{"id":227,"date":"2026-02-08T17:44:25","date_gmt":"2026-02-08T16:44:25","guid":{"rendered":"https:\/\/erlaxatu.fr\/index.php\/spondyloarthrites-et-rhumatisme-psoriasique\/"},"modified":"2026-03-15T21:16:06","modified_gmt":"2026-03-15T20:16:06","slug":"spondyloarthrites-et-rhumatisme-psoriasique","status":"publish","type":"page","link":"https:\/\/erlaxatu.fr\/index.php\/spondyloarthrites-et-rhumatisme-psoriasique\/","title":{"rendered":"Spondyloarthrites et rhumatisme psoriasique"},"content":{"rendered":"<p><strong>Spondyloarthrites et rhumatisme psoriasique <\/strong><\/p>\n<p><strong>1) D\u00e9f. g\u00e9n\u00e9rale des spondyloarthrites (SpA)<\/strong><\/p>\n<p>Les spondyloarthrites sont des rhumatismes inflammatoires chroniques caract\u00e9ris\u00e9s par :<\/p>\n<ul>\n<li>atteinte pr\u00e9f\u00e9rentielle de l\u2019enth\u00e8se,<\/li>\n<li>atteinte axiale (rachis, sacro-iliaques),<\/li>\n<li>arthrites p\u00e9riph\u00e9riques asym\u00e9triques,<\/li>\n<li>manifestations extra-articulaires,<\/li>\n<li>association fr\u00e9quente au HLA-B27. <\/li>\n<\/ul>\n<p>Principales formes :<\/p>\n<ul>\n<li>spondyloarthrite axiale (radiographique ou non),<\/li>\n<li>rhumatisme psoriasique,<\/li>\n<li>arthrite r\u00e9actionnelle,<\/li>\n<li>SpA associ\u00e9e aux MICI,<\/li>\n<li>formes indiff\u00e9renci\u00e9es. <\/li>\n<\/ul>\n<p><strong>2) Physiopathologie (point fondamental)<\/strong><\/p>\n<p>La l\u00e9sion cl\u00e9 est l\u2019enth\u00e9site (inflammation de l\u2019insertion tendineuse ou ligamentaire). <\/p>\n<p>Cons\u00e9quences :<\/p>\n<ul>\n<li>douleur inflammatoire,<\/li>\n<li>ossification secondaire,<\/li>\n<li>formation de syndesmophytes,<\/li>\n<li>ankylose progressive du rachis. <\/li>\n<\/ul>\n<p>Cytokines impliqu\u00e9es :<\/p>\n<ul>\n<li>TNF-\u03b1<\/li>\n<li>IL-17<br \/>\u2192 cibles th\u00e9rapeutiques majeures. <\/li>\n<\/ul>\n<p><strong>3) Spondyloarthrite axiale<\/strong><\/p>\n<p><strong>3.1 Clinique typique<\/strong><\/p>\n<p>Lombalgie inflammatoire chez sujet jeune :<\/p>\n<p>Crit\u00e8res caract\u00e9ristiques :<\/p>\n<ul>\n<li>d\u00e9but &lt; 45 ans,<\/li>\n<li>\u00e9volution &gt; 3 mois,<\/li>\n<li>r\u00e9veil nocturne,<\/li>\n<li>raideur matinale &gt; 30 min,<\/li>\n<li>am\u00e9lioration \u00e0 l\u2019activit\u00e9,<\/li>\n<li>aggravation au repos. <\/li>\n<\/ul>\n<p>Autres signes :<\/p>\n<ul>\n<li>douleur fessi\u00e8re (sacro-iliite) \u00e0 bascule,<\/li>\n<li>raideur rachidienne,<\/li>\n<li>limitation mobilit\u00e9 rachidienne. <\/li>\n<\/ul>\n<p><strong>3.2 Atteintes p\u00e9riph\u00e9riques<\/strong><\/p>\n<p>Typiques :<\/p>\n<ul>\n<li>oligoarthrite asym\u00e9trique,<\/li>\n<li>membres inf\u00e9rieurs (genou, cheville, hanche),<\/li>\n<li>enth\u00e9site (talalgie inflammatoire),<\/li>\n<li>dactylite (\u00ab doigt en saucisse \u00bb). <\/li>\n<\/ul>\n<p><strong>3.3 Manifestations extra-articulaires<\/strong><\/p>\n<p>\u00c0 rechercher syst\u00e9matiquement :<\/p>\n<ul>\n<li>uv\u00e9ite ant\u00e9rieure (\u2248 20 %),<\/li>\n<li>psoriasis,<\/li>\n<li>MICI,<\/li>\n<li>atteinte cardiaque (rare). <\/li>\n<\/ul>\n<p><strong>3.4 Imagerie<\/strong><\/p>\n<p>Radiographie :<\/p>\n<ul>\n<li>sacro-iliite,<\/li>\n<li>syndesmophytes,<\/li>\n<li>ankylose,<\/li>\n<li>colonne bambou (formes \u00e9volu\u00e9es). <\/li>\n<\/ul>\n<p>IRM ( Bassin \/ Rachis) :<\/p>\n<ul>\n<li>diagnostic pr\u00e9coce,<\/li>\n<li>visualisation inflammation avant l\u00e9sions radiographiques. <\/li>\n<\/ul>\n<p><strong>3.5 Biologie<\/strong><\/p>\n<p>Non sp\u00e9cifique :<\/p>\n<ul>\n<li>CRP parfois \u00e9lev\u00e9e,<\/li>\n<li>HLA-B27 fr\u00e9quent mais non sp\u00e9cifique. <\/li>\n<\/ul>\n<p><strong>4) Rhumatisme psoriasique (RP)<\/strong><\/p>\n<p>Le rhumatisme psoriasique est une spondyloarthrite associ\u00e9e au psoriasis.<\/p>\n<p>Pr\u00e9valence :<\/p>\n<ul>\n<li>5 \u00e0 15 % des patients avec psoriasis. <\/li>\n<\/ul>\n<p>Le psoriasis pr\u00e9c\u00e8de l\u2019atteinte articulaire dans 75 % des cas. <\/p>\n<p><strong>4.1 Atteinte articulaire (formes cliniques)<\/strong><\/p>\n<p><strong>1. Oligoarthrite asym\u00e9trique (forme la plus fr\u00e9quente)<\/strong><\/p>\n<ul>\n<li>grosses articulations,<\/li>\n<li>membres inf\u00e9rieurs. <\/li>\n<\/ul>\n<p><strong>2. Polyarthrite s\u00e9ron\u00e9gative<\/strong><\/p>\n<p>Ressemble \u00e0 PR mais :<\/p>\n<ul>\n<li>asym\u00e9trique,<\/li>\n<li>atteinte IPD,<\/li>\n<li>FR et ACPA n\u00e9gatifs. <\/li>\n<\/ul>\n<p><strong>3. Atteinte des IPD (tr\u00e8s \u00e9vocatrice)<\/strong><\/p>\n<p>Association fr\u00e9quente :<\/p>\n<ul>\n<li>atteinte ungu\u00e9ale,<\/li>\n<li>psoriasis. <\/li>\n<\/ul>\n<p><strong>4. Forme axiale<\/strong><\/p>\n<p>Identique \u00e0 spondyloarthrite axiale :<\/p>\n<ul>\n<li>rachialgies inflammatoires,<\/li>\n<li>sacro-iliite. <\/li>\n<\/ul>\n<p><strong>5. Dactylite<\/strong><\/p>\n<p>Tr\u00e8s \u00e9vocatrice :<\/p>\n<ul>\n<li>doigt ou orteil en saucisse. <\/li>\n<\/ul>\n<p><strong>6. Forme mutilante (rare)<\/strong><\/p>\n<p>Tr\u00e8s grave :<\/p>\n<ul>\n<li>destruction articulaire s\u00e9v\u00e8re. <\/li>\n<\/ul>\n<p><strong>4.2 Atteinte cutan\u00e9e<\/strong><\/p>\n<p>Psoriasis :<\/p>\n<p>Formes typiques :<\/p>\n<ul>\n<li>plaques coudes,<\/li>\n<li>genoux,<\/li>\n<li>scalp,<\/li>\n<li>pli interfessier,<\/li>\n<li>atteinte ungu\u00e9ale ,, \u00ab\u00a0 d\u00e9 \u00e0 coudre\u00a0\u00bb (tr\u00e8s \u00e9vocatrice). <\/li>\n<\/ul>\n<p>Signes ungu\u00e9aux :<\/p>\n<ul>\n<li>onycholyse,<\/li>\n<li>hyperk\u00e9ratose,<\/li>\n<li>aspect en \u00ab d\u00e9 \u00e0 coudre \u00bb. <\/li>\n<\/ul>\n<p><strong>4.3 Biologie<\/strong><\/p>\n<p>Typique :<\/p>\n<ul>\n<li>FR n\u00e9gatif,<\/li>\n<li>ACPA n\u00e9gatif,<\/li>\n<li>CRP parfois \u00e9lev\u00e9e,<\/li>\n<li>HLA-B27 possible surtout forme axiale. <\/li>\n<\/ul>\n<p><strong>4.4 Radiologie<\/strong><\/p>\n<p>Aspect caract\u00e9ristique :<\/p>\n<p>Association :<\/p>\n<ul>\n<li>l\u00e9sions destructrices (\u00e9rosions),<\/li>\n<li>l\u00e9sions reconstructrices (hyperostose). <\/li>\n<\/ul>\n<p>Image typique :<\/p>\n<ul>\n<li>pencil-in-cup. <\/li>\n<\/ul>\n<p><strong>5) Diagnostic des spondyloarthrites<\/strong><\/p>\n<p>Diagnostic bas\u00e9 sur un faisceau d\u2019arguments :<\/p>\n<ul>\n<li>lombalgies inflammatoires,<\/li>\n<li>enth\u00e9site,<\/li>\n<li>arthrite asym\u00e9trique,<\/li>\n<li>psoriasis ou uv\u00e9ite,<\/li>\n<li>sacro-iliite \u00e0 l\u2019imagerie. <\/li>\n<\/ul>\n<p><strong>6) Traitement des spondyloarthrites et rhumatisme psoriasique<\/strong><\/p>\n<p><strong>6.1 Traitement de premi\u00e8re intention : AINS<\/strong><\/p>\n<p>Traitement de base :<\/p>\n<ul>\n<li>efficaces dans &gt; 70 % des cas. <\/li>\n<\/ul>\n<p><strong>6.2 Traitement de fond si \u00e9chec<\/strong><\/p>\n<p>Bioth\u00e9rapies :<\/p>\n<ul>\n<li>anti-TNF,<\/li>\n<li>anti-IL-17. <\/li>\n<\/ul>\n<p>Dans rhumatisme psoriasique :<\/p>\n<ul>\n<li>csDMARD possibles (m\u00e9thotrexate). <\/li>\n<\/ul>\n<p><strong>6.3 Traitement non m\u00e9dicamenteux (indispensable)<\/strong><\/p>\n<ul>\n<li>kin\u00e9sith\u00e9rapie,<\/li>\n<li>activit\u00e9 physique,<\/li>\n<li>arr\u00eat tabac. <\/li>\n<\/ul>\n<p><strong>7) Complications<\/strong><\/p>\n<p>Principales :<\/p>\n<ul>\n<li>ankylose rachidienne,<\/li>\n<li>handicap fonctionnel,<\/li>\n<li>fractures rachidiennes,<\/li>\n<li>complications cardiovasculaires. <\/li>\n<\/ul>\n<p><strong>8) Points cl\u00e9s <\/strong><\/p>\n<p>\u00c9voquer spondyloarthrite devant :<\/p>\n<ul>\n<li>lombalgies inflammatoires chez sujet jeune<\/li>\n<li>enth\u00e9site<\/li>\n<li>arthrite asym\u00e9trique<\/li>\n<li>psoriasis ou uv\u00e9ite<\/li>\n<\/ul>\n<p>Rhumatisme psoriasique \u00e9voqu\u00e9 devant :<\/p>\n<ul>\n<li>psoriasis<\/li>\n<li>arthrite asym\u00e9trique<\/li>\n<li>atteinte IPD<\/li>\n<li>dactylite<\/li>\n<\/ul>\n<p>Traitement de premi\u00e8re intention :<br \/>\u2192 AINS ( puis, si n\u00e9cessaire,  TTT MTX et \/ ou Anti TNF en premi\u00e8re Intention)<\/p>\n<p>Si p\u00e9riph\u00e9rique MTX<br \/>Si axial Anti TNF<\/p>\n<p>Cible anatomique principale :<br \/>\u2192 enth\u00e8se<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Spondyloarthrites et rhumatisme psoriasique 1) D\u00e9f. g\u00e9n\u00e9rale des spondyloarthrites (SpA) Les spondyloarthrites sont des rhumatismes inflammatoires chroniques caract\u00e9ris\u00e9s par : [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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