Goldenstein-Schainberg Claudia, Favarato Maria Helena Sampaio, Ranza Roberto
Disciplina de Reumatologia, Universidade de São Paulo.
Rev Bras Reumatol. 2012 Jan-Feb;52(1):98-106.
Psoriatic arthritis (PsA) is a systemic, polymorphic joint disease with variable presentation and clinical course. The outcome depends on the association with severe comorbidities such as diabetes, hypertension and dyslipidemia. Early diagnosis requires a high degree of clinical suspicion, especially when skin manifestations are subtle and poorly defined. Progressive erosive disease can occur in up to half of patients, associated with anatomical and functional changes in about 20%. Thus, the prognosis of PsA remains unclear, especially if diagnosis and treatment are delayed. Based on extensive literature review (PubMed and Lilacs) and experience of our services, new concepts of immunogenetics, pathophysiology, and clinical and therapeutic aspects are discussed. Factors that reduce the quality of life and life expectancy of patients, as well as new guidelines for treatment, will be emphasized. Control of inflammation, especially in enthesitis and axial forms of PsA, was made possible due to the introduction of anti-TNF biologics. Finally, the role of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) should be emphasized, since it promotes meetings and joint studies between rheumatologists and dermatologists to provide scientific evidence for the sweeping changes in clinical management and treatment of patients with PsA.
银屑病关节炎（PsA）是一种全身性、多形性关节疾病，表现形式多样，临床病程各异。其预后取决于是否合并如糖尿病、高血压和血脂异常等严重共病。早期诊断需要高度的临床怀疑，尤其是当皮肤表现不明显且界定不清时。高达半数的患者可能会出现进行性侵蚀性疾病，约20%的患者会出现解剖结构和功能改变。因此，PsA的预后仍不明确，尤其是在诊断和治疗延迟的情况下。基于广泛的文献综述（PubMed和Lilacs）以及我们服务的经验，本文讨论了免疫遗传学、病理生理学以及临床和治疗方面的新概念。将强调降低患者生活质量和预期寿命的因素以及新的治疗指南。由于抗TNF生物制剂的引入，炎症得到了控制，尤其是在附着点炎和轴向型PsA中。最后，应强调GRAPPA（银屑病和银屑病关节炎研究与评估小组）的作用，因为它促进了风湿病学家和皮肤科医生之间的会议和联合研究，为PsA患者临床管理和治疗的全面变革提供科学依据。
