About psoriatic arthritis
What is psoriatic arthritis?
Psoriatic arthritis is a chronic disease characterized by a form of inflammation of the skin (psoriasis) and joints (inflammatory arthritis).
- Some 10%-15% of people with psoriasis also develop inflammation of joints (psoriatic arthritis).
- The first appearance of the skin disease (psoriasis) can be separated from the onset of joint disease (arthritis) by years.
- Psoriatic arthritis belongs to a group of arthritis conditions that can cause inflammation of the spine (spondyloarthropathies).
- Patients with psoriatic arthritis can develop inflammation of tendons, cartilage, eyes, lung lining, and, rarely, the aorta.
- The arthritis of psoriatic arthritis is treated independently of the psoriasis, with exercise, ice applications, medications, and surgery.
What is psoriatic arthritis?
Psoriatic arthritis is a chronic disease characterized by a form of inflammation of the skin (psoriasis) and joints (inflammatory arthritis). Psoriasis is a common skin condition affecting 2% of the Caucasian population in the United States. It features patchy, raised, red areas of skin inflammation with scaling. Psoriasis often affects the tips of the elbows and knees, the scalp and ears, the navel, and around the genital areas or anus. Approximately 10%-15% of patients who have psoriasis also develop an associated inflammation of their joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as having psoriatic arthritis.
The onset of psoriatic arthritis generally occurs in the fourth and fifth decades of life. Males and females are affected equally. The skin disease (psoriasis) and the joint disease (arthritis) often appear separately. In fact, the skin disease precedes the arthritis in nearly 80% of patients. However, the arthritis may precede the psoriasis in up to 15% of patients. In some patients, the diagnosis of psoriatic arthritis can be difficult if the arthritis precedes psoriasis by many years. In fact, some patients have had arthritis for over 20 years before psoriasis eventually appears! Conversely, patients can have psoriasis for over 20 years prior to the development of arthritis, leading to the ultimate diagnosis of psoriatic arthritis.
Psoriatic arthritis is a systemic rheumatic disease that also can cause inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys. Psoriatic arthritis shares many features with several other arthritic conditions, such as ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn's disease and ulcerative colitis. All of these conditions can cause inflammation in the spine and other joints, and the eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these conditions are collectively referred to as "spondyloarthropathies."
What are the symptoms for psoriatic arthritis?
Both psoriatic Arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.
Psoriatic Arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic Arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.
However, psoriatic Arthritis is more likely to also cause:
- Swollen fingers and toes. Psoriatic Arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
- Foot pain. Psoriatic Arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
- Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).
When to see a doctor
If you have psoriasis, be sure to tell your doctor if you develop joint pain. Psoriatic Arthritis can severely damage your joints if left untreated.
What are the causes for psoriatic arthritis?
Psoriatic arthritis occurs when your body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.
It's not entirely clear why the immune system turns on healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.
Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.
What are the treatments for psoriatic arthritis?
The treatment of the arthritis aspects of psoriatic arthritis is described below. The treatment of psoriasis and the other involved organs is beyond the scope of this article.
Generally, the treatment of arthritis in psoriatic arthritis involves a combination of anti-inflammatory medications (NSAIDs) and exercise. If progressive inflammation and joint destruction occur despite NSAIDs treatment, more potent medications such as methotrexate (Rheumatrex, Trexall), corticosteroids, and antimalarial medications (such as hydroxychloroquine [Plaquenil]) are used.
Exercise programs can be done at home or with a physical therapist and are customized according to the disease and physical capabilities of each patient. Warm-up stretching, or other techniques, such as a hot shower or heat applications are helpful to relax muscles prior to exercise. Ice application after the routine can help minimize post-exercise soreness and inflammation. In general, exercises for arthritis are performed for the purpose of strengthening and maintaining or improving joint range of motion. They should be done on a regular basis for best results.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that are helpful in reducing joint inflammation, pain, and stiffness. Examples of NSAIDs include aspirin, indomethacin (Indocin), tolmetin sodium (Tolectin), sulindac (Clinoril), and diclofenac (Voltaren). Their most frequent side effects include stomach upset and ulceration. They can also cause gastrointestinal bleeding. Newer NSAIDs called COX-2 inhibitors (such as celecoxib [Celebrex]) cause gastrointestinal problems less frequently.
What are the risk factors for psoriatic arthritis?
Several factors can increase your risk of psoriatic arthritis, including:
- Psoriasis. Having psoriasis is the single greatest risk factor for developing psoriatic arthritis. People who have psoriasis lesions on their nails are especially likely to develop psoriatic arthritis.
- Your family history. Many people with psoriatic arthritis have a parent or a sibling with the disease.
- Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.
Is there a cure/medications for psoriatic arthritis?
Psoriatic arthritis is a chronic condition classified by a form of inflammatory skin and inflammation in joints (inflammatory arthritis). Affecting males as much as females, this disease shows signs in the fourth and fifth decades of your lifetime.
Psoriasis targets the tips of one’s elbows and knees, the scalp and ears, the navel, and around the genital area or anus. Patients with both arthritis and psoriasis are diagnosed with psoriatic arthritis.
Cure/medications for Psoriatic Arthritis
Usually, the treatment of psoriatic arthritis involves a fusion of anti-inflammatory medications with exercise.
Potent medications for psoriatic arthritis:
1. Methotrexate (Rheumatrex and Trexall)
3. Hydroxychloroquine (Plaquenil)
Nonsteroidal anti-inflammatory drugs (NSAIDs):
2. Indomethacin (Indocin)
3. Tolmetin sodium (Tolectin)
4. Sulindac (Clinoril)
5. Diclofenac (Volteran)
6. COX-2 inhibitors (Celebrex)
Swollen fingers and toes,Foot pain,Lower back pain,Nail changes,Eye inflammation
Red patches of skin topped with silvery scales
NSAIDs,Conventional DMARDs,Biologic agents,Targeted synthetic DMARDs,Newer oral medication