文档介绍：银屑病关节炎
脊柱关节病包括的疾病
强直性脊柱炎是本组疾病的原型
反应性关节炎(ReA)/Reiter综合征(RS)
银屑病关节炎(PsA)
炎性肠病相关的关节病(IBDA)
幼年发病的脊柱关节病(JSpA)
分类未定的脊柱关节病(USpA)
脊柱关节病之间的重叠
AS
ReA
IBDA
PsA
USpA
急性虹膜炎
其它寡关节炎、JSpA
定义:因银屑病而引发的关节炎,属
血清阴性脊柱关节病的范畴。历史:1818 年(法国)Alibert 报道
1860 年 Bazin 命名20世纪60年
代:独立疾病
流行病学
发病:世界范围
患病率:美国 % 在银屑病中 5%~7%
专科医院:7% ~ 49%
我国:银屑病 %
15% PsA发生在银屑病之前
年龄:32 ~ 45岁
性别:男:女为 1: ~ 1:
NPF Benchmark Survey for Psoriasis and Psoriatic Arthritis (N = 27,000) Psoriatic Arthritis Statistics
Americans affected: 1 million adults
Impact on patients’ lives:
84% report moderate to significant impact on day-to-day activities
75% lose sleep or sleep poorly
69% report disease interferes with educational, vocational, and social activities
Satisfaction with treatment:
50% reported seeing 3 physicians for disease in past 2 years
1 in 4 were dissatisfied with treatment
National Psoriasis Foundation (2002). Press kit for psoriatic arthritis survey. January 2002. Available at: ges/papress . Accessed November 13, 2002.
Gladman DD. Rheum Dis Clin North Am. 1992;18(1):247-256. Gladman DD. UpToDate. 1997;7(1):1-8.
Familial Predisposition (倾向、易患病的体质)
1st degree relative with previous disease history: 40%
Concordance rates
Monozygotic 单卵twins: 65%–72%
Dizygotic twins: 15%–30%
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病因
遗传:1/3 有家族史银屑病第一代亲属中:银屑
病 %,PsA %
寻常型银屑病:HLA-B13,-B17,-A1,-CW6
PsA:HLA-B27 46% ~ 78%脊柱炎
周围型 HLA-B38,-B39
免疫异常
免疫球蛋白:IgA升高 60% PsA IgG免疫复合物升高, IgA免疫复合物升高
补体:CH50 C3 可升高
细胞因子:IL-6 IL-8,转化因子-α(TGF-α)……
Sources: Mease P. Ann Rheum Dis 2004;63:755-758
Krueger JG. J Am Acad Dermatol 2002;46:1-23
Immunologic basis of psoriasis
T-cells are continuously activated in lymph nodes淋巴结 by unidentified antigens 未识别的抗原
Activated T- cells migrate into skin and induce macrophages 巨噬细胞to produce TNF-a and other pro-inflammatory cytokines