| Abstract: |
Psoriasis is a chronic inflammatory skin disorder that affects approximately 2% of world’s population. Psoriasis is an ancient and universal inflammatory disease, initially described at the beginning of medicine. While the cause of psoriasis remains unknown, it appears to result from a combination of genetic and environmental factors. It is frequently inherited and passed from one generation to the next following a classical autosomal mendelian profile. Psoriasis can begin at any age, although epidemiological studies demonstrate that it most commonly appears for the first time between the ages of 15 and 25 years. It is a life long inflammatory disease with spontaneous remissions and exacerbations. It commonly occurs in males and females equally. Many factors may trigger an episode of psoriasis including bacterial pharyngitis, stress, HIV-1, and various medications. Skin injury may result in psoriasis outbreaks 5 or 6 weeks later at the injury site. Within the epidermis, the cells move up on a continual basis and are constantly begin to cast off. In a normal individual this process takes between 3 and 4 weeks but for individual suffering from psoriasis this process take 2-3 days resulting in buildup of scale on the surface of skin. Psoriasis may occur on the body any where, but it commonly affects the nails and scalp. Psoriatic arthritis (PSA), recognized for over 100 years as an inflammatory arthritis that is associated with psoriasis. It is considered the second most frequent diagnostic category of arthritis after RA. Arthritis appears in 7-40% of patients with psoriasis. Psoriatic arthritis is more common in white persons affects males and females equally with male predominance occurs in spondylitic form and female predominance occurs in the rheumatoid form. It usually affects persons aged 35-55 years, but it can occur in almost any age. Treatment includes physical therapy, patient education as well as medication. Mild PSA generally treated with NSAIDs. When only few joints are involved, local injections of steroids might be effective for extensive or severe PSA systemic therapies such as methotrexate and sulfasalazine are standard therapies. Recently drugs such as leflunomide and TNF- α antagonists have been added to the therapeutic options. In order to assess the impact of skin and/or joint disease on the patient’s family, and society and to evaluate the effects of therapy. It is important to be able to assess the different domains of PSA. Such domains include arthritis enthesitis, dactylitis, skin psoriasis, function, quality of life, fatigue, response to therapy. The assessment measures include the ACR joint count, DAS HAQ, psoriatic arthritis response criteria (PSARC). Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Psoriatic Area and Severity Index (PASI), Physician Static Globol Assessment (PSGA), Short form –36 (Sf-36), Psoriatic arthritis quality of life (PSAQOL). Conclusion: PSA is a chronic systemic inflammatory disease involving peripheral joints, spine and enthesis and seems to occur in patients of psoriasis. It is now recognized as distinct disease entity separated from other chronic arthropathies. The cause of PSA is unknown but genetic, environmental and immunologic factors play very important roles in its pathogenesis. PSA affects young adults and may be progressive, destructive, causing deformities and impaired functional status and quality of life. Accurate and reliable assessment of PSA as a distinct disease entity is very important step to assess the progression of the disease, its effect on functional status, and quality of life of the patient as well as the effect of therapy especially biologic response modifiers.
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