Psoriatic Arthritis

Psoriatic arthritis is a type of arthritis that can happen to people who have psoriasis. Psoriasis is a skin condition that causes red, scaly patches. Often, people get psoriasis first, and then years later, they develop psoriatic arthritis. But sometimes, joint problems start before or at the same time as the skin issues.

The main signs of psoriatic arthritis are pain, stiffness, and swelling in the joints. This can happen anywhere in the body, including the fingers and spine. The severity can vary greatly, from a little discomfort to a lot of trouble. Both psoriasis and psoriatic arthritis go through periods where the symptoms are worse (flares) and periods where they improve or disappear (remissions).

Unfortunately, there's no way to get rid of psoriatic arthritis completely. Treatment focuses on managing the symptoms and preventing any long-term damage to the joints. If left untreated, psoriatic arthritis can make it hard to do everyday activities.

Psoriatic arthritis and psoriasis are long-lasting health problems that can get worse over time. Sometimes, symptoms might improve or disappear for a while, but they often return.

Psoriatic arthritis affects joints on one or both sides of the body. The symptoms of psoriatic arthritis are similar to rheumatoid arthritis. Both conditions cause pain, swelling, and warmth in the joints.

However, psoriatic arthritis is more likely to cause these additional problems:

• Swollen fingers and toes: Psoriatic arthritis can make the fingers and toes swell up, creating a painful, sausage-like appearance.

• Foot pain: Pain can occur where tendons and ligaments connect to the bones, particularly in the back of the heel (Achilles tendonitis) or the bottom of the foot (plantar fasciitis). These areas are common sites for inflammation and pain in psoriatic arthritis.

• Lower back pain: A condition called spondylitis can develop from psoriatic arthritis. Spondylitis involves inflammation in the joints between the bones of the spine (vertebrae) and in the joints where the spine connects to the pelvis (sacroiliitis). This can lead to stiffness and pain in the lower back.

• Nail changes: Tiny pits, crumbling, or separation of the nails from the nail bed can be signs of psoriatic arthritis.

• Eye inflammation: Uveitis, a type of eye inflammation, can cause eye pain, redness, and blurred vision. If left untreated, it can lead to vision loss. It's important to seek medical attention for any eye symptoms.

If you have psoriasis, be sure to tell your doctor if you experience any joint pain. Psoriasis can sometimes lead to a related condition called psoriatic arthritis. If psoriatic arthritis isn't treated, it can cause significant harm to your joints, making it difficult to move and function. Early diagnosis and treatment are key to managing this condition effectively.

Psoriatic arthritis happens when your body's immune system, which is supposed to fight off infections, mistakenly attacks healthy parts of your body. This mistaken attack leads to inflammation in your joints and an overproduction of skin cells, which are the hallmarks of psoriasis.

Scientists believe that a combination of your genes and your environment play a key role in this immune system problem. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis itself, suggesting a genetic link. Researchers have identified certain genes that seem to be more common in people with this condition, but more research is needed to understand exactly how these genes contribute.

It's possible that something in the environment, like an infection (viral or bacterial), or even a physical injury, could trigger psoriatic arthritis in people who are already genetically predisposed to it. This means that while you might inherit a tendency toward the condition, an environmental trigger could be needed to actually cause the disease to develop.

Psoriatic arthritis is a condition where the joints become inflamed, often in people with psoriasis. Several things can make you more likely to get it:

• Having psoriasis: If you have psoriasis, you have a much higher chance of developing psoriatic arthritis. Psoriasis is a skin condition that causes red, scaly patches. The relationship between psoriasis and psoriatic arthritis isn't fully understood, but they often occur together.

• Family history: If a parent or sibling has psoriatic arthritis, you might be more likely to get it yourself. This suggests a genetic link, meaning that certain genes might make you more susceptible to the disease.

• Age: While anyone can get psoriatic arthritis, it's most common in adults between 30 and 55 years old. This doesn't mean it can't happen earlier or later in life, but it's a typical age range for diagnosis.

Some people with psoriatic arthritis, a type of arthritis, experience a more serious form called arthritis mutilans. This condition causes a lot of pain and makes it hard to use their hands. Over time, arthritis mutilans damages the small bones in the hands, especially the fingers, causing permanent deformities and difficulties with everyday tasks.

Psoriatic arthritis can also increase the chances of developing other health problems like high blood pressure (hypertension), metabolic syndrome (a group of health issues), diabetes, and heart disease.

Diagnosing psoriatic arthritis isn't easy, as there's no single test that confirms it. Doctors use a combination of methods to rule out other types of joint pain, like rheumatoid arthritis or gout, before suggesting psoriatic arthritis.

To help determine if you might have psoriatic arthritis, your doctor might:

Physical Examination:

• Check your joints: Your doctor will look for any swelling or tenderness in your joints. Swelling is a common sign, often accompanied by pain and warmth.
• Examine your nails: Look for signs on your fingernails like pitting (small indentations) or flaking. These can be clues.
• Check your feet: They might press on the soles of your feet and around your heels to feel for tenderness, a common symptom in psoriatic arthritis.

Tests:

• X-rays: X-rays can show changes in the joints that are specific to psoriatic arthritis. These changes often aren't seen in other types of arthritis. For example, x-rays may show bony changes or joint damage that isn't present in other conditions.
• MRI (Magnetic Resonance Imaging): MRI uses powerful magnets and radio waves to create detailed images of soft tissues and bones. This can be helpful in seeing if there are problems with the tendons or ligaments in your feet or lower back, which can be affected in psoriatic arthritis. MRI is very useful for looking at soft tissue damage, which x-rays can sometimes miss.
• Rheumatoid factor (RF) test: This blood test looks for a protein called rheumatoid factor. This protein is often found in people with rheumatoid arthritis but less commonly in those with psoriatic arthritis. This helps your doctor distinguish between the two types of arthritis.
• Joint fluid test: In some cases, your doctor may need to remove a small amount of fluid from a joint, usually the knee, using a needle. This fluid can be analyzed for uric acid crystals. High levels of uric acid crystals may suggest gout instead of psoriatic arthritis. It is possible to have both gout and psoriatic arthritis.

It's important to remember that a doctor will consider all these factors together to make an accurate diagnosis. They won't rely on just one test.

Psoriatic arthritis has no cure, but treatment focuses on managing the inflammation to prevent joint pain, disability, and skin problems. The goal is to slow the disease's progression and prevent lasting damage to joints and other tissues.

Different treatments are needed depending on the severity of the disease and which joints are affected. Finding the right treatment might take time and involve trying several options.

Medication options for psoriatic arthritis:

• Disease-Modifying Anti-Rheumatic Drugs (DMARDs): These are prescription drugs that can help slow the progression of the disease. They work by reducing inflammation in the body. Common DMARDs include:

  • Methotrexate: This is a frequently used DMARD. It can help prevent further joint damage. Potential side effects include liver problems, weakened bone marrow, and lung inflammation.
  • Leflunomide and Sulfasalazine: These are other DMARDs that may be used, each with its own potential side effects. They can also help slow the disease's progression. Possible side effects include liver damage, bone marrow issues, and lung problems.

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): These drugs, like ibuprofen and naproxen, can help reduce pain and inflammation, especially in people with mild psoriatic arthritis. NSAIDs can be purchased over-the-counter or by prescription. Possible side effects include stomach problems, heart issues, and liver/kidney problems.

• Biologic Agents (Biologics): These drugs target specific parts of the immune system involved in the inflammation. Examples include adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade). While effective, they can increase the risk of infections.

• Targeted Synthetic DMARDs: Tofacitinib (Xeljanz) is one example. This type of drug is sometimes used when other treatments haven't worked well. Potential side effects include blood clots, heart problems, and a slightly increased risk of cancer.

• Newer Oral Medication: Apremilast (Otezla) works by slowing down an enzyme that plays a role in inflammation. It's often used for people with mild to moderate psoriatic arthritis who don't want or can't use DMARDs or biologics. Possible side effects include diarrhea, nausea, and headaches.

• Steroid Injections: Injecting steroids directly into an affected joint can help reduce inflammation and pain.

• Joint Replacement Surgery: In severe cases, damaged joints may need to be replaced with artificial ones.

Other Treatments:

• Physical Therapy and Occupational Therapy: These therapies can help improve joint function, manage pain, and make daily tasks easier. A doctor can recommend these therapies.
• Massage Therapy: Massage may also provide some pain relief.

It's crucial to discuss all treatment options and potential side effects with your doctor to find the best approach for your specific situation. Remember that treatment plans are personalized and may need adjustments based on your response to the medication and any side effects you experience.

Taking care of your joints is important for managing arthritis. Here are some simple steps you can take to feel better:

1. Make Everyday Tasks Easier on Your Joints:

Many everyday tasks can put extra stress on your joints. Instead of twisting jar lids by hand, use a jar opener. When lifting heavy objects, use both hands for support. And instead of pushing a door with just your hands, use your whole body to open it. These small changes can make a big difference in how your joints feel.

2. Maintain a Healthy Weight:

Carrying extra weight puts a lot of pressure on your joints. Losing weight, if needed, can reduce pain, give you more energy, and improve your ability to move. It can even help your arthritis medication work better. Some medications for psoriatic arthritis may not work as well if you're overweight.

3. Stay Active with Gentle Exercise:

Regular exercise helps keep your joints flexible and your muscles strong. Choose activities that are easy on your joints, like biking, swimming, walking, yoga, or tai chi. These activities can help you feel better without putting too much stress on your joints.

4. Quit Smoking:

Smoking can increase your risk of developing psoriasis and make the symptoms worse. If you smoke, quitting is a great step towards better joint health.

5. Limit Alcohol:

Alcohol can weaken the effectiveness of your arthritis treatments and may increase side effects from some medications, such as methotrexate. Talk to your doctor about how much alcohol is safe for you to drink.

6. Take Breaks and Pace Yourself:

Dealing with arthritis pain and inflammation can be tiring. Some arthritis medications can also make you feel very tired. It's important to stay active, but don't push yourself too hard. Break down activities into smaller parts, take regular breaks, and make time for relaxation throughout the day.