Psoriatic arthritis is a chronic autoimmune disease that involves the skin (psoriasis) and joints (arthritis). It occurs when the body’s immune system attacks its own healthy cells, causing an inflammatory response that can affect the entire body and possibly cause permanent damage.
According to the National Psoriasis Foundation, more than 8 million Americans have been diagnosed with psoriasis, a skin disorder that is also an autoimmune disease. Up to 30 percent of people with psoriasis will develop psoriatic arthritis as well – usually years later. Any joint in the body can be affected, but most common are the hands and fingers, as well as the feet and toes, knees, ankles and spine.
May is Psoriatic Arthritis Action Month, so let’s take a closer look at this condition and its causes, symptoms and treatment options.
What Causes Psoriatic Arthritis?
Your immune system usually works to protect you against foreign substances in the body, but in the case of psoriatic arthritis, the body mistakenly targets its own tissues. This abnormal response results in a painful swelling of the tissue inside the joints, and in the overproduction of new skin cells that build up into patchy, raised areas with scaling. If untreated, the inflammation of psoriatic arthritis can permanently damage the joint and tissue.
It’s not known specifically what causes psoriatic arthritis, but several factors may increase the risk of developing this condition or making it worse:
- Having psoriasis (which is not contagious)
- Family history
- Certain genetic markers
- Age between 30 and 50
- An infection, physical trauma or stress that affects the immune system
What Are the Symptoms of Psoriatic Arthritis?
Joint pain, stiffness and swelling are the primary complaints of psoriatic arthritis, along with thick, red skin patches covered with flaky scales. The disease can progress slowly or quickly, with a varied severity of symptoms, and any part of the body may be affected. Periods of worsening inflammation and pain, called flares, are common and may last for months. At other times, patients may experience remissions and have no symptoms at all.
Other common symptoms of psoriatic arthritis include:
- Swollen, tender and throbbing joints, especially in the fingers or toes
- A sausage-like appearance of the fingers or toes
- Stiffness when getting out of bed or after sitting for long periods
- Reduced range of motion
- Nails that are pitted or separating from the nail bed
- Pain or swelling in the lower back, heel or foot
- Red and irritated eyes with disturbed vision
- Excessive fatigue
What Are the Different Types of Psoriatic Arthritis?
There are five types of psoriatic arthritis:
- Symmetric psoriatic arthritis: According to the Arthritis Foundation, this comprises about 50 percent of psoriatic arthritis cases. Similar to rheumatoid arthritis, it affects the same joints on both sides of the body and causes varying degrees of disability.
- Asymmetric psoriatic arthritis: Also a common type of psoriatic arthritis, this typically involves one to three joints and does not appear on the same joints on both sides of the body.
- Distal psoriatic arthritis: This involves the small joints near the ends of the fingers and toes, close to the nail. Patients with this type of psoriatic arthritis often see changes in toenails and fingernails such as pitting, white spots and separation from the nail bed.
- Spondylitis: This affects the spinal column, causing pain and stiffness in the spine, neck and pelvic area. In advanced cases, the vertebrae can begin to fuse together and cause immobility.
- Arthritis mutilans: The most destructive form of psoriatic arthritis, although it is rare. Arthritis mutilans causes severe inflammation that leads to bone loss, deformation and loss of function in the joints at the ends of the fingers and toes.
How is Psoriatic Arthritis Diagnosed?
There is no definitive test to diagnose psoriatic arthritis. During a physical exam, the most telling signs would be the presence of the skin and nail issues typically seen with psoriasis, combined with other common symptoms listed above.
When you visit your doctor or rheumatologist, be sure to discuss your symptoms in detail, and provide your personal and family medical history as fully and accurately as you can. Early diagnosis and aggressive treatment are key to limiting the damaging effects of psoriatic arthritis.
How is Psoriatic Arthritis Treated and Managed?
Unfortunately, psoriatic arthritis does not have a cure. The primary goals for treatment are to relieve pain, reduce inflammation and swelling, and limit joint damage. Treatment typically includes medications and managed self-care.
Common medications to treat psoriatic arthritis include:
- DMARDs: Disease-modifying antirheumatic drugs block the body’s immune system response, helping to slow the progression of psoriatic arthritis and the resulting joint damage. They also can help relieve symptoms.
- Biologics: Biologic response modifiers target specific parts of the immune system that cause inflammation. Biologics are often effective for patients who don’t respond as well to DMARDs, or both medications may be used as a combination.
- NSAIDs: Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can relieve pain and reduce inflammation in milder cases.
- Corticosteroids: Typically used short term to avoid side effects, medications such as prednisone can be fast and effective at reducing inflammation in a single joint.
- Topicals: Applied to the skin, topical medications can help treat the scaly, itchy rashes of psoriasis.
Other therapies that can help manage the effects of psoriatic arthritis include:
- Physical activity: Your doctor will advise gentle, low-impact exercises for range of motion, strengthening and flexibility, not to mention better overall health and a more positive outlook. A physical therapist can help customize a routine for you.
- Rest: Although it’s important to stay active regularly, you need a balance. Listening to your body and taking it easy during a flare will help you battle inflammation and fatigue.
- Hot and cold therapy: Heat is recommended to treat stiff, aching joints; cold is effective for swelling and acute pain.
- Weight management: Keeping extra weight off inflamed joints will help with mobility and pain.
- Diet: Foods that are high in antioxidants and omega-3 fatty acids have been shown to fight inflammation, which is fueled by unhealthy processed and fast foods.
- Surgery: If medication is not effective or if bone damage is advanced, surgery such as joint replacement may be an option to restore function to the affected joints.
What Happens If Psoriatic Arthritis Is Left Untreated?
If it is not treated quickly and aggressively, persistent inflammation from psoriatic arthritis can lead to permanent joint and tissue damage, even becoming disabling.
The cartilage covering both ends of the joint, which acts as a shock absorber, begins to wear away as a response to the inflammation, and the bones may start rubbing together. This can lead to joint deformities, shifting and possible erosion. Over time, the muscles, ligaments and tendons supporting the joint begin to weaken. The combination of these factors results in pain that can sometimes be severe and debilitating.
Getting the Right Care and Support
Learning you have a chronic disease like psoriatic arthritis can be a shock. But with early treatment, a strong support system and a commitment to self-care, many patients are able to maintain a positive quality of life.
If you are suffering from joint pain and would like to consult with us, please call us at 913-319-7600 for more information or expert recommendations on treatment.
About the Author
Mark J. Winston, M.D., is an orthopedic surgeon specializing in hand, wrist and upper extremity surgery as well as sports medicine. Before joining Dickson-Diveley Orthopaedics, Dr. Winston completed a hand and upper extremity fellowship at the Hospital for Special Surgery/Weill Cornell Medical College in New York.
The medical information contained in the Dickson-Diveley Orthopaedics website is provided to increase your knowledge and understanding of orthopedic conditions. This information should not be interpreted as a recommendation for a specific medical or surgical treatment plan. As each patient may have specific symptoms or associated problems, the treatment regimen for a specific patient may not be the proper treatment for another.
Gaining knowledge and understanding of a particular problem or condition is the first step in any medical treatment plan. I believe the information presented on our website will be helpful for those individuals experiencing hand and wrist diseases, injuries, or other related problems. However, this information is not intended to replace the advice of your family physician. You are encouraged to consult with your physician to discuss any course of treatment presented or suggested.