What is Psoriatic Arthritis

Psoriasis is a common skin condition which affects over 2% of the population in the United States. Typically featured as patchy, raised, red areas of skin inflammation with scaling, psoriasis often affects the tips of the elbows and knees, the scalp, navel, and around the anus and genital areas. About 10% of those who suffer from psoriasis will also develop and associated inflammation of the joints, called psoriatic arthritis.(1)

About 1 in 10 people with psoriasis will also develop inflammation of joints. Psoriatic arthritis belongs to a group of arthritis conditions that may cause inflammation of the spine. The cause of psoriatic arthritis is currently unknown, but a combination of genetic and immune factors as well as environmental factors, are likely involved.

Psoriatic Arthritis Types

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Physicians have identified five different types of psoriatic arthritis which will affect the symptoms that individuals experience over time.

The mildest form is called asymmetric psoriatic arthritis that affects joints on only one side of the body, or different joints on each side of the body. Most often fewer than five joints are involved.

When pain occurs on both sides of the body and is symmetrical it is called symmetric psoriatic arthritis. More than five joints are often affected and it appears that more women than men are at risk for symmetric psoriatic arthritis. The psoriasis that is associated with this condition tends to be more severe.

Another form of psoriatic arthritis is distal interphalangeal joints, which is rare in occurs mostly in men. In this type the smallest joints closest to the nails of the fingers and toes are affected.

Doctors have noted that 80% of patients who suffer from psoriatic arthritis will also have pitting and ridges seen in the fingernails and toenails. These particular nail changes are observed in only a minority of patients who also experienced psoriasis but do not have arthritis. There is also an increasing frequency of individuals who have psoriatic arthritis and also suffer from acne.

Another form is called spondylitis which causes inflammation of the spine as well as a stiffness and pain in the neck, lower back or sacroiliac joints. In approximately 50% of those who present with spondylitis a genetic marker can also be found.

The fifth type is destructive arthritis which a small percentage will experience. This is a severe, painful and disabling form of psoriatic arthritis which destroys the small bones of the hands and leads to permanent deformity and disability.3

Risk Factors

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Psoriatic arthritis often occurs within both males and females over the age of fifty and affects both sexes equally. Psoriasis and the joint disease arthritis often appear separately as the arthritis may precede the psoriasis in the majority of patients. Some patients may have had arthritis for over twenty years prior to developing psoriasis.

Patients may have psoriasis for over twenty years prior to the development of arthritis which eventually leads to the diagnosis of psoriatic arthritis. Patients with psoriatic arthritis may also develop inflammation of tendons, cartilage, eyes, lining of the lungs, and occasionally the aorta. Psoriatic arthritic may also mimic the pattern seen with rheumatoid arthritis.

Rheumatic Disease

Psoriatic arthritis is a systemic rheumatic disease which may cause inflammation in body tissues away from the joints other than the skin, typically in the eyes, heart, lungs, and kidneys. Psoriatic arthritis shares similar features with several other arthritic conditions, including Crohns Disease and ulcerative colitis. All of these conditions, including psoriatic arthritis, can cause inflammation in the spine and other joints, plus in the skin, eyes, mouth, and other various organs.

Research has shown that persistent inflammation in the joints from psoriatic arthritis can lead to damage that is permanent. Early diagnosis is important to avoid this joint damage.2

Treatment

The treatment of psoriatic arthritis typically involves a combination of anti-inflammatory medications and exercise. If progressive inflammation and joint destruction occur despite these treatment options, more potent medications such as methotrexate, corticosteroids, and anti-malarial medications are the next step in treatment.

Your physician or rheumatologists will assess the signs and symptoms you present with and try to rule out other causes of joint pain, such as osteoarthritis. The physician will often recommend x-rays, tests of the joint fluid, blood tests for sedimentation rate and rheumatoid factor and will perform a thorough physical examination.4

Because no causative agent has been discovered there is also no cure for psoriatic arthritis. The physician may prescribe nonsteroidal anti-inflammatory drugs or salicylates to reduce the pain and inflammation of the joints. Individuals who have severe arthritis may also be prescribed disease modifying antirheumatic drugs such as methotrexate.

Exercise programs are also highly recommended and may be done at home or with a

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. These exercise programs can be customized according to the disease and physical capabilities of each patient. Exercises for arthritis are performed for the sole purpose of strengthening and maintaining or improving joint range of motion. These exercises should always be done on a regular basis for the best results.

Currently, there are newer medications on the market that block the inflammatory protein called tumor necrosis factor and are fast becoming the treatment of choice. Three of these medications include Humira, Enbrel and Remicade.

On occasion physicians may inject joints which are particularly painful with steroid medications to help reduce the inflammation. In other cases, joint replacement surgery may be required in order to allow the individual to continue to be functional.

In almost all cases the physician will suggest a mix of rest and exercise in order to help support the joints. Physical therapy will help increase the movement of specific joints and teach individuals the types of exercises which will improve muscle strength, support the joints and reduce the damage.

Future treatments for patients with psoriatic arthritis will continue to evolve as more effective and safe medications are developed. Vitamin D has recently been shown to help improve arthritis of psoriatic arthritis. Additional areas of research involve treatment with medications which may alter the immune system of patients with psoriatic arthritis.

Other areas of research may involve treatment with medications that may alter the immune system of patients with psoriatic arthritis. As the immune system changes and genetics become better defined with this illness, the efficacy of available medical treatments will likely improve.

This particular type of arthritis also tends to alternate between flare ups in periods of improvement. Factors that will influence how severe the diseases includes clinical pattern, age at which the symptoms appeared, severity of any skin symptoms and family history of arthritis.

As with any other disease psoriatic arthritis responds best when found early. Therefore early diagnosis and treatment is essential to decreasing the damage done to the joints and improving the overall function in reducing the disability of individuals who suffer from this disease.

Sources:

(1) American Academy of Dermatology: Psoriatric Arthritis
(2) American College of Rheumatology: Psoriatric Arthritis
(3) National Psoriasis Foundation: Types of Psoriatric Arthritis
(4) Johns Hopkins Arthritis Center: Psoriatric Arthritis