Psoriatic arthritis is a type of arthritis that develops in some people who experience the skin condition psoriasis. The skin is in a constant process of regeneration and completely replaces itself over the course of a month.
New skin cells from underneath the outer layer of older skin, which then sloughs off to expose the newer skin.
Psoriasis develops when the regeneration process occurs too quickly- the new skin cells develop faster than they should and the old skin is, not shed quick enough.
This causes scaly red patches of skin to form, known as plaques, which can become very sore and itchy.
These psoriasis plaques are usually found in localized patches on the knees, elbows, buttocks or head but can be found anywhere on the body and can occasionally cover a wider area.
Psoriatic arthritis generally only develops in psoriasis sufferers, although this does not mean that psoriasis sufferers will automatically develop the condition, nor does it mean that those with the most severe psoriasis symptoms will develop more severe forms of psoriatic arthritis.
The condition occurs in around five to ten percent of people with psoriasis. In addition, around fifteen percent of people develop psoriatic arthritis before experiencing the symptoms of psoriasis.
- Pain, stiffness, and swelling of the joints
- Tender areas in and around joints
- Lower back pain, particularly in the sacrum
- A sausage-esque appearance caused by swelling in fingers and toes known as dactylitis
- Tendinitis, especially around the feet areas
- Plantar Fasciitis
These last 3 symptoms are especially associated with psoriatic arthritis as opposed to other forms of arthritis.
This condition develops in up to 30% of psoriasis sufferers. The likelihood of developing psoriatic arthritis has a genetic component. Individuals with the tissue type HLA-B27 are more at risk.
Different populations vary widely in the rate of occurrence of this antigen. However, it is important to note that other genetic and environmental factors mediate the disease process and possession of this tissue type is by no means a guarantee of eventual onset.
This condition has the potential to grow into a more serious joint condition. For this reason, an early diagnosis is beneficial as subsequent treatment helps to curb inflammation and mitigate damage to the joints. Psoriatic arthritis usually comes and goes in bouts or flare-ups.
Diagnosing psoriatic arthritis is somewhat complicated as there is no specific test for the disease. However, there are several possible indicators:
- Psoriasis in the patient
- Localization to the fingers and feet
- Ridged or pitted toenails and/or fingernails
- Negative test for rheumatoid factor (partially ruling out a diagnosis of rheumatoid arthritis)
Different Types Of Psoriatic Arthritis And Their Symptoms
There are five different types of psoriatic arthritis, and each type has its own symptoms and treatment.
- Symmetric Arthritis: This affects the same joints in pairs, on each side of the body; for example, both knee joints will be affected. The symptoms resemble a milder form of rheumatoid arthritis, although it can occur in more severe forms and cause deformity to the joints. Symmetrical arthritis is the second most common form of psoriatic arthritis and tends to cause more severe psoriasis symptoms.
- Asymmetric Arthritis: This tends to affect only a few joints, generally less than five, and joints are affected individually rather than in pairs. Although any joint can be affected, it is most common in the fingers and toes, and can cause a swelling in fingers known as ‘sausage digits.’ Asymmetrical arthritis is one of the most common forms of psoriatic arthritis and is milder and less progressive than other types.
- Digital Interphalangeal Predominant (DIP) Arthritis: This affects the last joint in the toes and fingers, and can be mistaken for osteoarthritis.
- Arthritis Mutilans: This is a rare form of psoriatic arthritis, affecting fewer than 5% of sufferers, but can be severe. It can destroy cartilage and bone tissue and can cause deformity to the hands, feet or spine. It generally occurs in flare-ups and subsequent remissions, which are reflected in the symptoms of psoriasis.
- Spondylitis: This is an inflammation of the spinal joints and discs, and can be very severe, resulting in spinal deformities if not treated. It can also affect the joints and ligaments in the arms and legs. The predominant symptoms include stiffness in the back and neck joints, tenderness, and inflammation.
People with psoriatic arthritis may develop more than one of these types and can show symptoms of several at any one time, which can make a diagnosis of one single type more difficult.
There are also other types of arthritis that sufferers of psoriasis are at risk of developing; these are Gout, which causes sudden inflammation in the toes, feet or hands, rheumatoid arthritis, osteoarthritis and Reiter’s Syndrome, which causes arthritis as well as inflammation of the urethra and eyes.
Other Psoriatic Arthritis Symptoms
In addition to the above symptoms, there are several more which can indicate the presence of the condition;
- Swelling, throbbing, redness, and stiffness in the affected joints, particularly first thing in the morning or after a period of rest
- Reduced range of movement in the affected joints of digits
- Swelling of the fingers or toes, as the joints and connective tissues, become inflamed
- General tiredness
- Changes in finger and toenails; nails may become thicker or become ‘pitted’ in appearance
These symptoms can be mild or more severe and can flare up and die down in a similar manner to the symptoms of psoriasis, and the two conditions can even mirror each other at times. Psoriatic arthritis occurs more frequently in the finger and toe joints, particularly the end joints, but can affect any joint in the body.
What Are The Causes?
Psoriatic arthritis is typically found in both males and females between the ages 50 to 60 and is a type of arthritis that causes swelling of the joints and skin. There is juvenile psoriatic arthritis which do affect children.
What Do We Know?
There are many things that are not known or clearly understood about psoriatic arthritis. The one seemingly certain cause is a gene commonly called HLA-B27. This is a common gene found in psoriatic arthritis suffers, so there appears to be a connection between this gene and the development of this type of arthritis.
This is especially true for those who suffer from spinal arthritis. This is a very common gene present in these sufferers. Aside from this limited knowledge, there are still an lot of unanswered questions surrounding this disease and its victims are hoping for more answers.
In studying those who have psoriatic arthritis, it has been noted that there are other genes that are commonly present and that are suspect to be a contributor to the disease.
There are also mutations of at least nine of these genes that could be the culprit as well. There is clearly a wide range of speculation as to the genes that could be at the root of psoriatic arthritis.
On the other hand, some believe that this genes or mutation of genes are not the culprits at all. It has been noted that problems with your immune system create a perfect environment for psoriatic arthritis.
White blood cells begin to create antibodies in error to fight off foreign tissue in the body that are in actuality not there. Since there is no actual foreign tissue to attack these antibodies begin to go attack healthy tissue which causes the symptoms of psoriatic arthritis.
Arthritis causes great discomfort, at times unbearable. At the forefront of the minds of those who suffer from arthritis is a resolution for the pain that they are experiencing.
Resolving the problem of pain that people with arthritis suffer is difficult because of the many types of arthritis that exist. There are the common forms of arthritis such as osteoarthritis, fibromyalgia, rheumatoid arthritis, and Gout. But there are several other types. These varied types make a solution hard to find.
To make matters even more complicated, the causes of psoriatic arthritis cannot be narrowed to certain genes or a problem your immune system.
A person’s surroundings can also create the perfect circumstances in which this disease can thrive and psoriatic arthritis can develop. There are so many unknown variables it is a difficult disease to fight.
What is The Treatment For Psoriatic Arthritis?
You might like to know that there is not any lab test for psoriatic arthritis. If you have psoriasis and have the symptoms of arthritis then you probably have it. They will stick needles in your joints and pull fluid out to see what they might find like gout crystals or something else, but no definite test results.
They have tested for other types of arthritis so by process of elimination they will be able to determine psoriatic arthritis and prescribe a psoriatic arthritis treatment.
This can be a very painful and debilitating disease and something you should not take lightly. Remember, you have psoriasis and there is a 30-35% chance you will get arthritis.
Usually, the treatment for psoriatic arthritis involves exercise, and inflammatory drugs called NSAIDs. These are an non-steroid medication and support inflammation, stiffness, and fever but may cause ulcers and internal bleeding with prolonged use.
If these drugs are no longer effective, they move on to other medications like methotrexate, corticosteroids, and antimalarial medications.
The exercise programs can be done at home or in a medical facility if you need the support and assistance. These routines would be tailored to the individual and the capabilities the patient or sufferer still obtained in their daily life or from one outbreak to the other.
When finished it is usually best practice to stretch afterward, take a warm shower or use hot compacts on the joints. The use of Ice packs is also a way of reducing the swelling and soreness that usually follow a workout routine.
Your exercising routine should be done on regular schedule. This type of treatment for psoriatic arthritis is to build and maintain strength in the muscles, skeleton, joints and encourage flexibility in the joints.
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