What is Psoriatic Arthritis?


Everyone must have heard about psoriatic arthritis but, what is psoriatic arthritis? Psoriatic arthritis is a chronic disease characterized by inflammation of the skin (psoriasis) and joints (arthritis). It is a common skin condition which affects approximately 2% of the Caucasian population in the United States. It features patchy, raised, red areas of skin inflammation with scaling. Psoriasis often affects the tips of the elbows and knees, the scalp, the navel, and around the genital areas or anus.

The onset of psoriatic arthritis generally occurs in the fourth and fifth decades of life and males and females are affected equally.

Few aspects of Psoriatic Arthritis

  • Psoriatic arthritis is a systemic rheumatic disease that can also cause inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys
  • Psoriatic arthritis shares many features with several other arthritic conditions, such as ankylosising spondylitis, reactive arthritis (formerly Reiter’s syndrome), and arthritis associated with Crohn’s disease and ulcerative colitis
  • The onset of psoriatic arthritis generally occurs in the fourth and fifth decades of life.
  • Males and females are affected equally.
  • In some patients, the diagnosis of psoriatic arthritis can be difficult if the arthritis precedes psoriasis by many years. In fact, some patients have had arthritis for over twenty years before psoriasis eventually appears.

What causes Psoriatic Arthritis?

  • The cause of psoriatic arthritis is currently unknown. It is being assumed that a combination of genetic and immune as well as environmental factors could be likely involved.
  • In patients with psoriatic arthritis who have arthritis of the spine, a gene marker named HLA-B27 is frequently, but not always found.
  • Certain changes in the immune system may also be important in the development psoriatic arthritis. For example, the decline in the number of immune cells called helper T cells in AIDS patients may play a role in the development and progression of psoriasis in these patients.

Psoriasis is a skin disorder that is marked by a fast growth of dry, rough and dead skin cells which form thick scales. While arthritis causes stiffness and pain in the joints. Both the health conditions are autoimmune problems that develop when the immune system of the body fights with the harmful organisms like bacteria and viruses, that attacks the healthy tissues and cells. The abnormal response results in joints inflammation and also excess production of the skin cells.

Risk Factors

  • Age. Though, anyone may suffer from psoriatic arthritis, this often occurs in adults between the ages 30-50.
  • Psoriasis. Having psoriasis is the most dangerous risk factor for this condition. People having psoriasis lesions on their nails have more chances of developing psoriatic arthritis.
  • Sex. Usually, psoriatic arthritis affects women and men equally, but symmetric arthritis affects women mostly, whereas spondylitis and DIP arthritis mostly affects men.
  • Family history. Most people with psoriatic arthritis have a very close relative with this condition.
  • Obesity. People with an abnormal BMI are also known to suffer from psoriatic arthritis.

Symptoms

The arthritis frequently involves the knees, ankles, and joints in the feet. A few symptoms for this ailment could be

  • Generally a few joints are inflamed at a time
  • The inflamed joints become painful, swollen, hot, and red
  • Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a “sausage”
  • Detached fingernails or toenails. Small holes in fingernails or toenails are also indications
  • Reduced range of motion
  • Joint stiffness is common

Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis.

Psoriatic Arthritis Patterns

Pain in joints on one side of the body

The mildest form of psoriatic arthritis, called asymmetric psoriatic arthritis, usually affects joints on only one side of your body or different joints on each side. Pain in joints on both sides of your body. Symmetric psoriatic arthritis usually affects four or more of the same joints on both sides of your body.

Pain in the finger joints

Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. DIP affects the small joints closest to the nails (distal joints) in the fingers and toes.

Pain in the spine

This form of psoriatic arthritis, called spondylitis, can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints.

Destructive arthritis

A small percentage of people with psoriatic arthritis have arthritis mutilans, a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.

Development of Psoriatic Arthritis

  • Localized mild psoriatic arthritis. It develops in a slow pattern. It shows mild symptoms and affects less than five joints. People with this type of psoriatic arthritis will often live without symptoms for an extended period of time.
  • Generalized disabling psoriatic arthritis. This is serious than Localized psoriatic arthritis. This form of arthritis often leads to permanent joint damage and disability, and requires medication early. In severe cases, surgery and rehabilitation may be required.

Outcome of Psoriatic Arthritis

  • In approximately 50% of those with spondylitis, the genetic marker HLA-B27 can be found. In rare instances, psoriatic arthritis involves the small joints at the ends of the fingers
  • Patients with psoriatic arthritis can also develop inflammation of the tendons (tendinitis) and around cartilage
  • Inflammation of the tendon behind the heel causes
  • Achilles tendonitis can lead to pain with walking and climbing stairs
  • Inflammation the of chest wall and of the cartilage that links the ribs to the breastbone (sternum) can cause chest pain
  • Apart from arthritis and spondylitis, psoriatic arthritis can cause inflammation in other organs, such as the eyes, lungs, and aorta
  • Acne and nail changes are commonly seen in psoriatic arthritis
  • Pitting and ridges are seen in finger and toe nails of 80% of patients with psoriatic arthritis

Types of Psoriatic Arthritis

Distal Interphalangeal Predominant

In this type of psoriatic arthritis, it affects the finger and toe joint. The symptoms are similar to osteoarthritis.

Asymmetrical Arthritis

In this type of arthritis the swelling of the joints happens in pairs which happens on both sides of the body. Asymmetrical arthritis is similar to rheumatoid arthritis. His affects atleast 15-70% people. It can also cause severe deformity in a person.

Symmertical Polyarthritis

In this type of arthritis the swelling in joints occurs in pairs which is on both sides of the body. This is the second most common type of arthritis affecting 15-70% people.

Spondylitis, or Psoriatic Spondyloarthritis

In this type of spondylitis the joint of the spine are affected with inflammation. People suffering from this problem experience severe pain in the legs and arms. Obvious symptoms are tenderness, stiffness in the joints and inflammation.

Arthritis Mutilans

This is a very severe type of arthritis and is rare with only 5% of people suffering from it. Gout, Reiter’s syndrome and rheumatoid are three other types of arthritis. Reiter causes inflammation in the eye and urethra. Gout arthritis causes inflammation and severe pain in the big toe. Rheumatoid arthritis causes deformity in the joints and may be severe at times.

How to Diagnose Psoriatic Arthritis?

How to diagnose psoriatic arthritis is one of the important questions one need to know. Psoriatic arthritis is a diagnosis made mainly on clinical grounds, based on a finding of psoriasis and the typical inflammatory arthritis of the spine and/or other joints. As such there is no laboratory test to diagnose psoriatic arthritis.

Treatment

There is no cure for psoriatic arthritis, hence treatment aims at reducing the inflammation of the affected joints for preventing joint disability and pain. Usually, a multidisciplinary approach is used for treating both joint and skin symptoms.

Medications for psoriatic arthritis include:

Anti-inflammatory Drugs

Drugs like ibuprofen and aspirin helps in controlling the swelling, pain and morning stiffness, and they are generally the first treatments tried for this condition. Prescribed anti-inflammatory drugs are very effective than over the counter medications. But most anti-inflammatory drugs may irritate intestine and stomach, and usage of these medications for long period may cause gastrointestinal bleeding and ulcers.

Other side effects are heart failure, damage to the kidneys and fluid retention. Additionally, anti-inflammatory drugs worsens the skin conditions. Yet, these drugs are beneficial for people with minor stiffness and joint pains.

Corticosteroids

Physician may prescribe corticosteroids if one has mild psoriatic arthritis. These are prescribed for controlling rare flares up of the joint pains. These drugs may be taken orally or may be injected into the painful joints. Corticosteroids give immediate relief and enhances the motion – for months in some cases. As they may cause damage, their usage is limited.

Immunosuppressant Medications

These act for suppressing the immune system that usually protects the body from the harmful organisms. But it attacks the healthy tissues in people suffering from psoriatic arthritis. Often, leflunomide (Arava), cyclosporine (Neoral, Sandimmune) and azathioprine (Imuran) are used.

These have very adverse effects and are generally used in treating severe cases of psoriatic arthritis. As they suppress your immune system, these medications may cause anemia and also high risks of severe infections. Also most of them cause kidney and liver problems.

Disease-modifying anti-rheumatic Drugs

These aid in stimulating the joint damage which develops in psoriatic arthritis. As these drugs act slowly, one may notice the effects in a few weeks or months. For this, the physician may recommend a pain reliever like aspirin in addition to these drugs.

Disease-modifying anti-rheumatic drugs have very serious side effects such as liver problems and lung disease. These side effects can be relieved by taking folic acid and methotrexate.

Disease Management
  • Physiotherapy, isometric exercise and cold compresses can make a world of a difference to these patients.
  • Dietary supplements such as glucosamine and chondroitin sulfate and warm climate are found to help.
  • Assisting devices such as canes, splints, braces go a long way in avoiding pain during routine use of the joints.

Foods that Cure Psoriatic Arthritis

There are no particular food that can individually cure psoriatic arthritis. In general, there are foods that might relieve some symptoms of arthritis. Such foods are garlic, apple cider vinegar, oilive oil, brown rice, ginger, baked beans, salmon fish, mackerel fish, etc. Also refer to our article on Psoriatic Arthritis Diet to find out more.

Apple Cider Vinegar and Psoriatic Arthritis

It is suggested that apple cider vinegar can help in absorbing the deposits formed by wearing down of bones and cartilages. This might help in relieving pain.

Legumes for Psoriatic Arthritis

It is suggested that selenium deficiency can cause long-term psoriasis inflammation. Since, legumes such as beans, peas, etc are rich in selenium, they can be effective in psoriatic arthritis.

Turmeric for Psoriatic Arthritis

It is suggested that the anti-oxidative and anti-inflammatory properties of turmeric might help in treating psoriatic arthritis. This properties can help in treating inflammation and cellular damage, thereby alleviating symptoms of psoriatic arthritis.