The Korean Journal of Medicine

  • 제85권3호
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  • Pages.250-255
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  • 2013
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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건선 관절염의 임상상과 진단

Clinical Manifestations and Diagnosis of Psoriatic Arthritis

  • 이상원 (연세대학교 의과대학 내과학교실 류마티스내과)
  • Lee, Sang-Won (Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine)
  • 발행 : 2013.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Psoriatic arthritis (PsA) is an autoimmune arthritis related to psoriasis and one of seronegative spondyloarthropathies. PsA provokes joint pain and morning stiffness more than 30 minutes, which is relieved by exercise. PsA usually affects distal small joints and exhibits asymmetry, which is one of the typical characteristics of PsA and gives clues to make a differential diagnosis between PsA and rheumatoid arthritis. Thirty to forty patients with PsA experience arthritis in one large joint or asymmetric multiple joints. Arthritis in distal joints and arthritis mutilans often develop concurrently and patterns of PsA change along with disease progression. Spondylitis is observed in 20-30% of PsA patients. In contrast to ankylosing spondylitis, spondylitis in PsA present with mild clinical symptoms despite radiological progression, inflammation limited to one spinal tract, cervical spine dominance, non-marginal syndesmophytosis. Enthesitis is also one of the typical characteristics of PsA and it frequently affects Achilles tendon, plantar fascia and tendons inserting pelvic bones. Tenosynovitis can develop accompanied by enthesitis. Typical dactylitis (sausage digit), pitting edema and nail lesions, including nail pits, onycholysis, hyperkeratosis and splinter hemorrhage, also contribute to a differential diagnosis of PsA. Anterior uveitis, SAPHO syndrome, amyloidosis and IgA nephropathy are well-known extra-articular manifestation of PsA. In 2006, a new classification-criterion for PsA was suggested by the CASPAR study. The CASPAR criteria included 5 categories with a certain number of points; 1) skin psoriasis, 2) nail lesions, 3) dactylitis, 4) negative RF and 5) bone formation around joints. The CASPAR criteria should be applied to PsA patients having at least one of three (peripheral arthritis, spondylitis and enthesitis).

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참고문헌

  1. Gladman DD. Current concepts in psoriatic arthritis. Curr Opin Rheumatol 2002;14:361-366. https://doi.org/10.1097/00002281-200207000-00005
  2. Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol 2000;27:1247- 1250.
  3. Madland TM, Apalset EM, Johannessen AE, Rossebö B, Brun JG. Prevalence, disease manifestations, and treatment of psoriatic arthritis in Western Norway. J Rheumatol 2005; 32:1918-1922.
  4. Tam LS, Leung YY, Li EK. Psoriatic arthritis in Asia. Rheumatology (Oxford) 2009;48:1473-1477. https://doi.org/10.1093/rheumatology/kep230
  5. Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK. Psoriatic arthritis (PSA): an analysis of 220 patients. Q J Med 1987;62:127-141.
  6. Turkiewicz AM, Moreland LW. Psoriatic arthritis: current concepts on pathogenesis-oriented therapeutic options. Arthritis Rheum 2007;56:1051-1066. https://doi.org/10.1002/art.22489
  7. Oriente P, Biondi-Oriente C, Scarpa R. Psoriatic arthritis. Clinical manifestations. Baillieres Clin Rheumatol 1994;8: 277-294. https://doi.org/10.1016/S0950-3579(94)80019-7
  8. Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973;3:55-78. https://doi.org/10.1016/0049-0172(73)90035-8
  9. Helliwell PS, Porter G, Taylor WJ; CASPAR Study Group. Polyarticular psoriatic arthritis is more like oligoarticular psoriatic arthritis, than rheumatoid arthritis. Ann Rheum Dis 2007;66:113-117.
  10. Cantini F, Niccoli L, Nannini C, Kaloudi O, Bertoni M, Cassara E. Psoriatic arthritis: a systematic review. Int J Rheum Dis 2010;13:300-317. https://doi.org/10.1111/j.1756-185X.2010.01540.x
  11. Helliwell PS. Established psoriatic arthritis: clinical aspects. J Rheumatol Suppl 2009;83:21-23. https://doi.org/10.3899/jrheum.090215
  12. Torre Alonso JC, Rodriguez Perez A, Arribas Castrillo JM, Ballina Garcia J, Riestra Noriega JL, Lopez Larrea C. Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. Br J Rheumatol 1991;30:245-250. https://doi.org/10.1093/rheumatology/30.4.245
  13. Hanly JG, Russell ML, Gladman DD. Psoriatic spondyloarthropathy: a long term prospective study. Ann Rheum Dis 1988;47:386-393. https://doi.org/10.1136/ard.47.5.386
  14. De Simone C, Guerriero C, Giampetruzzi AR, Costantini M, Di Gregorio F, Amerio P. Achilles tendinitis in psoriasis: clinical and sonographic findings. J Am Acad Dermatol 2003;49:217-222. https://doi.org/10.1067/S0190-9622(03)00904-6
  15. Mander M, Simpson JM, McLellan A, Walker D, Goodacre JA, Dick WC. Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. Ann Rheum Dis 1987;46:197-202. https://doi.org/10.1136/ard.46.3.197
  16. Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, et al. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003;62:127-132. https://doi.org/10.1136/ard.62.2.127
  17. Braun J, Brandt J, Listing J, et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 2002;359:1187-1193. https://doi.org/10.1016/S0140-6736(02)08215-6
  18. Healy PJ, Helliwell PS. Measuring clinical enthesitis in psoriatic arthritis: assessment of existing measures and development of an instrument specific to psoriatic arthritis. Arthritis Rheum 2008;59:686-691. https://doi.org/10.1002/art.23568
  19. Olivieri I, Salvarani C, Cantini F, et al. Fast spin echo-T2- weighted sequences with fat saturation in dactylitis of spondylarthritis: no evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum 2002;46: 2964-2967. https://doi.org/10.1002/art.10633
  20. Brockbank JE, Stein M, Schentag CT, Gladman DD. Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis 2005;64:188-190. https://doi.org/10.1136/ard.2003.018184
  21. Ritchlin CT, Kavanaugh A, Gladman DD, et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis 2009;68:1387-1394. https://doi.org/10.1136/ard.2008.094946
  22. Cassell SE, Bieber JD, Rich P, et al. The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis. J Rheumatol 2007;34:123-129.
  23. Williamson L, Dalbeth N, Dockerty JL, Gee BC, Weatherall R, Wordsworth BP. Extended report: nail disease in psoriatic arthritis: clinically important, potentially treatable and often overlooked. Rheumatology (Oxford) 2004;43:790-794. https://doi.org/10.1093/rheumatology/keh198
  24. Olivieri I, Brandi G, Padula A, et al. Lack of association with spondyloarthritis and HLA-B27 in Italian patients with Whipple's disease. J Rheumatol 2001;28:1294-1297.
  25. Salvarani C, Cantini F, Olivieri I, et al. Distal extremity swelling with pitting edema in psoriatic arthritis: evidence of 2 pathological mechanisms. J Rheumatol 1999;26: 1831-1834.
  26. Queiro-Silva R, Torre-Alonso JC, Tinturé-Eguren T, López- Lagunas I. The effect of HLA-DR antigens on the susceptibility to, and clinical expression of psoriatic arthritis. Scand J Rheumatol 2004;33:318-322. https://doi.org/10.1080/03009740410005953
  27. Dumolard A, Gaudin P, Juvin R, Bost M, Peoc'h M, Phelip X. SAPHO syndrome or psoriatic arthritis? a familial case study. Rheumatology (Oxford) 1999;38:463-467. https://doi.org/10.1093/rheumatology/38.5.463
  28. Wong K, Gladman DD, Husted J, Long JA, Farewell VT. Mortality studies in psoriatic arthritis: results from a single outpatient clinic: I. causes and risk of death. Arthritis Rheum 1997;40:1868-1872. https://doi.org/10.1002/art.1780401021
  29. Wright V, Moll JM. Psoriatic arthritis. Bull Rheum Dis 1971;21:627-632.
  30. Haddad A, Chandran V. Arthritis mutilans. Curr Rheumatol Rep 2013;15:321. https://doi.org/10.1007/s11926-013-0321-7
  31. Jones SM, Armas JB, Cohen MG, Lovell CR, Evison G, McHugh NJ. Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol 1994;33:834-839. https://doi.org/10.1093/rheumatology/33.9.834
  32. McHugh NJ, Balachrishnan C, Jones SM. Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology (Oxford) 2003;42:778-783. https://doi.org/10.1093/rheumatology/keg217
  33. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54:2665-2673. https://doi.org/10.1002/art.21972
  34. Chandran V, Schentag CT, Gladman DD. Sensitivity and specificity of the CASPAR criteria for psoriatic arthritis in a family medicine clinic setting. J Rheumatol 2008;35:2069- 2070.
  35. Leung YY, Tam LS, Ho KW. Evaluation of the CASPAR criteria for psoriatic arthritis in the Chinese population. Rheumatology (Oxford) 2010;49:112-115. https://doi.org/10.1093/rheumatology/kep348