Psoriatic Arthritis is a type of arthritis characterized by painful and swollen joints. It is associated with psoriasis, which is an inflammatory skin disease that causes scaly red and white patches on the skin. The condition can affect multiple joints and symptoms vary among patients. Persistent inflammation from psoriatic arthritis has been linked to joint damage. While the cause is not fully known, it can be caused by an infection that affects the immune system.
Symptoms vary considerably. Some people have mild discomfort in a few joints, such as the end of the fingers or toes. Others experience severe symptoms affecting many joints. When the disease affects the spine it is known as spondylitis, which results in pain in the back or neck and difficulty bending. including stiffness, burning and pain in the lower spine. Affected fingers and toes can resemble swollen sausages, known as dactylitis. The disease also causes tenderness where tendons and ligaments join bones, a condition called enthesitis. It affects the back of the heel, the sole of the foot and other areas.
The skin and nail changes associated with psoriasis may develop in people who also have arthritis.
The cause of psoriatic arthritis is not known, but experts believe genetics may be a factor. Factors that can increase the chances of getting the condition include:
- Having psoriasis, especially lesions on the nails
- Family history – a parent or sibling with the disease
- Being between 30 and 50 years old, although people of all ages can develop the disease
Although the disease itself cannot be prevented, there are a number of ways to prevent a flare (a period of more intense symptoms).
- Follow your doctor’s medication recommendations for over-the-counter and prescription drugs.
- Do strength-training exercise, which can help by improving muscle tone, which reduces stress on the joints.
- Do low-impact aerobic exercises like swimming to help prevent cardiovascular disease without stressing the joints.
Early diagnosis of psoriatic arthritis is an important factor in controlling symptoms. But diagnosis is complicated because symptoms are similar to those of other conditions. Your WellStar rheumatologist will conduct a physical exam to look for swollen and painful joints, certain arthritis patterns and the nail and skin changes associated with psoriasis. In some cases skin biopsies and blood tests will be performed to rule out other types of arthritis.
Tools and Tests
Your physician may order X-rays, MRI or CT scans can to assess joint damage and specific changes in the joints that indicate psoriatic arthritis. Blood tests can help reveal levels of inflammation and mild anemia, a sign of the disease. They can also help rule out other types of arthritis. For example, one blood test looks for an antibody known as rheumatoid factor (RF). It is found in the blood of those with rheumatoid arthritis, but is not usually present in those with psoriatic arthritis. A joint fluid test can test for the presence of uric acid crystals, which typically indicate gout and are not present with psoriatic arthritis.
Your doctor may discuss with you a new class of medications that act by blocking an inflammatory protein called tumor necrosis factor (TNF). Examples of these drugs inclue the brands Humira, Enbrel and Remicade. These drugs can have serious side effects, which you should discuss with your doctor before deciding to take them.
In some cases extremely painful joints may be injected with steroid medications. Surgery can help repair or replace severely damaged joints.
Other strategies to reduce pain:
- A healthy mix of rest and exercise. Walking (with a walking aid or shoe inserts to reduce stress), riding an exercise bike and swimming or pool walking are good choices
- Physical therapy to increase the movement in affected joints
- Heat and cold therapy
Psoriatic arthritis is a chronic condition. Work with your doctor to ensure a proper diagnosis and the best balance of medical and non-medical treatment options. Quickly treating flares can help. During these periods of intense symptoms some patients benefit from assistive devices such as braces. These help reduce inflammation by immobilizing some joints. Walkers, crutches or orthotics can also reduce the pain of walking.
The following tips can help you successfully managing the disease:
- Protect your joints by changing the way you conduct daily tasks. For example, use your whole body to push open a heavy door, rather than one hand.
- Maintain a healthy weight and lose weight if necessary. This can help recue pain and increase mobility.
- Use cold and hot therapy. Cold can dull the sensation of pain and heat can relax tense muscles and also relieve pain.
- Take it easy. Living in pain is difficult and, along with some arthritis medicines, can lead to fatigue. The goal is to stop and rest before becoming overly exhausted. In some people psoriatic arthritis causes mood swings and emotional challenges.