Almost everyone has heard of such a disease as psoriasis – a non-communicable skin disease of autoimmune nature. Red flaky plaques cause a lot of inconveniences: itching, sometimes cracks and pain, are a cosmetic disadvantage and notably affect the social behavior of a person and his self-esteem. However, this disease is characterized not only by skin manifestations but also by joint damage, which can lead to severe disability. Let’s talk about what is psoriatic arthritis (PA) and what drugs are used to treat it.
Three or four decades ago, no one even knew about such a form of psoriasis as arthritis, even in large medical centers in the USA. Fortunately, since then everything has changed and the wording of the diagnosis “Psoriatic arthritis” is not a wonder for anyone.
What unites arthritis and psoriasis
Arthritis is an inflammation of the joint. The cause of psoriasis is most likely due to the formation of autoantibodies (immune system cells as a result of genetic breakdown perceive the cells of the synovial membrane of the joint for the alien and begin to fight). As a result, the synovial fluid forms complexes of connective tissue, the nutrition of the cartilage is disturbed and its gradual destruction occurs.
The role of cartilage in the joint is very large: it is thanks to it that the movements are painless, unobstructed and in principle possible. As the disease progresses, the cartilage completely collapses, pathological changes in bone tissue begin.
The joint surfaces of the bones fuse, the movement in the joint becomes impossible, the affected limb deforms.
The medical history of a patient with psoriatic arthritis can begin with both skin manifestations and joint lesions. Sometimes rashes and joint pain appear at the same time.
In a large percentage of cases, the manifestation of the disease occurs after exposure to severe stress.
The joints on the tips of the fingers and toes (the phalanxes of the hands and feet) are most prone to destruction, asymmetrically, and the joints between the vertebrae are prone to arthritis. The joint symptoms are identical in other types and include pain, stiffness and skin change.
Diagnosis of arthritis includes examination and collection of history, X-ray – examination, laboratory tests and special diagnostic procedures.
X-ray signs of psoriatic arthritis are little different from those in other types of disease, especially in rheumatoid, and include cartilage destruction, bone resorption, joint sub-infection.
There are no specific laboratory tests to detect PA, sometimes there is an increase in rheumatoid factor, so when it is detected, the level of anti-CDC for accurate differential diagnosis is prescribed.
To clarify the process can be arthroscopy (surgical manipulation, allowing to assess the condition of the joint directly) with the analysis of synovial fluid and biopsy of the joint bag.
Treatment of psoriatic arthritis
It is unlikely that somewhere on the forums there will be people who have been cured of psoriatic arthritis. The disease is not cured, but with the help of modern methods and drugs can be achieved persistent and prolonged remission.
The main thing to remember is that the sooner you start the right treatment, the more likely it is to stop the process and prevent disability.
The protocols for the treatment of psoriatic arthritis have not changed for many years. The therapy uses both generally recognized means to combat the manifestations of inflammation of the joints of any etiology, and specific drugs aimed at retention of autoimmune response.
According to patients, the treatment of psoriasis arthritis is a long and exhausting affair. Many medicines have a lot of side effects, the type of deformed joints and affected skin initiates the appearance of psychological problems and nervous tension. Therefore, if you are faced with this problem, gain courage and patience and do not neglect the help of psychologists and psychotherapists.
Non-steroidal anti-inflammatory drugs
The NSAIDs group is a universal anti-inflammatory and painkiller for arthritis of any origin.
Tablets of this series suppress the synthesis of pro-inflammatory enzymes and reduce the susceptibility of pain receptors to irritants. As a result, the inflammatory process is reduced and the pain syndrome is relieved.
Choosing a particular remedy is only for the doctor, as most of them have a number of contraindications and side effects. Modern drugs for the treatment of pain in psoriatic arthritis can reduce its intensity and do not have a negative impact on the organs of the gastrointestinal tract.
The most commonly used NSAIDs include: diclofenac, ibuprofen, indomethacin, ketoprofen, meloxicam, nimesulide.
According to the reviews of patients, it is meloxicam (Mialis, Amelotex, Melox) in psoriatic arthritis gives a better effect and is less inclined to damage the mucous gastrointestinal tract.
A separate group of NSAIDs – coxibs (celecoxib, etoricoxib, and others) are a priority, but the high cost limits their reception.
Non-steroidal anti-inflammatory drugs for psoriatic arthritis are used as ointments for joints. Thus, systemic side effects are minimized, but the force of action is significantly reduced.
Corticosteroids and Glucocortioids
Hormonal drugs have found use in any kind of inflammation of the joints. They help relieve swelling and quickly relieve pain when NSAIDs are helpless. Their systemic use, especially over a long period, leads to the development of complex side effects and even syndromes. Therefore, they are often prescribed short courses (pulse therapy) or in the form of intraarticular injections. In psoriatic arthritis, dexamethasone, prednisone, methylprednisolone were widely used.
Basic anti-inflammatory drugs
Widespread use for the treatment of psoriatic arthritis received methotrexate – a cytostatic drug that suppresses the synthesis of DNA, thereby preventing cell growth and reproduction. In large doses it is actively used to treat malignancies of various localizations. The mechanism of action of methotrexate in psoriasis and inflammation of joints remains unclear, but it is established that the drug has an anti-inflammatory and immunosuppressive effect.
Thanks to the use of small doses, unlike the use in oncology, does not cause a powerful oppression of blood, but side effects on other organs and systems remain. Of the many forms of methotrexate presented by various pharmacological companies, the drug Methodzht received the most good reviews for psoriatic arthritis.
This is widely used in psoriatic and rheumatoid arthritis, with many positive reviews indicating its high effectiveness. The drug has an anti-inflammatory and bacteriostatic effect. It is also used for inflammatory bowel diseases and poorly penetrates the systemic blood flow. However, this does not prevent sulfasalazine from showing efficacy in non-cursive pathologies, including arthritis.
A powerful immunosuppressant, overwhelming T-lymphocytes is used to prevent and treat graft rejection reactions. But its effectiveness in autoimmune diseases sometimes justifies the use of psoriasis and rheumatoid arthritis, despite the side effects.
Infliximab, Adalimumab and others suppress the effect of tumor necrosis, one of the main inflammatory enzymes. However, their use is limited due to the high cost and large number of adverse events.
In the fight against this type of joint lesions, physiotherapy procedures, therapeutic gymnastics and massage have proved to be well established.
With the help of physiotherapy, you can introduce many different pharmacological drugs into the body, as well as have an anti-inflammatory effect. Exercise and massage are aimed at keeping the muscles in tone.
Nutrition is important for arthritis.
It has been proven that overweight people are more likely to suffer from joint pathologies, including psoriasis. Stick to a balanced diet, follow a diet rich in vitamins and trace elements, eat more fish and seafood, as well as plant food – this food will prevent aggravation.
Treatment at home
If the attending physician does not see any contraindications, you can use folk remedies to treat psoriatic arthritis. They are quite effective in relieving inflammation and relieving pain, but herbal medicine also has its opposites, special recommendations and side effects, so be careful. Here are a few recipes:
- Tea from cranberries leaves: 5 teaspoons of dry leaves pour 500 ml boiling water and let infuse for 10-20 minutes. Eat during the day instead of tea.
- You can rub a mixture of essential oils of lemon, cedar, juniper, black pepper, cypress and sage into the skin over the sore joint at home.
- Dandelion broth is used 3 times a day, 1 tablespoon for a month: pour 6 grams of chopped plant flowers with a glass of boiling water and insist for 30 minutes.
- Celery is great for treating pain and inflammation. You can use the stem or root of the plant itself, or you can squeeze the juice and take 1 tablespoon 3 times a day for a month or more.
Bay leaf infusion: pour half a pack of dry leaves with a glass of boiling water and keep on fire for 5 minutes. Drink before bed.
- A compress from raw potatoes is often used: one tuber is chopped on a grater along with the peel, spread on cheesecloth and this mixture is wrapped around the sore joint for the night.
Arthritis in psoriatic form requires increased attention. It is difficult to heal, but it cannot be completely cured. However, almost everyone can prevent exacerbations and slow down the progression. Knowing the above, the doctor’s recommendations will not be something unreasonable, and it will be much easier to understand the treatment strategy.