psoriatic arthritis scleritis
Introduction
Introduction to psoriatic arthritis scleritis Psoriatic arthritis (PA) is characterized by psoriasis [skin and/or nails], idiopathic arthritis [peripheral joints and/or spine] and rheumatoid factor (RF) negative triads. disease. basic knowledge The proportion of illness: 0.004%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: conjunctivitis, anterior uveitis, glaucoma, cataract
Cause
Causes of psoriatic arthritis scleritis
(1) Causes of the disease
At present, the disease is thought to be controlled by multiple genes, and it is also affected by external factors. The family history of this disease accounted for 11% to 30%, suggesting that genetic and environmental factors play an important role in psoriasis and PA and histocompatibility antigen HLA. -B13, HLA-B17, HLA-B27, HLA-BW38, HLA-BW39 and CW6 factors, HLA-B27 associated with psoriasis ankle arthritis and spondylitis, with psoriasis and psoriasis surrounding joints There is no correlation between inflammation, some cases may have immune abnormalities, serum IgA, IgE is elevated, IgM is decreased, serum may have anti-IgG antibodies, autologous antibodies can be found in the horn layer, and immunoglobulin and complement are found in the epidermis of psoriasis. The C3 fragment has anti-IgG factors in the lesion, ANA in the keratinized nucleus, infection (bacteria and virus), nervousness, female endocrine hormones, trauma, etc. may be the predisposing factors of psoriasis.
(two) pathogenesis
In addition to genetic factors, there is no definite evidence in many aspects of the pathogenesis. Due to the interference of genetic and various pathogenic factors, periodic T cell defects and damage occur, abnormal immune phenomena occur, autoantibodies in epidermal cells (anti-IgG) , anti-keratin, antinuclear) and their epidermal antigens interact to form a circulating immune complex (CIC), which causes complement binding, which leads to the production of chemokines and proteolytic enzymes that cause corneal cell membranes. Abnormal structure and function, resulting in a loss of balance between cyclic nucleotides and prostaglandins, leading to epidermal hyperplasia, many external factors can also interfere with the pathogenesis, so that the original latent defects manifested, resulting in different clinical symptoms.
Prevention
Psoriatic arthritis scleritis prevention
There is no effective prevention method for psoriatic arthritis, which focuses on early diagnosis and early treatment, so as not to delay the disease. Once psoriatic arthritis is diagnosed, aggravating factors should be reduced or avoided.
Complication
Psoriatic arthritis scleritis complications Complications, pre-conjunctivitis, uveitis, glaucoma, cataract
There may be conjunctivitis, anterior uveitis, glaucoma, cataract or macular edema.
Symptom
Psoriasis arthritis scleritis symptoms Common symptoms Scleral outer inflammation Osteopathy destruction Amyloid degeneration pustular nodule joint deformity
Eye performance
Psoriatic eye signs are mainly conjunctivitis and anterior uveitis, occasionally scleritis and scleral inflammation, anterior uveitis often accompanied by fine-grained KP, the differential diagnosis of anterior uveitis should consider whether there is PA possibility.
(1) Scleritis: It is reported that the incidence of PA in patients with scleritis is 1.44%, and the incidence of scleritis in patients with PA is 1.8%. Scleritis usually occurs several years after the active period of PA, although diffuse or nodules Sexual anterior scleritis is more common, but there are other types of scleritis. Patients with necrotizing anterior scleritis can further develop sclerosing stromal keratitis. All patients with scleritis must be examined for skin and nails.
(2) Scleral epidemic inflammation: The presence of PA in the sclera is also rare, occurring several years after the PA activity period.
2. Non-eye manifestations PA is characterized by skin and joint lesions. Skin lesions generally occur several years earlier than joint lesions, but 10% of PA patients can occur simultaneously, and occasional joint lesions occur before skin lesions appear.
Skin lesions occur first in the elbow, and later in the legs, scalp, abdomen and back, 80% of PA has nail lesions, while in psoriasis only 30%, the nails are loose, concave, convex, bleaching And the appearance of the fragment, the more serious the skin lesions, the more common the arthritis occurs, the following five types of joint lesions of PA:
1 finger and toe end asymmetrical single arthritis (5% to 10%), often accompanied by joint sausage-like changes and nail lesions;
2 chronic asymmetric single arthritis (50% to 70%), involving 2 to 3 joints at the same time;
3 Chronic symmetrical polyarthritis (15% to 25%) similar to RA, but negative for RF;
4 Spinal arthritis characterized by ankle arthritis (20% to 30%), more men than women, and closely related to HLA-B27;
5 erosive polyarthritis, the least common type, manifested as severe bone destruction, deformity and joint arthritic polyarthritic changes, due to multiple finger (toe) bone destruction, "cluster" refers to Spinal rigidity occurs, compared with RA, PA is a less serious disease, pain and dysfunction are not common, other rare lesions are amyloidosis, pulmonary fibrosis and aortic insufficiency, occasionally caused by small vasculitis Skin pustule lesions.
Examine
Examination of psoriatic arthritis scleritis
Patients with negative RF and ANA, elevated ESR, mild anemia, and severe skin lesions often have hyperuricemia and have been reported with gout.
Radiological examination: According to the type of arthritis, there are different manifestations. The end knuckles may have bone erosion, the joint cavity is widened, and the finger (toe) end is swollen. In the type of erosive polyarthritis, the tibia is common. The osteolysis of the bones, the appearance of the "cup pencil" or "fishtail" appearance deformed by the thinning of the bones, and the occurrence of ankle arthritis and spondylitis similar to ankylosing spondylitis.
Diagnosis
Diagnosis and diagnosis of psoriatic arthritis scleritis
diagnosis
When psoriasis and one or more joints are found to have swelling for more than 3 months, a diagnosis of PA can be made. The affected joints include the elbow, wrist, knee, ankle, metacarpophalangeal, proximal and distal fingers, , lumbar and cervical joints, radiological examination found that peripheral joint erosion and spinal changes help to diagnose, as with ankylosing spondylitis and Reiter syndrome, HLA-B27 positive increases the possibility of diagnosis, but can not be diagnosed.
Differential diagnosis
The disease does not need to be differentiated from other diseases.
