WHAT SHOULD BE KNOWN ABOUT PSORIATIC ARTHRITIS?

Psorijatični artritis (PsA) je kronična upalna artropatija koja može zahvatiti periferne zglobove i aksijalni skelet. Registrira se u 7 % do 42 % pacijenata s kožnom psorijazom. Promjene na zglobovima mogu godinama prethoditi pojavi kožnih promjena. Bolest se manifestira bolom i zakočenošću u zahvaćenim zglobovima. Važnu ulogu ima genetska predispozicija (prisutnost B27 udružena je s aksijalnim oblikom bolesti, a DR4 sa simetričnim poliartikularnim oblikom koji podsjeća na reumatoidni artritis). Entenzitisi su upalne promjene na hvatištu tetiva i ligamenata za kost. Navedene su promjene svojstvene spondiloartritisima, tj. skupini upalnih reumatskih bolesti kojima pripada i PsA. Za PsA, kao i za ostale spondiloartritise, tipična je pojava određenih ekstraartikulanih zglobnih manifestacija, kao npr. očne promjene (konjunktivitis i uveitis se viđaju u 1/3 bolesnika s PsA), srčane smetnje, upalne bolesti crijeva, te upale genitourinarnog sustava. U liječenju zglobnih promjena koriste se NSAR (nesteroidni antireumatici), DMARD (Disease-Modifying Antirheumatic Drugs), tj. lijekovi koji modiiciraju bolest kao što su metotreksat (MTX), lelunomid i sulfasalazin. U novije vrijeme sve se više koriste i biološki agensi. Fizikalna terapija je, u pravilu, nadopuna medikamentnoj terapiji. U težim oblicima PsA nameće se potreba i rekonstruktivnih kirurških zahvata. U liječenju PsA preporuča se istodobno liječenje kožnih i zglobnih promjena. Da bi se postiglo optimalne rezultate potrebno je naglasiti kolika je važnost zajedničkog pristupa reumatologa i dermatologa u liječenju bolesnika s PsA.Psoriatic arthritis (PsA) is chronic inlammatory arthropathy of peripheral joints and axial sceleton, occurring in 7% to 42% of patients with psoriasis. Arthritis might precede skin psoriatic lesion lesion in 13% to 17% cases. Patients present with pain and stiffness of the affected joins. A genetic factors play an important role (B27 has been associated with axial form, and DR4 with peripheral polyarticular form of PsA). Enthesopathy is a hallmark feature of PsA. It is an inlammation at the sites where tendons and ligaments attach to the bone. Extra-articular manifestations of disease are conjuctivitis and uveitis (occur in up to 1/3 of patients with PsA), heart disorder (aortic insuficiency), gut inlammation, urogenital inlammation.Treatment of PsA includes therapies for boths the skin and the joint disease. The treatment for the joint disease includes using NSAR (nonsteroidal anti-inlammatory drugs), DMARDs (Disease-Modifying Antirheumatic Drugs) such as methotrexat (MTX), lelunomid, sulfasalasin and biological agents. Second-line therapy are: systemic glucocorticoids, retinoic acid derivatives/etretinate, photochemoterapy with MTX, physical therapy as an adjunct to drug therapy, and reconstructive surgery. The most important is that rheumatologist and dermatologist need to have some approach in management of PsA for optimal results

WHAT SHOULD BE KNOWN ABOUT PSORIATIC ARTHRITIS?

Psorijatični artritis (PsA) je kronična upalna artropatija koja može zahvatiti periferne zglobove i aksijalni skelet. Registrira se u 7 % do 42 % pacijenata s kožnom psorijazom. Promjene na zglobovima mogu godinama prethoditi pojavi kožnih promjena. Bolest se manifestira bolom i zakočenošću u zahvaćenim zglobovima. Važnu ulogu ima genetska predispozicija (prisutnost B27 udružena je s aksijalnim oblikom bolesti, a DR4 sa simetričnim poliartikularnim oblikom koji podsjeća na reumatoidni artritis). Entenzitisi su upalne promjene na hvatištu tetiva i ligamenata za kost. Navedene su promjene svojstvene spondiloartritisima, tj. skupini upalnih reumatskih bolesti kojima pripada i PsA. Za PsA, kao i za ostale spondiloartritise, tipična je pojava određenih ekstraartikulanih zglobnih manifestacija, kao npr. očne promjene (konjunktivitis i uveitis se viđaju u 1/3 bolesnika s PsA), srčane smetnje, upalne bolesti crijeva, te upale genitourinarnog sustava. U liječenju zglobnih promjena koriste se NSAR (nesteroidni antireumatici), DMARD (Disease-Modifying Antirheumatic Drugs), tj. lijekovi koji modiiciraju bolest kao što su metotreksat (MTX), lelunomid i sulfasalazin. U novije vrijeme sve se više koriste i biološki agensi. Fizikalna terapija je, u pravilu, nadopuna medikamentnoj terapiji. U težim oblicima PsA nameće se potreba i rekonstruktivnih kirurških zahvata. U liječenju PsA preporuča se istodobno liječenje kožnih i zglobnih promjena. Da bi se postiglo optimalne rezultate potrebno je naglasiti kolika je važnost zajedničkog pristupa reumatologa i dermatologa u liječenju bolesnika s PsA.Psoriatic arthritis (PsA) is chronic inlammatory arthropathy of peripheral joints and axial sceleton, occurring in 7% to 42% of patients with psoriasis. Arthritis might precede skin psoriatic lesion lesion in 13% to 17% cases. Patients present with pain and stiffness of the affected joins. A genetic factors play an important role (B27 has been associated with axial form, and DR4 with peripheral polyarticular form of PsA). Enthesopathy is a hallmark feature of PsA. It is an inlammation at the sites where tendons and ligaments attach to the bone. Extra-articular manifestations of disease are conjuctivitis and uveitis (occur in up to 1/3 of patients with PsA), heart disorder (aortic insuficiency), gut inlammation, urogenital inlammation.Treatment of PsA includes therapies for boths the skin and the joint disease. The treatment for the joint disease includes using NSAR (nonsteroidal anti-inlammatory drugs), DMARDs (Disease-Modifying Antirheumatic Drugs) such as methotrexat (MTX), lelunomid, sulfasalasin and biological agents. Second-line therapy are: systemic glucocorticoids, retinoic acid derivatives/etretinate, photochemoterapy with MTX, physical therapy as an adjunct to drug therapy, and reconstructive surgery. The most important is that rheumatologist and dermatologist need to have some approach in management of PsA for optimal results

ASSOCIATION OF PSORIASIS WITH OTHER DISEASES

Psorijaza je kronična recidivirajuća autoimunosna bolest s multigenetskom predispozicijom koja se pojavljuje u Hrvatskoj u oko 2 % bolesnika, a u svijetu je različite pojavnosti. Psorijaza može biti udružena s različitim bolestima: od autoimunskih (pemfi gus, pemfi goid, vitiligo), a nešto rjeđe i s alergijskim bolestima (atopijski dermatitis, astma, urtikarija, kontaktni alergijski dermatitis). Prema kliničkoj slici psorijaza se pojavljuje kao plak psorijaza i pustulozna psorijaza. Provokativni čimbenici koji potiču psorijazu su infekcije, endogeni faktori, hipokalcemija, psihogeni faktori i lijekovi. Psorijazu mogu pogoršati i druge dermatoze poput kontaktnog alergijskog dermatitisa, upalnih dermatoza i karcinoma kože, a poznata je udruženost psorijaze s unutarnjim bolestima (HIV, Crohnova bolest, lezije jetre, vaskularne bolesti, amiloidoza i giht). Danas se psorijaza smatra upalnom mnogosustavnom bolešću koja može zahvatiti i zglobove. Atipične lokalizacije psorijaze kao i rezistentni slučajevi psorijaze i druge papuloskvamozne i egzematoidne dermatoze zahtijevaju detaljnu obradu i potvrđivanje dijagnoze zbog mogućnosti postojanja više bolesti. U radu se iznosi udruženost psorijaze s reumatskim i s drugim internističkim bolestima.Psoriasis is a chronic relapsing autoimmune disease with a multigenetic predisposition, which occurs in about 2% of patients in Croatia and shows variable occurrence in the world. Psoriasis can be associated with various diseases, including autoimmune diseases (pemphigus, pemphigoid, vitiligo), and slightly less with allergic diseases (atopic dermatitis, asthma, urticaria, allergic contact dermatitis). According to clinical manifestations, psoriasis appears as plaque psoriasis, erythrodermic form and pustular psoriasis. Provocative factors that encourage psoriasis are infections, endogenous factors, hypocalcemia, psychogenic factors and medications. Psoriasis may worsen other dermatoses such as contact dermatitis, infl ammatory dermatoses and skin cancer, and the association of psoriasis with internal diseases is quite common (HIV, Crohn’s disease, liver lesions, vascular diseases, amyloidosis and gout). Today, psoriasis is considered as a systemic infl ammatory disease that can also affect the joints. Atypical localization of psoriasis, as well as resistant cases of psoriasis and other papulosquamous and eczematoid dermatoses require detailed work-up and confi rming of diagnosis because of the possibility of the existence of other diseases. This paper discusses the association of psoriasis with rheumatic and other internal diseases

WHAT SHOULD BE KNOWN ABOUT PSORIATIC ARTHRITIS?

Psorijatični artritis (PsA) je kronična upalna artropatija koja može zahvatiti periferne zglobove i aksijalni skelet. Registrira se u 7 % do 42 % pacijenata s kožnom psorijazom. Promjene na zglobovima mogu godinama prethoditi pojavi kožnih promjena. Bolest se manifestira bolom i zakočenošću u zahvaćenim zglobovima. Važnu ulogu ima genetska predispozicija (prisutnost B27 udružena je s aksijalnim oblikom bolesti, a DR4 sa simetričnim poliartikularnim oblikom koji podsjeća na reumatoidni artritis). Entenzitisi su upalne promjene na hvatištu tetiva i ligamenata za kost. Navedene su promjene svojstvene spondiloartritisima, tj. skupini upalnih reumatskih bolesti kojima pripada i PsA. Za PsA, kao i za ostale spondiloartritise, tipična je pojava određenih ekstraartikulanih zglobnih manifestacija, kao npr. očne promjene (konjunktivitis i uveitis se viđaju u 1/3 bolesnika s PsA), srčane smetnje, upalne bolesti crijeva, te upale genitourinarnog sustava. U liječenju zglobnih promjena koriste se NSAR (nesteroidni antireumatici), DMARD (Disease-Modifying Antirheumatic Drugs), tj. lijekovi koji modiiciraju bolest kao što su metotreksat (MTX), lelunomid i sulfasalazin. U novije vrijeme sve se više koriste i biološki agensi. Fizikalna terapija je, u pravilu, nadopuna medikamentnoj terapiji. U težim oblicima PsA nameće se potreba i rekonstruktivnih kirurških zahvata. U liječenju PsA preporuča se istodobno liječenje kožnih i zglobnih promjena. Da bi se postiglo optimalne rezultate potrebno je naglasiti kolika je važnost zajedničkog pristupa reumatologa i dermatologa u liječenju bolesnika s PsA.Psoriatic arthritis (PsA) is chronic inlammatory arthropathy of peripheral joints and axial sceleton, occurring in 7% to 42% of patients with psoriasis. Arthritis might precede skin psoriatic lesion lesion in 13% to 17% cases. Patients present with pain and stiffness of the affected joins. A genetic factors play an important role (B27 has been associated with axial form, and DR4 with peripheral polyarticular form of PsA). Enthesopathy is a hallmark feature of PsA. It is an inlammation at the sites where tendons and ligaments attach to the bone. Extra-articular manifestations of disease are conjuctivitis and uveitis (occur in up to 1/3 of patients with PsA), heart disorder (aortic insuficiency), gut inlammation, urogenital inlammation.Treatment of PsA includes therapies for boths the skin and the joint disease. The treatment for the joint disease includes using NSAR (nonsteroidal anti-inlammatory drugs), DMARDs (Disease-Modifying Antirheumatic Drugs) such as methotrexat (MTX), lelunomid, sulfasalasin and biological agents. Second-line therapy are: systemic glucocorticoids, retinoic acid derivatives/etretinate, photochemoterapy with MTX, physical therapy as an adjunct to drug therapy, and reconstructive surgery. The most important is that rheumatologist and dermatologist need to have some approach in management of PsA for optimal results

Photocarcinogenesis – Molecular Mechanisms

The carcinogenicity (photocarcinogenicity) of sunlight to human skin has been recognized more than a century ago. Last decades numerous experimental studies show that UV rays damage DNA, cause gene mutations leading to the development of malignant tumors such basal cell carcinomas, squamous cell carcinomas and melanomas. The tumors occur most frequently in fair skinned people, and the mutations typically are found at dipyrimidine sites with C-T or / and CC-TT tandem double mutations. The authors briefly summarize their investigation of the p53 suppressor gene, and expose their hypothesis of hTERT involvement in cancerogenesis. Also their underline the importance of UV induced immunosuppression in photocarcinogenesis. Psoriatic patients are exposed to numerous cancerogens in their treatment. A better understanding of the mechanisms of photocarcinogenesis could provide new ways in the treatment of skin tumors