The underlying process in psoriatic arthritis is inflammation, therefore treatments are directed at reducing and controlling inflammation. Milder cases of psoriatic arthitis may be treated with NSAIDS alone; however there is a trend toward earlier use of Disease-modifying antirheumatic drugs or biological response modifiers to prevent irreversible joint destruction.
Nonsteroidal anti-inflammatory drugs
Typically the medications first prescribed for psoriatic arthritis are NSAIDs such as ibuprofen and naproxen followed by more potent NSAIDs like diclofenac, indomethacin, and etodolac. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding. Other potential adverse effects include damage to the kidneys and cardiovascular system.
Disease-modifying antirheumatic drugs
Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly, and may take weeks or even months to take full effect. Drugs such as methotrexate or leflunomide are commonly prescribed; other DMARDS used to treat psoriatic arthritis include ciclosporin, azathioprine and sulfasalazine. These immunosuppressant drugs can also reduce psoriasis skin symptoms, but can lead to liver and kidney problems and an increased risk of serious infection.
Biological response modifiers
Biologic medications are derived from living cells cultured in a laboratory. Different from the traditional DMARDS that impact the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion.
Biologics prescribed for psoriatic arthritis are TNF-α inhibitors, including infliximab, etanercept, golimumab, certolizumab pegol and adalimumab.
Biologics may increase the risk of both minor and serious infections. More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer.
Other treatments
Doctors may use joint injections with corticosteroids in cases where one joint is severely impacted. In psoriatic arthritis patients with severe joint damage orthopedic surgery may be implemented to correct joint destruction, usually with use of a joint replacement. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.
Psoriatic arthritis is a condition involving joint inflammation (arthritis) that usually occurs in combination with a skin disorder called psoriasis. Psoriasis is a chronic inflammatory condition characterized by patches of red, irritated skin that are often covered by flaky white scales. People with psoriasis may also have changes in their fingernails and toenails, such as nails that become pitted or ridged, crumble, or separate from the nail beds.
Signs and symptoms of psoriatic arthritis include stiff, painful joints with redness, heat, and swelling in the surrounding tissues. When the hands and feet are affected, swelling and redness may result in a “sausage-like” appearance of the fingers or toes (dactylitis).
In most people with psoriatic arthritis, psoriasis appears before joint problems develop. Psoriasis typically begins during adolescence or young adulthood, and psoriatic arthritis usually occurs between the ages of 30 and 50. However, both conditions may occur at any age. In a small number of cases, psoriatic arthritis develops in the absence of noticeable skin changes.
Psoriatic arthritis may be difficult to distinguish from other forms of arthritis, particularly when skin changes are minimal or absent. Nail changes and dactylitis are two features that are characteristic of psoriatic arthritis, although they do not occur in all cases.
Psoriatic arthritis is categorized into five types: distal interphalangeal predominant, asymmetric oligoarticular, symmetric polyarthritis, spondylitis, and arthritis mutilans.
The distal interphalangeal predominant type affects mainly the ends of the fingers and toes. The distal interphalangeal joints are those closest to the nails. Nail changes are especially frequent with this form of psoriatic arthritis.
The asymmetric oligoarticular and symmetric polyarthritis types are the most common forms of psoriatic arthritis. The asymmetric oligoarticular type of psoriatic arthritis involves different joints on each side of the body, while the symmetric polyarthritis form affects the same joints on each side. Any joint in the body may be affected in these forms of the disorder, and symptoms range from mild to severe.
Some individuals with psoriatic arthritis have joint involvement that primarily involves spondylitis, which is inflammation in the joints between the vertebrae in the spine. Symptoms of this form of the disorder involve pain and stiffness in the back or neck, and movement is often impaired. Joints in the arms, legs, hands, and feet may also be involved.
The most severe and least common type of psoriatic arthritis is called arthritis mutilans. Fewer than 5 percent of individuals with psoriatic arthritis have this form of the disorder. Arthritis mutilans involves severe inflammation that damages the joints in the hands and feet, resulting in deformation and movement problems. Bone loss (osteolysis) at the joints may lead to shortening (telescoping) of the fingers and toes. Neck and back pain may also occur.
The specific cause of psoriatic arthritis is unknown. Its signs and symptoms result from excessive inflammation in and around the joints. Inflammation occurs when the immune system sends signaling molecules and white blood cells to a site of injury or disease to fight microbial invaders and facilitate tissue repair. When this has been accomplished, the body ordinarily stops the inflammatory response to prevent damage to its own cells and tissues. Mechanical stress on the joints, such as occurs in movement, may result in an excessive inflammatory response in people with psoriatic arthritis. The reasons for this excessive inflammatory response are unclear.
Researchers have identified changes in several genes that may influence the risk of developing psoriatic arthritis. The most well-studied of these genes belong to a family of genes called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body’s own proteins from proteins made by foreign invaders (such as viruses and bacteria). Each HLA gene has many different normal variations, allowing each person’s immune system to react to a wide range of foreign proteins. Variations of several HLA genes seem to affect the risk of developing psoriatic arthritis, as well as the type, severity, and progression of the condition.
Variations in several other genes have also been associated with psoriatic arthritis. Many of these genes are thought to play roles in immune system function. However, variations in these genes probably make only a small contribution to the overall risk of developing psoriatic arthritis. Other genetic and environmental factors are also likely to influence a person’s chances of developing this disorder.
If you notice strange signs or symptoms in yourself or a loved one that don’t clear up in a couple of weeks, plan a visit with your healthcare provider.
Start with your family doctor and discuss what’s happening. Try to describe as best you can the exact nature of your symptoms, when they started and any changes you’ve noticed, such as pain lasting longer.
Be sure to mention any family history that might be helpful in diagnosing your condition.
If necessary, you will be referred to a specialist in the area of your concern. This may include a physician
who specializes in certain diseases or other types of healthcare professionals.
If you have any questions about your symptoms or what’s being recommended, don’t be afraid to ask for clarification.
To make sure you go over all your concerns, you may want to write down the questions you want to ask your healthcare provider.
You may also want to ask about the costs of any procedures being recommended.
Psoriatic arthritis affects an estimated 24 in 10,000 people.
Between 5 and 10 percent of people with psoriasis develop psoriatic arthritis, according to most estimates. Some studies suggest a figure as high as 30 percent. Psoriasis itself is a common disorder, affecting approximately 2 to 3 percent of the population worldwide.
Seventy percent of people who develop psoriatic arthritis first show signs of psoriasis on the skin, 15 percent develop skin psoriasis and arthritis at the same time, and 15 percent develop skin psoriasis following the onset of psoriatic arthritis.
Psoriatic arthritis can develop in people who have any level severity of psoriatic skin disease from mild to very severe.
Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults.
More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterized by nail pitting, separation of the nail from the underlying nail bed, ridging and cracking, or more extremely, loss of the nail itself.
Men and women are equally affected by this condition. Like psoriasis, psoriatic arthritis is more common among Caucasians than Africans or Asians
Common symptoms of psoriatic arthritis include:
- Pain, swelling, or stiffness in one or more joints.
- Joints that are red or warm to the touch.
- Sausage-like swelling in the fingers or toes, known as dactylitis.
- Pain in and around the feet and ankles, especially tendinitis in the Achilles tendon or Plantar fasciitis in the sole of the foot.
- Changes to the nails, such as pitting or separation from the nail bed.
- Pain in the area of the Sacrum (the lower back, above the tailbone).
- Along with the above noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest. The exhaustion lasts for days to weeks without abatement. Psoriatic arthritis may remain mild, or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission.
Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended[5]
Living with a chronic disease is no easy task. It takes around-the-clock commitment to deal with symptoms. But your condition does not have to keep you down. There are a number of steps and lifestyle choices you can make to keep your disease under control and continue living a fulfilling life.
Create a conversation
When it comes to dealing with a chronic disease, starting a conversation with your doctor and other health care providers is one of the most important things you can do.
While the internet is a helpful tool for gaining basic information on your disease and prescription drugs, it can also be misleading. Ask your doctor or nurse about the drugs used to treat your condition and their potential side effects. If you want to know even more, your doctor should be able to recommend trustworthy sources of medical information on the internet or in your library. If your doctor cannot give you this information, maybe it is time to start looking for a new doctor.
One common misconception among patients is that their doctor knows everything. This is not only false, but impossible. Your doctor cannot know everything that is going on in your body. That is why it is important to be aware of your body and any changes you might experience.
Your health is your responsibility. If you have diabetes, you must pay attention to changes in blood sugar. If you have heart problems, you need to pay attention to your weight.
Depending on your chronic condition, you may need to seek out experts. Your doctor is probably an intelligent person, but they cannot know everything there is to know about your condition. If you have arthritis, finding a rheumatology expert. If you have heart disease, find a cardiovascular expert.
Now that you have assembled a team, you and your primary doctor can coordinate care. Together, you and your health care team can decide what treatments are safe and effective for you.
Lifestyle Choices
Treating almost any chronic condition requires you to make healthy lifestyle choices. In just about every case of chronic disease, you will need to quit smoking, lose weight, exercise more, and eat a healthy diet.
Patients who make healthy lifestyle choices are more successful at controlling their disease. Certain patients, such as those with type 2 diabetes, can even reverse their disease through lifestyle changes.
Make it a family effort
The healthy choices you make to control your condition are not only good for you, but for almost anyone. Sometimes, it can be difficult to stick to the lifestyle changes you have made. But if your whole family jumps on board, you have some added support to keep your commitments.
Keep an eye on your mental health
Your condition may affect you day in and day out. This not only takes a toll on your physical health, but also on your mental health. Depression, anxiety, and stress are common among people with chronic conditions.
If you start to notice you are experiencing signs of depression, talk to your doctor. You may need to switch your medication or see a therapist.
There is no definitive test to diagnose psoriatic arthritis. Symptoms of psoriatic arthritis may closely resemble other diseases, including rheumatoid arthritis. A rheumatologist (a doctor specializing in diseases affecting the joints) may use physical examinations, health history, blood tests and x-rays to accurately diagnose psoriatic arthritis.
Factors that contribute to a diagnosis of psoriatic arthritis include:
- Psoriasis in the patient, or a family history of psoriasis or psoriatic arthritis.
- A negative test result for Rheumatoid factor, a blood factor associated with rheumatoid arthritis.
- Arthritis symptoms in the distal Interphalangeal articulations of hand (the joints closest to the tips of the fingers). This is not typical of rheumatoid arthritis.
- Ridging or pitting of fingernails or toenails (onycholysis), which is associated with psoriasis and psoriatic arthritis.
- Radiologic images indicating joint change.
Other symptoms that are more typical of psoriatic arthritis than other forms of arthritis include inflammation in the Achilles tendon (at the back of the heel) or the Plantar fascia (bottom of the feet), and dactylitis (sausage-like swelling of the fingers or toes).
There are five main types of psoriatic arthritis:
- Asymmetric: This type affects around 70% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves fewer than 3 joints.
- Symmetric: This type accounts for around 25% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to rheumatoid arthritis and is disabling in around 50% of all cases.
- Arthritis mutilans: Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage. Arthritis mutilans has also been called chronic absorptive arthritis, and may be seen in rheumatoid arthritis as well.
- Spondylitis: This type is characterized by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis.
- Distal interphalangeal predominant: This type of psoriatic arthritis is found in about 5% of patients, and is characterized by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.