( source; medicine.com)
Reviewed by Kirkwood Johnston, MD on Wednesday,
June 01, 2016
Psoriatic Arthritis
Symptoms, Treatment, Images
This tool does not
provide medical advice
What Is
Psoriatic Arthritis?
Psoriatic arthritis is a
type of arthritis (inflammation of the joints) accompanied by inflammation of
the skin (psoriasis). Psoriasis itself is a common skin condition characterized
by scaly red and white patches on the skin. Psoriatic arthritis usually develops
about 5 to 12 years after psoriasis begins.
Who Is at Risk for Psoriatic Arthritis?
About 15% of
people with psoriasis will develop psoriatic arthritis. It is equally common in
men and women, with most people diagnosed between the ages of 30 and 50. The
exact cause of psoriatic arthritis is unknown, but it is believed to involve
genetics, the environment, and a malfunction of the immune system. About 40% of
people with psoriatic arthritis have a family member with psoriasis or
arthritis, which suggests a hereditary link.
What Causes Psoriatic Arthritis?
The exact cause
of psoriatic arthritis is unknown, but it is believed to involve genetics, the
environment, and a malfunction of the immune system. A genetic marker HLA-B27
is found in more than 50% of psoriatic arthritis patients with spinal
inflammation. Other genes common in psoriatic arthritis patients have also been
found. Stressors or changes in the immune system may affect the development or
progression of the disease. Infectious agents and environmental factors are
also being investigated as possible causes.
What Are Psoriatic
Arthritis Symptoms and Signs?
Most people have
psoriasis for years before they develop psoriatic arthritis. Symptoms of
psoriatic arthritis include:
·
Swollen, painful, hot,
red joints – frequently in the knees, ankles, and feet
·
Swollen fingers or toes
that appear like "sausages"
·
Joint stiffness that is
worse in the mornings
·
Pitted nails, or nails
separating from the nail bed
·
Lower back pain
People may also develop
tendinitis (inflammation of the tendons), or costochondritis (inflammation of
the chest wall and the cartilage that connects the ribs to the breastbone).
Are There Different
Types of Psoriatic Arthritis?
There are five types of
psoriatic arthritis, based on the parts of the body that are affected and also
the severity of the inflammation. The type of psoriatic arthritis affects how
it is treated.
- Symmetric psoriatic arthritis
- Asymmetric psoriatic arthritis
- Distal interphalangeal predominant
(DIP)
- Spondylitis
- Arthritis mutilans
The following slides
will review the five types.
Symmetric Psoriatic Arthritis
Symmetric
psoriatic arthritis affects the same joints on both sides of the body, usually
in symmetrical pairs, such as both knees or both wrists. It is considered
similar to rheumatoid arthritis, and symptoms can range from mild to disabling.
Asymmetric Psoriatic Arthritis
Asymmetric
psoriatic arthritis can affect any joint, but usually not in symmetrical pairs
on both sides of the body as in symmetric psoriatic arthritis. It often affects
fingers and toes giving them a "sausage-like" appearance. It is usually
mild, but can affect some people more severely.
Distal Interphalangeal Predominant (DIP)
Distal
interphalangeal predominant (DIP) psoriatic arthritis is often confused with
osteoarthritis and it involves the distal joints in the fingers and toes (the small
joints closest to the nail) and may result in changes to the nails.
Spondylitis
Spondylitis is
inflammation of the spinal column and it may cause stiffness in the neck, lower
back, spinal verebrae, or sacroiliac region (pelvic area). This can make moving
around difficult.
Arthritis Mutilans
Arthritis
mutilans is the least common form of psoriatic arthritis, but the most severe,
causing degeneration and deformity. Usually the small joints in the fingers and
toes closest to the nail are involved but it can also affect the neck and lower
back.
How Is Psoriatic Arthritis Diagnosed?
There is not
one definitive test to diagnose psoriatic arthritis. It is usually diagnosed by
a combination of clinical findings. A doctor asks about your personal medical
history and family history of psoriasis or psoriatic arthritis, and performs a
physical examination of your joints. X-rays may be done to detect changes in
cartilage or bone injury. Blood tests may include sedimentation rate to detect
inflammation, rheumatoid factor to exclude rheumatoid arthritis, and tests for
the genetic marker HLA-B27, which is found in more than 50% of psoriatic
arthritis patients with spinal inflammation. Arthrocentesis (draining fluid
from a joint) may be performed.
What Is the Treatment for Psoriatic Arthritis?
Treatment for
psoriatic arthritis usually involves a combination of anti-inflammatory
medications (NSAIDs) and regular exercise, either with a physical therapist or
at home. Warm-up stretching or applying heat to muscles before exercise, and
ice after exercise can decrease soreness in the joints. If NSAIDs are not
sufficient, methotrexate (Rheumatrex, Trexall), corticosteroids, and
antimalarial medications may be prescribed.
Patients may
need to use devices to protect the joints, and surgery may be indicated in some
cases.
Is There a Cure for Psoriatic Arthritis?
There is
currently no cure for psoriatic arthritis. Medications may be able to help with
painful symptoms and slow or stop the progression of the disease. It is
important as a patient to learn how your body responds to psoriatic arthritis,
and how to use exercise, medications, and other treatments to manage symptoms.
Vitamin D may help with the inflammation associated with psoriasis.
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