The basics of psoriatic arthritis

Psoriatic arthritis is an inflammatory arthritis that affects up to 30% of people who have psoriasis, according to The Arthritis Society. This condition causes pain and swelling in joints - usually the joints of the fingers and toes, although it can also involve the wrists, knees, ankles, spine, and sacroiliac joints (located in the lower back where the spine connects with the hips).

The primary symptoms of psoriatic arthritis include:

  • pain and swelling around joints, particularly in the fingers and toes
  • pain and swelling in areas where tendons and ligaments attach to bone (such as your heel)
  • "pitting" (small holes or indentations) on fingernails or toenails
  • "lifting" of fingernails or toenails
  • decrease in range of motion of joints
  • stiffness and tiredness that occurs in the morning
  • silver scales on the skin around the scalp, knees, elbows, or lower back
  • back pain (if present at all) that increases primarily at night and in the morning

Psoriatic arthritis can affect both men and women of all races, and can appear at any time, although the onset usually occurs between the ages of 20 and 50. Usually it affects people who have already been diagnosed with psoriasis (typically, if psoriatic arthritis does appear, it does so about 10 years after the onset of psoriasis). About 15% of people with psoriatic arthritis develop this condition before their skin shows typical signs of psoriasis (raised, red, scaly patches).

Psoriatic arthritis is one of the less common forms of arthritis, and its cause is not well established, although it is known to be linked to psoriasis. Heredity is thought to play an important role, as many people who have the condition also have family members with psoriatic arthritis or psoriasis. If one of your parents has psoriatic arthritis, your chances of developing the condition increase three-fold. Other possible causes are believed to be related to environmental factors as well as to the individual's immune system.

If you think you may have psoriatic arthritis, or if you have any concerns about possibly developing it, speak to your physician. This condition can develop slowly or quickly, and an early diagnosis can help control and treat its effects.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-All-About-Psoriatic-Arthritis

Different types of psoriatic arthritis

Several different kinds of arthritis exist, and psoriatic arthritis is just one of them. And within psoriatic arthritis, there are five types that can appear. These types include symmetric arthritis, asymmetric arthritis, spondylitis, distal interphalangeal predominant (DIP), and arthritis mutilans. Some people may encounter features of more than one type of psoriatic arthritis, or over time they may experience a change in the pattern of their condition. For these reasons, it can be difficult to determine exactly which type of psoriatic arthritis you may have.

Symmetric arthritis (also called symmetrical polyarthritis): This is the type that affects about 50% of those with psoriatic arthritis. It resembles a mild form of rheumatoid arthritis and usually affects joints on both sides of the body (which is why this type is called "symmetric"). This condition tends to involve severe psoriasis, and may also progress to a disabling state for about half of those affected.

Asymmetric arthritis: This type involves the joints of the extremities. After symmetric arthritis, it is the next most common type, affecting about 35% of those with psoriatic arthritis. It does not usually affect joints on both sides of the body (hence the name "asymmetric"). This condition usually remains at a mild state; however, in some people it may progress to a stage of disability.

Spondylitis: This type of arthritis usually causes inflammation of the sacroiliac joints (located in the lower back where the spine connects with the hips) and spine, although it can also affect the arms, legs, hands, and feet. This condition makes it difficult for people to move about, and it causes pain while doing so.

Distal interphalangeal predominant (DIP): This condition involves the joints of the fingers and the toes that are closest to the nails.

Arthritis mutilans: This is a rare but severe form of psoriatic arthritis. Affecting less than 5% of people with psoriatic arthritis, it appears mainly in the joints of the hands and feet, and causes deformity to those areas. This condition tends to be closely linked to psoriasis in terms of flare-ups and remission, as these events will often occur around the same time.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-All-About-Psoriatic-Arthritis

Diagnosing psoriatic arthritis

Currently, no single test exists that can, on its own, provide a diagnosis of psoriatic arthritis. However, there are various tests and criteria that your doctor can evaluate to help arrive at this diagnosis.

Your doctor can most easily diagnose psoriatic arthritis if you already show signs and symptoms of psoriasis and have either red, swollen fingers or red, swollen toes. (The presence of psoriasis lesions on the skin and nails are a key to confirming this diagnosis.) Your doctor will also likely review your medical history and may perform a physical examination. If psoriatic arthritis is suspected, tests such as X-rays, blood tests, and joint fluid tests may be needed to help your doctor determine this diagnosis (and rule out other possibilities).

Your doctor may also refer you to speak with a specialist who has expertise in treating arthritis (a rheumatologist) and who may be able to best diagnose your condition. (As the symptoms of psoriatic arthritis are known to resemble those of other conditions such as rheumatoid arthritis or gout, the diagnosis can be difficult to make.) The rheumatologist may also be able to recommend the best treatment plan for you. If you have psoriatic arthritis, or think you do, keep in mind that an early diagnosis is important so that treatment can begin as soon as possible to help prevent bone loss and maintain maximum range of motion.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-All-About-Psoriatic-Arthritis

Treatment options for psoriatic arthritis

If you have been diagnosed with psoriatic arthritis, a variety of treatment options exist. Your doctor or specialist will work with you to find a treatment plan that works best for you. The goal of treatment is to reduce the pain and swelling in your joints, and to help you maintain the greatest range of motion. In addition, treatment may prevent any further damage from occurring.

Treatment for psoriatic arthritis can involve medications, exercise, skin care, hot/cold applications, relaxation techniques, or surgery.

Medications - NSAIDs: Your doctor may suggest you take NSAIDs (nonsteroidal anti-inflammatory drugs) to help control your pain and reduce the swelling and stiffness in your joints. Some types of NSAIDs (such as ASA and ibuprofen) are available over the counter (without a prescription), while most require a prescription from your doctor. Your doctor will work with you to see which of these medications give you the most relief while causing minimal side effects (such as stomach problems ).

Medications - DMARDs: DMARDs (disease-modifying anti-rheumatic drugs) may be recommended for cases of advanced psoriatic arthritis, and they work to alleviate the inflammation in your joints. They may take several months before they reach their full effect, and may be used in combination with NSAIDs. These types of medications include methotrexate, sulfasalazine, gold salts, hydroxychloroquine, and azathioprine. Side effects that may arise include mouth sores, diarrhea, and nausea. Corticosteroid medications taken by mouth may be used on a short-term basis to relieve inflammation, and corticosteroid injections to the joint (and areas around it) may also prove beneficial.

Exercise: Exercise is important to help keep your joints moving and prevent further damage. If you don't use a joint, it will stiffen and the surrounding muscles will weaken, both of which can cause further problems. Do your best to keep your joints in use, and talk to your doctor about starting an exercise schedule. He or she can recommend specific exercises designed to help improve and manage your condition.

Skin care: Because of the link to psoriasis, people with psoriatic arthritis need to take special care of their skin. See our feature on "Psoriasis: Managing and Preventing Flare-Ups" for further information. Light therapy in the form of PUVA treatment (psoralen plus ultraviolet light A) is used to treat psoriatic arthritis, usually together with other medications.

Hot/cold applications: Most of us know that applying hot packs can help when we have sore muscles, or cold packs for an injury that might swell. These same principles can be used to help manage psoriatic arthritis pain and swelling. Applying heat (such as a hot pack, or having a hot shower) can help relax tight muscles around painful joints and improve circulation to the desired area. Applying a cold pack (such as a bag of frozen peas) helps constrict the blood vessels in the area and helps reduce swelling and pain. Talk to your doctor before trying these treatments to make sure they are safe for you.

Relaxation techniques: Easing tension not only helps reduce sore, aching muscles around tender joints, but it can improve your outlook on your condition. Different people prefer different methods of relaxation. Explore what works well for you. This may involve a walk in the park, an hour of solitude, or prayer or meditation.

Surgery: Joint replacement surgery is an option for some people whose psoriatic arthritis has reached a point where their joints have become severely damaged. In this case, the surgeon will replace the damaged joint with a better-functioning, artificial one.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Psoriasis-All-About-Psoriatic-Arthritis