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General Concepts > Psoriatic Arthritis What is Arthritis? Approximately 40 million people are affected by arthritis. The term arthritis refers to a group of disorders which involve the body’s joints and have similar symptoms. The symptoms of arthritis include pain, stiffness and swelling of the joints and the surrounding area. Some types of arthritis include osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis and juvenile rheumatoid arthritis. Arthritis affects each person differently. It may attack one or more joints suddenly or gradually and may be constant and progressive or seem to come and go. Unfortunately the effects of arthritis are usually chronic, meaning that they will last a long time, perhaps for a lifetime. How much arthritis will affect a patient’s ability to function will be determined by the severity of the condition, which joints are affected, and for how long. A physician must examine each patient and carry out the appropriate blood tests and X-Rays to determine what type of arthritis a patient has and how best to treat it. There are many medical, rehabilitative and surgical treatments that can help lessen the pain, increase or preserve joint motion and even slow the progress of the disease. When first confronting the diagnosis of arthritis, the patient should gain an appreciation of the type of arthritis that he or she has and understand that the condition will probably last for a very long time, that it may affect different joints at different times and that medication adjustments may be required over time. What is Psoriatic Arthritis? Psoriatic Arthritis is a particular type of arthritis that occurs in some patients who have psoriasis, which is a chronic skin condition. It resembles rheumatoid arthritis in its effects, though the majority of people experience a mild form. Psoriatic Arthritis includes symptoms of both the skin disorder and joint conditions, and can cause additional symptoms as well. There is no cure for psoriasis or psoriatic arthritis, but there are many treatments available to alleviate the symptoms. It is a chronic disease, however, and if untreated can cause more serious health problems. The most common form of psoriatic arthritis affects the tips of the fingers or toes. However, one in five cases of the condition can affect the spine. The least common form of psoriatic arthritis is called “psoriatic arthritis mutilans,” which targets the joints, causing severe destruction. Psoriasis is a rough, scaly type of rash that appears most commonly on the knees, elbows and scalp. The rash consists of red or silvery gray, scaly patches on the skin. Psoriatic arthritis occurs in about five to ten percent of the 30 million Americans with psoriasis. The condition affects men and women evenly and generally appears between the ages of 30 and 50. In approximately 15 percent of the patients the appearance of psoriatic arthritis can precede the onset of psoriasis. The progress of psoriatic arthritis is generally mild in most people and can affect only a few joints. What Causes Psoriasis? The skin is made up of several layers, from a very thin outer layer of dead cells, to the very inner layer of skin. The skin normally regenerates itself completely over the course of approximately a month, from the outer layers to the lower layers. The “new skin” underneath replaces the layer on top of it, at the same time as the outer layer of dead skin cells are sloughed off. In patients with psoriasis, however, part of this process happens much too fast. The skin regenerates instead in a matter of days, and the layers of skin cells cannot be sloughed off quickly enough. The buildup of these dead skin cells then causes thick, itchy patches on the body. The most prominent symptoms are these resulting dry, scaly patches of skin. The areas may be cracked or raised, and covered with silvery scale-looking spots. The area around the patches may be red, with small pustules, or blisters. These patches are often itchy and sore. The most common areas that are affected by psoriasis are the elbows, knees, skin folds, and trunk, but it can affect the skin anywhere on the body. Patients may also experience problems with their toes or fingernails, and/or burning and itching eyes. There are known triggers for flare-ups of psoriasis, though the cause is not completely known. Injury to the skin, such as scrapes or cuts, insect bites, or other rashes, can aggravate the symptoms of psoriasis. People, who are immunosuppressed due to chemotherapy, AIDS, or other diseases such as rheumatoid arthritis, are also at risk for more severe symptoms. Many other factors, such as alcohol, lack or overexposure to sun, and stress can contribute to flare-ups of the disease. The disease is not contagious. Your doctor may take a skin biopsy of one of the scaly patches, and/or order blood tests to make a diagnosis of psoriasis. Most commonly, however, diagnosis will be made based on the medical history and the examination of the skin and/or nails. The 5 Types of Psoriatic Arthritis? There are actually five types of psoriatic arthritis, each with different symptoms, disease course, and treatment. The majority of people with psoriatic arthritis experience only mild arthritis symptoms, and in only a few joints. The most common type causes symptoms in one or two joints only. For those who do experience more severe symptoms, however, such as in the spine, the symptoms are usually able to be treated with medications and other therapy. Distal Interphalangeal Predominant This type of psoriatic arthritis primarily affects the last joint of the fingers and toes (the “distal interphalangeal joint.” It is similar to osteoarthritis, and in fact often mistaken for that type, though the symptoms are generally limited to these joints only. Asymmetrical arthritis Asymmetrical arthritis generally only affects two or three joints, and individually rather than in pairs. It can affect any joint in the body, though it is common in the fingers and toes. It often causes what your doctor may refer to as “sausage digits”, where your fingers swell. The joints are often red and warm to the touch. This type is quite common, affecting 55-70% of patients with psoriatic arthritis. It is generally mild, though, and doesn’t progress as much as some of the other forms. It is fairly responsive to treatment with NSAIDs and other drugs. Symmetrical polyarthritis Symmetrical polyarthritis, also referred to simply as symmetrical arthritis, is identified by the fact that joint swelling tends to occur in pairs, on both sides of the body. For instance, if the elbow is affected, both elbows will be affected. It resembles rheumatoid arthritis, though it is less severe. It is probably the second most common in patients with psoriatic arthritis, affecting 15-70% of patients. It can be severe and cause joint deformity, and the skin symptoms are often much more severe than in those with other types. Spondylitis, or Psoriatic Spondyloarthritis Spondylitis refers to inflammation of the joints in the spine. This is a serious condition that can cause deformity and changes in posture as a result. It is less common than the previously-mentioned types, affecting from 5-33% of those with the disease. In addition, patients with this form of psoriatic arthritis often experience symptoms in the joints in the arms and legs. The most prominent symptoms of this type include inflammation, tenderness, and stiffness in the joints of the joints in the back and neck. It can actually affect the ligaments in these areas as well. Arthritis mutilans Arthritis mutilans is a very severe type of psoriatic arthritis. It is fairly rare, affecting less than 5% of patients who are diagnosed with psoriatic arthritis. Its severity is due to the fact that it actually destroys bone and cartilage in the joints, deforming the joints in the hands and feet primarily. It tends to come and go in a series of exacerbations, or flares, and remissions. These often coincide with flares in the skin symptoms. Patients may have one or more of these types during the course of their disease, and may actually show signs of several types at once, so that identification of a single type is not always possible. In addition, there are three other forms of arthritis that may occur in patients with psoriasis: Reiter’s syndrome, gout, and rheumatoid arthritis. Reiter’s syndrome is a disease that causes inflammation of the urethra, inflammation in the eye, and arthritis. It is not a venereal disease but it does produce lesions on the genitals, as well as the palms of the hand, soles of the feet, and in the mouth. Gout is a form of arthritis that causes inflammation and sudden attacks of severe pain, often in the big toe. It results from excess uric acid in the blood, which causes crystals to form in the affected joints. In patients with psoriasis, the condition is generally only present for a short time. Where joint deformity occurs in one of the above-mentioned forms of psoriatic arthritis, the condition may be easily confused with Rheumatoid Arthritis, which is a type of arthritis associated with the immune system that causes severe deformity of the joints. These types are distinguished from Rheumatoid arthritis primarily by the absence of a particular antibody found in the blood of most patients with Rheumatoid Arthritis, known as the rheumatoid factor, in addition to the skin symptoms. Rheumatoid arthritis may occur in patients with psoriatic arthritis as well, however. Your doctor will use diagnostic tests such as blood tests and x-rays of the affected joints to help determine what type or types of arthritis you have. Causes of Psoriatic Arthritis? The cause of psoriatic arthritis is unknown. Doctors suspect that genetic, environmental and immune factors play a role in the condition. It is classified in the group of diseases called Seronegative Spondyloarthropathies. Approximately 40 percent of people who develop psoriatic arthritis have a family member with either psoriasis or arthritis. Symptoms of Psoriatic Arthritis? The nature of symptoms of psoriatic arthritis range depending on the type, but generally they are similar to those of other types of arthritis. Patients generally experience pain and stiffness or tenderness in the joints, usually in more than one joint. This pain is often accompanied by a reduced range of motion, or pain that worsens with motion. Psoriatic arthritis tends to affect the joints in the fingers and toes more frequently, particularly those joints near the ends of the fingers and toes. It also affects the knees and ankles. Pain and stiffness is generally worse in the morning, subsiding throughout the day. Treatments of Psoriatic Arthritis? There is no cure for psoriatic arthritis. Treatment programs are tailored to the individual’s symptoms, in order to manage them most effectively. Because the course of the disease can be very different from patient to patient, factors such as remissions and exacerbations of symptoms are also important to take into consideration. Every patient is different, and our treatment program will be tailored to your own particular needs. Treatment plans include reducing inflammation in the joints, reducing pain, and preventing further damage. Psoriatic arthritis is actually treated in much the same way that the conditions of psoriasis and arthritis are treated individually. The skin is treated with topical and oral medications, including antibiotics. One aim in patients with psoriasis is the prevention of secondary infections as a result of the skin irritation. Mild forms of the accompanying arthritis are treated like other forms of arthritis, using aspirin, anti-arthritis drugs and other medications. Non-steroidal anti-inflammatory drugs, or NSAIDs, are used to control the pain and swelling of the arthritis. Your doctor may inject steroids directly into affected joints instead of prescribing medications for you to take at home. In patients for whom this is not therapeutic, other drugs may be prescribed. These include methotrexate as well as an antimalarial drug known as hydroxychloroquine. Unfortunately some drugs used to treat one set of symptoms, particularly those that are classified as antimalarials, can trigger an exacerbation, or worsening, in another set, so it is especially important that you talk to your doctor about any side effects you have from the drugs. It is also important to understand that there doesn’t seem to be any link between the location of skin symptoms and the location of joint symptoms. You may have scaly patches on one part of your body, and joint pain and swelling in an entirely different part. It is not known what the link is between these two conditions. There are also some therapeutic treatments that can ease some pain and swelling in your joints, such as heat, cold, or soaking in warm water. It is important to get sufficient rest. Your doctor may also suggest an exercise program tailored to your condition, to improve your general health as well as your joint health. Other more aggressive treatments include corticosteroid injections into the joints or injections of gold salts for patients with more destructive joint damage. In the case of very severe joint damage, surgery may be necessary, but it is not common. One of the concerns the surgeon has is the worry of infection of the joint by going through skin lesions overlying the affected joint. Your doctor may refer you to a rheumatologist for specialized treatment for your condition. A rheumatologist is a doctor who specializes in rheumatic diseases, or diseases of the joints. While Psoriatic arthritis is not entirely rheumatic in nature, a rheumatologist may nevertheless be very helpful in prescribing the best course of treatment for patients. Your doctor may also refer you to a dermatologist, a doctor who specializes in diseases of the skin, for treatment of your psoriasis. With proper understanding of your condition, and good medical care, you should be much better able to assist in your own treatment. By understanding the various factors that can cause flare-ups in your symptoms, you can avoid these and minimize the effects on your body. Finally, if you have any questions about your disease, additional symptoms not mentioned here, or your treatment plan, you should consult with your doctor. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |