2/2/2020 OneNote

Artrita psoriatica
16 September 2019 20:54

Epidemiologie Clinica
• M:F= 1:1
• Incidenta 6/ 100.000/ an
• Prevalenta 1-2/1000 Oligoartrita asimetrica • IFP +
• 30-50 ani • + teno
• Psoriazis • Dege
○ 2% • MCF,
○ Fara predilectie: sex • Entez
○ Predisp genetica • Asime
○ 7-42% dezvolta artrita
Poliartrita psoriazica • Cea m
• Cutanat precede articular (maj cazurilor)
• Ca PR
• Ddx
Etiologie
•
Factor genetici
• 1/2 au istoric familial
•
• X55 la rude gradul I
• Cea mai inalta valoare predictiva: HLA-B27 (frecventa diferita fata de SA), HLA-B7
•
• Alte HLA
○ B13, B17, B57, CW*0602 Artrita IFD • Asoci
○ DR4: numai pt APS poliarticular, corelat cu progresie rx nefavorabil • In tim
• PSORS1 (HLA-CW*0602) • Intere
○ Susceptibilitate maxima pt psoriazis cutanat sever Artrita mutilanta • Rara l
○ Noua alela risc independent in APS: TNF*-857T (gena care accelereaza transcripitia TNF) • Osteo
• Sugerat: rol gene codifica Ig • + pso

Factori imunologici Spondiloartropatia • SI + co

• Initiere proces inflam placa psoriazica si sinoviu (neddx de PR) • SI= in
• Ig crescut •
• IL-1beta (11, 12), IL-6, factori plachetari crescut (secretate de fibroblasti) •
• Citokine pro-inflam in lichid sinovial - similar cu PR • Afect
○ Dar prod crescuta de • Evolu
• TNF- alpha
• IL-1beta, IL-2, IL-10
• IFN gamma • Manifestari extraarticulare
○ Diminuata: IL-4, IL-5
• Etapa 1 declansatoare: Ag mediu cutanat ---> fagocitate de celule Langerhans Cutanat • Placard eritem
• Ag descompuse, epitopii izolati, prezentati LT e • Margini
• Epitopi ID de LT • Scuame
• Lichid sinovial: LT majoritar CD8+ • Tegume
• Sinoviale: LT CD4+ • Localizare exte
presacrat, fesi
Factori de mediu Unghii • Poate fi singul
• Streptococ B-hemolitic tip A • Mici depresiun
○ Proteina M (in serotip 6)- mimetism cu keratina cutanata • Striuri
○ Stimulare directa LT cross-reactive ---> prin legare de TCR( situl V-beta2) • Neregularitati
○ Expansiune oligoclonala a LT TCR V-beta 2 +ve • Onicoliza
• HIV • 90% din pt cu A
○ Frecventa psoriazis = la fel • Asociere + afe
○ Mai frecvente: forme artritogenice, leziuni cutanate severe
Oculara • Una din cele m
• Exogeni
• Conjunctivita
○ Lezionali: fenomen Koebner profund
• Irita (M>F): aso
○ Inflamatori ---> eliberare mastocitara de activatori kinazici ai precursori IL-1 (din keratinocite si
• Episclerita: rar
fibroblasti tegumentari)
• Keratoconj sic
Cardiaca • Rara
• Aortita, IA (tar
Rare • Fibroza lobi su
• Nefropatie IgA
• Amiloidoza re
• Miopatia
• Policondrita re

Paraclinic

Modificari laborator
• VSH accelerat 40-60%
○ mai frecv poliarticular
○ asociat sev cutanta
• Gamma-globuline, IgA cresc
• CI crescute
• Absenta FR, ANA
• Cresteri acid uric la 10-20% (e
• Lichid sinovial- celularitate b
• Nivel seric amiloid seric A= c

Explorari imag

Rx • IFD

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2/2/2020 OneNote
• Asimetrica
• Absenta osteopo
• Eroziuni osoase m
• Resorbtie falang
• Aspect telescopa
• Tendinta anchilo
• Etalare 'in cupa a
• Osteoliza- predil
• Si art: sternoclav
• Reactia periostal
• Aspect cara
• Uneori: ost
• Scor Sharp- Van d
• Eroziuni
• Ingustare
• Subluxatii
• Anchiloza
• Osteoliza
• Toc in calim
• + IFD
• Afectare axiala -
• SI- poate fi
• Sponidilita
○ Sinde
○ Sinde
○ Sinde
○ Osifi
○ Afect
○ Tend
Scintigrafie • In dx precoce, ca
osoasa • Impact redus fata
CT • SI incipient - sen
• Decelate precoce
• osteolititic
• Afectare m
Eco • Hipervasc (semn
• Modificari sinovi
• Dactilita, tenosin
• Entezita Ahile (a
RMN • Mod structurale
• Vizualizare mai p
• Edem osos

• Cuantificare cutanta: PASI

○ Eritem, infiltratie (???i
○ Gradare 0-4 (absent, f p
○ Valoare PASI 0-72
○ >10 = extindere leziuni

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