Psoriatic arthritis is a form of arthritis

Many people first develop psoriasis and later develop joint inflammation – arthritis. But sometimes arthritis precedes psoriasis.

Joint pain, stiffness and swelling are among the main symptoms of psoriatic arthritis. Any joints are affected, including the small joints of the hands and the spine. The development of the disease is unpredictable: from moderate manifestations to pronounced changes in the joints. The course of psoriasis, like psoriatic arthritis, is wavy, and exacerbations can be followed by periods of complete absence of complaints.

Today, treatment consists of reducing the severity of the disease and preventing joint damage. Although there are no drugs that completely cure psoriatic arthritis, without treatment and regular exercise, the course of this disease can be very severe.

Symptoms of psoriatic arthritis

Both psoriasis and psoriatic arthritis are chronic diseases; over the years they tend to progress and become protracted, but there may be periods of “quiet” (remission), when the symptoms go away and the condition returns to normal, alternating with periods of exacerbation. As a rule, deterioration (improvement) of the condition of the skin and joints occurs simultaneously.

Manifestations of psoriatic arthritis

• Pain in the affected joints;
• Stiffness in the joints, which may also be a reason to make an appointment with a neurologist;
• The joints are hot to the touch.

Specifics of joint damage in psoriatic arthritis

There are five main types of psoriatic arthritis, which can occur over time in the same person:

• Joint pain on one side of the body. This is a mild form of psoriatic arthritis, called asymmetric psoriatic arthritis, which affects joints on one side of the body or different joints on each side of the body, including the hips, knees, ankles and wrists. Usually less than 5 joints are involved and they become painful and red. When asymmetrical arthritis affects the hands and feet, inflammation and swelling of the tendons can cause the fingers to become characteristically thick (dactylitis) and look like a small sausage (“sausage toes”).
• Bilateral or symmetrical joint pain. Typically, symmetrical psoriatic arthritis affects 5 or more joints symmetrically, that is, on both sides of the body. This form of arthritis is more common in women, and psoriasis associated with arthritis is more severe.
• Pain in the small joints of the hands. Psoriatic arthritis, which affects the smallest joints of the hands and feet near the nails (distal interphalangeal joints), is a rare form and occurs mainly in men. Nails also quite often become characteristic of psoriasis: they thicken, change color, and pits appear in them.
• Backache. This form of psoriatic arthritis, called spondylitis, can cause inflammation of the spine, as well as stiffness and inflammation of the cervical spine, lumbar spine, and the joints between the spine and pelvis (sacroiliac joints). Inflammation can occur where the ligaments attach to the spine. As the disease progresses, movement becomes painful and difficult.
• Destructive arthritis. A small percentage of people with psoriatic arthritis have a severe form of psoriatic arthritis called arthritis mutilans. Over the years, this form of arthritis destroys the small bones of the hands, especially the fingers, leading to permanent deformity and loss of function.

If you have psoriasis, be sure to tell your doctor about any additional joint pain. Psoriatic arthritis can begin suddenly or gradually, but either way, the disease can seriously damage your joints if left untreated.

Causes of psoriatic arthritis

Psoriasis is a skin disease in which plaques form on the skin, consisting of dense areas covered with dry, keratinized layers of skin cells. Arthritis causes pain and stiffness in the joints. Both diseases belong to the group of autoimmune diseases, that is, they occur when the immune system, which normally protects the body from harmful agents such as bacteria and viruses, mistakenly begins to attack healthy cells and tissues. An abnormal immune response causes joint inflammation and overproduction of skin cells.

Heredity and environment

It is not yet entirely clear why the immune system attacks healthy tissue, but heredity and environment are thought to play a role. Many people with psoriatic arthritis have close relatives (parents, siblings) with psoriasis.

Researchers have discovered specific genetic markers associated with this disease. If one of your close relatives suffers from psoriatic arthritis, this does not mean that this disease will develop in you, it only means that you have a predisposition to this disease.

Physical trauma or an infectious (viral) disease can trigger the development of psoriatic arthritis in people with a hereditary predisposition.

Factors that increase your risk of developing psoriatic arthritis

• Psoriasis. The presence of psoriasis is one of the most important risk factors for psoriatic arthritis. People with severe psoriatic nail disease are especially susceptible to developing psoriatic arthritis;
• Hereditary predisposition. Many people with psoriatic arthritis have close relatives who also have the disease;
• Age. Although anyone can develop psoriatic arthritis, adults between 30 and 50 are especially susceptible;
• Floor. In general, both men and women are affected equally; symmetrical arthritis is more common in women, and spondylitis and damage to the distal interphalangeal joints is more common in men.

Complications of psoriatic arthritis

Psoriatic arthritis can be painful and damage your joints, even with treatment. Some types of psoriatic arthritis can present additional difficulties, such as:

• Swelling of the fingers and toes (dactylitis). Psoriatic arthritis can cause painful, sausage-like swelling in the fingers and toes. Swollen toes can make it difficult to find the right shoes. An orthopedist specializing in foot diseases (podiatrist) will help you choose special shoes.
• Foot pain. Another condition associated with psoriatic arthritis is enthesopathy, which is pain and inflammation where tendons and ligaments attach to bones, most commonly affecting the Achilles tendon and the plantar part of the foot (plantar fasciitis).
• Back and neck pain. Some people develop inflammation in the intervertebral joints (spondylitis) and the joints between the vertebrae and pelvis.

Diagnosis and examination of psoriatic arthritis

There is no specific test to confirm psoriatic arthritis, so the doctor will evaluate all the symptoms and prescribe tests to rule out other possible causes of the disease, which have similar complaints, such as osteoarthritis and rheumatoid arthritis.

• X-ray examination. Will allow you to distinguish changes that are characteristic of psoriatic arthritis and not found in other diseases.
• Analysis of synovial fluid. From a large joint, usually the knee, a small amount of synovial fluid can be removed with a needle and its composition can be examined in the laboratory. If uric acid is found in it, this most likely indicates that you have gout, not psoriatic arthritis.
• Erythrocyte sedimentation rate (ESR).
• Rheumatoid factor (RF). RF is an antibody, a protein produced by the immune system, often present in the blood of rheumatoid arthritis. It is not found in psoriatic arthritis, so it is prescribed to distinguish these diseases.

Treatment of psoriatic arthritis

There is no specific treatment for psoriatic arthritis, and the main goal is to reduce inflammation in the affected joints to prevent pain and loss of function.

Drugs used to treat psoriatic arthritis:

• Non-steroidal anti-inflammatory drugs (NSAIDs),
• Glucocorticoids,
• Basic drugs,
• Immunosuppressive drugs.

All medications are prescribed only by a doctor, taking into account the course of the disease, the risk of side effects and the presence of concomitant diseases.

Surgery

The help of a surgeon is rarely resorted to, only in cases where conventional treatment does not give a good result and does not alleviate the symptoms.

Lifestyle with psoriatic arthritis

The good news about psoriatic arthritis is that you can do a lot on your own to keep yourself in good health. These measures will help significantly relieve symptoms without causing side effects:

• Maintain normal weight.
• Regular physical activity.
• Use cold and heat.
• Use the movements that suit you.