.100 Cases Of Joint Disease Psoriasis Clinical Analysis And Diagnostic Criteria Discussed

Background:Psoriatic arthritis,also known as "arthritic psoriasis",is a more severe type of Psoriasis disease that causes inflammatory pathological changes in skin and joints.How to distinguish PsA from spinal or joint diseases which are negative in serologic test become an important study topic.Despite various diagnostic standards and methods of differentiation of PsA in foreign countries,most scholars all over the world still like to use MWC.However,the author discovers certain limitations of such standard that it is unable to cover all aspects of clinical manifestation of patients with PsA.Since MWC,there have been 7 more types of diagnostic standards.There are relatively bigger differences in the above diagnostic standards with their own advantages and disadvantages.ACR announced a "guidelines of diagnosis and treatment plan in PsA",in which suggested that the evaluation baseline of PsA patients shall include the following:(1) systemetic function division standard (ARA);(2) visual evaluate method(VAS);(3) DLQI;(4) chronic fatigue evaluation.In this research,the author also uses the above methods to conduct patient evaluation.Objective:Clinical evaluation and analysis of patients with PsA.Discussion of the current diagnostic and classification standards,which leads to more knowledge to this disease and inspiration of the diagnosis and treatment of PsA.Method:The author collected 100 cases of psoriasis with current or past joint-related symptoms from Dermatology Department of Huasan Hospital during September 2007 and April 2009.Patients' medical history, physical examination and laboratory examination and evaluation are collected and analysed retrospectively,and therefore the aspects in it's epidemiology,including prevalence,inducing factors,family history and past history of psoriasis are discussed in this study. Moreover,the clinical manifestations of PsA are concluded,results of the laboratory examination are analysed,current diagnostic and classification standards are discussed,and conclusively early prevention better treatment of PsA are suggested in this study.Results:Among 100 cases of psoriatic arthritis,sex ratio of male to female is 1.44:1,and the initial onset of this disease can occur at 1 month old as youngest,oldest can be 62 years old.Percentages of dermal related damages as initial presentaton is 73%.Among dermal-related damages as initial presentaton,96%are presented as PV.There are 20 patients with family history of PV.The average age of onset is 25.85 years old in patients with family history of PV.34%of the patients suggested that joint-related symptoms worsen during winter.Among 100 patients,there are 43 cases experience complicating symptons along with joint ache,the commonest is fever(59%).ESR and CRP demonstrate positive correlation,and both are positively correlated to acute joint swelling and pain.While studying the correlations between HLA-B27 and axial bones,the author noticed that implication of damages to sacroiliac joint is much more likely to be found in HLA-B27 positive patients in comparison to the HLA-B27 negative patients.Among the 4 items of evaluation in chronic diseases,VAS is positively correlated to numbers of joints damaged;severity level of DLQI and evaluation in fatigue are positively correlated to the mass of dermal-related damage.Conclusion:Psoriatic arthritis can affect both sex.Initial symptoms are most commonly present as dermal-related damages,however joint-related damages as PsA shall not be ignored.In dermal-related damages,PV is most commonly seen type,followed by PP.Although not not all patients have family history of PV,the author concluded that patients with family history has much earlier onset compared to those without family history.In laboratory examinations,most patients present with increase in CRP,ESR,CCP,and most patients present with negative RF although 14%of HLA-B27 positive patients can have positive RF. Joint-related damages are most commonly seen in distal interphalangeal joints.In evaluation of chronic diseases the larger area of the affected dermal damage,the lower quality of life with higher fatigue level.After our retrospective analysis,we found out that the commonly used WMC is no longer applicable.Some patients can still be diagnosed as PsA while they do not meet the criteria of MWC;In MWC,PsA are divided into 3 types by its clinical symptoms,and we also found out that such classification cannot be applied to all patients.Such issues above will be further discussed in this study.