If your psoriasis has turned into psoriatic arthritis, you may be feeling some serious joint pain. But your painful joints may not be the same as those of another patient. There are five different types of psoriatic arthritis, and each type affects different joints.
Psoriatic arthritis is an inflammatory condition that affects the joints of people with psoriasis. Psoriasis is a skin condition that causes red, scaly patches on the body. Not every psoriasis patient goes on to develop psoriatic arthritis, but every patient with psoriatic arthritis has psoriasis.
According to the National Psoriasis Foundation, about 7.5 million Americans have psoriasis. Research has shown that between 10 and 30 percent of these patients will go on to develop psoriatic arthritis.
In some cases, psoriatic arthritis may involve only a few joints, particularly those in the fingers and toes. However, the condition can become more severe and involve many joints, including the spine. As psoriatic arthritis worsens, the patchy scales of psoriasis may also become worse.
People with psoriatic arthritis may experience any of the five types of psoriatic arthritis. Some patients may even experience all five types over the course of their disease.
If you have psoriasis or psoriatic arthritis, you should know what each type of psoriatic arthritis looks like. Knowing the signs and symptoms of psoriatic arthritis can help you and your doctor figure out the right course of treatment.
Types of Psoriatic Arthritis
Symmetric psoriatic arthritis
Symmetric arthritis is one of the most common forms of psoriatic arthritis. It may look much like rheumatoid arthritis, but is typically milder and involves less joint deformity.
Symmetric arthritis affects the same joints on both sides of the body. Any joint can be affected.
Asymmetric psoriatic arthritis
This is another one of the most common types of psoriatic arthritis. Unlike symmetric arthritis, asymmetric arthritis does not happen in the same joints on both sides of the body.
In some patients, asymmetric arthritis involves only a few joints. In others, the condition involves many joints.
Asymmetric arthritis can affect any joint. Joints may feel warm and tender and may appear red. Joint pain may come in episodes, but can be controlled with medication.
Generally, asymmetric arthritis is mild. However, some patients may develop disability.
Distal interphalangeal predominant psoriatic arthritis
This type of psoriatic arthritis mainly involves the joints closest to the nails of the fingers and toes, which are known as the distal joints.
Distal interphalangeal predominant arthritis is rare, affecting only about 5 percent of patients with psoriatic arthritis. In some cases, this form of psoriatic arthritis is mistaken for osteoarthritis. However, changes to nails are frequent and easily seen.
Some patients experience a form of psoriatic arthritis that mainly affects the spine. This form is called spondylitis and causes inflammation in the joints between the vertebrae of the spine. Spondylitis is the main symptom in about 5 percent of psoriatic arthritis patients.
Symptoms of spondylitis often include pain and stiffness in the neck or back, which can lead to disability. Spondylitis can also spread to joints in the arms, legs, hands and feet.
Arthritis mutilans is the most severe and damaging form of psoriatic arthritis. It is the least common type of psoriatic arthritis, affecting less than 5 percent of patients.
Arthritis mutilans mainly affects small joints in the hands and feet. These joints can become deformed and cripples. Patients may even experience bone loss (osteolysis) at the joints, which can cause the fingers and toes to become shorter.
The neck and back may also be involved in this form of psoriatic arthritis.
Treating Psoriatic Arthritis
Treatment of psoriatic arthritis depends on the level of pain, how many joints are affected and whether patients respond to certain medications. Some patients with very mild arthritis may need treatment only when their joints are painful. But when the pain stops, they may also stop treatment.
In most cases, treatment starts with non-steroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs - such as Motrin, Advil or Aleve - are over-the-counter medications. Other NSAIDs - including Celebrex (celecoxib) and Voltaren (diclofenac) - can be obtained by prescription only.
If arthritis does not improve with NSAID therapy, doctors may prescribe disease modifying anti-rheumatic drugs (DMARDs). These medications include Azulfidine (sulfasalazine), Rheumatrex (methotrexate), Neoral or Sandimmune (cyclosporine) and Arava (leflunomide).
In certain cases, patients take combination medications that include anti-malarial drugs like Plaquenil (hydroxycholoroquine).
A class of newer medications has also become available to patients with psoriatic arthritis. Tumor necrosis factor (TNF) inhibitors have been shown to treat both the arthritis and skin problems that come with psoriasis. TNF inhibitors include Humira (adalimumab), Enbrel (etanercept) and Remicade (infliximab), among others.
Sometimes, steroid injections are used to treat very painful joints.
In the rarest of cases, patients may need surgery to repair or replace severely damaged joints. Surgery is generally reserved for patients with limited motion and function despite medical treatment.
Physical activity plays a key role in the treatment of most forms of arthritis. Regular exercise can help patients maintain strength and range of motion.
Exercises like weightlifting can strengthen the muscles around affected joints, giving those joints more support. Aerobic (e.g., walking, swimming or biking) and stretching exercises can help keep joints from becoming stiff and immobile.
While certain exercises can help, patients can overdo it. Pain lasting longer than two hours after exercise could be a sign of overuse or choosing the wrong exercise. Patients should talk to a doctor or physical therapist to find an exercise plan that best suits them.
Work with your doctor
At first, it's never clear which treatments will work best for which patients. Some patients may only need to keep up with an exercise plan and use over-the-counter medications when their joints become painful. Other patients, however, may need lifelong prescription treatment.
The only way your doctor can give you the best treatment possible is if you provide your doctor with the necessary information. Keeping track of your symptoms and how you feel when you take a certain drug can help your doctor decide on the treatment path that is best for you.
Tell your doctor what symptoms you are experiencing, what medications your are taking and the types of exercise you are doing. All this information is useful to your doctor.
Now that you know...
If you have psoriasis, it's important to know the signs and symptoms of psoriatic arthritis. This knowledge can allow you to realize when your condition has progressed into arthritis.
If you are experiencing joint pain in addition to your normal psoriasis symptoms, see your doctor as soon as possible. A doctor can provide advice and treatment for keeping your condition from getting worse.