Psoriatic Arthritis
Psoriatic arthritis is a form of arthritis linked with psoriasis, an autoimmune disorder that can cause red, scaly patches on the skin. About a third of the people with psoriasis develop psoriatic arthritis (PsA). They experience pain, swelling, and inflammation in affected joints. The severity varies from person to person, but medications, physical therapy, and lifestyle changes can help manage symptoms, especially with early diagnosis and treatment.
Symptoms
The symptoms of psoriatic arthritis tend to worsen as time goes by, but it is not unusual for symptoms to come and go. Symptoms are often similar to rheumatoid arthritis — with painful joints that seem swollen and warm. They can affect one side of the body or both.
These symptoms are common in psoriatic arthritis:
- Foot pain where tendons and ligaments attach to bone. Most commonly felt in the sole or back of the heel.
- Painful swelling in the fingers and toes, sometimes giving the appearance of “sausage” fingers.
- Damage to the nails. They form dents, crumble, or separate from the skin below.
- Lower back pain and stiffness, a condition known as spondylitis.
- Redness and pain in the eyes (uveitis), with possible loss of vision if untreated.
Causes and Risk Factors
Psoriatic arthritis results from the body’s immune system attacking its own cells. That results in inflammation, joint damage, and overgrowth of skin cells. No one knows for certain why this happens. Environmental and genetic factors likely play a part, and physical injury or illness may trigger the disease.
- Psoriasis. People with psoriasis are at the greatest risk of developing psoriatic arthritis.
- Family history. Many people with psoriatic arthritis have a family history of psoriasis or psoriatic arthritis.
- Age. The disease usually appears in people ages 30 to 55.
Diagnosis
Part of diagnosing PsA is ruling out other causes of joint pain. A doctor will conduct a physical exam and review medical and family history.
One or more of these tests may be ordered:
- Imaging tests. Ultrasound imaging, X-rays, CT scans, and MRIs can help find changes in bones and joints.
- Lab tests. Blood tests look for signs of inflammation. Your doctor may also take skin biopsies and draw fluid from joints to test for signs.
Treatment
There’s no cure for the disease. Treating psoriatic arthritis involves relieving and controlling symptoms and reducing joint damage. Treatment options are based on symptoms, age, health, and the condition’s severity. Both skin problems and joint inflammation must be treated.
Lifestyle
Eating a balanced diet that is low in sugar, salt, and fat can control weight and improve overall health, whereas eating unhealthy foods can worsen inflammation. Regular exercise can help keep joints flexible. A skin care regimen that includes moisturizer may be recommended. And healthcare professionals also recommend no smoking and limiting alcohol consumption.
Medications
- Over-the-counter nonsteroidal anti-inflammatories — NSAIDs such as ibuprofen, aspirin, and naproxen — can reduce swelling and pain. Other OTC creams containing salicylic acid, coal tar, and vitamin A derivatives are often helpful.
- Stronger anti-inflammatories, such as corticosteroids, may be prescribed for severe skin outbreaks or joint pain.
- Conventional DMARDs. Disease-modifying anti-rheumatic drugs suppress the immune system to slow the progression of RA.
- Biologic agents. This type of DMARD is engineered to target a specific pathway in the immune system to reduce inflammation.
- Synthetic DMARDs. This type of conventional, synthetic DMARD targets specific molecular structures.
Therapies
- Ultraviolet light treatments — phototherapy — target psoriasis symptoms.
- An occupational therapist teaches patients how to perform daily activities and provides work-around advice for living with psoriatic arthritis.
- Physical therapy teaches patients how to exercise, stretch, and stay flexible. Building muscle and keeping the joints mobile reduces fatigue and pain.
- Some psoriatic arthritis patients find comfort through acupuncture. The nerve stimulation produces natural endorphins that relieve pain.
- Anti-smoking therapies, such as nicotine patches, hypnosis, acupuncture, and prescription medications, can help smokers quit.
- Hot/cold therapies may provide relief. Hot or cold packs are applied to skin outbreaks or afflicted joints. Heat works to improve blood flow and reduce stiffness. Cold reduces swelling with the side effect of pain relief. Some find greater relief when both hot and cold are alternatively applied to the same areas.
Treatment for Psoriatic Arthritis
The Florida Medical Clinic Department of Rheumatology offers consultative, diagnostic and therapeutic services to help you reclaim your quality of life. Let us apply our expertise in the diagnosis and treatment of rheumatic diseases to help you. Contact us today to schedule an appointment.
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