| Abstract | Psorijatični artritis (PsA) i psorijaza (PsO) dvije su bolesti međusobno povezane zajedničkom patogenezom (genetskim i okolišnim čimbenicima), zajedničkim nastupom (većina bolesnika s PsA ima PsO) i zajedničkim udruženim bolestima (kardiovaskularna bolest, metabolički sindrom, depresija) pa u novije vrijeme govorimo o psorijatičnoj bolesti. PsA je kronična, autoimuna upalna reumatska bolest povezana s PsO koja se očituje artritisom, daktilitisom, entezitisom i spondilitisom, a u dijela bolesnika prisutne su i izvanskeletne manifestacije bolesti (uveitis i upalna bolest crijeva). Muškarci i žene jednako obolijevaju. PsO u PsA uz kožu u pravilu zahvaća i nokte te prethodi PsA. Kožne i zglobne promjene utječu na kvalitetu pacijentova života te se pravovremenim liječenjem utječe na razinu psihičkih i fizičkih smetnji. Liječenje psorijatične bolesti mora biti usmjereno na kožnu i na zglobnu bolest, a većina lijekova istovremeno utječe na oboje. Iako ne postoji lijek kojim se psorijatična bolest može izliječiti lijekovima se može kontrolirati tijek bolesti, a u dijela bolesnika postići i remisija bolesti uz vrlo malu vjerojatnost održavanja stabilne remisije po prekidu terapije. Fizikalna terapija se primjenjuje u svim stadijima bolesti. U liječenju PsA primjenjuju se nesteroidni antireumatici, glukokortikoidi (primjenjuju se sustavno i lokalno) i lijekovi kojima se mijenja tijek bolesti (eng. disease modifying antirheumatic drugs - DMARDs) kao što su konvencionalni sintetski lijekovi (csDMARDs; sufasalazin te citostatici metotreksat i leflunomid), biološki lijekovi (bDMARDs; inhibitori TNF-alfa, interleukina 17 i 23 te PDE4) i ciljani sintetski lijekovi (tsDMARDs; JAK inhibitori). Fizikalnom terapijom umanjuju se simptomi PsA, održava pokretljivost zglobova i kralježnice, mišićni status i ukupna funkcionalna sposobnost bolesnika te time čuva kvaliteta života. Najvrijednija metoda fizikalne terapije je kineziterapija. Primjenom toplih ili hladnih obloga te ultrazvuka postiže se smanjenje boli, upale i mišićnog spazma. Osim toga i razni oblici elektroterapije poput TENS-a ili IFS-a, magnetoterapija i laser umanjuju simptome bolesti. Na psorijatičnu bolest tj. na PsA i PsO vrlo povoljno utječe i primjena naftalanoterapije, balneoterapija i hidroterapija u morskoj i sumpornoj vodi. U zadnja dva desetljeća dramatično se promijenilo shvaćanje PsA od blage, neprogresivne upalne reumatske bolesti prema sustavnoj upalnoj reumatskoj bolesti s ozbiljnim posljedicama koje ne uključuju samo oštećenje mišićno-koštanog sustava već i povećan rizik od kardiovaskularnih bolesti uz visok socioekonomski teret bolesti i značajno smanjenu kvalitetu života. Stoga je rana dijagnoza i rano uvođenje najnovijih lijekova koji modificiraju tijek bolesti - DMARD važno u poboljšanju dugoročnih ishoda bolesti. |
| Abstract (english) | Psoriatic arthritis (PsA) and psoriasis (PsO) are two diseases interconnected by common pathogenesis (genetic and environmental factors), common occurrence (most patients with PsA have PsO), and commonly associated diseases (cardiovascular disease, metabolic syndrome, depression), and in more recent times we are talking about psoriatic disease. PSA is a chronic, autoimmune inflammatory rheumatic disease related to PsO. This disease manifests itself in arthritis, dactylitis, enthesitis, and spondylitis. Some patients also have extraskeletal manifestations of the disease (uveitis and inflammatory bowel disease). Men and women are equally affected. PsO in PsA usually affects the nails, and the skin and precedes PsA. Skin and joint changes affect patient's quality of life, and timely treatment influences the level of psychological and physical disorders. Treatment of psoriatic disease must be aimed at the skin and joint disease, and most drugs affect both at the same time. Although no medication can cure psoriatic disease, it can inhibit the course of the disease. In some patients remission of the disease can be achieved with a very low probability of maintaining a stable remission after stopping therapy. Physical therapy is used in all stages of the disease. In the treatment of PsA, non-steroidal anti-rheumatic drugs, glucocorticoids (applied systemically and locally) and disease-modifying anti-rheumatic drugs (DMARDs) are used, such as conventional synthetic drugs (csDMARDs; sulfasalazine and cytostatics methotrexate and leflunomide), biological drugs (bDMARDs; inhibitors of TNF-alpha, interleukin 17 and 23, and PDE4) and targeted synthetic drugs (tsDMARDs; JAK inhibitors). Physical therapy reduces the symptoms of PsA and maintains the mobility of joints and spine, muscle status, and overall functional ability of the patient, thus preserving the quality of life. The most valuable method of physical therapy is kinesitherapy. Reduction of pain, inflammation, and muscle spasm is achieved by applying hot or cold compresses and ultrasound. Various forms of electrotherapy (TENS, IFS), magnetotherapy, and laser can also alleviate the symptoms of the disease. The use of naphthalene therapy, balneotherapy, and hydrotherapy in seawater and sulfur water also have a favorable effect on psoriatic disease.
In the last two decades the view of PsA have changed from a mild, non-progressive arthritis to an inflammatory systemic disease with serious health consequences, not only associated with joint dysfunction, but also with an increased risk of cardiovascular disease and socioeconomic consequences with significantly reduced quality of life. Thus, early recognition and treatment with modern DMARDs is essential for the patient long-term outcome. |
