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Psoriasisartrit

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Definition:
Psoriasisartrit är en autoimmun, inflammatorisk ledsjukdom som är associerad med hudsjukdomen psoriasis.
Förekomst:
Cirka 2–4 % av befolkningen har psoriasis och av dem får 7–48 % psoriasisartrit.
Symtom:
Ofta utveckling över längre tid med ledsmärtor, svullnad, ömhet och rörelseinskränkning i de angripna lederna. Dessutom smärtor vid senornas och ligamentens fästen.
Kliniska fynd:
Asymmetriska lokalisationer av drabbade leder. Entesit – inflammation i senfästen. Daktylit – inflammation av helt finger eller hel tå. Artrit i DIP- och PIP-lederna. Grovt indelat har cirka 70 % av patienterna perifer sjukdom medan cirka 30 % har axialt engagemang (sakroiliakalederna).
Diagnostik:
Vid aktiv sjukdom kan SR och CRP vara måttligt förhöjda, ofta lätt anemi. Eventuellt  HLA-B27, anti-CCP, RF, lever- och njurfunktionsprover i differentialdiagnostiskt syfte. Röntgen av leder och MR över senfästen kan vara till hjälp i diagnostiken.
Behandling:
Symtomlindrande läkemedelsbehandling med NSAID, COX-2-hämmare eller lokala kortisoninjektioner. Om utebliven effekt av dessa kan DMARD-behandling, till exempel metotrexat ellerTNF-hämmare övervägas.
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  • Britt-Marie Nyhäll-Wåhlin, med dr och överläkare, Reumatologkliniken, Falu lasarett
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet