Physical activity helps maintain joint movement.
Psoriasis is a skin disorder characterized by scaly red, white, and grey patches that develop on the skin. It results from a disturbance in the body's immune system, which becomes overactive and attacks itself (the skin in this case). When the immune system targets the joints as well, some individuals with psoriasis can also develop psoriatic arthritis. Psoriasis & psoriatic arthritis symptoms flare (become worse) and subside, vary from person to person, and even change locations in the same person over time.
Psoriatic arthritis can affect any joint in the body, and it may affect just one joint, or several joints or multiple joints at once. For example, it may affect one or both knees. When fingers and toes are affected, they take the shape of swollen sausages, a condition often referred to as dactylitis. Scalp, finger and toe nails also may be affected.
Spondilytis is psoriatic arthritis in the spine; pain in the back or neck with difficulty bending is the hallmark of spondilytis. Psoriatic arthritis also can cause tender spots where tendons and ligaments attach onto bones. This condition, called enthesitis, is one of the characteristic features of psoriatic arthritis, and can result in pain at the back of the heel, the sole of the foot, around the elbows or in other areas.
Psoriatic arthritis typically affects the large joints, especially those of the lower extremities, distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis.
The exact cause of psoriatic arthritis is not known, but genetic factors play a major role, since 40% of patients have a family member with psoriasis or arthritis.
Although psoriasis itself is not infectious, it might be triggered by a streptococcal throat infection that activates the immune system.
Psoriatic arthritis usually affects people between the 4th and 6th decades of life, but can begin as early as childhood. Men and women are equally affected. Children with psoriatic arthritis are also at risk to develop uveitis (inflammation of the middle layer of the eye). At times, the arthritis can appear before the skin disorder.
Diagnosis is made based upon the presence of swollen and painful (inflamed) joints, certain patterns of arthritis, and skin and nail changes typical of psoriasis. X-rays often are taken to look for joint damage. MRI, ultrasound or CT scans can be used to look at the joints in more detail.
Blood tests may be done to rule out other types of arthritis that have similar signs and symptoms, including gout, osteoarthritis and rheumatoid arthritis. In patients with psoriatic arthritis, blood tests may reveal high levels of inflammation and mild anemia. Occasionally skin biopsies (small samples of skin removed for analysis) are needed to confirm the psoriasis.
Treatment choice depends on the degree of pain. Those with very mild arthritis may require treatment only when their joints are painful and may stop therapy when they feel better.
Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil) or naproxen re used as 1st line treatment.
If the arthritis does not respond, disease modifying anti-rheumatic drugs may be prescribed. These include sulfasalazine(Azulfidine), methotrexate (Rheumatrex), cyclosporine (Neoral, Sandimmune) and leflunomide (Arava). Sometimes combinations of these drugs may be used together. The anti-malarial drug hydroxychloroquine (Plaquenil) can help, but it usually is avoided as it can cause a flare of psoriasis. Azathioprine (Imuran) may help those with severe forms of psoriatic arthritis.
The more recently available anti-tumor necrosis factor agents such as adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade) are also available and can help the arthritis as well as the skin psoriasis.
For swollen joints, corticosteroid injections can be useful. Surgery can be helpful to repair or replace badly damaged joints.