An Overview of Psoriatic Arthritis

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Psoriatic arthritis is an inflammatory type of arthritis associated with psoriasis (a skin condition) and chronic joint symptoms. It is an autoimmune disease where the body’s immune system mistakenly attacks healthy tissue in the joints and skin. 

The symptoms of psoriasis and joint inflammation often develop separately. In 85 percent of people with the disease, psoriasis is the first symptoms, though arthritis may develop first in up to 15 percent of cases.

Psoriatic arthritis affects slightly more than 1 million adults in the United States, with men and women affected equally. First diagnosis is typically between ages 30 and 50, but it can develop at any age.

Symptoms

Psoriatic arthritis affects the joints and skin. Symptoms vary among different individuals but include both pain, stiffness, swelling, and skin rashes.

Any joint in the body can be affected by psoriatic arthritis. Stiffness and loss of range of motion in the morning especially are common and typically lasts more than a half hour.

Psoriasis can also be present in any part of the body with red, patchy, raised, or scaly skin. In addition, nail abnormalities may appear as pitting and thickened or discolored fingernails.

Other common symptoms associated with psoriatic arthritis include fatigue, swollen sausage-shaped fingers and toes (dactylitis),  tendinitis, enthesitis, low back pain, and conjunctivitis.

Causes

Psoriatic arthritis is an autoimmune disease, which means it occurs when the immune system mistakenly attacks healthy tissue of the joints and skin. This faulty immune response causes inflammation that triggers joint pain, stiffness, and swelling. The inflammation can affect the entire body and may lead to permanent joint and tissue damage if it is not treated early and aggressively.

Psoriatic arthritis belongs to a group of conditions known as spondyloarthropathies. There are five recognized types of psoriatic arthritis which are differentiated by their symptoms and may overlap:

  • Symmetric Psoriatic Arthritis affects joints on both sides of the body (e.g., both knees, both hips), and usually affects multiple joints (polyarthritis). It is similar to rheumatoid arthritis but is typically milder. About 25 percent of psoriatic arthritis patients have this type.
  • Asymmetric Psoriatic Arthritis does not affect the same joints on both sides of the body. Any joint can be affected, though. Sausage-like appearance of fingers and toes is common. Joints may be red, warm, swollen, and painful. Generally considered a mild form of psoriatic arthritis, it may become disabling in some people. About 80 percent of people with psoriatic arthritis are affected by this type.
  • Distal Interphalangeal Predominant (DIP) Psoriatic Arthritis is considered the "classic type," according to the National Psoriasis Foundation, although it occurs in only about 5 to 10 percent of those with psoriatic arthritis. This type primarily involves the distal joints of fingers and toes (the joint closest to the nail), and may alter the appearance of fingernails and toenails.
  • Spondylitis Type of Psoriatic Arthritis primarily affects the spine. Between 5 percent and 20 percent of people with psoriatic arthritis have this type and about half of those with spondylitis are positive for the genetic marker HLA-B27.
  • Arthritis Mutilans Type of Psoriatic Arthritis is a severe, disabling, and rare form that affects less than 5 percent of people with psoriatic arthritis. The arthritis mutilans type is characterized by joint deformity with the small joints of the hands and feet most impacted. Neck pain and low back pain are also associated with this type of psoriatic arthritis.

Diagnosis

Psoriatic arthritis is typically diagnosed and treated by a rheumatologist. There is no single test used for diagnosis, but your doctor will likely perform a physical examination then take x-rays and possibly an MRI, along with blood tests to rule out other types of arthritis with similar symptoms, such as rheumatoid arthritis, gout, reactive arthritis, ankylosing spondylitis, and osteoarthritis.

While some aspects of psoriatic arthritis are similar to other types of arthritis, it differs because it includes skin lesions and nail abnormalities, and has distinct patterns of inflammation.

Once the diagnosis is confirmed by your doctor, appropriate treatment can begin. Early diagnosis and early treatment are important to bring the disease under control, providing the best chance to prevent disability, disease progression, and permanent joint damage.

Treatment

Since psoriatic arthritis involves both the skin and joints, different treatments may be offered for different symptoms.

Your rheumatologist will determine your course of treatments by the severity of symptoms and potential positive and negative effects of different treatments, along with comorbidities.

NSAIDs (nonsteroidal anti-inflammatory drugs) are typically the first-line medication for people with mild peripheral arthritis symptoms. For people with moderate to severe arthritis symptoms, who do not respond well to NSAIDs alone, DMARDs (disease-modifying anti-rheumatic drugs), such as methotrexate or Arava (leflunomide), may be used.

Biologic drugs, such as TNF blockers, are appropriate for people with severe disease (e.g., evidence of erosions, several joints affected, considerable functional limitation). Corticosteroids are typically not used for psoriatic arthritis.

When skin symptoms are prominent, medications that can control both are optimal. TNF blockers are regarded as an effective treatment for both skin and joint aspects of psoriatic arthritis. Methotrexate, photochemotherapy, PUVA, retinoic acid, and cyclosporine A may help both skin and joint manifestations as well.

Coping

Being proactive in your treatment and practicing self-care is important for people with psoriatic arthritis. In addition to taking medications as prescribed, here are some ways you can help cope with the condition: 

  • Get regular exercise: Physical activity, such as walking and stretching daily, can help keep affected joints flexible and improve health and wellbeing. 
  • Lose weight: Excess weight puts added stress on joints. If you are carrying extra pounds, losing weight can help you feel better. Maintaining a healthy weight will hep you feel better long term.
  • Manage stress: Stress can increase inflammation and make it hard to manage daily activities. Deep breathing exercise, meditation, yoga, tai chi, or joining a support group can help to reduce stress. If these self-care methods do not work, talk to your doctor for other ideas. Some people find one-on-one counseling can help them learn new coping skills. 
  • Keep skin protected: Moisturize with lotions, remember to use any prescription or over-the-counter ointments or creams daily, and avoid hot baths or showers. 
  • Use gentle detergents: Stick to fragrance-free detergent and fabric softeners for washing clothes to reduce skin reactions.

A Word From Verywell

Psoriatic arthritis is a painful, progressive illness, and without proper treatment, could lead to a reduced quality of life and disability. If you think you may have psoriatic arthritis, speak to your doctor and start treatment as quickly as possible.

Psoriatic arthritis can be managed successfully so you can maintain your quality of life. This requires following your treatment plan and exercising self-care. Speak to your doctor about any problems, concerns, or side effects you have that may impact your willingness to take your medications.

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