DIAGNOSIS OF EARLY PSORIATIC ARTHRITIS – CLINICAL CHALLENGES
Keywords:psoriatic arthritis, early clinical manifestations
Objectives. The aim was to study clinical manifestations in psoriatic arthritis: enthesities, dactylitis, peripheral and axial arthritis, skin expressions, for early diagnosis, which would allow the establishment of an adjusted treatment and developing measures to prevent complications.
Material and methods. The study has an analytical-observational retrospective character, and included the patients who were hospitalized in the Rheumatology and Artrology departments within the "Timofei Moşneaga'' Republican Clinical Hospital, during the years 2019-2021, and included 103 patients with psoriatic arthritis (47 men and 56 women) with various skin psoriasis forms.
Results. After clinical examination, there were found: peripheral arthritis in 15 patients (24.6%), dactyleitis – 37 (60.7%), heel pain was detected in 32 (52.5%), axial arthritis – 30 (49.2%), enthesities, distal interphalangeal arthritis and tendinitis were not detected. Those who primary or addressed with joint manifestations, in 35 (57,4%) of patients was present peripheral arthritis, dactylitis – in 40 (65,6%), enthesis of the elbow joints – in 11 (18%), knee joints – in 8 (13,1%), calcaneal region – 25 (41%), arthritis of the distal interphalangeal joints was detected in 21 (34,4%), tendinitis – 13 (21,3%).
Discussions. The results obtained allow us to state that one of the directions in improving the diagnosis of psoriatic arthritis is the use of ultrasound and magnetic resonance examinations of the joints of hands and plants. This makes it possible to effectively identify the characteristic of enthesopathy, edema of tissues, as well as destructive changes in the joints of the hands and feet.
Conclusions. Diffuse enthesopathy with subclinical evolution is an early manifestation within psoriatic arthritis, which, in association with dactylitis (or tendinitis) and damage to the distal interphalangeal joints significantly increases the sensitivity for the option of a definite diagnosis. Likewise, it requires the mention of musculoskeletal ultrasonography as an effective method in the diagnosis of subclinical enthesities and can be recommended as a valuable option instead of magnetic resonance imaging.
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