Psoriatic Arthritis

Statistics

  • Psoriatic arthritis affects at least 10% of the 3 million people with psoriasis in the United States.
  • It affects men and women equally and usually begins between 30-50 years of age, but can begin in childhood.

What is Psoriatic Arthritis?

Psoriatic arthritis is a type of inflammatory arthritis that is associated with psoriasis, a chronic skin and nail disease. There are five types of PA.

  • Symmetric arthritis is much like rheumatoid arthritis. It affects pairs of joints and can be disabling. The associated psoriasis is often severe. About 50 percent of people with this form of psoriatic arthritis will develop variable degrees of progressive, destructive disease, although it is usually less severe than rheumatoid arthritis. Asymmetric arthritis usually involves only one to three joints. It can affect any joint, such as the knee, hip ankle and wrist. One finger can be involved or many can be affected.Distal Interphalangeal Predominant (DIP) arthritis occurs in about five percent of people with PA. It involves primarily the distal joints of the fingers and toes (the joint closest to the nail).Spondylitis occurs in about five percent of individuals with PA. Inflammation of the spinal column is the major symptom. Inflammation and stiffness of the neck, lower back, sacroiliac, or spinal vertebrae are also common. There may be peripheral disease in the hands, arms, hips, legs and feet. Spondylitis can also attack connective tissue such as ligaments. Arthritis Mutilans is a severe, deforming and destructive arthritis which affects less than five percent of people with psoriatic arthritis. It mostly affects the small joints of the hands and feet.

What causes it?

Like most other forms of arthritis, the cause of PA is unknown. Immune system malfunction, genetics, and environmental factors are all suspected. Up to 40% of those with PA have a history of psoriasis or arthritis in family members.

What are the symptoms?

The joint symptoms of PA are often similar to those of rheumatoid arthritis. Morning stiffness, pain, redness, swelling, fingers and toes may swell to such a degree that they resemble a sausage. Nail changes may occur; the nail may separate from its nail bed and pits may appear. Fever, fatigue, and general flu like symptoms may be present.

How is it diagnosed?

There is no one test to diagnose PA. Other types of arthritis with similar symptoms must be rules out. Medical exam, history, blood tests and x-rays are all used as diagnostic tools. The skin and nail changes that are common with PA are often what the final diagnosis is based on.

How is it treated?

Treatment of psoriatic arthritis focuses on relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the person’s sense of well-being and ability to function. A combination of treatments is almost always used.

Rest and exercise:
Both rest and exercise help in important ways. People with psoriatic arthritis need a good balance between the two, with more rest when the disease is active and more exercise when it is not. A physical therapist is useful in instructing the person with arthritis how to exercise without further damaging the joints.

Joint protection:
Splints, braces and supports can protect the joints and help prevent further damage. A doctor or a physical or occupational therapist can help get a splint and ensure that it fits properly. Other ways to reduce stress on joints include self-help devices, devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a person carries out daily activities.

Diet:
There is no specific diet used to treat PA. However all people with arthritis can befit from a healthy, well balanced diet.

Medications:
NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly used to treat PA. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. NSAIDS may relieve pain and swelling, but they do not slow the disease process.

DMARDS (disease modifying anti-rheumatic drugs) are also known as SAARDS (slow acting anti rheumatic drugs. As their name might suggest these medications take some time to be effective, up to several months.

The newest medications used to treat RA, biologic response modifiers, are drugs that interfere with the autoimmune response in RA. These are drugs that are genetically engineered to target the immune factors known as cytokines, particularly tumor necrosis factor (TNF) and certain interleukins, which play a major role in the destructive process. These drugs are also showing benefit when used to treat PA.

Corticosteroids can be injected directly into the joint for relief of inflammation limited to one particular joint.

Surgery:
Several types of surgery are available to patients with severe joint damage. These procedures can help reduce pain, improve the affected joint’s function and appearance, and improve the patient’s ability to perform daily activities. Surgical procedures include joint replacement, tendon reconstruction, and synovectomy.

What research is being done?

Researchers continue to search for genes that contribute to the inherited and other causes of psoriasis & psoriatic arthritis. Scientists are also working to improve our understanding of what happens in the body to trigger this disease. In addition, much research is focused on developing new and better treatments. Some of these experimental treatments, such as agents directed at the specific types of T cells involved, work to improve the disease with less overall suppression of the immune system.

Some of the related information found on Arthritis Insight:

For support visit our Chat Room and Message Boards.
For medication information see our Medication Index.
For information about tests and blood work go to Tests & Labs.
To find tips for getting through the day, stop by our Better Living section.
To find out about surgeries and joint replacements see Surgeries.
For more sites about Psoriatic Arthritis check out our Web Links.

For more information:

Psoriatic Arthritis: by drdoc online
Aase Marit’s Psoriasis and Eczema Homepage
Psoriatic Arthritis Fact Sheet – NPF
PA Support Page

References:
Dambro: Griffith’s 5-Minute Clinical Consult, 1999 ed., Copyright © 1999 Lippincott Williams & Wilkins, Inc.
American College of Rheumatology
The National Institute of Arthritis and Musculoskeletal diseases, Questions & Answers about Psoriasis
National Psoriasis Foundation