5 Types of Psoriatic Arthritis: Symptoms and Key Differences

What Is Psoriatic Arthritis and How Is It Classified?

A lot of us suffer from skin issues like itching, bleeding, and burning sensations. This often leads to thick and scaly patches in your skin. You are having such issues because you have psoriasis. It is a long-lasting skin issue, caused by a fault in your body's defense mechanism. Almost two to three percent of the world’s population suffers from this skin problem. However, psoriasis can also cause other health issues.

Almost 30 percent of patients with psoriasis develop bone health issues. This happens due to psoriatic arthritis. Mostly, the genes for these diseases are passed on to you by your parents. However, your gut infection or excessive weight can play an important role in this disease. Because of this, you can see issues such as joint pain, joint enlargement, and a crooked body structure. Identification or confirmation of this bone disease is difficult. This is not only due to its similarity to other joint diseases but also due to its varying symptoms. That is why a proper method of classification for psoriatic arthritis is needed.

In 1973, two doctors, Moll and Wright, classified psoriatic arthritis based on the following factors:

1. Psoriasis is present or not present.

2. The cause of the joint problem is inflammation or not.

3. Rheumatoid factor is present or not.

Based on these factors, you can have any of the five types of psoriatic arthritis.

What Are the 5 Types of Psoriatic Arthritis?

Based on your symptoms and clinical factors, you can have any of the five types of psoriatic arthritis. These are.

1. Asymmetrical Oligoarticular Psoriatic Arthritis: This is the most common type, which affects almost 70% of cases. You can see that fewer than five of your joints are having some issues. Usually, both small and large joints are affected. Different joints of your body on both sides are affected.

2. Symmetric Polyarthritis: Almost 15 to 20 percent of cases suffer from this. In this condition, the more you face problems with more than five joints, the worse it gets. This condition is very similar to rheumatoid arthritis. There will be pain, swelling, and deformation of the small and large joints of your hand and legs.

3. Distal Interphalangeal Predominant (DIP) Psoriatic Arthritis: This type of psoriatic arthritis affects your small joints of fingers and toes. You can also see some nail issues in this type. Also, your fingers may appear crooked due to joint damage.

4. Spondylitis (Axial Psoriatic Arthritis): This is a serious condition where joint problems affect your back. Due to damage to your spinal bones, deformation of your body structure occurs. Also, this can make you crippled.

5. Arthritis Mutilans: This is the most severe and dangerous type of joint issue. Only 5 percent of people suffer from this. This type breaks down your bones rapidly. You will eventually notice shortening of your fingers and toes due to the breakdown of the bones.

How Does Each Type Affect Daily Life?

Psoriatic arthritis and its symptoms affect your daily life. Deformity of the joint and its limited movement impact your daily work.

1. Mobility and Joint Function: Almost all types of psoriatic arthritis affect your mobility and joint functions. This happens due to your joint deformity. Also, muscles and ligaments attached to your joint don’t perform properly. You will experience swelling of the joint, tenderness, joint pain, and stiffness in the joint. The most common feature is morning stiffness. Also, a crooked joint makes it difficult for you to walk and move.

2. Skin Involvement: More or less every type of psoriatic arthritis shows skin changes. Along with itching, you can experience thick scaly patches in your elbows and knees. However, it is most common in peripheral, asymmetric, or distal types of psoriatic arthritis.

3. Nail Changes: If you see discoloration in your nails or pitting surfaces, you might be suffering from distal interphalangeal predominant (DIP) psoriatic arthritis. Also, in severe cases, you will see your nails lift off from the nail bed or some yellow patches under your nails.

4. Fatigue and Systemic Symptoms: If you have psoriatic arthritis, across all the types, you will face fatigue and body pain. Also, other systemic problems like anemia, fibromyalgia, and depression are common.

How Is Psoriatic Arthritis Diagnosed and Which Type Do You Have?

Doctors will ask you to undergo the following blood tests to confirm your psoriasis diagnosis.

1. C-reactive protein test. (CRP remains high in the case of psoriasis).

2. Erythrocyte sedimentation rate. (ESR remains high).

3. Blood tests for rheumatoid factor and anti-cyclic citrullinated peptide antibodies (both must be negative).

Apart from these tests, doctors use X-ray, MRI (magnetic resonance imaging), and CT (computerized tomography) scans to see the bone damage. Your bones will show decay in the joints, loss of spacing in between joints, and abnormal bone deposition in different joint spaces. If you have psoriatic arthritis, you will have a special pencil-in-cup deformity.

Tests like MRI and musculoskeletal ultrasound (MSUS) and MRI can show your muscle and ligament damage. Also, your back issues will be revealed by spinal cord damage. This happens due to damage to your vertebrae due to spondylitis and sacroiliitis. Apart from these, doctors diagnose the type of psoriatic arthritis you have based on clinical symptoms.

What Are the Treatment Options by Type of Psoriatic Arthritis?

The treatment of psoriatic arthritis depends on the severity of the condition. Rather than the type of psoriatic arthritis you have, doctors focus on symptoms like the amount of joint involvement, pain, joint mobility, and other health symptoms.

1. Lifestyle Changes:

• You must stop smoking and alcohol consumption.

• The Mediterranean diet, like fatty fish and nuts, can lower your inflammation.

• Regular mobility exercises and weight loss exercises are very useful.

• Hot and cold compression in the joint areas will help you.

2. Medication:

• If you have mild issues, non-steroidal anti-inflammatory drugs will be helpful.

• In moderate cases, where a few joints are involved and you have moderate pain, doctors might use disease-modifying antirheumatic drugs (DMARDs) like Methotrexate, Sulfasalazine, or Leflunomide. This is particularly used in asymmetrical oligoarticular psoriatic arthritis.

• If your condition is serious, doctors will prescribe biologic therapies, such as TNF (full form) inhibitors (Adalimumab, Etanercept) or interleukin (IL)-17/IL-12/23 inhibitors (Secukinumab, Ustekinumab) for you.

Can Psoriatic Arthritis Type Change Over Time?

Yes, the psoriatic arthritis type can change over time. In most cases, the condition can worsen. From the involvement of a few joints, multiple joints may get involved. Also, it can turn into serious conditions like arthritis mutilans.

When to See a Rheumatologist About Psoriatic Arthritis?

If you are suffering from skin issues like skin itching, blackish discoloration, scalp formation, or thickening of skin, you must be careful about joint issues. You should consult a rheumatologist in cases of the following symptoms:

1. Persistent joint pain.

2. Joint swelling.

3. Difficulty in moving fingers, walking, or running.

4. Change in the body posture.

5. Pain in the body in the morning.

Conclusion:

If you have psoriasis, you can face joint or bone issues. Such issues are caused by your bone damage. The severity of the symptoms, the amount of your joints involved, the nature of joint damage, and the types of joints involved determine the type of psoriatic arthritis you have. However, if you do not take precautions, symptoms may worsen, and you may suffer from a more dangerous type. If you have any queries regarding the symptoms of psoriatic arthritis, you can talk to our rheumatologist online.

Key Takeaways:

1. Psoriatic arthritis can damage your joints.

2. There are five types of psoriatic arthritis. The type of arthritis you have is based on factors like the number of joints involved, the types of joints involved, and the severity of the damage.

3. If your symptoms worsen, your type might change.