Arthropathic psoriasis is considered one of the most severe forms of this disease, as it often develops in young people of working age, is difficult to treat, greatly impairs the quality of life of patients and in many cases leads to disability. Manifestations of arthropathic psoriasis cause many doctors difficulties in diagnosis due to the specificity of the articular syndrome. However, timely treatment can significantly slow the progression of the disease and prevent joint destruction.
Here is a clinical observation
Patient P., 65 years old, was admitted to the clinic with complaints of rashes on the skin of the face, trunk, extremities, itching, peeling, dry skin at the sites of rashes, pain in the joints of the hands, feet, ankles and in the heel region during movement , morning stiffness in the joints lasting up to 7–10 min.
History of the disease: considers himself ill for about 30 years, pain in the joints has been bothering him for about 10 years. The disease worsens 2-3 times a year in the autumn-winter period. The last aggravation – since mid-September 2014, notes the appearance of rashes on the skin of the face, trunk, limbs. Independently used lipocream "Lokoid", cream "Betamethasone", without a pronounced effect. From the anamnesis of life it is known that the patient's father suffered from psoriasis.
Local status: dermatosis is symmetrical, widespread. On the skin of the face in the area of the cheeks, chin – multiple papular elements of red color with moderate infiltration and small-lamellar peeling. On the skin of the abdomen, chest, extensor surfaces of the shoulders, thighs, there are also multiple red papules with moderate infiltration and fine-lamellar peeling. On the skin of the extensor surfaces in the region of the middle and lower third of the forearms, the skin of the wrists, the back of the hands – infiltrated plaques of bright red color, merging into large foci with clear irregular boundaries up to 5–7 cm in diameter with pronounced large-lamellar peeling. The psoriatic triad is positive. There is a "sausage-like" configuration and moderate swelling of the third fingers.
During X-ray examination: signs of bilateral pronounced sacroiliitis with partial ankylosing are determined; ankle joints in lateral projection – signs of Achilles bursitis and plantar bursitis are determined on both sides with the formation of “calcaneal spurs“ along the plantar surfaces of the calcaneal bones, resorption of the necks of the talus bones, marginal resorption of the heads of the fifth metatarsal bones; stop in direct projection – marginal deformity of metatarsal heads, especially V on the right, signs of arthrosis in the metatarsophalangeal joints with subluxation of the fingers, exostoses at the base of the distal phalanges of the 1st finger, subluxation of the 2nd finger on the left in the metatarsophalangeal joints; brushes in direct projection – early signs of arthrosis in the interphalangeal and metacarpophalangeal joints are determined,
Diagnosis: "Psoriasis widespread, progressive stage, winter form. Psoriatic polyarthritis. Activity II. NPS І–II stage. Psoriatic onychodystrophy".
Treatment. In the complex treatment, the patient received methotrexate in conventional doses. At the moment, after receiving all the results of the examination and taking into account the progression of the articular process, the treatment was revised taking into account a differentiated approach, the patient was prescribed leflunomide, starting with a loading dose of 100 mg 1 time per day, for 3 days with a transition to a maintenance dose of 20 mg 1 time per day.
The patient also received the following therapy: desensitizing, short-course NSAIDs, vitamin therapy, hepatoprotectors, potassium and magnesium preparations; externally: keratolytic, keratoplastic agents. By the end of the 2nd week of treatment, the patient noted an improvement, decreased pain in the joints and almost disappeared morning stiffness in the joints. The patient needs further dynamic monitoring and long-term administration of leflunomide at a maintenance dose under the control of a biochemical blood test every 2 weeks.
This clinical observation indicates the importance and necessity of a differentiated approach to the treatment of AP in order to prevent the progression of the disease, maintain the working capacity and quality of life of such patients.
According to kiai.com.ua