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Irina Alexandrovna Zborovskaya – doctor of medical sciences, professor, cathedral professor of hospital therapy with the course of clinical rheumatology of the doctors improvement faculty of Volgograd state medical university, director of the Federal Budgetary State Institution (FBSI) “Research and development institute of clinical and experimental rheumatology” of the RAMS, head of the regional Osteoporosis Center, presidium member of the Association of rheumatologists of Russia, member of the editorial boards of the magazines “Scientific and practical rheumatology” and “Modern rheumatology” Definition. Psoriasis is referred to as dermatosis, which is characterized by proliferation of the epidermis. The exact aetiology of proliferation of the epidermis is unclear. Psoriasis is clinically manifested by clearly marked pink papules with silvery scales. Psoriasis of the palms and feet, pustular psoriasis as well as skin involvement in flexion areas of extremities and skin folds occur less commonly. It is typically localized at the extensor surface of large joints such as knee and elbow, scalp, intergluteal cleft, umbilicus and sacral region. Psoriatic nail involvement is frequently present in psoriatic arthritis. Psoriasis is a systemic disease, which is clinically manifested by either dermal or dermal-articular and visceral symptoms, depending on the extent of the disease severity. Psoriatic arthritis is one of the main forms of inflammatory diseases of the spine and joints. It is a chronic systemic progressive disease associated with psoriasis. It usually results in the development of erosive arthritis, resorption of bone (osteolysis), multiple enthesitis and spondylarthritis. In as many as 75 percent of patients psoriasis usually precedes arthritis. In 15 percent psoriatic arthritis may be present with obvious skin lesions. In other cases joint involvement appears before psoriasis. There is a group of the so-called seronegative spondylarthritis, which are referred to as diseases characterized by frequent involvement of iliosacral joints and absence of rheumatoid factor in blood serum. Family history of these disorders should also be considered. Psoriatic arthritis, Reuter’s disease, arthritis in chronic non-specific diseases of the intestine belong to this group. Ankylosing spondylitis also belongs to this subgroup. Seronegative spondylarthritis is characterized by the following clinical manifestations: 1. Negative test result for rheumatoid factor (RF) (negative test result for antinuclear factor). 2. Absence of subcutaneous rheumatoid nodules. 3. Arthritis of peripheral joints, most commonly asymmetric. 4. Radiologic evidence of sacroileitis and/or ankylosing spondylitis. 5. Clinical overlaps (“overlap” syndrome) among diseases belonging to this group. They are characterised by the following two or more features:
Diagnostic rule. If the sum of the scores is 16, psoriatic arthritis is considered to be classical, 11 – 15 points – defined; 8 – 10 – possible; 7 and even less, psoriatic arthritis is unlikely.
Differential diagnosis. Psoriatic arthritis should be differentiated from the following rheumatic conditions:
- Psoriasis or psoriasis-like skin or nail involvement.
- Ocular involvement, including conjunctivitis or acute anterior uveitis.
- Ulcer of the mucous membranes of the cheeks.
- Ulceration of the large or small intestine.
- Inflammatory processes in the urogenital tract, in particular urethritis and/or prostatitis.
- Erythema nodosum.
- Gangrenous pyodermia.
- Common (moderate and mild)
- Without any systemic manifestations;
- With systemic manifestations: trophic disturbances, generalized amyotrophy, polyadeny, carditis, heart failure, pericarditis, aortitis, nonspecific reactive hepatitis, hepatic cirrhosis, amyloidosis of internal organs, skin and joints, diffuse glomerulonephritis, acute anterior uveitis, nonspecific urethritis, polyneuritis, Raynaud`s syndrome.
- Periarticular osteoporosis;
- Poorly marked articular space and unpronounced osteoporosis;
- Narrowing or enlargement of the articular space, subchondral osteosclerosis;
- Vulgar: focal and diffuse
- Psoriasis rupioides
|1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 2 3 4||Psoriasis Psoriatic rash on the skin — Psoriasis associated with nail involvement; — Skin psoriasis in first-degree relatives; — Arthritis of distal interphalangeal joints of the hand; — Arthritis of 3 joints of the same finger (axial lesion); Subluxations of fingers in different directions Asymmetrical chronic arthritis Purple colour of the skin above the involved joints with poor palpatory sensitivity «Sausage-like» deformity of toes Skin and bone involvement Pain and morning stiffness in any part of the spine for more than 3 months Seronegative rheumatoid factor Acroosteolysis Ankylosis of distal interphalangeal joints of the radiographic features of specific sacroiliitis Syndesmophytes or paravertebral ossificates Differentiation criteria Absence of psoriasis Seropositive rheumatoid factor Rheumatoid nodules A certain correlation between intestinal and urogenital infection.||+5 +2 +1 +1 +5 +4 +2 +5 +3 +4 +1 +2 +5 +5 +2 +4 -5 -5 -5 -5|
- Rheumatoid arthritis
- Ankylosing spondylarthritis
- Urogenital reactive arthritis (Reiter`s syndrome)
- Gout arthritis
- SAPHO syndrome (Synovitis, Aсne, Pustulosis, Hyperostosis, Osteomyelitis) – pustulosis palmaris et plantaris, acne, purulent hydradenitis, sternoclavicular hyperostosis, chronic sterile multiple lymphadenitis, hyperostosis of the spine.