Psoriatic Arthritis

Published: November 3, 2010

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What is it?

Psoriatic arthritis is a form of arthritis that typically affects joints in the fingers or toes. It is often characterized as having swollen, sausage-like fingers and toes with nail deformities, but may also affect the lower back, wrists, knees or ankles. Generally, there are five types of psoriatic arthritis:

1.Symmetrical affects several joints, the same joints on both sides of the body, and can be disabling. It is generally milder with less deformity, and symptoms resemble those of rheumatoid arthritis.

2.Asymmetrical affects fewer joints on one or both sides of the body. Fingers and toes may be enlarged and tender.

3.Distal interphalangeal (DIP) is known as the "classic" type of psoriatic arthritis, and it primarily affects the joints of the fingers and toes closest to the nail, resulting in deformed nails and nail beds.

4.Arthritis mutilans affects small joints in the hands and feet and is the rarest form of the five types.

5.Axial arthritis affects the spinal column between the neck and the lower back.

While there is no cure or known cause for this disease, there are steps of prevention and treatment therapies that can alleviate the symptoms.

Symptoms & Warning Signs

Symptoms of psoriatic arthritis are varied and can include a number of issues:

  • Tender, swollen joints, similar to those of tendonitis
  • Back pain
  • Swelling of fingers and toes (they may look sausage-like)
  • Muscle or joint pain, with or without inflammation
  • Abnormal nail change, such as pitting, ridging or separation of the nail from nail bed
  • Discoloration of the nails, similar to that of a fungal nail infection
  • Morning stiffness of the joints
  • General fatigue
  • Reduced range of joint movement
  • Redness and pain around the eyes

Initial symptoms usually happen in acute episodes, meaning there may be short, sudden periods of worsening symptoms alternated with periods of no symptoms. There has been a link between having psoriatic arthritis and experiencing the psoriasis skin condition beforehand, so it is very important for psoriasis patients to notify a physician if he or she is experiencing any type of symptoms above.

Causes & Risk Factors

The cause of psoriatic arthritis is unknown, but the risks increase with age, just like with all types of arthritis. It most commonly affect people 30 to 50 years old, and men are more at risk than women. An increased risk has been shown for siblings of individuals with the disease. Also, individuals who already have the psoriasis skin condition have a higher rate of developing psoriatic arthritis, as the skin disease typically precedes the arthritis. It is important to note, however, that not every individual who has psoriasis will develop psoriatic arthritis.

Prevention & Treatment

While there is no cure, treatment plans can help alleviate symptoms and possibly prevent further joint damage. Depending on symptom severity, doctors will prescribe and customize treatments accordingly. Exercise and stretching can help build muscle strength, maintain range of motion and reduce stiffness. Rehabilitation can also maximize the functions of affected joints through targeted physical therapy. Doctors may also recommend splints and shoe inserts to help support the spine. Warm, stable climates have been shown to reduce symptom episodes, and cold packs may help reduce swelling of sausage-like digits. Calcium supplements with vitamin D can be taken as a preventative measure against developing other forms of arthritis in the future.

Anti-inflammatory drugs, along with therapy, may be prescribed in pill form or intravenous (IV) infusions to help reduce swelling, joint pain and stiffness. In more serious cases, surgery can also be an option. However, medications and surgery also come with side effects and risks, so it is important to consult with your physician beforehand.

Tests & Diagnosis

There is no definitive method for diagnosing psoriatic arthritis. Since this disease has many overlapping symptoms with other types of arthritis and gout, physicians usually perform a series of tests, confirming the psoriatic arthritis diagnosis via process of elimination. A physical examination will first be performed to rule out symptoms pertaining to other forms of arthritis. Then a blood test may be done to help further eliminate other diseases. For example, doctors may run a blood screening to test for antibodies present in other types of arthritis. If there are particularly painful joints present in the patient, a fluid sample drawn from the affected joint will be tested to potentially rule out the presence of gout.

X-rays may help with diagnosis in the later stages of psoriatic arthritis, and doctors will be looking for a phenomenon unique to psoriatic arthritis known as the "pencil-in-cup" formation. In this case, the end of the bone near the joint is degraded and narrowed to a sharp point, as opposed to a rounded end typical of normal joint bones. Changes in joint position of the spine can also support the diagnosis of psoriatic arthritis. However, X-rays cannot detect the disease during its early stages.

While some primary care physicians and dermatologists can treat symptoms of psoriatic arthritis, it is best to seek out a rheumatologist, which is an arthritis specialist, to ensure that the symptoms will not be misdiagnosed

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