Psoriatic Arthritis - Types, Symptoms, Causes, Diagnosis, and Treatment

What Is Psoriatic Arthritis?

The type of arthritis that commonly affects certain people with psoriasis is called psoriatic arthritis (PsA). Psoriasis is a skin and scalp condition that results in red patches of skin with silvery scales. In most cases, patients are first diagnosed with psoriasis, and they later develop symptoms of psoriatic arthritis. Sometimes, joint problems begin before skin lesions. The primary symptoms of psoriatic arthritis are joint pain, swelling, stiffness. The joints commonly affected are fingertips and spine, but it can affect any joint. Like psoriasis, psoriatic arthritis also has periods of flares alternating with periods of remission.

As of now, there is no cure for psoriatic arthritis exists, and treatment aims at controlling symptoms and preventing permanent joint damage. If left untreated, this condition can be disabling.

Types:

The types of psoriatic arthritis are:

1. Symmetric PsA - It affects the same joints on both sides of the body. The symptoms are milder and result in less joint deformity than rheumatoid arthritis. Around 50 % of PsA patients have this type.

2. Asymmetric PsA - It only affects a joint or joints on the single side of the body. This type is also mild and affects around 35 % of PsA patients.

3. Distal interphalangeal predominant PsA - Here, the joints closest to the nails (distal joints) get affected. Around 10 % of PsA patients are affected by this type.

4. Spondylitis PsA - Here, the spine is affected. It sometimes involves the entire spine. It makes movement difficult and can also affect the hands, feet, arms, legs, and hips.

5. Psoriatic arthritis mutilans - This the most severe and deforming type. Approximately only 5 % of PsA patients have this type. Psoriatic arthritis mutilans commonly affects the hands and feet.

What Are the Signs and Symptoms of Psoriatic Arthritis?

The symptoms of psoriatic arthritis can vary from mild to severe and can be different from person to person. Some of the most common symptoms include:

• The affected joints become swollen, painful, and swollen.

• The fingers and toes become swollen.

• Morning joint stiffness.

• The muscles and tendons are sore and painful.

• Flaky scalp.

• Red patches with scaly skin.

• Tiredness.

• Red eyes.

• Uveitis (eye pain).

• Nail pitting (shallow or deep holes in the nails).

• The nail gets separated from the nail bed.

Spondylitis PsA results in back pain and stiffness, and pain in the hips, knee, elbow, feet, wrists, and toes. Symmetric PsA commonly affects five or more joints on both sides of the body, while asymmetric PsA affects less than five joints on either side of the body. Psoriatic arthritis mutilans results in joint deformation.

What Causes Psoriatic Arthritis?

Psoriatic arthritis is an autoimmune condition, that is the body's immune system attacks its own cells and tissue. This immunological response results in inflammation in the joints and overproduction of skin cells. The exact cause of this abnormal immune response is still not clearly understood, but genetics and environmental factors seem to play a role. Certain genetic markers have been identified, which seem to cause psoriatic arthritis.

Risk Factors:

1. Psoriasis.

2. A parent or sibling with psoriatic arthritis.

3. More common in adults between 30 and 50 years of age.

4. Psoriasis on the nails.

5. Viral or bacterial infection in people with an inherited tendency.

How Is Psoriatic Arthritis Diagnosed?

The doctor will examine the joints to look for signs of swelling, check the nails for pitting, and will check for tenderness around the soles of your feet and heels. There is no specific test that can diagnose psoriatic arthritis. The doctor usually performs various tests to rule out all other conditions that can result in similar symptoms, such as rheumatoid arthritis or gout. The following tests might be needed:

1. X-rays - The changes in the joints can be seen in psoriatic arthritis and not in other types of arthritis.

2. Magnetic resonance imaging (MRI) - Here, strong radio waves and magnetic fields are used to produce detailed images of the joints and surrounding structures. The tendons and ligaments are checked using an MRI.

3. Rheumatoid factor (RF) - This blood test detects the presence of RF, which is an antibody present in the blood rheumatoid arthritis patients. In PsA patients, this antibody is absent.

4. Joint fluid test - The fluid from the affected joint will be collected by your doctor using a needle. This fluid is then tested for the presence of uric acid crystals, which indicates gout.

What Are the Treatment Options for Psoriatic Arthritis?

There is no cure for PsA, but treatment is done to control inflammation in the affected joints and to prevent permanent deformity. The treatment options include:

• NSAIDs (nonsteroidal anti-inflammatory drugs) - used to relieve pain and reduce inflammation. Examples include ibuprofen and Naproxen sodium.

• Disease-modifying antirheumatic drugs (DMARDs) - helps in slowing the progression of psoriatic arthritis and prevents the tissue from permanent damage. Examples include Methotrexate, Leflunomide, and Sulfasalazine.

• Immunosuppressants - these medicines suppress the action of your immune system. Examples include Cyclosporine and Azathioprine.

• Biologic response modifiers - these are newer DMARDs drugs, which target specific actions of the immune system that cause inflammation. The commonly used drugs are Abatacept, Adalimumab, Etanercept, Golimumab, and Infliximab.

• Apremilast - it is a new medicine that decreases the function of the enzyme that controls inflammatory activity within cells.

• Steroid injections - Steroid injections are injected directly into the affected joint to reduce inflammation.

• Joint replacement surgery - In severe cases, where the joints have been damaged beyond repair, the diseased joint is replaced with metal and plastic artificial prostheses.

Home Remedies:

• Avoid straining your joints while performing everyday tasks.

• By maintaining a healthy weight, you put less weight on your joints.

• Regular exercise can help keep your joints flexible and strong.

• Quit smoking, as it increases the risk of psoriasis.

• Do not consume alcohol in excess, as it can interact with your medicines and result in unwanted side effects.

• Rest and give your body time to heal.

What Are the Possible Complications of Psoriatic Arthritis?

In some cases, psoriatic arthritis can lead to arthritis mutilans, which is a painful and disabling disease. The small bones in the hands can be damaged permanently, resulting in permanent deformity. Psoriatic arthritis patients are more prone to develop eye problems, such as conjunctivitis or uveitis. It also increases the risk of heart diseases.

To know more about psoriatic arthritis, consult a rheumatologist online now!