relief psoriatic arthritis, relief psoriatic arthritis.

relief psoriatic arthritis, relief psoriatic arthritis.



Nathan Wei is a nationally known certified rheumatologist board and author of the second treatment Kit Opinion arthritis. It is available exclusively on this site. Not available in stores.

The term "polyarthritis" means inflammation of more than one joint. (Technically, the term "oligoarticluar arthritis" is used when 4 or less joints are inflamed.)

Patients with inflammatory polyarthritis (ie inflammation in more than 4 joints) are a diagnostic and management challenge.

When symptoms are recently onset, the range of possible diagnoses is great. Some viruses, including those that cause rubella, mumps, and human parvovirus B19 and some enteroviruses can cause acute polyarthritis; However, these viral arthritis normally regress within 6 weeks without residual complications.

In patients who are under 50 years of age with pain and swelling that lasts more than 6 weeks the diagnoses to be considered include rheumatoid arthritis, psoriatic arthritis, other seronegative spondyloarthropathies and SLE.

In patients over the age of 50, crystal induced synovitis should be considered. Osteoarthritis can also cause significant inflammation of the affected joints. For most of these conditions specific therapies aimed at controlling inflammation, preserving the range of movement in the joints and preventing joint damage have succeeded in decreasing morbidity and improving quality of life.

However, this is not an absolute since patients with fibromyalgia, a disease that is not associated with inflammation could be prolonged morning stiffness and pain and also have subjective swelling of the joints.

A history of psoriasis in the patient or a family member is an important indication of the possibility of psoriatic arthritis. A history of iritis or inflammatory bowel disease, both of which are associated with seronegative spondyloarthropathies can be detected.

A recent episode of infectious diarrhea or genitourinary infections are indications for the possible Reiter's syndrome. Does the patient have symptoms suggestive of SLE (eg, photosensitive or ill rash, alopecia or pleurisy)? Is there a past history of acute episodes of arthritis and gout? Are the joints joint or swelling? Is it limited movement? The choice of laboratory tests that can contribute depends on the differential diagnosis.

The typical patient with rheumatoid arthritis has inflammation in the wrist and MCP or metatarsal-phalangeal (MTP) joints, or both, which persists over 6 weeks. Among patients under 50 years, more women are affected, but after age 50 the incidence is the same for men and women. Morning stiffness and "gelling" (stiffness during the day with prolonged sitting) are almost always present, and swelling of the affected joints is clear with careful examination. The condition may be intermittent at first, but within weeks or months the symptoms become persistent and more disabling.

A positive rheumatoid factor test supports the diagnosis; however, as many as 30% of those affected have negative results. A positive test for anti-CCP can help, because it is more specific to the AR. Inflammatory changes in the early stages of small joints can be detected in both ultrasonic diagnostics, as well as magnetic resonance imaging. If the patient has had active polyarthritis for more than 1 year, erosion of the joint can be seen on X-rays of the hand or foot.

Laboratory tests useful for patients with recent inflammatory polyarthritis onset may include blood count, VES, C-reactive protein, rheumatoid factor test, anti-CCP, serum and urine chemistries. VES is an economic measure of disease activity in patients with rheumatoid arthritis; However, the test is not diagnostic and rates are not high in all affected patients. A positive result for rheumatoid factor is useful but not essential to confirm the clinical impression of rheumatoid arthritis in the context of symmetrical inflammatory polyarthritis.

If rheumatoid arthritis is mild and in its early stages many rheumatologists favor using hydroxychloroquine (Plaquenil) because it is safe and convenient. If control is optimal after 2 months, other DMARDs are often prescribed.

A recent study reported some efficacy with minocycline for patients with early rheumatoid arthritis. However, long-term efficacy data for patients treated with minocycline are not available, and radiographs show that the injury progresses at the same rate as in placebo-treated patients.

If a patient has moderate to severe rheumatoid arthritis, especially if the rheumatoid factor is positive, methotrexate is the drug of choice. Methotrexate is relativament


There is often a delay between the presentation of polyarthritis and the confirmed diagnosis, and there is always a delay before a prescribed DMARD has the expected benefit. When optimal DMARD therapy or a combination of DMARD does not control synovitis, low-dose prednisone can provide relief from symptoms, low acceptable toxicity, and joint protection.

Biologics should be started within three months of diagnosis if the disease is or is not in remission or is not at an acceptable low disease level.

The purpose of the therapy is to minimize the pain, stiffness and swelling of the joints; delay joint damage; and reduce future disability.

Psoriatic arthritis is almost as common as rheumatoid arthritis. This condition must be suspected when the patient or family of the patient has a history of psoriasis, when the distal joints are affected or when there is a history of unexplained chronic or recurrent back pain with prolonged inactivity. Another common feature of psoriatic arthritis and spondyloarthropathies is bursitis or enthesitis (ie inflammation of the muscular attachment or tendon to the bone).

Typical examples of bursitis, tendonitis and enthesitis include trochanteric bursitis, Achilles tendinitis and lateral epicondylitis. heel pain or plantar fasciitis are commonly associated with psoriatic arthritis, and the nails can show pitting and onicolisi. Close examination can reveal psoriatic plaques on the scalp or ears that the patient has not noticed. Interestingly, the severity of psoriasis has poor correlation with the presence or severity of psoriatic arthritis.

Psoriatic arthritis may be indistinguishable from rheumatoid arthritis in onset and progression, and there are no diagnostic laboratory tests for psoriatic arthritis. However, more typically it is asymmetric or mono-articular. Most cases of psoriatic arthritis are controlled by NSAIDs; for those whose arthritis is not satisfactory controlled with NSAIDs and for those who are experiencing joint damage the biological DMARDs and used for the treatment of rheumatoid arthritis are effective.

seronegative spondyloarthopathies such as reactive arthritis and Reiter's syndrome most commonly present as asymmetric oligoarthritis affecting lower limb joints. Reactive arthritis is an inflammatory arthritis that occurs as a result of infection at a remote site.

The activation infection must be treated as appropriate; Projection of at-risk contacts should be included in the management of patients with genitourinary reactive arthritis and selected patients with intestinal reiter syndrome. Arthritis management must be personalized and may include NSAIDs, oral or intra-articular steroids and, in resistant cases, DMARDs.

Patients with systemic lupus erythematosus (female ratio: males is about 10: 1) often present with polyarthritis - typically a peripheral polyarthritis with symmetrical involvement of small and large joints. Symptoms reflect multisystem involvement, in particular photosensitivity, unexplained skin rashes, malar rash, pleural chest pain, history of convulsions, oral ulcers, hair loss, Raynaud's phenomenon, fevers and sweating. The deformities between subluxation at the MCP joints, ulnar deviation, "swan neck" and boutonniere deformity (Jaccoud arthropathy) may develop in about 15% of patients with SLE.

An antinuclear antibody test is a useful screening test because a negative test result will practically exclude the LES. If the test is positive and there is a clinical suspicion of multisystem disease, the doctor should consider further laboratory tests.

Older polyarthritis onset differs from rheumatoid arthritis based on a negative rheumatoid factor, a markedly elevated erythrocyte sedimentation rate, usual age of onset over 60 years, and marked improvement in the response to low-dose steroids. Although it is rare it is not uncommon. The onset is often sudden, and there is generally swelling of the wrists and the pain, stiffness and restriction of the shoulder joints. The clinical course of this very similar syndrome polymyalgia rheumatica in its sudden onset and response to prednisone.


Rheumatic polymyalgia typically presents with the shoulder and pelvic belt involvement and the absence of clinically detectable synovitis; elderly onset polyarthritis syndrome occurs with peripheral synovitis that may be indistinguishable from seronegative rheumatoid arthritis, except in its response to prednisone and its course over time. Synovitis disappears with 10-15 mg / day of prednisone, and the condition is nonprogressive and non-erosive. Once the disease is under control the dose of prednisone can be lowered every 1-3 months, with the goal for the lower dose that the symptom control. Strategies to prevent steroid-induced osteoporosis, particularly anti-osteoporosis drugs, are necessary. If the dose of prednisone can not be lowered or if pain and swelling persist despite low-dose prednisone, the physician should reevaluate the patient and consider other diagnoses, such as rheumatoid arthritis, psoriatic arthritis, temporal arteritis, and other vasculitis.

Gout or pseudogout can cause inflammatory polyarthritis. The typical patient with polyarticular gout had acute attacks of monoarthritis and typical gout attacks for many years. Each municipality can be affected and, in the most serious cases, the patient may have fever and have a high white blood cell count; tofi are commonly found on careful examination. Patients are usually over 50 years of age or have identifiable risk factors for gout such as the use of diuretics, kidney disease or alcohol abuse. Although serum uric acid level is often high this is not always the case. Synovial aspiration of the liquid will demonstrate the typical urate crystals.

The calcium pyrophosphate dihydrate deposition disease (ie pseudogout) can also cause polyarthritis. Patients are usually over 60 years of age, and this condition commonly coexists with osteoarthritis. The presentation may resemble rheumatoid arthritis - typical joint inflammation distribution includes the wrists, knees, shoulders, hips and finger joints. X-rays commonly show chondrocalcinosis, but the diagnosis is confirmed when calcium pyrophosphate dihydrate crystals are present in the synovial fluid of the inflamed joints.

Arthrosis affects DIP, PIP and CMC joints may be associated with symptoms and signs of inflammation. The onset is common in perimenopausal women, and there is often a family history of Heberden's osteoarthritis. Patients complain of tenderness and episodes of swelling usually in 1 or more joints of the fingers at the joint time. The examination reveals knots of Heberden and Bouchard of in one finger and sometimes the joints of the feet; MCP and MTP joints are not affected. Radiographs of affected joints show narrowing, osteophytes, sclerosis and, in advanced stages, PIP or DIP joint erosions. Because of the prominent involvement of DIP joints, it can be difficult to distinguish inflammatory osteoarthritis of psoriatic arthritis, which may also develop in elderly patients. It is important to remember that rheumatoid arthritis can occur in patients who also have osteoarthritis.

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