Ebook Psoriasis: Part 2
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Ebook Psoriasis: Part 2
73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2 and deep impact on the quality of life of those afflicted. Pv\ provides a source of great scientific deliberation and clinical need. Recent advances in epidemiology, immunogene tics, and clinical classification have enhanced our understanding of this enigmatic and often debilitating joint disease.D Ebook Psoriasis: Part 2iscussions of treatment and quality of life considerations related ro RsA can be found in rhe relevant chapters of this book and are nor discussed herEbook Psoriasis: Part 2
e.GENERAL DESCRIPTION_________________________PbA joins a unique group of arthritic- diseases unified by involvement of rhe joints and connective tiss73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2ortion of gamma immunoglobulin. A positive test for RT is one of the hall marks of perhaps rhe best known! of all inflammatory joint diseases, rheumatoid arthritis (RA). Clinicians should be aware, however, that 10-13% of patients with PsA are seropositive for RE'1. Along with Rs A, rhe so-called ‘s Ebook Psoriasis: Part 2eronegative spondyloarthropathies’ include ankylosing spondylitis, reactive arthritis (Reiter syn-drorne) and arthritis related to inflammatory bowelEbook Psoriasis: Part 2
disease. Diseases of this group commonly produce signs and symptoms beyond rhe joints, such as lesions in rhe mucous membranes, inflammation of the ir73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2ion among the seronegative spondyloarthopathies, PsA is unique. Experts in the field suggest that the spine is invoked in only a minority of patients with PsA and, when it is, characteristics ofsymmetry, pain, and movement restriction differentiate rhe disease from rhe orher spondyloarthropathies (s Ebook Psoriasis: Part 2ee below'). Indeed, many patients with PsA remain free of spinal inflammation alrogerher and can display a partem of peripheral joint involvement virtEbook Psoriasis: Part 2
ually identical lo RA’.EPIDEMIOLOGY________________________________Estimates of the prevalence of PsA among patients with psoriasis vary7 widely, with73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2 may explain this broad estimate-0. Nonetheless, research assessing disease prevalence reveals interesting Trends. Northern European countries. for example, maintain higher prevalence of PsA than southern, a trend also found with skin disease. In a study from Sweden, for example, the prevalence of P Ebook Psoriasis: Part 2sA in patients with psoriasis was 30%°, roughly four limes greater than that of an Italian snidy population with psoriasis111 and twice that from a smEbook Psoriasis: Part 2
all sample of Croatian psoriarics". Dara aimed ar assessing prevalence in the general population, rather than solely among patients with psoriasis, de73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2 cases per unit rime, revealed a rare of 23 cases per 100,000 per year in Finland14.In rhe United Srares, a recent population-based survey of psoriasis patients estimated prevalence of RiA at 11%' As expec ted, incidence rales in America, estimated ar around 6.6 cases per 100,000 per year, are less Ebook Psoriasis: Part 2than a third of those in Finland16.rhe temporal relationship between rhe onset of skin and joint disease captures the attention of not only epidemioloEbook Psoriasis: Part 2
gists, but also clinical dermatologists. Data suggest that rhe vast majority of patients with PsA (80-90%) develop skin disease up to 10 years prior t73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2of patients, skin disease and arthritis commence simultaneously5. Rarely does joint disease present prior to skin involvement, except in the pediatric population, in which PSA prevalence may lx- grossly underestimated.Other miscellaneous trends are noteworthy. Unlike RA. which maintains a strong fem Ebook Psoriasis: Part 2ale preponderance. PSA affects males and females equally7'n. rhe average age of onset ranges between 30 and 50 years20. ()t rhe many phenotypes of psoEbook Psoriasis: Part 2
riasis, plaque-type psorialics are most likely to develop BA’.GENETICS, IMMUNOLOGY, AND PATHOGENESISStudies of idcnUcal, or monozygotic, twins affirm 73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2ins* 1. Other work suggests dial first degree relatives of those affected with PsA have a 50% greater risk of developing rhe disease than does the general population-As with psoriasis, certain alleles encoding human leukocyte antigens (HI A), cellular glycoproteins involved with antigen presentation Ebook Psoriasis: Part 2 lo T cells, associate with PsA. Class I loci, designated as HI A-A, -B, or-C, encode molecules dull interact with CD8+ I cells. (. class II loci. I IEbook Psoriasis: Part 2
LA D, encode peptides that interact with CD'I * I cells. Certain polymorphisms of both class I and II alleles confer risk for PsA\ B 27, well known fo73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2e, found in many patients until psoriatic skin disease, maintains only a moderate association with BA'1I .inkages snidies, seeking association between rhe PsA phenotype and specific genetic loci, had been sur prisingly fruitless initially. Indeed, early smdies of rhe PSORS1 locus, rightly associated Ebook Psoriasis: Part 2 with psoriasis26, failed to demonstrate linkage with BA 7. However, more recent genome-wide studies counter this by demonstrating association of variEbook Psoriasis: Part 2
ous single nucleotide polymorphisms (SNPS) adjacent to PSORS1 with the PSA phenotype27. The PSORS2 locus on the long arm of chromosome 17, as well as 73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2tion plays a significant role in the pathophysiology of BA. Indeed, both the humoral and cellular systems arc implicated. Scrum and synovial fluid of PsA patients demonstrate increased immunoglobulins (1g), particularly IgA and G7-29. IÒ support rhe role of cellular immunity in BA. activated CD8 ’ T Ebook Psoriasis: Part 2 cells are prolific in synovial fluid’17. Furthermore, medications preventing the activation of T cells have been a hallmark of treatment for BA (seeEbook Psoriasis: Part 2
below).CLINICAL MANIFESTATIONSrhe distribution of affected joints, presence of psoriasis, and, in most cases, absence of rheumatoid factor characteriz73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2soriasis and/or psoriatic arthritis**. (. Classic symptoms of inflammatory arthritis can also lead the physician to the presence of BA. Examples include morning joint stiffness lasting longer than 30 minutes that improves with activity, as well as arthralgias ar rest’7.Physical examination can point Ebook Psoriasis: Part 2 to BA. Dactylitis (250-252), inflammation around an interphalangcal joint extending along an entire digit, strongly' suggests BA**. Another importantEbook Psoriasis: Part 2
sign, enihcsilis (253), pres enrs with tenderness ar sires of insertion of ligaments and tendons. The examiner elicits pain on palpation of the Achil73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology. Ebook Psoriasis: Part 2may act as a marker tor BA. ()ne study proposes that more than 20 nail pits may distinguish PsA from RA*Clinical manifestations250-252 Dactylitis. Swelling involves the entire digit and is most pronounced at the interphalangeal joint.253 Enthesitis. Tenderness at the insertion of the Achilles tendon Ebook Psoriasis: Part 2 is common.254, 255 Nail disease adjacent to affected joints.PSORIATIC ARTHRITIS 75 -----------76Clinical manifestations256 Radiograph of 1’sA. ErosioEbook Psoriasis: Part 2
n of the Dll’joints (aero-osteolysis) causing characteristic 'pencil-in-cup' deformity.257,258 Asymmetric oligoarthritis.259, 260 Symmetric polyarthri73PSORIATIC ARTHRITISLike its cutaneous counterpart, psoriatic arthritis (PsA) has a broad range of clinical manifestations, complex pathophysiology.Gọi ngay
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