Published on Mar 09, 2020 - 4 min read
Psoriatic arthritis is a type or form of arthritis that affects certain people with psoriasis. To know its types, symptoms, causes, and treatment, read the article.
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.
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.
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.
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.
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.
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.
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.
Red patches with scaly skin.
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.
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.
A parent or sibling with psoriatic arthritis.
More common in adults between 30 and 50 years of age.
Psoriasis on the nails.
Viral or bacterial infection in people with an inherited tendency.
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:
X-rays - The changes in the joints can be seen in psoriatic arthritis and not in other types of arthritis.
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.
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.
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.
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.
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.
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!
Psoriatic arthritis is a chronic inflammatory disorder that causes severe pain in the joints. In severe cases, it can lead to a disability of the patient due to the permanent damage of the joints. It is not a life-threatening disease, yet it increases the risk of comorbidities like cardiovascular diseases, fatty liver disease, and diabetes.
Psoriatic arthritis primarily causes inflammation in the joints, which leads to pain, tenderness, and stiffness of those affected joints. A person affected with psoriatic arthritis might feel pain in just one or several bones. Psoriatic arthritis commonly affects the knee joints, small joints at the fingers, toes, ankles, and lower back. Patients are known to report severe pain only if they have a problem in several joints.
The most common trigger of psoriatic arthritis is stress. Stress is known to make symptoms worse. Medications like Lithium, antimalarials like Hydroxychloroquine, beta-blockers like Propranolol, Quinidine, and Indomethacin, are also some triggers for psoriatic arthritis. Physical stress on the joints, due to obesity, can also make the inflammation worse.
The most commonly affected joints in psoriatic arthritis are:
- Knee joints.
- Metacarpophalangeal joints.
- Proximal and distal interphalangeal joints.
- Metatarsophalangeal joint.
- Ankle joints.
- Joints in the lower back region.
Psoriatic arthritis is not a disease that affects the life expectancy of the patients. It causes chronic inflammation and pain at joints. It leads to difficulty in maintaining a normal routine in those patients. People with psoriatic arthritis, however, may develop comorbidities like diabetes and hypertension, yet they have a good life.
If psoriatic arthritis is left untreated, it can cause permanent damage to the joints and bones. Chronic psoriatic arthritis that is not controlled by treatment may sometimes result in permanent disability. You should consult your doctor to get proper treatment options.
The most common causes of a flare-up episode in psoriatic arthritis are as follows.
- Uncontrolled stress.
- Excessive physical stress.
- Cold weather.
- Intake of medications like Lithium, Hydroxychloroquine.
The common presentation in the hands of psoriatic arthritis patients is stiff, puffy, sausage-like fingers, which are seen along with joint pain and tenderness. The skin in the palms may look dry and reddish with patches of silvery-white scales.
The following are the factors that aggravate psoriatic arthritis.
- Cold weather.
- Exposure to cigarette smoke.
- Older age.
- Intake of chicken.
- Physical as well as mental stress.
The inflammation seen in psoriatic arthritis patients significantly has short-term effects such as severe pain and swelling in joints of the body. The usual reason for this severe pain is an altered immune response to certain triggers. Also, when there is a combination of inflammation and stress, it can make the patient more sensitive to pain. There is also no complete cure for this condition. These are some reasons why psoriatic arthritis hurts so bad.
The following are the foods that have to be avoided when a person is affected by psoriatic arthritis.
- Processed meats like hot dogs, sausages, bacon, etc.
- Alcoholic beverages.
- Sugary drinks.
- Processed foods such as packaged cakes, cookies, soda, etc.
- White bread.
- White rice.
Yes, when your psoriatic arthritis is not treated well, it can cripple you. However, it is very rare. The variant of psoriatic arthritis is known as arthritis mutilans, which is a severe form of psoriatic arthritis that could destroy the joints of your hands and feet, which leads to permanent disfigurement and disability of those joints.
The skin of a person affected with psoriatic arthritis looks very dry and warm. It has the presence of red patches and silvery-white scales. However, it is unique for some patients.
The feet of psoriatic arthritis patients look very painful, swollen, and warm due to the inflammatory process. The typical appearance of fingers and toes in this condition is described to be sausage-like.
Psoriatic arthritis is a chronic inflammatory disease that has no cure to date. It can get worse over time as the person becomes aged. Age is one of the essential and frequently noted factors for relapse of this condition. If we note these factors, the recurrence of this condition can be identified.
Disease-modifying antirheumatic drugs (DMARDs) are the most common class of drugs that are being used in the treatment of psoriatic arthritis. These drugs have the ability to slow the progression of psoriatic arthritis in complicated stages of the disease and save the joints and other affected tissues from permanent damage. The most commonly used disease-modifying antirheumatic drugs (DMARDs) include Methotrexate, Leflunomide, and Sulfasalazine.
Psoriatic arthritis can never be diagnosed with the help of a simple blood test. Since the symptoms of psoriatic arthritis are often similar to the symptoms of rheumatoid arthritis, the doctor will always need to order a blood test to rule out rheumatoid arthritis. The blood test will determine if the person’s blood is positive for rheumatoid factor or not. Psoriatic arthritis does not have a positive rheumatoid factor.
There are many tests that can help in diagnosing psoriatic arthritis. That includes blood tests, X-ray, magnetic resonance imaging (MRI), and ultrasound of the affected joint. You should get recommendations from your doctor for performing these diagnostic tests.
Usually, rheumatoid arthritis and psoriatic arthritis present with very similar symptoms, and the treatment provided are usually the same. The only visible difference is the typical appearance of joints of the hands and feet in psoriatic arthritis, which has the silvery scales in the skin and fingers, which are sausage-like in nature.
Yes, psoriatic arthritis can go into remission. Certain factors can cause a remission of this condition that includes older age, chronic stress, physical trauma, intake of foods like chicken, winter weather, and smoking.
There is no definitive cure for psoriatic arthritis yet. However, certain day to day changes can help in decreasing the frequency of flare-up episodes and the severity of symptoms. That includes
- Make exercise as a routine activity so that it can strengthen the joints and prevent permanent disability.
- Proper treatment from a rheumatologist and regular follow-ups.
- Cope with stress by mindfulness practices and yoga. It can reduce the main triggers.
- Maintain personal hygiene at all costs since it can prevent superficial infections.
- Quit smoking and alcoholism.
There is no drug that can permanently cure the pain caused by psoriatic arthritis. However, non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Naproxen can be used during acute flare-up episodes where severe pain is experienced. It is important to note that these drugs should always be taken with a proper prescription from a doctor in prescribed doses only. Increased intake of these drugs can lead to peptic ulcers as well as liver toxicity.
Yes, with proper medical management and avoidance of triggers, patients affected with psoriatic arthritis can live a very normal life like any other person. Only if psoriatic arthritis is not well-treated, patients might develop permanent joint damage that leads to disability.
A rheumatologist is a specialist who will deal with diseases like psoriatic arthritis and rheumatoid arthritis. It is sometimes necessary to follow a multi-disciplinary approach.
Vitamin D containing topical ointments are being used around the world to treat psoriasis at the initial stage. The reason behind the use of this vitamin is that vitamin D can change the way cells grow.
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