Psoriatic arthritis
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Psoriatic arthritis (PsA) is a chronic, inflammatory autoimmune disease belonging to the group of seronegative spondyloarthropathies. The condition develops in a portion of patients with skin psoriasis and involves both peripheral joints and axial structures as well as tendon insertions (entheses). It is characterized by a heterogeneous clinical course – from mild forms to aggressive forms leading to joint destruction and disability. Chronic inflammation associated with the activation of the immune system and the interaction of genetic and environmental factors plays a key role in the pathogenesis.
Psoriatic arthritis – causes
The etiopathogenesis of PsA is complex and multifactorial. Contemporary research points to a significant role of the interaction between genetic predispositions and an abnormal immune response.
The most important factors include:
- Genetic predispositions - HLA antigens (HLA-B27, HLA-Cw6) are of particular importance, as they modulate the immune response.
- Activation of the immune system - excessive activity of the IL-23/IL-17 axis and TNF-α leads to the maintenance of chronic inflammation.
- Enthesitis (enthesopathy) - considered a key process initiating joint changes.
- Environmental factors:
- micro-traumas and mechanical overloads,
- infections (especially streptococcal),
- chronic stress,
- obesity and insulin resistance.
It is worth noting that in some patients, joint symptoms may precede skin lesions, which makes early diagnosis of the disease difficult.
Psoriatic arthritis – is it dangerous
Psoriatic arthritis is one of the diseases with a potentially severe clinical course. Chronic inflammation leads to progressive damage to cartilage and bone tissue, resulting in irreversible deformations.
The most important consequences include:
- Joint destruction - bone erosions, deformations, ankylosis (joint stiffness),
- Progressive disability - limitation of mobility and ability to work,
- Axial involvement - changes within the spine and sacroiliac joints,
- Systemic complications:
- cardiovascular diseases,
- metabolic syndrome,
- type 2 diabetes.
Long-term inflammation also affects the quality of life, leading to chronic fatigue, sleep disorders, and an increased risk of depression. Early implementation of treatment significantly limits disease progression.
Psoriatic arthritis – symptoms
The clinical presentation of PsA is varied and depends on the disease phenotype. Symptoms may be localized or generalized.
The most common manifestations include:
- Joint pain and swelling - often asymmetric, mainly affecting the joints of the hands and feet,
- Morning stiffness - lasting more than 30 minutes, indicating active inflammation,
- Dactylitis (“sausage digit”) - diffuse inflammation of the entire digit,
- Enthesopathies - pain at the sites of tendon attachments (e.g., Achilles tendon),
- Skin and nail changes:
- plaque psoriasis,
- nail pitting,
- onycholysis.
Depending on the clinical phenotype, several forms of PsA are distinguished:
| Disease form | Characteristics |
|---|---|
| asymmetric oligoarthropathy | involvement of a few joints |
| symmetric polyarthropathy | resembles rheumatoid arthritis |
| axial form | involvement of the spine and sacroiliac joints |
| distal form | changes in the distal interphalangeal joints |
| destructive form (arthritis mutilans) | severe deformations and bone resorption |
Skin symptoms often precede joint changes, however, in some patients they appear simultaneously or only after their occurrence.
Psoriatic arthritis – treatment
Treatment of PsA requires a multidirectional approach and individualization of therapy. The goal is to inhibit inflammation, prevent joint damage, and improve motor function.
PharmacotherapyBasic drug groups include:
- NSAIDs - reduction of pain and inflammation,
- Disease-modifying antirheumatic drugs (DMARDs):
- methotrexate,
- leflunomide,
- sulfasalazine,
- Biological treatment:
- TNF-α inhibitors,
- IL-17 inhibitors,
- IL-23 inhibitors.
Biological therapies are currently the standard in moderate to severe forms of the disease.
Physiotherapy and supportive treatmentRehabilitation plays an important role in maintaining fitness:
- range-of-motion exercises,
- muscle strengthening,
- manual therapy,
- movement education.
Additionally, it is recommended to:
- normalize body weight,
- follow an anti-inflammatory diet,
- control comorbidities.
In supportive therapy, methods utilizing physical energy and tissue regeneration processes are of increasing importance.
- INDIBA (monopolar radiofrequency at a frequency of 448 kHz)
This technology works by stimulating cellular metabolism, improving microcirculation, and increasing collagen production. In the context of PsA, it can support:
- reduction of pain and tissue tension,
- reduction of inflammation within periarticular structures,
- acceleration of soft tissue regeneration.
- Platelet-rich plasma (PRP) - provides growth factors supporting regeneration,
- Physical treatments (laser therapy, ultrasound) - anti-inflammatory and analgesic effects,
- Regenerative therapies - improvement of tissue quality and joint function.
Although these procedures do not replace systemic treatment, they constitute a valuable supplement to therapy, especially in alleviating pain and improving motor function.
