What is Psoriatic Arthritis?
Psoriatic arthritis is an inflammatory arthritis that affects people already suffering from a skin condition called psoriasis. The onset of arthritis may develop later in patient with psoriasis or may also develop before the skin lesions appear. It can affect any part of the body including the spine and can relatively be mild or severe while flares of the disease may be alternating and in periodic remissions. Psoriatic arthritis is among the arthritis condition that can lead to inflammation of the spine and can also involve inflammation of the cartilage, tendons, eyes and lung lining.
Types of Psoriatic Arthritis
There are five types of psoriatic arthritis classified according to patterns of involvement and such include:
- Symmetrical polyarthritis is one of the most common types of psoriatic arthritis that involves the wrists, hands, feet and ankles while simultaneously affecting the both sides of the body on their joints. This type has a similarity with rheumatoid arthritis and can incapacitate patient in half of reported cases of psoriatic arthritis.
- Asymmetrical oligoarticular arthritis is a type of psoriatic arthritis that generally involves the digits of the hands and feet associated with inflammation of flexor tendon and synovium that result to sausage appearance of the fingers and toes.
- Arthritis mutilans is a rare, deforming and destructive type of psoriatic arthritis that can severely damage the joint. This type is observed to appear with osteolysis and dissolution of joint with observed radiographic finding of pencil-and-cup deformity.
- Spondylitis is a type that predominantly affects the male gender that can occur with or without sacroiliitis as revealed in radiologic evidence. This type of psoriatic arthritis involves the neck and spine characterized with stiffness and can also involve the hands and feet in similar manner with symmetric arthritis.
- Distal interphalangeal arthropathy is a rare type of psoriatic arthritis that primarily affects men and is marked by joint stiffness and inflammation in close proximity to the ends of the fingers and toes including nail changes.
There has been no racial predilection with regards to development of psoriatic arthritis although there have been reports of whites more commonly affected than the other racial group. Both male and female are equally affected and the onset is usually at the age of 35 to 55 years although psoriatic arthritis can occur in almost all age group including children in juvenile form that usually occur by age of 9 to 11 years.
Psoriatic Arthritis Symptoms
Psoriatic arthritis is a chronic disease that may worsen over time with symptoms that may progress or may lessen alternately as the condition worsens. It can affect the joint one side or both sides of the body with clinical manifestations marked by joint swelling and joint pain that is rather warm to touch.
General symptoms of psoriatic arthritis may include the following:
- Fingers and toes swelling that leads to sausage-like appearance and pain among affected parts
- Painful walking as a result of swelling in Achilles tendon and soles of the feet
- Joint stiffness is frequent and is usually worse in the morning
- Inflammation of the spine and sacrum is common in patients with psoriatic arthritis that results to lower back pain including pain in the buttocks, neck and the upper back.
- Marked changes in the nails of fingers and toes characterized by pitting or severance from the nail beds often seen in almost majority of the patient.
- The affected joints are reddish in appearance and warm to touch
- Rapid damage to joints may occur although this symptom and form is rare in occurrence
Other symptoms of psoriatic arthritis may include:
- Extreme exhaustion that do not respond to adequate rest and usually lasts for several days or weeks without subsiding
- Iritis may occur as a result of inflammation in the iris
- Chest pain may also be experienced especially with deep breathing when psoriatic arthritis has affected the lungs causing it to swell
- Shortness of breath and heart failure may occur as a result of inflammation in the aorta
The exact cause of psoriatic arthritis has not been identified although genetic factor, immune and environmental factor have been implicated to trigger psoriatic arthritis.
Deficient immune system is considered to cause psoriatic arthritis when the body’s own immune system attacks the healthy tissues and cells. The aberration in terms of immune system response leads to inflammation in the joints including excessive production of skin cells.
Half of reported cases of psoriatic arthritis are found to have HLA-B27 gene. HLA-B27 is a class I surface antigen and is associated with ankylosing spondylitis although there has been no clear explanation on the association of this gene in many diseases including that of psoriatic arthritis.
Environmental factors include physical trauma that includes trigger of psoriatic arthritis from viral or bacterial infection. This is believed to affect individuals that are genetically predisposed or may have inherited the disease from the family.
Diagnosing psoriatic arthritis is difficult as there is rather no definite diagnostic procedure that can confirm psoriatic arthritis except for some test to rule out the other cause of joint inflammation such as that of rheumatoid arthritis.
Imaging tests such as x-ray and magnetic resonance imaging can be utilized to clearly define the changes in joint and other problems in the tendons and ligaments that cause other problems and single out the possibility of psoriatic arthritis.
Laboratory test may be done in ruling out other disease and condition that may trigger the inflammation of the joint. Rheumatoid factor presence is tested to verify if joint inflammation is caused by rheumatism as this factor is usually not present in the blood of individuals suffering from psoriatic arthritis. Joint fluid test is carried out through gathering of fluid sample from affected joint to determine the presence of other substance that may cause the inflammation such as the presence of uric acid crystals which is rather an indication of gout rather than psoriatic arthritis.
Doctors or rheumatologist usually gather information based on physical examination, x-rays, blood tests and health history to diagnose psoriatic arthritis accurately while considering some factors to confirm the diagnosis such as:
- Rheumatoid factor in negative result clearly rules out rheumatism and consider the possibility of psoriatic arthritis
- Family history and medical history of psoriasis and psoriatic arthritis
- Presence of onycholysis or changes in the fingernails and toenails marked by ridging or pitting often associated with psoriasis and psoriatic arthritis
Psoriatic Arthritis Treatment
No definite cure or treatment has been indicated for psoriatic arthritis that the goal of treatment is geared towards the reduction of inflammation in preventing pain and joint damage and disability.
Treatment of psoriatic arthritis may include:
Non-steroidal anti-inflammatory drugs are given to control swelling and pain including stiffness in the mornings. This drug is the initial treatment given to patients with psoriatic arthritis. Such drugs include Ibuprofen and Naproxen.
Immunosuppressant medications can be given to suppress the immune system and commonly prescribed are the likes of Leflunomide, Cyclosporine and Azathioprine.
TNF-alpha inhibitors are prescribed to patient with severe psoriatic arthritis as this drug acts by inhibiting the protein responsible for the inflammation while signs and symptoms of psoriasis can be improved.
Psoriatic arthritis is believed to be mild although the condition can be deforming and erosive on the affected part and may lead to psychological effects among patients.