Psoriatic Arthritis Mutilans: What to Know

Psoriatic arthritis mutilans is a rare subtype of psoriatic arthritis (PsA). Fewer than 5% of people with PsA develop the condition. Though it's most common in people with PsA it can also develop in those with rheumatoid arthritis.

Psoriatic arthritis mutilans is also the most destructive form of PsA. In addition to common PsA symptoms, psoriatic arthritis mutilans damages and destroys the affected joints and bones.

This article discusses causes, symptoms, and treatment for psoriatic arthritis mutilans, as well as coping strategies for living with this condition.

Symptoms of Psoriatic Arthritis Mutilans

Psoriatic arthritis mutilans (PAM) is the most severe subtype of PsA. Symptoms are worse during “flares,” or periods of increased disease activity that can last for days or months.

General symptoms of PsA include:

• Joint pain
• Stiffness
• Decreased joint movement
• Swollen joints
• Fatigue
• Changes in the nails
• Red, painful eyes
• Itchy, red patches of skin

The psoriatic arthritis mutilans subtype has additional symptoms caused by the breakdown of bone in the hands and feet. These include:

• Shortening of the fingers or toes
• Flail joints (inability to hold your fingers in any position)

This condition also causes “opera glass hands” or “telescoping fingers”—when the affected finger is pulled on, it stretches out like opera glasses or a telescope.

On X-ray, additional deformities are often seen with PAM, including:

• Pencil-in-cup: One end of the bone is worn down into the shape of a “pencil tip.”
• Joint subluxation: Bones are partially out of place.
• Ankylosis: Bones fuse together.

Causes of PsA Mutilans

The exact cause of PsA and its subtypes, including PAM, is not known. This condition is a result of the immune system attacking the body’s joints as if they are foreign substances.

High levels of inflammation also make your joints more vulnerable to additional damage from mechanical stress—pressure on your joints from everyday movements.

Who Is at Risk?

PsA affects both men and women equally, typically after the age of 30 years. It most commonly occurs in White people.

Several risk factors can possibly increase a person’s risk of developing PAM and other types of psoriatic arthritis. These include:

• Obesity
• Severe psoriasis
• Smoking
• Physical trauma
• High stress levels
• Infectious diseases
• Repetitive heavy lifting
• Excessive alcohol consumption
  

Diagnosing Psoriatic Arthritis Mutilans

There isn’t one specific test for psoriatic arthritis mutilans. This condition is diagnosed through a series of blood tests, X-rays, MRI scans, and physical examination.

Blood Tests

Blood tests do not specifically diagnose PAM. However, they can provide information about inflammation in the body.

Higher rates of erythrocyte sedimentation rate and C-reactive protein are sometimes present in people with PAM. Blood testing is also used to look for the presence of specific HLA genes.

X-Rays

X-rays of the hands and feet are useful in the diagnosis of psoriatic arthritis mutilans. X-rays show the bone loss and deformities (joint collapse, subluxation, and bone fusion) that occur with this condition.

MRI Scans

MRI scans provide images of soft tissues—tendons and ligaments—that are often inflamed when you have psoriatic arthritis mutilans.

Skin Exam

Psoriatic arthritis mutilans often occurs along with a skin condition called psoriasis. This condition speeds up skin growth from around one month to three to four days.

Skin exams are used to look for symptoms of psoriasis, such as:

• Patches of thick skin
• Red, itchy skin
• Painful skin

Treatments and Home Remedies

There is no cure for psoriatic arthritis mutilans. However, a variety of treatments and home remedies can help manage your symptoms.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) help decrease inflammation and pain caused by PAM. Several types of NSAIDs are available over-the-counter, including Advil (ibuprofen), Ecotrin (aspirin), and Aleve (naproxen).

However, higher doses of these medications, available by prescription, are often needed to effectively treat PAM.

Steroids

Corticosteroids are strong medications that reduce inflammation and suppress the immune system. These medications are often taken orally, but steroids can also be injected directly into joints affected by your psoriatic arthritis mutilans.

Long-term use of corticosteroids can have serious side effects, however, such as:

• Increased risk of infection
• Ulcers
• Gastrointestinal bleeding
• Osteoporosis (bone loss)
• Weight gain
• Difficulty sleeping
• Mood swings
• Increased blood pressure
• High blood sugar levels
• Fluid retention
• Vision problems
  

DMARDs

Disease-modifying anti-rheumatic drugs (DMARDs) are often used to treat PAM. Rather than just treating the symptoms of your condition, DMARDs target your overactive immune system.

DMARDs are taken orally, through injection, or by infusion. The most commonly used DMARD is methotrexate.

These medications can also cause negative side effects, including:

• Mouth sores
• Upset stomach
• Low blood cell counts
• Abnormal liver function

Biologics

Biologics are a specific type of DMARD that target a specific part of your immune system. These treatments are typically used when traditional DMARDs are not effective.

There are four types of biologics:

• Tumor necrosis factor (TNF) inhibitors
• B-cell inhibitors
• Interleukin inhibitors
• Selective co-stimulation modulators

Physical Therapy

Physical therapy can help treat the joint stiffness, decreased range of motion, pain, and weakness that occur with psoriatic arthritis mutilans.

Physical therapists use a variety of modalities—UV therapy, ultrasound, cryotherapy, heat, electrical stimulation, and massage—to help decrease pain and inflammation in your affected joints. Splinting can also be used to support joints that are impacted by your condition.

If your mobility is significantly impacted by your condition, your physical therapist can teach you how to use assistive devices to improve your walking, and provide adaptive equipment to make daily tasks easier.

Your physical therapist will also teach you safe ways to exercise to improve flexibility, strength, and cardiovascular fitness.

Coping With PsA Mutilans

While you can’t control what happens with your medical condition, there are things you can do to improve your quality of life when you’re living with psoriatic arthritis mutilans:

• Take your medications: Follow your doctor’s instructions and take your medications as scheduled.
• Incorporate a healthy diet: Try to minimize intake of processed foods.
• Reduce your stress: Incorporate stress-relieving techniques—meditation, deep breathing, guided imagery, and gentle exercise—into your life to help you cope with your chronic illness.
• Seek support: Living with chronic illness can make you feel like you’re alone, but you’re not. Talk to your friends and family about your symptoms. Consider joining a support group.
• Pace yourself: Take frequent rest breaks during the day to conserve energy.
  

Summary

Psoriatic arthritis mutilans is a subtype of psoriatic arthritis—an autoimmune disease that causes severe inflammation in your joints. This condition causes joint pain, swelling, fatigue, and stiffness. Although the exact cause of PAM is not known, genetics play a role.

PAM is diagnosed through a combination of blood tests, X-rays, MRI, and physical exam. Treatment includes physical therapy and medications such as NSAIDs, corticosteroids, DMARDs, and biologics. Home remedies can be used to help manage your symptoms.

A Word From Verywell

Living with a chronic disease such as psoriatic arthritis mutilans can feel overwhelming, but educating yourself about your condition and ways to manage your symptoms can help. Talk to your doctor about treatment options and ways you can improve your quality of life.