Psoriatic Arthritis: Symptoms, Causes, Diagnosis, Treatment & Prevention

 

Psoriasis, a chronic skin condition, is associated with psoriatic arthritis, a type of arthritis. The most typical symptoms include skin rashes, changes to your fingernails and toenails, and joint pain and stiffness. Psoriatic arthritis has no known cure, but a doctor can help you find ways of managing your symptoms.

As they age, some individuals with psoriasis may develop psoriatic arthritis.

Also Read:Rheumatoid Arthritis, Symptoms, Causes, Diagnosis and Treatment

What is psoriatic arthritis?

 Family history of the condition is usually affected. A common condition that affects your joints is arthritis.  It makes the area around your joints painful and inflamed.  Your skin becomes inflamed when you have psoriasis.  Scale-covered patches of discolored skin are known as psoriasis rashes.  Plaques are these thick, scaly patches.  Additionally, it may cause your toenails and fingernails to thicken and appear pitted or flaky (covered in tiny indentations).

Psoriasis and arthritis are both autoimmune conditions. When your immune system accidentally attacks the immune system rather than defending itself, you can develop an autoimmune disease. When you experience joint inflammation and psoriasis symptoms on your skin, you have psoriatic arthritis.

The skin and joint symptoms of psoriatic arthritis typically flare up and subside during these intervals. During a flare, a medical professional will recommend therapies that relieve your symptoms.

If you experience any new skin symptoms or joint pain, swelling, or stiffness, see a doctor.

Which five types of psoriatic arthritis exist?

A medical professional may categorize psoriatic arthritis according to the joints it affects or the side of the body where symptoms are felt. The following are the five types of psoriatic arthritis:

• Distal interphalangeal predominant psoriatic arthritis. The joints close to the tips of your fingers and toes (phalanges) are affected by distal interphalangeal predominant psoriatic arthritis. Your fingernails and toenails are affected by the most common type of psoriatic arthritis. Your nails may appear pitted, flaky, or discolored.

• Symmetric polyarthritis. that affects five or more joints simultaneously is known as symmetric polyarthritis. The same joints on both sides of your body are impacted by symmetric polyarthritis. For instance, both of your elbows and both of your knees. This type of psoriatic arthritis is among the most common.

•  Asymmetric oligoarticular psoriatic arthritis. One knee and one elbow, for instance, are affected by asymmetric oligoarticular psoriatic arthritis, which affects two to four joints on both sides of the body.  Along with symmetric polyarthritis, it is the other most prevalent type of psoriatic arthritis.

•  Spondylitis. The vertebrae (plural of vertebra) are the 33 bones that make up your spine.  Inflammation and other symptoms in the joints between your vertebrae are caused by spondylitis.  Additionally, it may result in shoulder and hip pain.

•  Arthritis mutilans. Your hands and feet may experience severe symptoms from arthritis mutilans.  Usually, the inflammation is so bad that it results in osteolysis, or bone loss.  This type of psoriatic arthritis is the rarest.  Arthritis mutilans affects less than 5% of psoriatic arthritis.

What symptoms are present in psoriatic arthritis?

Any joint in your body may be impacted by psoriatic arthritis. There may be minimal signs of psoriasis on your skin, along with mild pain and stiffness. In addition to causing larger psoriasis patches on your skin, more severe flare-ups of psoriatic arthritis can make it difficult or impossible to move and use your joints.

The following are the most typical signs of psoriatic arthritis:

• Discomfort in the joints

• Rigidity

• Redness or discoloration close to the afflicted joints

• Where tendons and ligaments connect to your bones, such as close to your Achilles tendon, you may experience pain or tenderness.

• Dactylitis, also known as "sausage fingers," is swelling in your fingers and toes.

• Silver or gray scaly patches on your skin, particularly on your scalp, elbows, knees, and lower back, are known as psoriasis rash.

• Discoloration or pitting on your fingernails or toenails are symptom of nail psoriasis.

• Fatigue

 Causes:

The cause of psoriatic arthritis is unknown to experts. According to certain research, psoriatic arthritis sufferers share genetic mutations. It is unclear to experts whether these genetic alterations are the cause of psoriatic arthritis or if they develop after the condition strikes.

About 40% of psoriatic arthritis sufferers have a family member with the condition. This suggests that it could be a genetic disorder that is passed down from biological parents to their children.

If you have a family member with psoriasis or psoriatic arthritis, let your doctor know.

Risk factors:

Your risk of developing psoriatic arthritis can be raised by several factors, such as:

• Psoriasis. The single biggest risk factor for psoriatic arthritis is having psoriasis.

• Family history. Many psoriatic arthritis sufferers have a sibling or parent who also has the condition.

• Age. Psoriatic arthritis can strike anyone, but it usually strikes adults between the ages of 30 and 55.

Complications:

Arthritis mutilans is a severe, excruciating, and incapacitating form of psoriatic arthritis that affects a small percentage of people with the condition. The small bones in the hands, particularly the fingers, are gradually destroyed by arthritis mutilans, resulting in irreversible deformity and disability.

Additionally, some people with psoriatic arthritis are more likely to develop diabetes, metabolic syndrome, hypertension, and cardiovascular disease.

How is the diagnosis of psoriatic arthritis made?

A physical examination and a few tests will be used by a medical professional to diagnose psoriatic arthritis. In addition to examining your skin and joints, your healthcare provider will inquire about your symptoms.

Rheumatologists are medical professionals who specialize in treating autoimmune diseases, inflammatory conditions, and musculoskeletal disorders. You may need to see one of these specialists. Psoriasis can be diagnosed and treated by a dermatologist, a medical professional who specializes in skin care.

Although psoriatic arthritis cannot be diagnosed with a test, your doctor may use one to rule out other possible causes of your symptoms. Blood tests may be used to look for infections. Your joints can be photographed during imaging tests to reveal inflammation or damage. One or more imaging tests may be required, such as:

• MRIs

•  X-rays

• Ultrasound 

• CT scan

How does one treat psoriatic arthritis?

Treatment recommendations will be made by your healthcare provider to control your symptoms. The treatments you require are determined by:

• Which joints are affected by arthritis?

• The severity of your symptoms.

• The degree to which the symptoms interfere with your ability to engage in your regular activities.

The following are the most popular therapies for psoriatic arthritis:

• Acetaminophen or NSAIDs are examples of over-the-counter anti-inflammatory medications.

• Either heat or cold therapy.

• Corticosteroids.

• DMARDs, or disease-modifying antirheumatic medications.

• Occupational therapy or physical therapy.

Surgery for  psoriatic arthritis

Injections of steroids. Inflammation can be reduced with injections into the affected joint.

 Joint replacement surgery. Artificial joints made of plastic and metal can be used to replace some joints that have been severely damaged by psoriatic arthritis.

 Surgery is extremely uncommon for people with psoriatic arthritis. You may require an arthroplasty (joint replacement) if your joints are damaged or you have lost bone. You will learn what to anticipate and what kind of surgery you will require from your physician or surgeon.
Surgery for psoriatic arthritis

Prevention:

You can't prevent psoriatic arthritis because experts don't know what causes it. You can reduce your risk of getting all types of arthritis by:

• Keep your joints safe. Modifying your daily routine can have an impact on your emotional state. For instance, use devices like jar openers to push doors open with your entire body rather than just your hands, lift heavy objects with both hands, and twist jar lids. When engaging in any activity that could harm your joints, always wear proper safety equipment.

•  Keep your weight in check. Your joints will be less stressed as a result, which will lessen pain and give you more energy and mobility. If necessary, losing weight can also improve the effectiveness of your prescription drugs. Certain medications for psoriatic arthritis are less effective in overweight individuals.

• Regular exercise. Maintaining strong muscles and flexible joints can be achieved through exercise. Exercises like biking, swimming, walking, yoga, and tai chi are less taxing on the joints.

• Give up smoking. Smoking is linked to both a higher chance of getting psoriasis and more severe symptoms.

• Don't drink too much. Alcohol can increase the side effects of some medications, like methotrexate, and reduce the effectiveness of your treatment.

• Take it slow. Fighting inflammation and pain can wear you out. Additionally, fatigue is a side effect of some arthritis medications. Continue to be active, but take a break before you get too exhausted. Break up work or exercise activities into manageable chunks. Throughout the day, schedule downtime for relaxation.

References:

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• Psoriatic arthritis: Diagnosis and treatment. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/psoriatic-arthritis-treatment. Accessed June 27, 2021.

• Newer drug treatments for psoriatic arthritis. Arthritis Foundation. https://www.arthritis.org/diseases/more-about/newer-drug-treatments-for-psoriatic-arthritis. Accessed July 3, 2021.

• American College of Rheumatology. Psoriatic Arthritis (https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis). Accessed 9/19/2023.

• Gladman DD, et al. Clinical manifestations and diagnosis of psoriatic arthritis. https://www.uptodate.com/contents/search. Accessed June 27, 2021.

• National Library of Medicine (U.S.). Psoriatic arthritis (https://medlineplus.gov/ency/article/000413.htm). Accessed 9/19/2023.

• Psoriatic arthritis: Diagnosis and treatment. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/psoriatic-arthritis-treatment. Accessed June 27, 2021.

• Singh JA, et al. Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis & Rheumatology. 2018; doi:10.1002/art.40726.

• Ferri FF. Psoriatic arthritis. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed June 29, 2021.

• Biologics. National Psoriasis Foundation. https://www.psoriasis.org/biologics. Accessed July 6, 2021.