Although there are many treatment methods for this disease, most of them can only achieve the recent clinical effect, but cannot stop the recurrence.
1.General treatment Patients should take proper rest, reduce labor intensity, avoid overexertion and joint injury. All joints should have enough activities and exercises every day to maintain and improve joint function.
2.Non-hormonal anti-inflammatory drugs have strong anti-inflammatory effects and are effective in eliminating inflammatory pain. At present, commonly used enteric aspirin, anti-inflammatory pain (indomethacin), inflammatory pain Xikang, aminomethacin, ketone based ibuprofen, fenbid, etc.. Recently, there are reports that anti-inflammatory pain has aggravated psoriasis lesions, so the use of this drug is still controversial.
Although these drugs have certain efficacy, they have toxic reactions and are prone to relapse after stopping. Therefore, they are not the direction of treatment for psoriasis, and the indications should be strictly selected when applying them. Liver and kidney functions and white blood cell counts should be checked regularly before and during the use of medication. Drugs effective in psoriatic arthritis are.
(1) Methotrexate (MTX): MTX mainly acts on the DNA synthesis phase (S phase) of the cell cycle, and all psoriatic epidermal cells are inhibited after 36 hours of administration.
Opinions vary on the method of dosing. There are single-dose oral, intramuscular or intravenous injections, with a weekly dosage of 25-50mg; there are also daily oral? .5mg for 5d with 2d rest, then 5d with 7d rest. weitein provides the principle of epidermal cell kinetics and proposes oral administration of 2.5-7.5mg every 12hl for a total of 3 doses in 6h and weekly administration in the same way thereafter.
(2) Propionamide (rozoxane, ICRF159): This drug acts mainly in the late prophase of mitosis (G2) and the early stage of mitotic segregation (M). The efficacy in psoriatic arthritis may be superior to that of MTX. MTX should not be used in patients with pre-existing liver disease or the drug should be discontinued in those who develop hepatotoxic reactions after use. atherton et al. reported that the drug rapidly suppressed the accompanying arthritis. The main side effect is neutropenia, which can occur rapidly, sometimes severely, and may even cause.
Dosage: The initial dose is 125mg 3 times daily, 2d per week. 4-8 weeks later, depending on the white blood cell count, the dose is increased appropriately to 125mg or 250mg 3 times daily, 2d per week, alternately. For psoriatic arthritis it can also be given 3 d weekly.
(3) Lymphocyte inhibitor Cyclosporin A, which inhibits T lymphocytes, mainly TH cells, resulting in reduced expression of HLA-DR antigens.
Dose and method: Generally 5-12mg/kg daily, administered orally. Usually requires a plasma concentration of not less than 100ng/ml, and is most effective above 200ng/ml, but higher than 400ng/ml is likely to cause nephrotoxic reactions, and more than 600ng/ml is required for neurological toxicity. This drug should not be used in combination with ketoconazole or levosarcoma (melphalan) to produce serious side effects due to high plasma concentration in rabbits.
(4) Heavy metal agents: Comparative studies have shown that heavy metal agents have a high remission effect on psoriatic arthritis, mediated to psoriatic lesions are not effective.
Sodium arsenite (soclium arsenite), also known as sodium caguti, is commonly used. 100mg daily, intramuscular injection, 10-20d a course of treatment.
(5) Anti-syndromic drugs: chloroquine (chloroquini phohas), which has variable efficacy on psoriasis. Some people report better effect on photosensitivity and psoriatic arthritis; others report that psoriatic and erythrodermic diseases can be induced during the treatment, which is rarely used at present.
(6) Corticosteroids: At present, it is generally not advocated to treat PA with such drugs. sometimes it is only used for patients whose condition is serious and other drug treatments are ineffective.
4.Chinese medicine Chinese medicine believes that psoriatic arthritis is mostly caused by wind-damp paralysis and liver-kidney deficiency.
(1) Paralysis and obstruction of wind-dampness: joint swelling and pain are the main causes, and the course of the disease is relatively short.
Treatment: Expel dampness and clear heat, detoxify and clear the ligaments.
Formulation: Doklamia parasiticus Tang with addition and subtraction. Medicines used: Gentiana macrophylla, Fenfeng, Mulberry branch, Doklamia, Wailingxian, Baixiang Pi, Tu Fu Ling, Angelicae, Radix Paeoniae, Chrysanthemum, Niubizi.
The symptoms of upper limbs mainly add turmeric, sea breeze vine; the symptoms of lower limbs mainly add Fang Wei.
(2) Liver and kidney deficiency: joint deformation and restricted movement are the main causes, with a long duration of illness.
Treatment: Jian Bu Hu Qian Wan is used as a treatment. Medicinal use: rehmannia, dogwood, angelica, danpi, eucommia, sequestra, papaya, dog’s backbone, tortoise board, tiger bones, wuzhishan, fu ling, g sign grass, stretching tendons, etc.
(3) Proprietary Chinese medicines: ①Legongteng tablets: an ethyl acetate extract containing leigongteng methicin, which has strong anti-inflammatory and immunosuppressive effects. Take 2 tablets each time, 3 times a day. It can also be used to take Lei Gong Vine polysaccharide tablets 1~1.5mg/kg per day, divided into 3 times. ②Kunming bergamot tablets: each tablet contains 0.5mg of ethanolic paste powder of Kunming bergamot (2g of raw herbs), 3-6 tablets each time, 3 times a day. The amount should not exceed 18 tablets at a time.
5.Topical medicine mainly targets psoriasis skin lesions. Commonly used drugs include: 5% sulfur, 5%-10% salicylic acid, 2%-10% coal tar, 0.1%-1% anthralin, 1:10,000-1:20,000 mustard gas, 0.05% ammoniacal mustard, 10%-15% psoralen, 2%-5% anthelmintic, 0.025%-0.1% vitamin A acid, etc., formulated as ointment, solution or tincture.
6.Physical therapy
(1) Photochemotherapy: also known as long-wave ultraviolet therapy with psoralen. This therapy is effective for peripheral psoriatic arthritis, but not for axial arthritis.
Treatment method: Oral administration of 8-methoxypsoralen (8-MOP) 0.6mg/kg, followed by UVA irradiation after 2h. A therapeutic dose slightly lower than the minimum erythema amount was used, 2-3 times per same. The treatment course should not be too long, and the total cumulative amount should not exceed 500～600J/cm2.
(2) Extracorporeal photochemical method: recently Wilfer reported that it is effective for psoriatic arthritis. Blood sedimentation, pain, duration of morning stiffness, grip strength, and joint swelling all improved to varying degrees after treatment.