Psoriasis Help Organisation - Online Psoriasis Forum

Psoriatic arthritis is a painful disease characterized by both joint erosion and skin lesions. It causes inflammation in and around the joints and affects an estimated one million adults. People with psoriatic arthritis experience progressive joint pain and swelling, which is often coupled with scaly, red skin lesions.

Life Impact

Psoriatic arthritis has a physical impact causing frustration and can make simple daily activities more difficult. It also has an emotional impact on people’s feelings, behaviors and experiences. Because of the skins lesions associated with psoriatic arthritis, patients may feel sadness, despair, guilt, anger and low self-esteem. A person’s sense of self-worth can be affected and, in some cases, the emotional turmoil of psoriatic arthritis can lead to depression.

Causes and Symptoms

The exact cause of psoriatic arthritis is unknown, but it is believed to be an autoimmune disease with genetic components. Environment may also be a factor in the development of the disease. Psoriatic arthritis can manifest differently in various patients. About 95 percent of people with psoriatic arthritis have swelling in joints outside the spine, and more than 80 percent of people with psoriatic arthritis experience changes in their nails such as indentations or lifting of the nail. Other symptoms may include:

• Stiffness, pain, swelling and tenderness of the joints and the soft tissue around them 
• Reduced range of motion 
• Morning stiffness and tiredness 
• Silvery layers of skin that flake off leaving red, inflamed skin underneath 
• Redness and pain of the eye, similar to conjunctivitis

Diagnosis

Psoriatic arthritis can develop at any time. On average, it appears about 10 years after the first appearance of the skin lesions associated with psoriatic arthritis. However, about one of seven people develops arthritic symptoms before any skin lesions appear. The disease can be difficult to diagnose, particularly in its milder forms and earlier stages. Typically, diagnosis of psoriatic arthritis is based on the patient’s medical history, physical exam, blood studies, and x-rays. Like rheumatoid arthritis, psoriatic arthritis can be a disabling disease if left untreated. In fact, half of those with psoriatic arthritis already have bone loss by the time the disease is diagnosed.

Types of Psoriatic Arthritis

There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans.

Symmetric Arthritis, the most common type, usually affects multiple symmetric pairs of joints (occurring in the same joints on both sides of the body). Approximately 50 percent of people with this form of psoriatic arthritis will develop varying degrees of progressive disease, which destroys joints and can be disabling. 

Asymmetric Arthritis affects about 35 percent of those with psoriatic arthritis and usually involves only one to three joints, such as the knee, ankle, wrist or finger, but usually does not occur on the same joint on the opposite side of the body. Affected hands and feet have enlarged “sausage” digits, caused by swelling and inflammation of tendons. The joints may be warm, tender and red. 

Distal Interphalangeal Predominant (DIP) arthritis occurs in only about five percent of people with psoriatic arthritis. It primarily involves joints closest to the nail in the fingers and toes. 
Spondylitis involves inflammation of the spinal column. The common symptoms are inflammation with stiffness of the neck, lower back, or spinal vertebrae, making motion painful and difficult.

Arthritis Mutilans is a severe, deforming form of arthritis that affects fewer than 5 percent of people with psoriatic arthritis. It predominantly affects the small joints of the hands and feet, though it can be associated neck or lower back pain.

Treatments

A physician must evaluate each patient with psoriatic arthritis individually. Common treatments include:

• Nonsteroidal anti-inflammatory drugs (NSAID5) such as ibuprofen and aspirin are used to decrease the symptoms of psoriatic arthritis, including inflammation, joint pain and stiffness.
  
• Disease-modifying antirheumatic drugs (DMARD5) such as methotrexate and cyclosporine relieve severe symptoms and attempt to slow or stop joint and tissue damage.
  
• Biologic Response Modifiers target specific pathways of the immune system. Treatment with biologics can provide rapid and significant relief of symptoms. 
  
• Other Treatment Approaches such as heat for stiffness, warm water soaks, ice for swelling, light therapy, exercise programs and physical therapy are used in the treatment of psoriatic arthritis.