PSORIATIC ARTHRITIS: EARLY DIAGNOSIS

PSORIATIC ARTHRITIS: EARLY DIAGNOSIS

Hatem Ghaleb Maabreh

graduate student, Peoples' Friendship University of Russia (RUDN University),

Russia, Moscow

Nadejda Batkaeva

Candidate of Medical Sciences, Peoples' Friendship University of Russia (RUDN University),

Russia, Moscow

Edward Batkaev

Professor, Peoples' Friendship University of Russia (RUDN University),

Russia, Moscow

Nashaat Sultan Al Khateeb

graduate student, Peoples' Friendship University of Russia (RUDN University),

Russia, Moscow

Ziad Ahmad Alabdallah

PHD, Al Furat University,

Syria, Deirez-or

ABSTRACT

Psoriatic arthritis (PsA) is a heterogeneous disease that can involve a variety of distinct anatomical sites including a patient's peripheral and axial joints, entheses, skin and nails. Appropriate management of PsA requires early diagnosis, monitoring of disease activity . To accomplish the former there are a variety of PsA-specific tools available to screen, diagnose, and assess patients.

Including the Toronto Psoriatic Arthritis Screening Questionnaire (TOPAS), the Psoriasis Epidemiology Screening Tool (PEST), the Psoriatic Arthritis Screening and Evaluation (PASE), and the Psoriasis and Arthritis Screening Questionnaire (PASQ). 

Screening and early diagnosis of PsA in patients with psoriasis:

In the absence of timely diagnosis and treatment of PSA in patients with psoriasis, the risk of disease progression and the development of functional disorders increases. In some studies, 47% of PsA patients were found to have joint erosions 2 years after the onset

Early detection of psoriatic arthritis (PSA) remains a challenge in clinical practice. Tools such as screening questionnaires have been developed for this purpose.

Several patient-filled tools are currently available for PSA screening, including the Psoriatic Arthritis Screening Assessment. [1,4,6]

Keywords: Psoriatic arthritis, Early diagnosis, Disease severity measures, Treatment.

1. Introduction

Psoriatic arthritis is a chronic inflammatory disease of the joints, spine and entheses from the group of spondyloarthritis (SpA), usually associated with psoriasis [2],This is a heterogeneous disease that can involve various anatomical sites, including the peripheral and axial joints, enthesis, skin and nails of the patient. Proper PSA management requires early diagnosis, monitoring of disease activity, and the use of advanced treatments. [8]

Early diagnosis of psoriatic arthritis

In the vast majority of PsA patients, cutaneous lesions indicative of psoriasis precede development of arthritic signs and symptoms [7]. Although currently in development, there are no serum biomarkers to accurately predict which psoriasis patients will go on to develop PsA [3].

In fact, it may take many years for a patient with psoriasis to develop inflammatory arthritis [5]. Thus, dermatology and primary care providers should be keenly poised to diagnose PsA in their at-risk patients with cutaneous psoriasis. For these patients, achieving a good long-term clinical outcome depends in part on the physician's ability to make an early diagnosis of PsA and to initiate treatment prior to the onset of significant and permanent joint damage [9] .

The Classification Criteria for Psoriatic Arthritis (CASPAR) was developed using data collected from patients with long-standing PsA and is based on an established diagnostic criteria for inflammatory articular disease that was modified to include additional clinical findings specific to PsA, such as the presence of psoriatic nail dystrophy, a negative RF test, dactylitis, and radiographic evidence of juxta-articular bone formation [10]

Etiology- The etiology of PsA is unknown. The disease occurs as a result of complex interactions between genetic, immunological and environmental factors. There is evidence of a hereditary predisposition to the development of both psoriasis and PsA: more than 40% of PsA patients have first-degree relatives suffering from these diseases. Psoriasis and PsA are considered T-cell-mediated diseases, in which cellular immunity is activated in the skin and synovium, followed by hyperproduction and imbalance of key pro- and anti-inflammatory cytokines, such as TNF-α, interleukins: IL-12, IL-23, IL -17, IL-1, IL-1ß, IL-6. [11]

Currently, the immune system and genetic predisposition play a leading role in the pathogenesis of both psoriasis and psoriatic arthritis. Thus, the main phenomenon is the formation of a complex network of interactions between immunocompetent cells, keratinocytes, synovial membrane cells and cytokines, which are among the most significant markers of impaired immunoregulation processes in inflammatory diseases.[12]

In psoriatic arthritis, as in other spondyloarthritis, various changes in the profile of pro- and anti-inflammatory cytokines are observed, which form a regulatory network and, having a pleiotropic effect, participate in the pathogenetic mechanisms of this type of arthritis, being inducers of inflammation and tissue destruction.[13]

Classification:

The polymorphism of psoriatic skin changes in combination with various forms of damage to the joints, spine, and often internal organs caused a variety of terminology found in the scientific literature: psoriatic arthropathy, psoriatic arthritis with systemic and extra-articular manifestations, psoriatic disease, etc.[14]

this pathology is defined as psoriatic arthritis . The following clinical and anatomical variants of the articular syndrome of psoriatic arthritis are distinguished:

• distal;

• monooligoartric;

• osteolytic;

• spondyloarthritic.

DIAGNOSTICS :

Psoriasis is an independent risk factor for the development of one or two autoimmune diseases, while any rheumatic disease can develop in this dermatosis.

The diagnosis of PsA is established primarily on the basis of the identification of characteristic clinical signs of the disease, there are no specific laboratory tests, in 40-60% of patients, inflammatory biomarkers (ESR, CRP) remain normal. In a third of patients, the HLA-B27 antigen is detected. The analysis of synovial fluid does not give specific results, sometimes high cytosis is detected. With PsA, RF (rheumatoid factor) and ACCP (antibodies to cyclic citrullinated peptide) are rarely detected in the blood of patients (12 and 15% of cases, respectively), mainly in low titers.

For early diagnosis of inflammatory changes in the spine (spondylitis) and ileosacral joints (sacroiliitis), tendon-ligamentous apparatus (enthesitis, tendinitis), peripheral arthritis (synovitis), magnetic resonance imaging (MRI) is used, as well as ultrasound with power Doppler mapping (EDC) . In some cases, skeletal scintigraphy is recommended for early diagnosis.

Conclusions

Several identified unmet needs warrant additional attention and action, including improved severity assessment, PsA screening, patient awareness, and treatment options.

References:

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