Psoriatic Arthritis

Overview

Psoriasis, a common skin condition, is characterized by itchy, scaly rashes. Some 10 to 30 percent of people with psoriasis can develop psoriatic arthritis. This is an inflammatory condition that caused joint pain, stiffness, and swelling.

It may affect any joint in the body, though most commonly it appears in the fingers. It can affect just one joint, or several joints throughout your body. Like psoriasis that affects the skin, psoriatic arthritis tends to flare up episodically. Symptoms can range from mild to very intense pain. In its most severe forms, psoriatic arthritis can cause joint damage, deformity, and disability.

Psoriatic arthritis usually occurs in people between the ages of 30 and 50. Although there is no cure, psoriatic arthritis can be effectively treated with medications, exercise, physical therapy, lifestyle adaptations, and, in some cases, surgery

Types

:Psoriatic arthritis may take one of the following forms

.
Distal interphalangeal predominant (DIP) affects the small joints of the fingers and toes
Symmetric affects the same joints on both sides of the body. Multiple sets of joints are affected, and this
condition can be progressive. This pattern may resemble rheumatoid arthritis
Asymmetric usually affects 1 to 3 joints, and does not necessarily involve both sides of the bospondylitis involves inflammation of the spine and results in pain and limitation of normal movement of the back. It can affect any part of the spine, from the sacrum to the neck
Arthritis mutilans affects a small percentage of people with psoriatic arthritis and causes damage and deformity of the joints of the hands and feet

Symptoms

Common symptoms of psoriatic arthritis include pain, swelling, and stiffness in the joints. Other possible
manifestations of this condition are

Cracking, discoloration, or separation of fingernails or toenails
Swollen, painful fingers and toes, commonly called "sausage digits"
Pain or swelling in tendons and ligaments
Pain, tenderness, inflammation, and redness of the eye, called iritis

Causes and Risk Factors

Psoriatic arthritis is a disorder of the body's immune system, which means that the immune system inappropriately attacks healthy tissue, causing inflammation and swelling. This type of disease is also known as an autoimmune disease.
Autoimmune disorders may have genetic or environmental causes. For example, you are at a much greater risk of developing psoriatic arthritis if you have a close relative with the condition, or if you have had psoriasis. Physical traumas or infections (viral or bacterial), such as a streptococcal throat infection, may trigger the development of psoriatic arthritis, particularly if you have a genetic predisposition

Diagnosis

There is no single test for diagnosing psoriatic arthritis. If you have symptoms characteristic of psoriatic arthritis, we will explore your medical and family history. After a thorough history and physical examination, we may request one or more of the following tests:

• X-rays can reveal inflammation and changes in the joints
• Blood tests can help us check levels of inflammation in your body and help us to rule out other conditions, such as rheumatoid arthritis
• Joint fluid analysis can identify gout or another infection that may be causing inflammation

A diagnosis of psoriatic arthritis can usually be confirmed once we have evaluated your symptoms and ruled out other possible causes. If the skin rash is not typical of psoriasis, we may refer you to a dermatologist for additional tests

Treatments

Psoriatic arthritis is normally treated with a combination of medication and lifestyle adaptations including exercise. Most people with psoriatic arthritis will experience a marked reduction of symptoms and a
significantly improved quality of life with proper treatment

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or aspirin may be recommended to control pain. Corticosteroids such as prednisone (Deltisone, Meticorten) can help reduce inflammation. At times, cortisone joint injections may be recommended to relieve particularly troublesome joints. Other types of medicines can help reduce inflammation and the risk of joint damage

Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine (Azulfidine) and methotrexate (Rheumatrex). These agents have been used for psoriatic arthritis for many years. The benefits of these medicines may take weeks to appear

TNF-alpha inhibitors (also known as anti-TNF agents) such as etanercept (Enbrel), infliximab (Remicade), and golimumab (Simponi) all have been approved by the FDA for this indication


These are very potent medicines to reduce inflammation and can be given only as an injection or an intravenous infusion. They can increase the risk of infection while you are taking them, so we will monitor you closely

Other immunosuppressant drugs such as azathioprine (Imuran) and cyclosporin (Neoral, Sandimmune) are used less frequently but are effective in many cases


Any of these medications may have side effects, some of which can be serious. We will prescribe medication for you based on your symptoms and degree of inflammation. If you experience side effects, please discuss this with us so that we can adjust your medication accordingly. We may also recommend vitamins or supplements if they are appropriate for your condition. We will make sure that this treatment does not interfere with any other health issues you may have

Surgery

Joint surgery may be recommended to relieve pain from severely involved joints that do not respond to medical treatment. Types of joint surgery include joint fusion or replacement

Other treatments

Physical therapy, yoga, and range of motion exercises can help to improve mobility and relieve pain and stiffness. Hydrotherapy or water therapy done in a pool can also help increase range of motion in the joints.

Heat and cold therapy can be done either on your own or with the help of a healthcare professional. The application of a hot towel (or simply a warm shower or bath) can relax muscles and relieve stiffness. Applying an ice pack can reduce joint inflammation

Lifestyle Management

Self-care is very important to managing psoriatic arthritis. Activities you do and habits you maintain on your own are essential for controlling your symptoms.
Daily exercise – including aerobic, range of motion, and strength-building exercises – will help relieve stiffness and pain, preserve mobility and flexibility, and improve joint function. It is important to have an exercise routine that works for you and your needs. We can help you create an appropriate exercise program. Improper or overly strenuous exercise may make your condition worse.
Maintaining a healthy weight will help to reduce pressure on your joints. A healthy diet of fresh fruits and vegetables, whole grains, legumes, and lean meat will boost your energy and improve how you feel. You should also consume alcohol and caffeine in moderation

Body mechanics

Reduce stress on your joints by changing your body position often and not sitting in one position for a long time. In addition, you may consider

Taking frequent breaks when performing physical tasks, particularly repetitive tasks

Using your bigger stronger joints instead of smaller joints whenever possible, such as carrying a shoulder bag rather than holding a briefcase or pushing doors open with your shoulder rather than your hand

Using both hands to lift heavy objects

Using assistive devices, such as canes or grab bars

A physical therapist can coach you in the techniques of proper body mechanics. An occupational therapist may help you select assistive devices

Pacing yourself

Your condition and your medication both may contribute to fatigue. Do not push yourself to the point of exhaustion. Staying active is healthy, but it is equally important to respect your body's need for rest. For example, you may wish to perform tasks in short segments. Take naps and, in general, make sure you are getting plenty of sleep. Set a schedule of weekly activities, prioritizing the activities that matter most, including spending pleasurable time with loved ones

Coping and Support

Psoriatic arthritis is a stressful and sometimes debilitating condition. It is not something you have to cope with by yourself. It is best if you have a strong support system of family and friends, people who can help care for you and with whom you can express your feelings. Consider getting counseling or joining a support group.
Maintaining your emotional health is as critical to your well-being as your physical health. If you are feeling depressed, we can assist in finding counseling resources. Joining a support group of people with psoriatic arthritis can also be helpful. Regular exercise will reduce your stress. Stress-reduction techniques such as meditation, yoga, and listening to soothing music are also effective.

Learn everything you can about your condition, the latest treatment options, and your prognosis for the future. The more you know, the more empowered you will be to make the best decisions for yourself and the more in control you will feel