Psoriatic Arthritis

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Psoriatic Arthritis

A complete guide for patients...

Psoriatic arthritis is a type of arthritis & causes inflammation in and around the joints. It usually affects people who already have psoriasis; a skin condition that causes a red, silver crusted scaly rash, especially on the elbows, knees, back, buttocks, groins and scalp. In women it can occur underneath the breasts.

 

However, some people develop the arthritis symptoms before the psoriasis, while others will never develop the skin condition.In most people diagnosis of Psoriatic arthritis is delayed as they are focusing more on cosmetic aspect and lack of awareness regarding the association of skin and joints. These patients can have low self-esteem given the burden of skin disease.

What are symptoms of Psoriatic Arthritis?

Symptoms of psoriatic arthritis can include:

 

  • A red, scaly rash (psoriasis)
  • Swollen, stiff and painful joints
  • Sausage-like swelling of fingers or toes (dactylitis)
  • Thickening, discoloration and pitting of the nails
  • Pain and swelling at the back of the heel
  • Fatigue.

How is Psoriatic Arthritis diagnosed?

Your doctor will examine you and ask if there is a family history of psoriasis. Your doctor will also want to know if you have or have had psoriasis. The skin rash can be very subtle and does not correlate with severity of joint disease. There are no specific blood tests available for confirming diagnosis - it is a clinical diagnosis, blood tests help to exclude other causes like gout which can affect the toes. You may also have magnetic resonance imaging (MRI) scans, ultrasound scans and X-rays which can help to confirm the diagnosis.

How does Psoriatic Arthritis differ from Rheumatoid Arthritis?

The joints involved in Rheumatoid Arthritis mostly are usually multiple small joints and large joints affecting both sides i.e right and left. Psoriatic Arthritis usually affects large joints initially and can be even single joints or just toes and can move from one joint to another.

What are nail changes in Psoriatic Arthritis?

The nail changes include brittle nails, ridging and pitting.

Is Enthesitis a special feature?

Enthesitis - In some people with Psoriatic Arthritis symptoms may begin with pain in heels which is worse in the mornings after a period of inactivity and they struggle to walk the first few steps after waking up, the pain improves gradually on walking and exercise.

What causes Psoriatic Arthritis?

The arthritis and the skin condition are both caused by inflammation. The processes of inflammation are very similar in the skin and the joints. We don’t yet know exactly what triggers the inflammation in Psoriatic Arthritis but is a combination of genetic and environmental factors that lead to rapid turnover of skin cells resulting in patches of psoriasis.

Does Psoriatic Arthritis affect other organs?

Psoriatic Arthritis doesn’t usually affect major organs such as the liver or lungs. However, you may be more likely to develop a painful red eye. If this affects you, it’s important not to ignore it. These symptoms may be caused by a condition called uveitis, also known as iritis, which is inflammation at the front of the eye.

Course of the disease?

The severity of disease can vary in individuals. Some may experience flare ups which can be triggerd with stress and infection .There can be seasonal variation.

Treatment of Psoriatic Arthritis

The treatment ideally should be jointly managed by a skin specialist and Rheumatologist. The treatment is guided by the severity of the skin and joint disease. In most cases treatment given for the skin works for joints and vice versa. The appropriate treatment should be decided jointly by both specialists.

 

The skin specialist will initially manage the skin with topical treatment which continues with the systemic treatment, light therapy and vitamin A The variety of treatment used for joints include:

 

Pain killers - anti -inflammatory usually help relieve symptoms of mild joint pain while awaiting confirmation of diagnosis
Steroids - could be used as an initial treatment either orally or injecting either intramuscular into joint areas affected.

 

DMARDs - immunosuppressive drugs like methotrexate, sulfasalazine, leflunomide, ciclosporin; newer drug available for moderate skin and joint, enthesitis is available called apremilast.

 

Biologics - In diseases resistant to initial management or severe skin and joint involvement- biologic drugs are very effective.
They help skin and joint symptoms equally.

 

Variety of biologics are available including, etanercept, adalimumab, golimumab, secukinumab.

 

Role of exercise?

It’s important to strike a balance between rest and exercise. Rest will make inflamed joints feel more comfortable, but without movement your joints will stiffen and muscles will become weaker. It is very important to include exercise as part of routine in daily life especially when suffering from joint problems as it can help the joints to remain flexible and functional.

Diet in Psoriatic Arthritis

There are lots of myths in society regarding consumption of sour or fermented foods causing arthritis. However there is no scientific evidence to support the theories. It is advisable to eat healthy diet including lots of fresh fruits and vegetables, oily fish and avoid junk food.
If you quit certain foods you may develop deficiency of the essential nutrients. Gout is only condition requiring dietary modification.

Role of surgery in Psoriatic Arthritis

In damaged joints due to long standing untreated arthritis, surgery may be recommended after disease control.

Looking after self

Patients with Psoriatic Arthritis are at more risk for cardiovascular problems including obesity, high blood pressure, high cholesterol. Hence it is advisable for regular screening by your doctor for above conditions and early treatment for the same.