Improving recognition of psoriatic arthritis.

摘要: Psoriatic arthritis (PsA) is a common form of inflammatory but underdiagnosed. Psoriasis affects over 1.5% the UK population. Around 15% these patients will be diagnosed with PsA, up to 40% may have evidence if reviewed thoroughly. PsA can difficult diagnose as present variety different patterns arthritis. Most relatively mild skin psoriasis, some more significant disease. Only 10-20% develop before their Many psoriasis that they are unaware of, or not had diagnosed. Joint involvement far variable in compared rheumatoid arthritis, and with: monoarthritis; oligoarthritis; distal interphalangeal joints; arthritis-like picture multiple joints involved including small hand axial disease producing symptoms similar ankylosing spondylitis. Features such dactylitis (uniform sausage-like swelling whole digit either finger toe) enthesitis (inflammation at sites muscle tendon attachment bone) also help PsA. Skin majority although all. Hidden areas for include: behind ears; top natal cleft around umbilicus. Larger joints, particularly knees, very big effusions causing obvious swelling. Areas test should include Achilles tendon, plantar fascia, costochondral elbow. Patients suspected referred promptly rheumatologist further assessment treatment. Diagnosis made on clinical grounds blood tests radiographs performed routinely aid diagnosis. Initial therapy NSAIDs ease pain stiffness. Local injections corticosteroids recommended peripheral (given IA) (usually by injection into flexor adjacent joints). DMARDs used treat all aspects psoriatic disease, except spinal prescribing initiated specialist.