Psoriatic Arthritis: More Than Skin Deep
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. For most people, psoriasis develops first, and later they feel the symptoms of psoriatic arthritis. However, in some cases, it is the reverse.
Both conditions are chronic autoimmune diseases – which means some of the body’s cells attack other cells and tissues at the joints. With both conditions, there can be flares that alternate with periods of remission.
While researchers are not sure why the immune system turns on healthy tissue, it seems that genetic and environmental factors are involved. The family history of either psoriasis or psoriatic arthritis is key. Physical trauma or something in the environment — a bacterial or viral infection — may trigger psoriatic arthritis if there is a genetic tendency.
As there is no cure for psoriatic arthritis, doctors focus on controlling symptoms and preventing damage to the joints. Unless there is treatment, psoriatic arthritis can be disabling.
What Are the Symptoms?
Psoriasis involves raised red patches covered with a whitish buildup of dead skin cells (called scales). The scales can occur anywhere on the body.
The onset of psoriatic arthritis may be subtle and develop gradually while others may develop this condition suddenly. Arthritis can affect joints on just one side of the body – or on both sides. Joints become swollen, painful and warm to the touch.
Psoriatic arthritis can also cause these symptoms:
- Swollen fingers and toes. You may also develop swelling in hands and feet before developing significant joint problems.
- Foot pain. Tendons and ligaments at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis) can become painful.
- Lower back pain. A condition called spondylitis can cause inflammation between the spinal vertebrae and between your spine and pelvis (sacroiliitis).
People with psoriatic arthritis sometimes develop pinkeye (conjunctivitis) or uveitis, causing painful, red eyes and blurred vision, and are also at risk for heart disease.
When to See a Doctor
If you have psoriasis, be sure to tell your doctor if you develop joint pain. Psoriatic arthritis can severely damage your joints if it is untreated.
The Approach to Treatment
Early diagnosis and treatment can relieve pain and inflammation and help prevent progressive joint involvement and damage. Without treatment, psoriatic arthritis can potentially be disabling and crippling.
The type of treatment will depend on how severe your symptoms are at the time of diagnosis. Some early indicators of the more severe disease include onset at a young age, multiple joint involvement, and spinal involvement.
Good control of the skin may be valuable in the management of psoriatic arthritis. In many cases, you may be seen by two different types of doctors – a rheumatologist and a dermatologist.
What Are the Treatment Options for Psoriatic Arthritis?
As there is no cure for this disease, the goal is to relieve symptoms. Treatment may include any combination of these therapies:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Cortisone injections
- Oral steroids
- Disease modifying anti-rheumatic drugs (DMARDs)
DMARDs work by curbing the body’s out-of-control immune system response that causes psoriatic arthritis – which reduces inflammation.
DMARDs are into categories, biologic and non-biologic:
- Non-biologic DMARDs – Slow the disease process by modifying the immune system. Methotrexate is the most conventional non-biologic DMARD for psoriatic arthritis. effective in suppressing the immune system and can treat both psoriases as well as arthritis.
- Biologic DMARDs – Target cells to prevent inflammation at a very early stage. They block the immune system’s activity that contributes to psoriasis and arthritis.
DMARDs slow down the condition, and it may improve the quality of life or may help people achieve a remission. In many cases, the disease is still active – but at a slower, less intense rate.
Because DMARDs are a systemic treatment, there may be side effects like stomach upset, blood or liver problems. Your physician will need to find the right regimen for you.
These also help relieve joint pain:
- Exercise. Regular exercise can reduce joint stiffness and suffering. Range-of-motion and strengthening exercises –combined with low-impact aerobics – may be helpful. Talk to your doctor or physical therapist first as the wrong exercise can make psoriatic arthritis worse.
- Heat and cold therapy. Moist heat helps relax aching muscles and relieve joint pain, swelling, and soreness. A hot pack, warm towel, warm bath or shower are excellent examples. Cold therapy can reduce swelling and relieve pain by numbing the affected joints. A bag of ice or frozen vegetables wrapped in a towel can be very useful.
- Splinting. Splinting the affected joints can ease inflammation as well as joint stability problems. Splints will be removed periodically to allow for range-of-motion exercises.
- Surgery. Most people with psoriatic arthritis never need surgery. However, if joints are severely damaged there may be required for joint replacement surgery.
Living With Psoriatic Arthritis
When you understand the disease and know what to expect, you can learn how to cope. You can plan certain activities for times when you are less bothered by the disease.
You can use exercise and therapy to reduce the discomfort, as well as the stress and fatigue – to improve your quality of life.