Psoriatic arthritis

Specialty of Rheumatology

What is it?

Psoriatic arthritis is a rheumatic disease that causes joint inflammation. This condition is associated with a skin condition called psoriasis and it tends to appear after the psoriasis. This condition tends to affect finger and toe joints, causing them to become inflamed and lose functionality. As the condition progresses, it can deform and destroy the joints.
 
Treatment involves relieving symptoms with non-steroidal anti-inflammatory medications (NSAIDs) as well as immunosupressants to slow down progression. Physical rehabilitation and rest are very important during periods of inflammation. In cases where a child has psoriatic arthritis, it is classed under juvenile arthritis, which has a range of clinical variations such as juvenile idiopathic arthritis, rheumatoid arthritis in children, and reactive arthritis in children, among others.

Prognosis

This condition tends to be mild, and only affects a few joints. Psoriatic arthritis usually affect the limbs (hand and feet) or the spine, where it can cause deformities. For patients with more serious arthritis, treatment may help ease the pain and prevent joint damage. If treatment is started early on, it will be more effective.

What are the symptoms?

Sometimes the disease doesn’t last long and it only affects some joints, mainly the tips of the fingers or toes. Sometimes the condition can be severe and affect many joints, as well as the spine. If the spine is affected, the symptoms may include stiffness, burning, and general pain, especially around the lumbar and sacrum. People who also have arthritis quite often experience skin and nail changes due to psoriasis. The skin often gets worse if the arthritis worsens.

Medical tests

The specialist will carry out a physical examination in order to find:

  • Joint inflammation
  • Cutaneous patches (psoriasis) and nail pitting
  • Sensitivity.

The specialist may need to do a joint X-ray to correctly diagnose the condition.

What causes it?

Psoriasis is a common chronic skin condition that causes red skin patches. 1 in 20 people affected by this condition will have arthritis as well as the skin condition. Generally speaking, the psoriasis will start before the arthritis. The cause of psoriatic arthritis is unknown, but it is believed that genes can influence its appearance. People who have psoriasis tend to have a higher chance of developing arthritis.

How can it be prevented?

There is no known way to prevent psoriatic arthritis.

What is the treatment?

Treatment mainly aims to alleviate joint pain and reduce inflammation via non-steroidal anti-inflammatory drugs (NSAIDs). In more severe cases the specialist may prescribe antirheumatic medications such as:

  • Leflunomide
  • Methotrexate
  • Sulfasalazine.

There are new medications that are able to block the inflammatory protein, called tumour necrosis factor, which are becoming the go to treatment for psoriatic arthritis. The new medications are:

  • Adalimumab
  • Etanercept
  • Golimumab
  • Infliximab.

If patients have extreme joint pain, they may need to resort to having steroid injections. In extreme cases, patients will need to have surgery to repair or replace the damaged joints. The specialist will most likely recommend following a healthy lifestyle with plenty or rest and exercise. Physiotherapy is a known way to increase strength in the affected joints. Hot and cold therapy is also often recommended.

What specialist should I see?

Rheumatologists treat psoriatic arthritis and other arthritic conditions.
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