[Psoriatic rheumatism].

Five to 7% of patients with cutaneous psoriasis suffer from inflammatory rheumatism that is sero-negative for rheumatoid factor, and is often erosive. The inflammation is predominant to the entheses and can affect the axial or peripheral skeleton, often in an associated manner. The most common peripheral signs are those of an asymmetrical oligo-arthritis type, and the most evocative are arthritis of the distal inter-phalangeal joints. A symmetrical polyarthritis can also be observed. The severe mutilating forms are fortunately very rare. Axial signs include sacro-iliitis that is more often bilateral and spinal involvement of an ankylosing spondyloarthitic type, predominating in the cervical and thoracic spine. The treatment usually calls for a non-steroidal anti-inflammatory and local injection of cortisone. Steroids must be used with care and reserved for the severe forms. DMARDS include Salazopyrin, methotrexate, and in the severe and resistant forms, the inhibitors of TNFalpha.