulcerative colitis:

adult patients are prescribed 500 mg of the substance 4 times a day on the first day. On the second day, 2 tablets 4 times, on the third day, 3-4 tablets 4 times. As soon as the signs of the acute pathological process subside, the medicine is prescribed in a maintenance dosage of 1 tablet 3-4 times a day. The course will be several months (the doctor will tell you for sure);
Children 5-7 years old are recommended to take half or 1 tablet 3 to 6 times a day. Children over 7 years old should take 1 piece 3-6 times a day.

Adverse reactions, contraindications

The drug is usually well tolerated by patients. Even if you need to take it for a long time, there are practically no side effects. If negative reactions of the body appear, they are very weakly expressed and disappear without a trace in a short time. This is confirmed by reviews of patients and their doctors.

Thus, the patient may experience headache, tinnitus, sleep disturbance, limb cramps, vomiting, nausea, and diarrhea. Symptoms of hepatitis, pancreatitis, renal dysfunction, and interstitial nephritis may appear. There is also a risk:

skin rashes;
dizziness;
hallucinations;
anorexia;
oligospermia;
fever;
anaphylactic shock.

The skin and urine may turn yellow. If at least one of these signs appears, you should stop taking the drug and consult a doctor.

He may note the treatment or adjust the recommended dosage (reduce).

As for contraindications, there are few of them. If there is a need to treat pregnant women with Sulfasalazine, then they are shown the minimum possible therapeutic dosage and only in exceptional cases.

When the underlying disease allows, the drug should be discontinued in the last trimester of pregnancy.

The use of the product is prohibited when:

individual intolerance to any component of the drug;
women during breastfeeding;
children under 2 years of age.

Patients with various kidney and liver pathologies, bronchial asthma, and allergic reactions are also treated with extreme caution.

When treating during lactation, it is necessary to resolve the issue of its curtailment. Otherwise, the newborn baby may develop jaundice with all the ensuing negative consequences. This occurs due to the fact that substances pass into mother's milk.

During treatment, you should stop driving vehicles and operating machinery that requires concentration and speed of psychomotor reactions.

Cases of overdose

If for some reason the patient has taken an inadequate dose of Sulfasalazine, he will experience abdominal pain, vomiting, and convulsions. Other disorders, for example, from the central nervous system, cannot be excluded.

In this case, therapeutic measures should be aimed at gastric lavage, use of activated carbon or other sorbent.

If you have symptoms of kidney damage, you should immediately limit the amount of fluid and electrolytes consumed. As reviews show, this is especially true for anuria.

Drug interactions

If the patient is taking other medications, he must inform the doctor about this. Such information can be very important, because not all drugs Sulfasalazine is well tolerated by the body.

When used in parallel with Digoxin and folic acid, Sulfasalazine reduces their absorption. The medication can also enhance the effect of:

anticoagulants;
oral hypoglycemic agents;
antiepileptic drugs.

Simultaneous use may enhance adverse reactions of cytostatics, nephrotics, hepatotoxic drugs, and immunosuppressants.

If used in parallel with antibiotics, the effectiveness of Sulfasalazine in ulcerative colitis may decrease.

This is explained by the inhibitory effect of antibiotics on the patient’s intestinal microflora.

Analogues of the product

Pharmacology offers a structural analogue of Sulfasalazine (based on the main substance). This is the drug Sulfasalazine EH. Reviews say that this version of the drug is no worse.

There are analogs for therapeutic effect (drugs against ulcerative colitis): Diprospan, Mesacol, Hydrocortisone, Alginatol, Lemod, Salosinal, Yogulact forte, Pentasa, Azathioprine, Celeston, Eglonil, Enterosan, Maltofer, Methyluracil, Neonutrin, Fortecortin Mono, Lactobacterin powder, Urbazon, Prednisolone, Dexamethasone, Irmalax Triamcinolone, Fortecortin, Yogulact, Reopoliglyukin with glucose, Salofalk.

Psoriatic arthritis: symptoms and treatment, photos, causes, classification

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, and appears several years after the onset of skin psoriatic lesions, sometimes preceding it. Diagnosed in approximately 40% of patients with psoriasis. Psoriatic arthritis almost never occurs in children under 12 years of age.

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

Reasons for appearance and development

Psoriasis is an autoimmune disease, in half of 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 onset of which is nervous tension, mental disorders, and 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 minor bruises can cause the development of arthritis, which, as the disease progresses, will affect healthy joints.
Treatment with certain medications can give impetus to the development of psoriasis and subsequent arthritis, for example, a group of nonsteroidal anti-inflammatory drugs, medications to lower blood pressure, and others.
Systemic connective tissue diseases.
Scars in the joint area, 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 disease, the location of pathological changes and the severity of symptoms.

Psoriatic arthritis comes in several forms:

Asymmetric arthritis, affecting one or more joints. Usually the hip, ankle, knee, elbow, and phalanges of the limbs are affected. The joints are swollen, their flexion and extension are impaired.
Symmetrical arthritis. Bilateral damage to one or more groups of joints, with a milder course, however, in 50% of cases this form progresses to the patient’s inability to work, resulting in disability.
Distal arthritis of the phalanges of the limbs. Affects the hands and feet.
Deforming or mutilating arthritis. A severe form of psoriatic lesions affecting the fingers, with irreversible changes.
Psoriatic spondyloarthritis, sacroiliitis. Forms of arthritis affecting the spine and hip joints.

Juvenile psoriatic arthritis is a separate 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 joint groups affected, psoriatic arthritis is divided into three forms:

Groups 1-2 – monoarthritis;
Groups 2-4 – 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 - from peripheral polyarthritis.

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

Easy.
Moderate.
Heavy.
Malignant psoriatic arthritis - this type is very difficult to treat and occurs in combination with psoriatic erythroderma.

Psoriatic arthritis primarily manifests itself as pain in the joints. The pain is accompanied by the following symptoms, the presence of which can make a preliminary diagnosis:

The joint is swollen, the swelling spreads to the surrounding tissue.
Pain is felt when palpating the diseased organ.
The periarticular area is bluish, sometimes the skin becomes purple. Interphalangeal joints with such symptoms resemble radishes in shape and color.
The skin over the painful area has a higher temperature.
Psoriasis lesions of the nails are often observed.
The fingers of the limbs are thickened and often appear shortened.
Due to a violation of the elasticity and density of the ligaments, dislocations may occur.
When intervertebral joints are damaged, ossifications are formed, leading to stiffness and painful movements.

The malignant form is also distinguished by a number of symptoms:

The vertebral joints and skin are always affected.
There is fever, exhaustion, and increased fatigue.
The joints have limited mobility and the pain is intense.
Enlarged lymph nodes.
Psoriasis also affects other organs: liver, kidneys, eyes, nervous and cardiovascular systems.

Malignant arthritis in psoriasis develops only in male patients and quickly leads to disability. The consequences are very serious, including death. Death is often caused by encephalopathy, glomerulonephritis and severe hepatitis.

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

Diagnostics

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

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

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

An x-ray is required; the image shows the following x-ray signs:

Presence of osteophytes.
Bone erosion.
Ingrowth and deformation of bones in the articular area, deformation of joints.
There are no signs of osteoporosis.

Based on the research results obtained, differential diagnosis is made with rheumatoid polyarthritis, Reiter's and ankylosing spondylitis, osteoarthritis, and gouty arthritis.

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

Malignant psoriasis requires urgent treatment in a hospital setting to avoid rapid death.

Treatment of psoriatic arthritis includes prescribing courses of medications, physiotherapy, exercise therapy, and an appropriate diet. In case of serious deformation of the joints and in case of inflammation that is difficult to treat, 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 fingers, wrist and ankle can be used.

How to treat psoriatic arthritis with conservative means

Treatment includes prescribing courses of the following medications:

Nonsteroidal anti-inflammatory drugs that relieve pain and swelling. They are often 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, and Kenalog is recommended. Long-term treatment with these drugs is undesirable, since there is a possibility of the disease becoming malignant.

Immunosuppressants. These are substances that suppress the formation of pathological cells, reducing 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 analogs have a fairly serious list of contraindications and side effects.
Gold preparations are prescribed when immunosuppressants are ineffective, these include crizanol; Antimalarial drugs such as delagil and plaquenil are also recommended as second-line treatments.
Monoclonal antibodies are prescribed to permanently maintain treatment results and prevent relapses, these are adalimumab, infliximab.
B vitamins, injectable, accelerate treatment and tissue restoration, as well as vitamin A, folic acid and mineral complexes.
Sedatives such as valerian, motherwort infusion, antidepressants. When taking them, clinical manifestations decrease.
External preparations, ointments with NSAIDs and corticosteroids (prednisolone).
Chondroprotectors for bone tissue restoration. These are chondroitin sulfate, glycosamine sulfate, hyaluronic acid and others.

Rheumatologist of the highest category Ilya Maslakov also talks about the disease and methods of its treatment:

Physiotherapy uses the following treatment methods:

Ultrasound.
Laser in combination with magnetotherapy.
Microcurrents.
Pressure chamber.
Balneotherapy.

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

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

The diet for psoriatic arthritis aims to preserve joint function and reduce the rate of progression of the disease. Frequent meals in small portions are recommended. Nutrition for psoriatic arthritis should include dairy and plant products, dietary meat, and eggs. It is necessary to limit carbohydrates and animal fats. The necessary products include fruits and vegetables, with the exception of nightshades, citrus fruits, legumes, and sorrel. Spicy, fried foods, red meat, and salted fish are excluded from the menu.

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

You also need to give up negative habits and follow all doctor’s recommendations.

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

The following traditional recipes are used to treat swelling and pain:

Infusion of cinquefoil. The cinquefoil grass is poured with vodka in a ratio of 30 grams per 0.5 liter and infused for two weeks. This infusion is taken orally for 8 weeks, 3 times a day, 1 teaspoon before meals. The treatment gives its results within 2-3 weeks.
Parsley infusion. Parsley with roots 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.

Psoriasis is a systemic disease that primarily affects the skin. However, it is possible that pathological reactions of the body may also spread to internal organs and joints. Psoriatic arthritis is a consequence of the development of inflammatory reactions in the cartilage and bone tissue of the articular surfaces, which also affects the ligaments and tendons.

After rheumatoid arthritis, psoriatic joint damage ranks second among all inflammatory changes in the musculoskeletal system. Arthritis is reported in 10-38% of patients with psoriasis and occurs more often in patients aged 26-54 years. After the first psoriatic plaques appear on the skin, changes in the joints occur approximately 10-15 years later. However, in some patients (10-15%) this systemic disease begins with impaired mobility.

Classification

According to ICD 10, psoriatic arthritis according to its clinical course is divided into the following types:

Arthritis of the distal interphalangeal joints, which predominantly affects these areas.
Oligoarthritis (less than five joints are involved) and polyarthritis (more than five joints are affected).
Mutilating articular psoriasis is accompanied by osteolysis (destruction of bone tissue) and shortening of the fingers.
Symmetrical polyarthritis, which in symptoms and signs resembles rheumatoid arthritis.
Spondyloarthritis is accompanied by inflammation and limited mobility of the spinal column.

Articular psoriasis can be of varying degrees of activity:

active (minimum, maximum, moderate);
inactive (remission phase).

Depending on the degree of preservation of functional abilities in arthritis, three degrees are distinguished:

performance is preserved;
performance is lost;
a person is unable to care for himself due to severe limitation of mobility.

Symptoms and signs

Symptoms of psoriatic arthritis in most cases occur after cutaneous or visceral manifestations of the disease. But in a fifth of patients, psoriasis begins with changes in the joints.

The onset of the disease is sometimes gradual, but can also be acute. However, as a rule, there are signs of psoriatic arthritis listed below:

change in the shape of joints;
the appearance of painful sensations that are more noticeable not when moving, but at night;
stiffness, more pronounced in the morning;
joint deformity;
sometimes there is a burgundy coloration of the skin in the area of development of the pathological process;
with the osteolytic form of the disease, significant shortening of the fingers occurs;
Due to a violation of the density and elasticity of the ligaments, multidirectional dislocations often occur.

Most often, at the onset of the disease, changes are observed in small joints located on the hands and feet; less often, the elbow and knee joints are involved. Quite characteristic symptoms of joint psoriasis are signs of dactylitis, which is a consequence of inflammation of the flexor tendons and the cartilaginous surfaces themselves. This condition is accompanied by:

severe pain syndrome;
swelling of the entire affected finger;
limitation of mobility, which is associated not only with deformation, but also with pain when bending.

In approximately 40% of cases of psoriatic arthritis, the intervertebral joints are also affected. In this case, changes occur in the ligamentous apparatus, resulting in the formation of syndesmophytes and paravertebral ossifications. Mobility in these joints is rarely reduced, but pain and stiffness are quite common.

Also, psoriasis with articular syndrome is characterized by damage to the area where the ligaments attach to the bones. In this case, inflammation occurs, and then destruction of the adjacent bone tissue. Favorite places for localizing these processes are:

the surface of the calcaneus at the site of attachment of the Achilles tendon;
calcaneal tubercle in the area of attachment of the plantar aponeurosis;
tuberosity on the upper surface of the tibia;
in the area of the humerus.

80% of patients with psoriatic arthritis have symptoms. First, small pits or grooves form on the surface, covering the entire nail. Subsequently, the color changes due to disruption of microcirculation, as well as as a result of accelerated division of skin cells in the nail bed area.

Psoriatic arthritis and pregnancy have some relationship, because when carrying a child, a hormonal transformation of the entire body occurs. And since it is assumed, among other things, that the disease is of a hormonal nature, it is quite possible that an exacerbation will develop or even the first signs of joint damage will appear. In addition, increased arthritis symptoms during pregnancy are often associated with weight gain.

Unfortunately, treatment of this group of patients is extremely difficult, since most drugs for systemic use are contraindicated for them. However, psoriasis does not affect reproductive function in any way and a woman with this disease in most cases is able to bear a baby. During the pre-pregnancy period, you should undergo a full examination by a dermatologist and, possibly, a preventative one.

Organ changes in psoriatic arthritis

Damage to joints in psoriasis can be isolated or combined with damage to other organs and tissues. Systemic manifestations include:

generalized amyotrophy;
trophic disorders;
heart defects;
splenomegaly;
polyadenitis;
carditis;
amyloidosis of internal organs, joints and skin;
hepatitis;
ulcerative necrotic damage to the mucous membrane of the gastrointestinal tract;
cirrhosis of the liver;
diffuse glomerulonephritis;
polyneuritis;
nonspecific urethritis;
eye damage.

With psoriatic arthritis, both disability and the inability to care for oneself are usually the result of not only severe damage to the joints, but also changes in the function of internal organs.

The leading factor in the development of the inflammatory process in the area of internal organs is a violation of microcirculation in the vessels of the mucous membrane. Most often, angiopathy appears as a result of focal damage to the inner lining of blood vessels, spasm of the arteries and dilatation of capillaries. In addition, immune complexes can be deposited in the thickness of the vascular wall, as a result of which it becomes denser and its elasticity decreases.

Diagnostics

Diagnosis of psoriatic arthritis is largely based on the presence of a number of characteristic radiological signs of the disease:

periarticular osteoporosis;
narrowing of the joint space;
the presence of cystic clearings;
multiple patterns;
bone ankylosis;
ankylosis of joints;
the presence of paraspinal ossification;
sacroiliitis.

In addition to radiography, patients with suspected psoriatic arthritis are prescribed:

A blood test that reveals signs of inflammation and anemia, an increase in the level of sialic acids, fibrinogen, seromucoid and globulins. A very important difference from rheumatoid arthritis is a negative test for rheumatoid factor. The level of immunoglobulins of groups A and G also increases in the blood and circulating immune complexes are determined.
Quite often, synovial fluid obtained from joints is examined. In this case, increased cytosis and neutrophils are detected. The viscosity of the joint fluid is reduced, and the mucin clot is very loose.

The main criteria that allow us to make a correct diagnosis are:

finger joint involvement;
multiple asymmetric joint damage;
the presence of psoriatic skin plaques;
presence of characteristic radiological signs;
negative test for rheumatoid factor;
signs of sacroiliitis;
family history of psoriasis.

What causes psoriatic arthritis?

The exact cause of joint psoriasis has not yet been established. However, heredity undoubtedly plays a leading role. Arthropathic psoriasis can also occur with the participation of the following factors:

trauma at the onset of the disease, which is mentioned by about a quarter of patients;
stress and emotional tension, which have a negative impact on the immune system;
significant physical activity;
systemic infections.

The following are involved in the development of the disease:

a genetic factor associated with mutation and the presence of certain histocompatibility antigens and a number of so-called “psoriasis” genes;
the immune factor is confirmed by an increase in the level of immune complexes and antibodies in the blood of patients, and a decrease in lymphokines;
The occurrence of arthritis in patients with a number of viral diseases, including HIV, after a streptococcal infection testifies in favor of an infectious nature;
In more than half of patients, signs of joint damage first appear after suffering a severe emotional shock.

Treatment methods

To the question of whether psoriatic arthritis is curable, it is more correct to answer in the negative. However, modern advances in medicine help doctors prevent further progression of the process. In some cases, even partial restoration of joint function is possible.

How to treat psoriatic arthritis in a particular patient should be decided by the doctor after a full examination and medical history.

Drug therapy

For joint damage and psoriasis, treatment is not specific, it is aimed at:

slowing down the progression of the disease;
elimination of acute symptoms;
normalization of the function of the musculoskeletal system;
reduction of inflammatory and immune reactions.

The use of medications is the leading method of treating psoriatic arthritis. For this purpose, various groups of active substances are used.

Anti-inflammatory

Non-steroidal drugs (ibuprofen, diclofenac) are taken to reduce the manifestations of inflammation, as well as pain and associated mobility limitations. At the same time, the swelling in the area of the changes decreases.

Glucocorticosteroids

Hormonal medications can quickly eliminate the main symptoms of psoriatic arthritis. Since their systemic use poses a risk of developing negative reactions, they can be injected directly into the joint cavity.

Methotrexate for psoriatic arthritis is the most commonly prescribed systemic drug. Despite this, there are still no definitive studies proving its effectiveness. The standard dose is 15-20 mg over a week. However, patients receiving such therapy should constantly monitor liver and kidney function. If significant deviations are detected, it is necessary to reduce the dose or completely discontinue the drug. When the spine is involved in the process and ankylosing spondylitis develops, methotrexate has low effectiveness.

Sulfasalazine

Sulfasalazine has anti-inflammatory and antibacterial effects and is often prescribed for rheumatoid arthritis. However, after recent clinical trials, this drug was approved for use in psoriasis. Sulfasalazine for psoriatic arthritis is usually prescribed in a dose of 2 g. It must be taken for a long time. But due to the presence of a large number of side effects, in particular from the intestines, as well as the lack of effectiveness in cases of damage to the spine, the question of prescribing this medicine should be decided on an individual basis.

Tumor necrosis factor inhibitors

In the treatment of psoriatic arthritis with drugs, the most effective drugs have been those that inhibit tumor growth (adalimumab, etanercept, infliximab). This therapy affects pathogenetic mechanisms, that is, it not only eliminates the symptoms of the disease, but also counters its main causes. The main inconvenience of this technique is the injection of the drug, but most patients are okay with this, as they feel a clear improvement in their condition.

Cyclosporine

Cyclosporine for psoriatic lesions is taken 3 mg per day. This drug slows down the changes that occur in bone and cartilage tissue, which is confirmed by x-rays.

Leflunomide

Leflunomide has a positive effect on the course of the disease, reducing arthralgia and swelling in the joints, and also slows down bone destruction. This undoubtedly improves the patient's quality of life. Take it at a dose of 100-20 mg per day.

Physiotherapy

Against the background of psoriasis, treatment of arthritis using physiotherapeutic procedures in some cases can be very effective. The most commonly used methods are:

laser irradiation of blood;
PUVA therapy;
magnetic therapy;
electrophoresis using glucocorticosteroids;
phonophoresis;
physical therapy.

Diet

Diet for psoriatic arthritis of the joints plays an important role in the treatment of the disease, as it helps to consolidate the results achieved through medication. A fairly significant condition for normalizing the condition is maintaining an alkaline environment in the body, since otherwise there is a high probability of developing an exacerbation of the disease.

Nutrition for psoriatic arthritis must be carried out according to the following rules:

refusal of alcoholic products;
exclusion of possible allergens, which is carried out on an individual basis;
eating small portions;
refusal of smoked foods, preservatives, spicy and salty foods;
It is forbidden to eat citrus fruits;
limited intake of easily digestible carbohydrates;
increasing the volume of fermented milk products, cereals, vegetables, legumes;
replace butter with vegetable oil.

At the same time, the diet for psoriatic arthritis should be low-calorie, since excess weight increases the load on the joints. This leads to increased pain, as well as deformation and the appearance of other symptoms. Since most physical activity is contraindicated in case of serious intra-articular changes, patients’ only chance to eliminate excess weight is.

Traditional methods of treatment

Treatment of psoriatic arthritis with folk remedies should never be used as an independent technique. However, their use in addition to the main therapy in some cases makes a contribution.

Lingonberry decoction is prepared from two small spoons of dry leaves and a glass of hot water. The freshly prepared solution should be cooled and drunk in small sips.
Mix a few drops of turpentine, vegetable oil and one finely grated carrot. Apply a compress at night.
Mix coltsfoot, St. John's wort and medicinal dandelion in equal proportions and make an infusion with a liter of boiling water. Take 50 ml daily.
Birch buds are boiled for a quarter of an hour over low heat, cooled and taken 30 ml before eating.

Surgical treatment for psoriatic arthritis is performed quite rarely when conservative medicine has not helped to cope with the disease. The surgical technique includes removal of diseased tissue from the joint in order to restore its function, prosthetics of large joints, and fixation in a given position.

It is impossible to unequivocally answer the question of how to cure psoriatic arthritis, because this is determined taking into account individual characteristics. That is why, if you suspect the development of the disease, you should conduct a full examination as soon as possible. It must be remembered that if patients present late, there is a possibility that joint function will not be restored.

Immortal, my choice is a normal life with intact joints, a healthy liver and stomach. Everything can be treated, but perhaps let the patient live? :)

I am not a supporter of the theory that one must choose the lesser of two evils. This assumes that the opportunity to choose good is taken away from us initially, “by default,” I don’t like this and it shouldn’t be like that. It is equally bad to live with healthy joints and problematic liver and stomach, or with diseased joints and a healthy liver/stomach. When it seems that there is no choice and we are at a dead end, we need to stop and look another option. And only after you are convinced that there is no third (fourth? fifth?) way (and there is almost always one), then - having weighed, if possible, all the pros and cons - choose. I wish I could learn to distinguish evil from good... :(

ESR is so... Sulfasalazine is a serious drug, no better or simpler than Arava. Arava is newer and more focused. And Sulfasalazine, if I’m not mistaken, is the same as methotraxate in treating joints as a side effect.

Among the indications for sulfasalazine are joint diseases. in particular, arthritis:

Elena Arava is a very good and effective drug. Yes, it’s strong, but there are many side effects, and you need to get tested every month. But it’s worth it, if you take care of yourself and it suits you for arthritis, there’s a chance you’ll forget it for at least half a year.

Unfortunately, with psora there are no GUARANTEED minimum periods of remission, everything is so individual...

Elena IF the drug suits you, it will really help. I think it's worth a try after you weigh the pros and cons. If you haven’t seen it yet, then look at the article on the website and a couple more links.