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Psoriatic arthritis is a condition characterized by inflammation that leads to stiffness, swelling, and pain in the joints. It mostly affects individuals who already have psoriasis, a skin condition marked by red patches of skin covered in silvery scales.
The severity of psoriatic arthritis can range from mild to severe. It can present as oligoarticular, polyarticular and spondylitis. It affects any area of the body, including the fingertips and spine. Most people get psoriasis years before they get psoriatic arthritis. However, for some people, joint problems arise before or at the same time as skin patches appear.
Both psoriasis and psoriatic arthritis are chronic autoimmune diseases, where certain cells in the body attack other cells and tissues. Both conditions can experience episodes of flare-ups and remissions.
While there is no known cure for psoriatic arthritis, the aim of treatment is to relieve symptoms and prevent joint damage. If left untreated, psoriatic arthritis can result in disability. However, by acknowledging the disease and having a clear understanding of its nature, the impact of the condition can be reduced.
Symptoms
The symptoms of psoriatic arthritis can vary among patients, ranging from mild to severe and slow to rapid progression. The condition may only affect a single joint and cause minor discomfort, or it may impact multiple joints and lead to severe pain. Additionally, there can be periods where symptoms improve or even disappear temporarily.
Psoriatic arthritis symptoms are frequently similar to those of rheumatoid arthritis. Both disorders induce painful, swollen, and warm-to-the-touch joints. It can damage one or both sides of the body’s joints.
Psoriatic arthritis is more likely to lead to:
- Pain: People with psoriatic arthritis may experience tenderness, soreness, or swelling where tendons and ligaments attach to bone (enthesitis), such as the sole of the feet and heel’s Achilles’ tendon.
- Back pain: A condition known as spondylitis, is an inflammation that frequently spreads to the joints between the vertebrae, which make up the spinal column. People with psoriatic arthritis may acquire this condition.
- Swelling of fingers and toes: Dactylitis is a painful inflammation of entire fingers or toes that causes them to look like sausages.
- Nail changes: Nails might develop small pits, disintegrate, or split from the nail beds.
- Inflammation of eye: Uveitis is an inflammation in the eyes that often affect the uvea, the central layer of the eye. It can impact the other areas of the eye. If left untreated, it can result in vision loss or irreversible blindness.
It is advisable to seek medical advice if the signs and symptoms of psoriatic arthritis persist. Without proper treatment, psoriatic arthritis can cause permanent joint damage. However, early diagnosis and treatment can help alleviate pain and inflammation, while also preventing further joint complications and damage.
Causes
The exact cause of psoriatic arthritis is not yet fully understood. Psoriatic arthritis develops when the immune system destroys healthy cells and tissue in the body. The immunological reaction induces joint inflammation as well as an increase in skin cell development.
However, experts believe that a mix of genetic (hereditary) and environmental factors is responsible. Researchers have identified genetic markers that seem to be associated with psoriatic arthritis. In addition, a family history of psoriasis or psoriatic arthritis is common among many patients with the condition.
It is also believed that immune system issues, infection, obesity, and physical trauma influence who gets the condition.
Risk factors
Psoriatic arthritis affects men and women equally. There are factors that may contribute to a higher risk of getting it, such as:
- Family history: Children of psoriatic parents are three times more likely to get psoriasis and are more likely to develop psoriatic arthritis. People who have psoriatic arthritis most likely have a parent or sibling who also has the condition.
- Psoriasis: The major risk factor for developing psoriatic arthritis is having psoriasis.
- Age: The most common age for juvenile onset of psoriatic arthritis is 9-11 years old. In adults, it is more common between the ages of 30 and 55.
Diagnosis
Psoriatic arthritis cannot be diagnosed with a single test. In most cases, if the psoriasis appears together with arthritis symptoms, doctors will be able to confirm the diagnosis of psoriatic arthritis more easily. The diagnosis is usually made based on a patient’s medical history, physical exam, blood tests, and X-rays of the affected joints.
The physical examination usually involves checking the joints for inflammation or pain, examining the fingernails for pitting, flaking, and other irregularities, and checking for tender spots by pressing on the soles of the feet and around the heels.
In the early stages of the illness, X-rays are frequently ineffective in making a diagnosis. However, X-rays in the later stages may reveal alterations that are more typically seen in psoriatic arthritis. Several tests may be required to rule out other potential causes of joint discomfort, such as rheumatoid arthritis or gout.
- Imaging tests:
- X-rays. Also known as radiograph, uses a safe amount of radiation to create images of the bones and soft tissues. It can assist in identifying joint abnormalities present in psoriatic arthritis but not in other arthritic diseases.
- MRI. This test is often required only for special circumstances. An MRI can be utilized to look for tendons and ligaments abnormalities in the feet and lower back. It combines radio waves and a strong magnetic field to create very clear photographs of the body’s hard and soft tissues.
- Laboratory tests
- Rheumatoid factor (RF). Positive biomarker tests like RF can assist with differentiating between rheumatoid arthritis and psoriatic arthritis. RF is an antibody found in the blood of people with rheumatoid arthritis but not in those with psoriatic arthritis. About 80% of people with rheumatoid arthritis test positive for rheumatoid factor.
- Joint fluid test. Gout and psoriatic arthritis can coexist. The presence of uric acid crystals in the joint fluid could signify gout instead of psoriatic arthritis. During the procedure, a fluid sample from one of the problematic joints is extracted through a needle for laboratory analysis.
Treatment
Psoriatic arthritis is presently incurable. The treatment strategy usually depends on the severity of the symptoms when diagnosed. The primary goal is to manage the disease, aiming for remission and minimizing the risk of complications. Patients may need to undergo multiple therapies before discovering one that is successful for them.
The medication will focus on reducing inflammation in the affected joints to prevent joint pain and disability, as well as managing skin involvement. Prescription pharmaceuticals known as disease-modifying antirheumatic drugs (DMARDs) are one of the most widely used therapies.
Treatment may include any combination of the medications, surgery and other procedures.
- Medications: Medication options for psoriatic arthritis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Mild inflammation may respond to NSAIDs in the early stages of the disease. It can help decrease pain and inflammation. Stomach irritation, cardiac problems, and liver and kidney damage are all possible side effects. Over-the-counter NSAIDs are ibuprofen and naproxen sodium and other stronger medications may require a prescription.
- Conventional DMARDs: When NSAIDs are unsuccessful and patients have persistent and/or erosive condition, DMARDs are utilized. Unlike NSAIDs, it can reduce the disease progression by altering the immune system. It can prevent irreparable damage to joints and other tissues.
Methotrexate, sulfasalazine, and cyclosporine are examples of DMARDs that are useful in the treatment of psoriatic arthritis. Liver damage, bone marrow suppression, and lung inflammation and scarring are all possible side effects. DMARDs may be prescribed alone or in conjunction with other medications.
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- Biologic agents (biologic response modifiers): When NSAIDs or DMARDs are ineffective for disease control, biologic medicines should be considered. This family of DMARD targets different immune system pathways.
Commonly known biologic agents are adalimumab, certolizumab, etanercept, golimumab, among others. Although known to be extremely effective at slowing and preventing joint deterioration progression, these medications may raise the risk of infection.
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- Targeted synthetic DMARDs: If standard DMARDs and biologic medicines did not work, tofacitinib may be administered. Risk for pulmonary blood clots, severe cardiac events, and cancer is increased with higher doses of tofacitinib.
- Newer oral medication: A medication, known as apremilast is prescribed for people with mild to moderate psoriatic arthritis who refuses or are unable to use DMARDs or biologic medicines. Diarrhea, nausea, and headaches are all possible adverse effects. Apremilast inhibits the action of an enzyme in the body that regulates inflammation inside the cells.
- Therapies: Various non-pharmacologic methods can be employed to aid with the joint discomfort. Massage treatment as well as physical and occupational treatments may help to relieve discomfort and make daily activities easier.
Range-of-motion and strengthening exercises performed as directed by a physical or occupational therapist may be beneficial when combined with low-impact aerobics. Regular, moderate exercise may help alleviate joint stiffness and pain associated with psoriatic arthritis.
- Surgical and other procedures
- Steroid injections: This form of treatment in which a large dose of drug is delivered directly to the affected joint. Steroids works by decreasing inflammation.
- Joint replacement surgery: In most instances, surgery is not necessary for psoriatic arthritis. However, if a joint has suffered severe injury, joint replacement surgery may be necessary. In certain cases, damaged joints can be replaced with artificial joints made of metal and plastic. The primary objective of surgery is to restore function, alleviate pain, enhance mobility, or improve the physical appearance of the affected area.
