银屑病性关节炎中西医治疗研究进展

A review on TCM and Western medicine treatment of psoriatic arthritis

银屑病性关节炎(Psoriatic Arthritis,PsA)归属风湿免疫病,是一类伴有银屑病皮损的慢性炎性关节病,该病中后期多出现关节及关节软组织肿痛、晨僵和运动障碍等症状,可渐致关节活动度受限甚至造成残疾等严重影响,此外该病易合并各种代谢类疾病,增加患者病死率。中医学对PsA没有固定的名称概括,认为其归属“白疕”“痹病”。现代医家多认为该病应当作为独立疾病。由于PsA的病程漫长,大部分患者皮损症状早于关节症状出现,导致早期诊断不够完整,存在漏诊,从而不能早期进行临床干预,影响患者预后,目前广泛认可的诊断标准是2006版银屑病关节炎分类标准,治疗标准是欧洲风湿病防治联合会发布的欧洲风湿病防治联合会指南。其致残率高,药物干预不及时可影响患者生活质量,为早期控制患者症状,文章总结了近年来PsA的治疗进展。PsA早期发病隐匿,机制复杂,确定好特异性高的诊断标准和做好相关宣教有助于医生早期诊断及转诊和患者及时就诊,有利于患者预后,早期诊断与预后密切相关,一般患者常规治疗疗效尚可,有多种PsA治疗药物及中西医结合治疗可供临床选择,必要时可考虑外科操作,顽固性患者仍需新型治疗。目前,生物制剂还是治疗PsA的优选之一,同时也需要更加详细的诊疗标准和各种新型的药物来保证PsA治疗的安全性和疗效。

Psoriatic arthritis(PsA)belongs to the category of rheumatic immune disease,and is a chronic inflammatory joint disease accompanied by psoriatic skin lesions.In the middle and later stages of this disease,symptoms such as swelling and pain of joint and joint soft tissue,morning stiffness,and movement disorders often occur.It can gradually lead to limited joint mobility and even serious effects such as disability.In addition,this disease is prone to merging with various metabolic diseases and increasing patients’mortality.Traditional Chinesse medicine does not have a fixed name to summarize psoriatic arthritis,and believes that it belongs to“white rheumatism”and“Bi syndrome”(痹证).Modern medical experts believe that this disease should be treated as an independent disease.Due to the long course of PsA,most patients have skin lesion symptoms that appear earlier than joint symptoms,leading to incomplete early diagnosis and missed diagnosis,which prevents early clinical intervention and affects patient prognosis.Currently,the widely recognized diagnostic standard is the 2006 CASPAR classification standard,and the treatment standard is the EULAR guideline issued by the European League Against Rheumatology.The disability rate is high,and untimely drug intervention can affect the quality of life of patients.In order to have an early control of the patients’symptoms,this article summarizes the treatment progress of PsA in recent years.The early onset of PsA is insidious and the mechanism is complex.Determining high specific diagnostic criteria and conducting relevant education can help doctors diagnose and refer patients in an early manner,and help patients seek timely treatment,which is beneficial for patients’prognosis.Early diagnosis is closely related to prognosis,and the conventional treatment effect of general patients is acceptable.Multiple PsA treatment drugs and the integrative medicine treatment can be selected for clinical use.If necessary,surgical procedures can be considered,but refractory patients still need new treatment.At present,biopharmaceutical drugs are still one of the preferred treatments for PsA,and more detailed diagnostic and treatment standards and various new drugs are also needed to ensure the safety and efficacy of PsA treatment.