Psoriatic Arthritis: Types, Symptoms, Causes, Risk factors, Complications, Diagnosis and Treatment


Psoriatic arthritis is a chronic disease characterized by psoriasis and inflammatory arthritis.

May 23, 2018

Psoriatic arthritis is a chronic disease characterized by psoriasis and inflammatory arthritis. Usually this affects people who have psoriasis, a condition that results in red patches of skin topped with silvery scales.
Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before the appearance of skin lesions.
The main symptoms of psoriatic arthritis include joint pain, stiffness and swelling. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe.
Delaying treatment for psoriatic arthritis can result in permanent joint damage and disablity. Early recognition, diagnosis and treatment of psoriatic arthritis can help to relieve pain and inflammation and help prevent joint damage. Patients who have inflammatory arthritis and psoriasis are diagnosed as having psoriatic arthritis. Males and females are equally affected by this disease. Psoriasis and the arthritis often appear separately.
Psoriatic arthritis is a systemic rheumatic disease that can also cause inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys. Many symptoms of psoriatic arthritis are similar to several other arthritic conditions, such as ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn's disease and ulcerative colitis. All of these health conditions can cause inflammation in the spine and other joints, as well as the eyes, skin, mouth, and various organs.

Types of of Psoriatic Arthritis:

Depending on the number of joints affected, psoriatic arthritis can be oligoarticular or polyarticular. If four or fewer joints in the body are affected it is considered as mild and known as oligoarticular. Severe psoriatic arthritis is often referred to as polyarticular which affects four or more joints.
The inflammation of the spinal column is refer as Spondylitis which may occurs in some individuals with psoriatic arthritis. Inflammation with stiffness of the neck, lower back and sacroiliac joints are the most common symptoms. Joint motion in these areas will be painful and difficult in Spinal arthritis.
The inflammation of entheses, the site where ligaments or tendons insert into the bones is refer as Enthesitis. This may occur at bottoms of the feet, the Achilles' tendons, and the places where ligaments attach to the ribs, spine and pelvis.
Enthesitis can make the tissues in the affected area become ropey known as fibrosis or solid known as ossification or calcification. This is the unique identification of this disease which can be distinguishable from other form of arthritis.
The inflammation of an entire finger or toe is refer as Dactylitis, or sausage digits. It occurs when the small joints and entheses of the surrounding tendons become inflamed. Dactylitis is another distinguishing indicator of psoriatic arthritis. Usually dactylitis occurs in a few fingers and toes, but not in a symmetrical pattern. Different toes and fingers can get affected on different sides of the body.
Psoriatic arthritis also can affect the joints of your arms and legs, including the elbows, wrists, hands and feet.

Symptoms of Psoriatic Arthritis:

Psoriatic arthritis is a chronic diseases that get worse over time. You may have periods when your symptoms improve or go into remission as well as symptoms become worse with time.
Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble with rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch. Joint aches and stiffness, joint swelling, joint warmth and redness, joint pain and tenderness and loss of range of motion of the affected joints are the most common symptoms of psoriatic arthritis.
However, psoriatic arthritis is more likely to cause the following symptoms which can be useful in diagnosing it. These include:

Swollen fingers and toes:

Psoriatic arthritis can cause a painful, sausage like swelling of your fingers and toes. Swelling and deformities in your hands and feet may also develop before having significant joint symptoms.

Foot pain:

Pain at the points where tendons and ligaments attach to your bones can occur in psoriatic arthritis. Especially it occurs at the back of your heel called as achilles tendinitis or in the sole of your foot called as plantar fasciitis. If there is presence of a achilles tendinitis, you may also experience limping, pain with walking, and pain with climbing stairs.
Inflammation of the areas at which ligaments and tendons meet the bone is known as Enthesitis, which is a characterized feature of psoriatic arthritis.

Lower back pain:

Inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis happens in psoriatic arthritis which is known as Spondylitis. There can be pain and stiffness in the low back, buttocks, neck, and upper back if the spine is affected.
Having a severe case of psoriasis does not necessarily mean a person will have a severe case of psoriatic arthritis. A person could have many joints affected by the arthritis with very few skin lesions.

Causes of Psoriatic Arthritis:

When the immune system of your body begins to attack healthy cells and tissue, Psoriatic arthritis may develop. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells. The decline in the number of immune cells called helper T cells in people with AIDS or HIV infection may play a role in the development and progression of psoriasis in these patients.
The exact cause of abnormal immune response of the body is unknown. But, both genetic and environmental factors seems to play a role in this cause. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Certain genetic markers such as HLA-B27 found in people with psoriatic arthritis appears to be associated with this disease.
Physical trauma or a viral or bacterial infection in the environment may trigger psoriatic arthritis in people with an inherited tendency.

Risk factors:

Your risk of psoriatic arthritis, increases if you
  • have Psoriasis, especially if you have psoriasis lesions on your nails are likely to develop psoriatic arthritis.
  • have it in your family history. Many people with psoriatic arthritis have a parent or a sibling with the disease.
  • are aged between 30 and 50 years of age. However, anyone can develop psoriatic arthritis, it occurs most often in adults. 

Complications of Psoriatic Arthritis:

Psoriatic arthritis can lead to arthritis mutilans which is a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in your hands, especially the fingers, leading to permanent deformity and disability.
People who have psoriatic arthritis sometimes also develop eye problems such as conjunctivitis or uveitis, which can cause painful, reddened eyes and blurred vision. The color of eye changes to pink. Inflammation in the colored portion of the eye (iris) causes iritis, which is a painful health condition. This can be aggravated by bright light as the iris opens and closes the opening of the pupil.
Risk of cardiovascular disease ia also higher in these people. Inflammation of the aorta (aortitis) can cause leakage of the aortic valves, leading to heart failure and shortness of breath.

Diagnosis Psoriatic Arthritis:

Primary care doctors or dermatologists often can help in diagnosing  psoriatic arthritis, but psoriatic arthritis patients should consider seeing a rheumatologist, a doctor who specializes in arthritis.
There is no definitive test to diagnose psoriatic arthritis. The diagnosis is made mostly by the observations of your doctor and by a process of eliminating the undelying causes. Your medical history, particularly your history with psoriasis will be taken in to consideration, and some test will be performed which include a physical examination, blood tests, MRIs and X-rays of the joints that have symptoms to diagnose psoriatic arthritis.
During the physical examination, your doctor may closely examine your joints for signs of swelling or tenderness and will check your fingernails for pitting, flaking and other abnormalities. He/she may press on the soles of your feet and around your heels to find tender areas. As most of the symptoms are similar to rheumatoid arthritis or gout, the following test can be done to rule out other causes of joint pain.

Imaging tests:

X-rays:

The changes in the joints that occur in psoriatic arthritis only but not in other arthritic conditions can be found out by doing a plain X-rays. X-rays may show changes of cartilage or bone injury which are indication of arthritis of the spine, sacroiliac joints, and joints of the hands.

Magnetic resonance imaging (MRI):

As radio waves and a strong magnetic field are used in MRI to produce very detailed images of both hard and soft tissues in your body, this type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back. MRI scanning is sometimes used to identify early erosion of joints.

Laboratory tests:

Rheumatoid factor (RF):

RF is an antibody that is often present in the blood of people with rheumatoid arthritis, but it is not usually in the blood of people with psoriatic arthritis. Therefore, this test can help your doctor distinguish between the two conditions.

Joint fluid test:

A small sample of fluid from one of your affected joints, often the knee will be removed using a needle by your doctor. The fluid is then analyzed for inflammation, infection, gout crystals, and other inflammatory conditions. The presence of uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.

Sedimentation rate:

Blood tests such as sedimentation rate may show an abnormal elevated result which is an indication of presence of inflammation in the joints and other organs of the body.

HLA-B27 test:

The blood test for the genetic marker HLA-B27 is often performed with psoriatic arthritis patient who have spine inflammation.

Treatment for Psoriatic Arthritis:

As there is no cure for psoriatic arthritis, the focus of the treatment is on controlling inflammation in your affected joints to prevent joint pain and disability.
Psoriatic arthritis is a chronic, progressive disease that can lead to permanent joint damage if treatment is delayed. Treating your disease on time can lower your risk of developing some comorbidities, like cardiovascular disease. The treatment of psoriatic arthritis usually involves a combination of anti-inflammatory medications (NSAIDs) and exercise. If progressive inflammation and joint destruction occur despite NSAIDs treatment, more potent medications such as methotrexate, corticosteroids, and antimalarial medications are used.

Medications:

Drugs used to treat psoriatic arthritis include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) :

NSAIDs can be used to relieve pain and reduce inflammation. Ibuprofen and naproxen sodium are some of the over the counter NSAIDs. Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems, and liver and kidney damage.

Disease-modifying antirheumatic drugs (DMARDs):

These drugs can slow down the progression of psoriatic arthritis and there by help decresing the risk of permanent damage to the joints and other tissues. Common DMARDs include methotrexate, leflunomide and sulfasalazine. Side effects may include liver damage, bone marrow suppression and severe lung infections.

Immunosuppressants:

These medications are used to tame your immune system, which does not respond the way it should in psoriatic arthritis. Azathioprine and cyclosporine are some of the examples of these kind of drug. These medications can increase your susceptibility to infection.

TNF alpha inhibitors:

Tumor necrosis factor alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Etanercept, adalimumab, infliximab, golimumab and certolizumab are some of the examples of these kind of inhibitors. Potential side effects include nausea, diarrhea, hair loss and an increased risk of serious infections.

Other medications:

Apremilast, ustekinumab and secukinumab are some medication used for plaque psoriasis can also reduce the signs and symptoms of psoriatic arthritis.

Surgical and other procedures:

Steroid injections:

This type of medication is sometimes injected directly into an affected joint. This can reduces inflammation quickly.

Joint replacement surgery:

Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic. Joint replacement surgery can relieve pain and restore function in joints which are badly damaged psoriatic arthritis.

Exercise:

Exercise programs can be done at home or under the supervision of a physical therapist. These should be customized according to the disease and physical capabilities of each patient.
Warm-up stretching, or other techniques, such as a hot shower or heat applications are helpful to relax muscles prior to exercise. To help minimize post-exercise soreness and inflammation, ice application after the exercise is a good idea. Exercises for arthritis are performed for the purpose of strengthening and maintaining or improving joint range of motion. For best results they should be done on a regular basis.
Psoriatic arthritis is a serious illness that has a similar impact on quality of life as rheumatoid arthritis (RA) and another inflammatory arthritis.