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Psoriatic Arthritis: Types Symptoms Causes and Treatments

Introduction

Arthritis is the term used for diseases that affect joints. There are different types of arthritis affecting different age groups. Some types of arthritis do affect children and young adults as well. Psoriatic arthritis is one of those types which is seen in any age group.

All about psoriatic arthritis

  • Psoriatic arthritis can cause swelling, stiffness and pain in and around your joints/tendons.
  • It generally affects those who have already have the skin psoriasis, which causes patches of red, raised skin with white and silvery flakes associated with itching.
  • Sometimes people have arthritis symptoms before they are even diagnosed with skin psoriasis. In some rare cases, people have psoriatic arthritis and may never show any obvious patches of psoriasis.
  • Both psoriasis and psoriatic arthritis are autoimmune conditions. Our body’s immune system protects us against infection and illness. In autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body, in this case skin and joints.
  • Both conditions can affect individuals of any age.
  • It is projected that around 1 in 5 people with psoriasis may develop psoriatic arthritis.
  • Psoriatic arthritis is categorized under spondyloarthropathy. These are a group of disorders with some similar manifestations.
  • Psoriatic arthritis is completely treatable condition. Early diagnosis and appropriate treatment in timely manner can prevent joint deformities and long-term disability. Psoriatic arthritis can occur in any part of the body, including spine and the fingertips.

What are the types of psoriatic arthritis?

The types of psoriatic arthritis are the following:

  1. Symmetric psoriatic arthritis: The symptoms of symmetric psoriatic arthritis are similar to rheumatoid arthritis. It affects similar joints on both sides of your body. Symmetric psoriatic arthritis can restrict movement.
  2. Asymmetric psoriatic arthritis: Around 35% percent of people who have psoriatic arthritis have asymmetric joint involvement, which means joints in different parts of the body are affected. The joints become painful, swollen and red.
  3. Psoriatic arthritis involving spine/Sacroiliac joint: Your spine will get involved including sacroiliac joints leading to back pain, stiffness and alternating buttock pain in this condition.
  4. Distal interphalangeal predominant psoriatic arthritis: Around 10% of people with psoriatic arthritis have this arthritis. It affects the joints which are close to your nails. These joints are called distal interphalangeal joints.
  • Psoriatic arthritis mutilans: This form of arthritis can completely deform the hands. Five percent of people who suffer from psoriatic arthritis have psoriatic arthritis mutilans.

What are the symptoms of psoriatic arthritis?

              · Swelling/Pain in your joints.

              · Weakness and fatigue.

              · Inflammation of tendons.

              · Restriction in movement.

              · Pain in the foot and lower back.

              · Changes in nails.

              · Stiffness and body pain in the morning.

              · Pain and redness in the eyes.

              · Patchy, itchy and scaly skin, which is more common in the elbows and knees.

When to see a doctor?

You should seek medical advice from Rheumatologist, if your skin psoriasis is accompanied by joint pain as it is a symptom of psoriatic arthritis. Psoriatic arthritis can lead to irreversible damage to affected joints if left untreated.

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What are the complications of psoriatic arthritis?

  • Psoriatic arthritis can lead to obesity because movement/exercises become restricted due to pain. This leads to increase stiffness in joints.
  • Research has shown that the chances of developing diabetes is more than 40% in patients with psoriatic arthritis.
  • Many patients with psoriatic arthritis can develop arthritis mutilans, which is very painful. Arthritis mutilans destroy the finger bones leading to permanent deformity.
  • Eye problems such as recurrent uveitis can develop in patients with psoriatic arthritis. Uveitis causes pain and redness in eyes and can even affect your eyesight.
  • People with psoriatic arthritis have a high chance of developing cardiovascular diseases such as stroke or heart attacks if left untreated due to ongoing inflammation.
  • Psoriatic arthritis can lead to severe joint pain, which can make you less mobile. This affects your daily routine and work. The inability to move and work can lead to stress and depression.
  • Psoriatic arthritis patients are prone to get Inflammatory Bowel Syndrome or IBD.

What are the causes of psoriatic arthritis?

The exact cause of psoriatic arthritis is unknown. The factors that can cause psoriatic arthritis can be certain immune, genetic, or environmental factors. 40% of all psoriatic arthritis patients have a family history of the disease. According to researchers, stress or trauma can worsen psoriatic arthritis/skin psoriasis.  

Who are at risk of developing psoriatic arthritis?

  • People between the age group of thirty to fifty years are more at risk of developing psoriatic arthritis.
  • Thirty percent of all men and women with psoriasis are at a high risk of developing psoriatic arthritis.
  • Around forty percent of people who have psoriatic arthritis have a family history of psoriasis or arthritis.

What are the treatments of psoriatic arthritis?

Aim of treatment in psoriatic arthritis is controlling pain, inflammation and prevent further damage to joints. Medications used also helps in controlling skin psoriasis.

  • For immediate pain relief Nonsteroidal anti-inflammatory (NSAIDs) drugs like ibuprofen, etoricoxib, naproxen sodium, etc can be used. Disease-modifying antirheumatic drugs (DMARDs) also called immunomodulatory drugs like methotrexate, leflunomide, apremilast and in severe cases biologics like etanercept, adalimumab, infliximab, tofacitininb, etc are used to control the disease in the long term.
  • If left untreated at early stage, it will lead to irreversible damage to joints needing joint replacement surgery.  
  • Steroid injections help treat inflammation quickly in patients who have excessive joint pain and swelling in one joint.  

What are the joint protective measures for psoriatic arthritis?

With early diagnosis and appropriate treatment patients can lead a normal life like anybody else. You can ease the stress on your joints with regular exercises and keeping your weight under check. Taking help of devices like grab bars or luggage carts, makes your daily life more comfortable. But that does not stop you from living your life; you can carry on with your regular daily routine with medication and lifestyle changes.

Psoriatic arthritis is completely treatable condition and with latest advances in medical research there are many treatment options are available. Treatment needs to be long-term to keep disease under remission. Certain lifestyle changes can help you keep the flare-ups in control. You can embrace a healthy diet, by consuming more fruits and vegetables, which can also help you to maintain a healthy weight. Regular exercises advised by your doctor can help ease stiffness and joint pain.

Conclusion

Psoriatic arthritis is a type of arthritis which can affect any age group. Diagnosing and treating at early onset will prevent permanent joint damage and help you to lead a normal life like anybody else. Regular follow up with your Rheumatologist is very important to monitor your disease activity and to look out for any side effect with medications. Stop smoking and avoid excess alcohol intake which will make medicines more effective and prevents any side effects with drugs. Maintaining a healthy lifestyle will help you fight against it.

Frequently Asked Questions (FAQs)

1. Does psoriatic arthritis completely go away?

Ans: The symptoms of psoriatic arthritis can completely go away with appropriate long-term treatment. But it can relapse suddenly, making the condition worse if medications stopped abruptly. Therefore, its strongly recommended to follow up with your Rheumatologist at regular intervals.

2. What kind of doctor treats psoriatic arthritis?

Ans: A patient diagnosed with psoriatic arthritis will be referred to a rheumatologist. A rheumatologist is a specialist in treating arthritis and joint problems.

3. Who is more prone to psoriatic arthritis- men or women? Ans: Men and women both are at an equal risk of developing psoriatic arthritis.

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Verified By Dr Uma Karjigi
MBBS, MRCP (UK), MRCP ( Rheumatology), CCT Consultant Rheumatologist Apollo Hospitals

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