Mosaab I. Diagnosis and treatment of patients with knee disorder at psoriatic arthritis

Psoriatic arthritis (PA) is found from 7 to 30% of total number patient with psoriasis, mainly men are sick (60%) with age capable of working, namely from 25 to 54 years (81,81%) . often PA is the cause of total disability and invalidity (30%) . Disease etiology and main links of pathogenesis disorder is not clear up finally. Complex treatment of patients with PA and knee joint lesion include medicamental and physiotherapeutic methods, their main object is to stop progress of pathologic progress in general and development prevention of irreversible proliferative and destructive changes, concordant and disconcordant deformation in the joint with disorder of its function. However according to literature date, orthopedic treatment and prophylaxis of deformation development proper attention is not paid and there is no tendency including complex treatment by means of orthopedic methods.This work is based on complex examination and treatment of 72 patient with knee joint damage at different stage of pathologic process development. Knee joint lesion at PA was found up to 58.2% of cases and in 87.3% of cases is combined with damage of other sections of locomotorium. Clinical picture of knee joint lesion depends mainly on stage and the form of lesion besides it depends on degree of process activity. The analysis of obtained data of immunologic investigation is evidence of the fact that characteristic lesions of immune system in patient with PA independently of disease duration concern changes in T- system of immunity namely content of T- helpers and T- supressors and their correlation. The content of lymphocytes and immunoglobulins are in norm limits while monocytes content, T- lymphocytes and T- active is decreased or indices respond lower limit of norm. On the basis of sonographic investigation the degrees of synovial membrane thickening were defined and it was the basis for development of indication for surgical treatment and objective criteria for conservative treatment control. Particularly it is necessary to underline value of arthroscopic method both in diagnostic and treatment . Treatment of PA should be complex, differentiated taking into account state and dynamics of dermal and articular syndromes. The treatment includes medicamental and physiotherapeutic and sanatorium treatment. In patient with knee damage at PA conservative treatment not always can lead to positive result of treatment which can manifistate as stable remission, decrease of inflammatory process and improvement of functional values. Surgical method of treatment often as following after conservative method is very important both from medical and prophylactic point of view. In this connection and taking into consideration lesion of dermal integuments definition of indication and contraindication for carrying out of surgical methods of treatment is important moment. Among surgical methods important place take synovectomy, synovcapsulectomy, which are carried out by eans of "classical" and orthopedic method , arthroplasty, joint replacement and apparatus of external fixation. Differentiated approach in choice of treatment method allowed to reach positive results at conservative method depending on degree of general activity of inflammatory process, the result at light degree of inflammatory process were 93%, result at middle degree were 80%, heavy inflammatory process gave 60% of results. Surgical treatment provided good result in 77% of cases and satisfactory results in 18% of cases and 5% of cases had unsatisfactory results.