Psoriatic arthritis (Part 2): complications and treatment options

Complications:
Psoriatic arthritis can be exhausting, painful and may make it difficult to meet their daily activities. Although untreated, psoriatic arthritis can cause joint erosion. Physicians may find difficult to establish who will aggravate the disease and who do not. Generally, people diagnosed with psoriatic arthritis at a young age, female or those with sudden pain, are more prone to developing severe forms.

Treatment options:
There is still no cure for this disease, ofter are used drugs and rarely surgery, the doctor tries to control inflammation, thereby preventing pain and disability.

The information below are purely informative and do not replace a professional consultation. Do not administer medication how you like, but consult with your doctor!

Of the drugs commonly used to treat psoriatic arthritis include:

1. Nonsteroidale inflammatory drugs. Medicines such as aspirin and ibuprofen can help control pain, inflammation and stiffness that you can feel the morning. But these drugs can affect the stomach and intestines and prolonged use can cause ulcers and gastrointestinal bleeding. They can worsen skin problems, but may be a good choice for patients with mild arthritis pain.

2. Corticosteroids. If you have a mild form of psoriatic arthritis, your doctor may recommend corticosteroids to control pain that sometimes occurs in the joints.

3. Antirheumatic drugs that modify the disease. Not only reduces pain and inflammation, but these drugs help to limit erosion of joints. But these drugs have a slow action and results are seen in a few weeks or months. For this reason your doctor may prescribe a painkill medication (aspirin).

4. TNF-alpha inhibitors. Your doctor may recommend inhibitors TNF-alpha (tumor necrosis factor) if you have a severe form of psoriatic arthritis. These drugs block an inflammation-caused by protein in certain types of arthritis. These include adalimumab (Humira), infliximab (Remicade) and etanercept (Enbrel). TNF-alpha inhibitors help relieve the symptoms of psoriasis. But these drugs shows significant side effects.

5. Surgery. Although rarely resorting to surgery, your doctor may recommend certain interventions, when other treatments do not work.

Home care guide. Here are some tips that may help you:

1. Have a healthy weight. A proper weight will reduce pain and will increase the amount of energy and mobility.

2. Exercise performed regularly. Physical activity is important for patients with psoriatic arthritis. Exercise can alleviate many of the symptoms of the disease (pain, fatigue).

3. Use appropriate techniques. Changing the methods by which you accomplish daily activities improve your quality of life.

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Psoriatic arthritis (Part1): general information

Psoriatic arthritis occurs in patients with psoriasis, a chronic skin disease that affects approximately 3% of world population (180 million). Psoriasis affects the skin and appears as a rash. A percentage of 10 to 30% of patients with psoriasis develop psoriatic arthritis. Psoriatic arthritis commonly occurs in males and females aged between 30 and 50 years, but can also affect children.

Signs and symptoms of psoriatic arthritis often have the hands and feet similar to those found in rheumatoid arthritis, and painful inflammation of the tendon or arthritis in the spine.

Psoriatic arthritis is a combination of symptoms of psoriasis such as dry skin, skin exfoliate and redness areas, arthritis symptoms: pain and swelling in the joints. Joint pain can range from mild to strong. Common symptoms of psoriatic arthritis include varying degrees of skin damage associated with the psoriatic plaque stiffness (stiffness), pain, joint swelling. They may reduce joint mobility to severe joint damage. Untreated, psoriatic arthritis can lead to progressive disability.

Causes. Like rheumatoid arthritis, psoriatic arthritis is an autoimmune disease in which one human protein, tumor necrosis factor alpha (TNF-alpha) plays an important role in disease development. It seems as infection and trauma play an important role in triggering the disease. And favors the emergence of psoriatic arthritis. Approximately 40% of patients with psoriatic arthritis had a family event.

Risk factors. Is a greater risk to people with psoriasis to develop psoriatic arthritis. A percentage of 10 to 30% of patients with psoriasis develop psoriatic arthritis.

Other factors:
* Cases in the family. Many people with psoriatic arthritis have a close relative with the disease;
* Age. Although anyone at any age can suffer from this disease, psoriatic arthritis is more common in people aged between 30 and 50 years;
* Sex. Occurs more often in women;
* Weight. Overweight people are more susceptible.

When you go to the doctor? If you feel a constant discomfort and swollen joints, go to the doctor.

How is it diagnosed? A simple test can not diagnosed psoriatic arthritis. The doctor will take into account all symptoms and determine if they are caused by psoriatic arthritis or other diseases (osteoarthritis, rheumatoid arthritis).

Here are some tests that can help the diagnosis:

* X-rays help the doctor to observe changes in the joints that occur in psoriatic arthritis;
* Joint fluid analysis. For this test, the doctor harvest a small sample of fluid from the joints (usually the knee);
* Rheumatoid factor test. RF antibody present in the blood of patients with rheumatoid arthritis. This test helps your doctor to determine which of the two conditions is present.

Most people are first diagnosed with psoriasis and then begin to experience symptoms of psoriatic arthritis.

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Rheumatoid arthritis (Part 3): biological therapy

Rheumatoid arthritis is a serious condition that affects work capacity. Visceral lesions are responsible for shortening the average life of 5 to 10 years. Major consequence of this disease is disability. The loss of work ability is the most costly consequence of early rheumatoid arthritis.

Try to treat early rheumatoid arthritis. Despite major advances in the field of therapy, so far there is no known cure for rheumatoid arthritis, as neither prophylactic methods. Optimal treatment of disease require early diagnosis and timely use (ie early enough), to reduce the probability of irreversible joint injuries. It is very important to treat a patient early, when symptoms do not evolve more.

Progress in recent years in understanding the pathogenic mechanisms of disease led to major developments necessarily to treat rheumatoid arthritis. Recognizing the central role of cytokines in particular TNF-alpha in rheumatoid synovium of hypothesis testing led to the control of rheumatoid arthritis by blocking TNF-alpha.

Biological therapy (anti-TNF agents)

Clinical studies in recent years have demonstrated that the TNF alpha blockers cause a rapid and significant improvement of the clinical disease (pain and inflammation), creating thereby a substantial improvement of life quality of patients treated, but also a unique effect of stopping the progression of radiological (joint structural damage) characteristic of the disease.

TNF blockers are indicated in patients with rheumatoid arthritis, despite a complete and correct therapy. TNF blockers slow or even stop disease progression, if is used early (before the onset of osteoarticular lesions).

TNF blockers can be administered only under the supervision of an experienced physicians in the diagnosis and treatment of rheumatoid arthritis, including evaluation:
* Disease evolution
* Efficiency and tolerance of immunomodulatory therapies.

Before initiation by setting specific goals for each patient. Your doctor will do a complete examination, including a Rg. chest to exclude any contraindications.

Contraindications. Use of TNF blockers is contraindicated in cases of acute or chronic infections (including tuberculosis) or recent cancer. Their appearance during treatment. require discontinuation, which will be resumed only after complete cure.

For monitoring the effectiveness of therapy:
* Assessing the number of swollen and painful joints;
* Determination of acute phase reactants (ESR and CRP);
* Global assessment of disease evolution by the physician and the patient (visual analogue scale or a scale with five degrees);
* Assessment of joint pain (visual analogue scale 100 mm);
* A functional assessment (such as Haq).

Based on understanding the molecular mechanism of disease, anti-TNF therapy opens a new era in the treatment of rheumatoid arthritis.

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