Department of Medicine, Section of Dermatology and Venereology, University of Verona, Piazzale A. Stefani 1, Verona, Italy.
Dermatology. 2010;221 Suppl 1:6-14. doi: 10.1159/000316170. Epub 2010 Aug 9.
Psoriasis is a complex disease involving the skin, nails and musculoskeletal structures. Psoriatic arthritis (PsA) affects peripheral joints, entheses, the synovial sheaths of tendons and the axial skeleton. PsA is now recognised as a potentially debilitating disease, with bone erosions and deformities affecting about half of patients and arising early after disease onset. Because PsA usually coincides with or follows the development of psoriasis, dermatologists are in a strategic position to diagnose and manage early PsA. In general, patients with severe psoriasis appear to have a higher risk of arthritis than patients with mild psoriasis. In addition, scalp lesions, nail dystrophy and intergluteal/perianal lesions have been found to be associated with a higher risk of PsA development. The diagnosis of PsA is based primarily on clinical features, and several classification criteria have been developed. Ultrasonography, magnetic resonance imaging and bone scintigraphy, rather than standard radiography, are the most accurate and effective diagnostic imaging approaches for documenting early PsA. The therapeutic strategy for early PsA should be aimed at inducing lasting remission, preventing permanent damage and possibly modifying the natural disease course.
银屑病是一种涉及皮肤、指甲和肌肉骨骼结构的复杂疾病。银屑病关节炎（PsA）影响外周关节、肌腱附着点、滑膜鞘和轴骨骼。现在认为银屑病关节炎是一种潜在的使人衰弱的疾病，大约一半的患者会出现骨侵蚀和畸形，并且在疾病发作后早期就会出现。由于银屑病关节炎通常与银屑病的发展同时发生或紧随其后，皮肤科医生处于诊断和早期管理银屑病关节炎的战略位置。一般来说，重度银屑病患者似乎比轻度银屑病患者患关节炎的风险更高。此外，头皮病变、指甲营养不良和臀间/肛周病变已被发现与更高的银屑病关节炎发病风险相关。银屑病关节炎的诊断主要基于临床特征，已经制定了几个分类标准。超声、磁共振成像和骨闪烁显像术，而不是标准的 X 射线摄影术，是记录早期银屑病关节炎最准确和有效的诊断成像方法。早期银屑病关节炎的治疗策略应旨在诱导持久缓解、预防永久性损伤，并可能改变自然病程。
