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Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic type of arthritis that causes inflammation, swelling, and joint pain. It affects people who are already diagnosed with psoriasis. Psoriasis is a skin condition that causes red patches to appear on the skin. Psoriatic arthritis causes the joints in these areas to swell and stiffen, causing a large amount of pain. Sometimes, the damage to the joints can be so severe that it causes permanent deformities.

The disease has no known cure. However, early diagnosis prevents the disease from progressing further. Psoriatic arthritis usually develops five to ten years after a psoriasis diagnosis. Though, some people may start experiencing joint problems long before the psoriasis symptoms appear. People with psoriatic arthritis go through periods of remission and relapse. Any treatment helps to manage symptoms and prevent further damage to the joints.


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Types of Psoriatic Arthritis

Listed below are the types of psoriatic arthritis:

  1. Symmetric PsA: This type of psoriatic arthritis affects the same kind of joints on each side of the body. It is the most common type, with about half of all psoriatic arthritis diagnoses being symmetric PsA. The symptoms of symmetric PsA are like those of rheumatoid arthritis. The only difference is that symmetric PsA is mild and doesn’t cause as much joint deformity as RA. It can, however,r lead to a disability.
  2. Asymmetric PsA: This type of PsA affects joints on only one side of the body. The affected joints may appear red and feel sore. The condition is usually mild and doesn’t progress to severe or permanent joint damage.
  3. Distal PsA: This type of psoriatic arthritis affects just the distal joints. Distal joints are the joints closest to the nails on the hands and feet. The toenails and fingernails change appearance with this type of arthritis.
  4. Spondylitis PsA: This type affects the spine in areas like the neck and lower back. Spondylitis PSA results in pain while moving. It can affect any part of the body including the arms, legs, feet, hips, and hands.
  5. PsA Mutilans: This is a severe type of PsA. It is rare and makes up only about 5% of cases. Psoriatic arthritis mutilans lead to joint deformity of the hands and feet. It can also cause chronic lower back and neck pain.

Symptoms of Psoriatic Arthritis

The symptoms of PsA differ from one person to another. Depending on the type and progression of the disease, symptoms can either be mild or severe. Common symptoms include:

  • Swelling and tenderness in the joints (on one or both sides of the body)
  • Joint stiffness (especially after waking up)
  • Swelling of the toes and fingers
  • Muscle and tendon pain
  • Scaly skin that may worsen when the pain flares up
  • Flaky skin on the scalp
  • Fatigue and eye redness
  • Nail pitting and sometimes nails might appear to be separated from the nail bed

Diagnosis of Psoriatic Arthritis

To diagnose PsA, the doctor will conduct a physical exam to see if there are any swollen or painful joints. They will also look for specific arthritis patterns and nail and skin changes. The doctor can also order tests like:

Imaging Test: The doctor will use X-rays, ultrasounds, MRIs, and/or CT scans to assess the extent of joint damage.

Blood Test: Blood tests diagnose other types of arthritis. These include rheumatoid arthritis, osteoarthritis, and gout — which all cause similar symptoms as PsA.

Skin Biopsy: A small sample of the skin is taken to confirm a psoriasis diagnosis.

How to Treat Psoriatic Arthritis

The goal of PsA treatments is to alleviate symptoms like joint pain, inflammation, and skin rash. Some common treatments used are:

  • Disease-Modifying Antirheumatics: These medications halt the disease progression and slow down joint damage. The most common include methotrexate (Trexall), sulfasalazine (Azulfidine), and leflunomide (Arava).
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are medications used to manage joint swelling and pain. The doctor will first recommend over-the-counter options like ibuprofen and naproxen. If these don’t ease the symptoms, higher doses of NSAIDs are prescribed.
  • Biologics: Biologics are a different class of drugs. The drug prescribed will depend on what the drug will target or inhibit. Biologics are given as an infusion or injection under the skin. However, the drugs can affect the body’s immune response, leaving you prone to infections.
  • Immunosuppressants: Immunosuppressants calm an overactive immune response, especially in psoriasis patients. The most common include cyclosporine (Gengraf) and azathioprine (Imuran). Immunosuppressants are only used if a TNF-alpha inhibitor is not an option.
  • Steroids: Steroids help reduce inflammation. For psoriatic arthritis patients, steroids are injected directly into the affected joints.
  • Light Therapy: Light therapy aims to treat skin rashes common with psoriasis.
  • Topical Treatments: The doctor may also prescribe topical treatments in the form of lotions, gels, and creams. These relieve itchy rashes and are available over the counter as long as you have a prescription.

How to Manage Psoriatic Arthritis

Living with any form of arthritis can be difficult. Arthritis causes muscle and joint weakness due to limited use. With psoriatic arthritis, you have to deal with unpredictable periods of flare-up and remission.

Exercise should help improve joint flexibility and your overall health. When walking, use shoe inserts or a walking aid to avoid straining the joints further. Stretching and yoga can also help improve joint strength and flexibility. Occupational and physical therapy has been used in managing psoriatic arthritis too. These strengthen the muscles, increase flexibility, and prevent further joint damage.


FAQ

  1. What are the common symptoms of PsA? Joint pain, stiffness, swelling, and reduced range of motion are some of the common symptoms of PsA. If left untreated, it can cause permanent joint damage and disfiguration.
  2. What lifestyle changes do I need to make after a psoriatic arthritis diagnosis? The first thing you need to consider is switching to a nutritious diet. The right diet can increase your energy levels while reducing and preventing inflammation. At the same time, low-impact exercises (like walking and swimming) can help strengthen the muscles and joints and improve your range of motion.

Healthier Me Today is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment, always consult with your healthcare professional. Stay healthy!

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