Psoriatic arthritis

Description

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis, a disease that causes red patches of skin covered with silvery scales. Most people develop psoriasis years before being diagnosed with psoriatic arthritis. But for some, the problems in the joints begin before skin patches appear or at the same time.

Pain in the joints, stiffness and swelling are the main signs and symptoms of psoriatic arthritis. It can affect any part of the body, including the scope and the spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

There is No cure for psoriatic arthritis. The goal of treatment is to control symptoms and prevent joint damage. Without treatment, psoriatic arthritis may be disabling.

Symptoms

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time. However, there may be periods when your symptoms improve or go away temporarily.

Psoriatic arthritis can affect joints on one or both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and hot to the touch.

However, psoriatic arthritis is more likely to also cause:

  • Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of the fingers and toes.
  • Pain in the foot. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of the heel (Achilles tendinitis) or in the sole of the foot (plantar fasciitis).
  • Back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly because of the inflammation of the joints between the vertebrae of the spine and the joints between the spine and the pelvis (arthritis).
  • Changes in the nails. Nails can develop tiny dents (pits), crumble or separate from the nail.
  • Inflammation of the eyes. Uveitis can cause eye pain, redness and blurred vision. If left untreated, uveitis can lead to loss of vision.

When to see a doctor

If you have psoriasis, tell your doctor if you develop pain in the joints. Psoriatic arthritis can cause serious damage to the joints if left untreated.

Causes

Psoriatic arthritis occurs when the body's immune system attacks healthy cells and tissues. The immune response that causes inflammation in the joints as well as the overproduction of skin cells.

It seems likely that genetic and environmental factors play a role in this response of the immune system. Many people with psoriatic arthritis have a family history of psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Physical Trauma or something in the environment, such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Risk factors

There are several factors that can increase the risk of psoriatic arthritis, including:

  • Psoriasis. Having psoriasis is the single greatest risk factor for the development of psoriatic arthritis.
  • The history of the family. Many people with psoriatic arthritis have a father or brother with the disease.
  • Age. Although any person can develop psoriatic arthritis, occurs most often in adults between the ages of 30 and 55 years.

Complications

A small percentage of people with psoriatic arthritis develop arthritis mutilans, a serious, painful and disabling form of psoriatic arthritis. Over time, arthritis mutilans destroys the small bones of the hands, especially the fingers of the hands, leading to permanent deformity and disability.

The psoriatic arthritis also put some people at higher risk of developing hypertension, metabolic syndrome, diabetes and cardiovascular disease

Psoriatic arthritis

Diagnosis

During the exam, your doctor may:

  • Examine joints for signs of swelling or tenderness
  • Check the nail for pitting, flaking, and other abnormalities
  • Click on the soles of the feet and around the heels to review sensitive areas

There is No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of pain in the joints, such as rheumatoid arthritis or gout.

Imaging tests

  • The x-rays. These can help to identify the changes in the joint that occur in psoriatic arthritis, but not in other arthritic conditions.
  • The magnetic resonance imaging. This uses radio waves and a powerful magnetic field to produce detailed images of the soft and hard tissues in your body. Magnetic resonance imaging can be used to verify if there are any problems with the tendons and ligaments of the feet and the lower back.

Laboratory tests

  • The rheumatoid factor (RF). the rheumatoid factor (rf) is an antibody that is often present in the blood of people with rheumatoid arthritis, but generally not in the blood of people with psoriatic arthritis. This test can help your doctor distinguish between the two conditions.
  • The joint fluid test. The use of a needle, the doctor may remove a small sample of fluid from one of your affected joints — often to the knee. Uric acid crystals in the joint fluid, may indicate that you have gout in place of psoriatic arthritis. It is also possible to have the gout and psoriatic arthritis.

Treatment

There is No cure for psoriatic arthritis. The treatment focuses on the control of inflammation in your affected joints to prevent joint pain and disability and the control of the involvement of the skin. One of the most common treatments are prescription medications called disease-modifying antirheumatic drugs (DMARDs).

The treatment depends on the severity of your disease and what joints are affected. You may have to try different treatments before finding the one that brings relief.

Drugs

The drugs used for the treatment of psoriatic arthritis are:

  • Nsaids. Nonsteroidal anti-inflammatory drugs (Nsaids) can relieve pain and reduce inflammation in people with mild psoriatic arthritis. nonsteroidal anti-inflammatory drugs (Nsaids) available without a prescription include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger Nsaids are available by prescription. Side effects may include stomach irritation, heart problems, liver and kidney damage.
  • Conventional disease-modifying antirheumatic drugs (DMARDs).These medications can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage. The most commonly used disease-modifying antirheumatic drugs (DMARDS) is methotrexate (Trexall, Otrexup, others). Others include leflunomide (Arava), and sulfasalazine (Azulfidine). Side effects may include liver damage, bone marrow suppression, and inflammation of the lungs, and scarring (fibrosis).
  • Biological agents. Also known as biologic response modifiers, this class of DMARDS objectives of the different pathways of the immune system. Biological agents include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade®), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), guselkumab (Tremfya), and abatacept (Orencia). These medicines may increase the risk of infections.
  • Directed syntheticDMARDs. Tofacitinib (Xeljanz) can be used if the Dmards and biologic agents have not been effective. The higher dose of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events and the cancer.
  • New oral medications. Apremilast (Otezla) decreases the activity of an enzyme in the body that controls the activity of the inflammation within the cells. Apremilast is used for people with mild to moderate psoriatic arthritis who do not want to or cannot be treated with Dmards or biological agents. Possible side effects include diarrhea, nausea, and headaches.

Conventional disease-modifying antirheumatic drugs (DMARDs). These medications can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage.

The most commonly used disease-modifying antirheumatic drugs (DMARDS) is methotrexate (Trexall, Otrexup, others). Others include leflunomide (Arava), and sulfasalazine (Azulfidine). Side effects may include liver damage, bone marrow suppression, and inflammation of the lungs, and scarring (fibrosis).

Therapies

Physical and occupational therapy, may relieve the pain and make it easier to do everyday tasks. Ask your doctor for a referral. Massage therapy can also provide relief.

Surgical and other procedures

  • The steroid injections. The injections on an affected joint can reduce inflammation.
  • Joint replacement surgery. Some of the joints that have been severely damaged by the psoriatic arthritis can be replaced by artificial ones made of metal and plastic.

Self-care

  • Protect the joints. Changing the way of doing everyday tasks can make a difference in how you feel. For example, the use of gadgets such as opening jars to twist the lids of the jars, lift heavy objects with both hands and push the doors open with the whole body instead of just your hands.
  • Maintain a healthy weight. This puts less stress on the joints, which leads to a reduction of pain and increase of the energy and mobility. Lose weight if necessary you can also help your medicines work better. Some medications for psoriatic arthritis are less effective in overweight people.
  • Exercise regularly. Exercise can help to keep joints flexible and your muscles strong. Types of exercise that are less stress on the joints include biking, swimming, walking, yoga and tai chi.
  • Stop smoking. Smoking is associated with an increased risk of developing psoriasis, and with more severe the symptoms of psoriasis.
  • Limit the consumption of alcohol. Alcohol may decrease the effectiveness of treatment and increase the side effects of some medications, such as methotrexate.
  • A rhythm. Fighting against the pain and inflammation can leave you exhausted. In addition, some medications for arthritis can cause fatigue. Don't stop being active, but the rest before it is too tired. Divide the exercise or the work activities in short segments. Find moments to relax throughout the day.

Coping and support

The support of friends and family can make a big difference when you're facing the challenges of psoriatic arthritis. For some people, support groups can offer the same benefits. A counselor or therapist can help you to design coping strategies to reduce their levels of stress.

Preparing for your appointment

It is likely that you first discuss your signs and symptoms with your family doctor. He or she may refer you to a doctor who specializes in the treatment of arthritis and related disorders (rheumatologist).

What you can do

If possible, bring a friend or a family member with you to your appointment to help you remember the information that is obtained.

Make a list of:

  • Your symptoms and when they began
  • Your medical and family history, including family members with psoriatic arthritis
  • All the drugs, vitamins, and other supplements you are taking, including dose
  • Questions to ask your doctor

Basic questions about psoriatic arthritis may include:

  • What is the cause of my symptoms?
  • What tests do I need?
  • What treatments are available?
  • What lifestyle changes will I need to do?
  • Do you have printed information about psoriatic arthritis can I have? What sites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your doctor may ask some of the following questions:

  • What joints are affected?
  • There are activities or positions that make your symptoms better or worse?
  • What treatments have you tried? You have any help?
Symptoms and treatment of Psoriatic arthritis