Around 30 percent of people who have psoriasis are affected by psoriatic arthritis. Psoriatic arthritis is a chronic, inflammatory disease affecting the joints and the point where tendons and ligaments attach to bone (enthesis).
There is no cure for psoriatic arthritis. Psoriasis and PsA may be inherited. PsA is more common in whites.
PsA can occur at any age and may affect children. Psoriatic arthritis usually appears with ages 30 and 50. Many people have had it start around 10 years after the development of psoriasis. Others have had it develop first or not ever having or noticing psoriasis.
The development of PsA may be slowly, with mild symptoms or come on quickly with more severe symptoms.
Working with a rheumatologist is very important in selecting a treatment plan. The range of treatments continues to grow with help to stop the condition progressing, decreasing pain, protecting joints and help with range of motion.
PsA can cause difficulty with your quality of life by interfering with daily task and movement that consist of severe pain.
Diagnosis and treatment early on can prevent or limit joint damage that can be extensive with later stages of the disease.
Psoriasis and Psoriatic Arthritis Symptoms
Itchy painful, red lesions or silvery overgrowth of dead skin patches, most often occurs on knees, elbows and scalp, a rash may develop on any area. It is not contagious.
Most often develops in the fingers (closest joint to nail) one whole individual finger or toe may swell up causing pain and difficulty with bending. This may be called dactylitis.
It may be called peripheral arthritis, involving the peripheral joints (arms and legs, such as elbows, wrist, hands and feet). Symptoms can be painful, tender, warm and swollen, this may happen on different sides of the body (right hand, left knee).
Having pain and stiffness with the lower back, buttock area can also develop. Rarely the axial skeleton (spine, hips and shoulders) are affected and this may be called spondylitis or axial arthritis.
Cracking, pitting, white spots and nail separating from bed can occur. And this can be called nail disease.
Uveitis is inflammation of the middle layer (uvea) in our eye. The most common type affects the iris referred to as (anterior uveitis) or iritis.
Uveitis requires a medical diagnosis. Symptoms are redness, pain, sensitivity to light, blurred vision and dark floating spots in vision. Usually improves in a couple months.
Depending on how severe, eye drops help with inflammation. If it is caused by an infection, antibiotics or antiviral medications may be given. It can be serious resulting with permanent loss of vision. Early diagnosis and treatment are important.
Severity of psoriasis and severity of PsA have little connection. For example; someone may have few skin lesions but arthritis affecting many joints.
Psoriasis and Psoriatic Arthritis Diagnosis
There are no tests yet for PsA. It is mainly your doctors observation and by ruling out other diseases. The symptoms are like those of rheumatoid arthritis, gout and reactive arthritis. Testing the fluid of the joint helps with ruling out gout or infectious arthritis.
Your doctor will review your medical history and may give a physical exam, looking for joint pain, tenderness, swelling, warmth or limited movement. Along with any skin or nail changes.
X-rays may be ordered to look for changes in bones and joints. Blood test help with diagnosing inflammation. This would be a C-reactive protein and rheumatoid factor (RF). Those having PsA are almost always RF-negative; if the blood test is positive for rheumatoid factor the doctor will suspect RA.
An increase with inflammation and or symptoms that become worse is called a flare. These can go on for days or months.
If PsA inflammation is not treated, this may lead to other health conditions. Those with PsA also may develop metabolic syndrome. These conditions include obesity, high blood pressure and poor cholesterol levels.
A rheumatologist is a doctor who has further training with diagnosing and treating musculoskeletal disease and systemic autoimmune conditions also known as rheumatic diseases.
The 5 Types of Psoriatic Arthritis
Distal Interphalangeal predominant PsA involving the joint (distal joints) next to your nails. This type develops in about 10 percent of those having PsA.
Dactylitis is inflammation of a digit (either finger or toe). The digit may swell resembling a sausage shape and this can be painful.
Treatment may include NSAIDs for easing pain and reducing inflammation. DMARDs help to relieve pain decrease inflammation and prevent joint damage.
Asymmetric Oligoarticular affecting the joint or joints, (4 or less) on one side of body. The joints can be sore and inflamed. Asymmetric PsA can be mild. Around 35 percent of people can be affected.
Symmetric polyarthritis affects both sides of body with same joints (5 or more) such as left and right knee. This is similar to Rheumatoid arthritis.
Symmetric PsA is usually milder and with less joint deformity compared to RA. Still it can be disabling. Around half of those with PsA will be diagnosed with symmetric PsA.
Spondylitis PsA The whole spine including your neck to your lower back may be affected, making movement painful. This may also include your limbs, hands, feet and hip. It usually occurs in early adulthood and more common among men.
Spondylitis PsA causes a reduction in movement eventually resulting in a hunched over position.
Treatment consist of; medication, physical therapy and may include surgery in rare cases.
Psoriatic Arthritis Mutilans asevere and deforming type of PsA is rare, affecting around 5 percent.
Psoriatic arthritis mutilans often affect the hands and feet. There can also be pain of the neck and lower back.
Enthesis (plural entheses); are areas on the body where a tendon or ligament attaches to bone, may have inflammation and swelling. This is common at the back of heel and bottom of foot, referred to as enthesitis.
Treatment is to reduce the inflammation and pain such as; plenty of rest, application of cold compresses and anti-inflammatory medications.
Managing Psoriasis Suggestions
Protecting the skin by moisturizing using lotions and creams with aloe vera, jojoba or zinc may lubricate affected skin. Also soothing to skin is use of oatmeal baths (Aveeno), Dead sea or Epsom salts.
Getting in the habit of using moisturizers after daily showers, baths or swimming is beneficial.
Using a fragrant-free (All) dye free detergent and fabric softener to wash clothes will prevent some skin irritation. Wearing loose fitting clothes will also keep fabrics from rubbing and scratching scaly areas. Cotton, a natural, soft fiber that is less irritating and cooler in warm months is more comfortable.
Eating an anti-inflammatory diet containing lots of fruits and vegetables will help people with psoriatic arthritis boost their overall health and manage weight.
Applying heat can reduce joint stiffness and muscle spasms increasing blood circulation. Cold compresses will help decrease swelling by constricting the blood vessels.
To encourage muscles to relax and slow your thoughts breathing techniques like deep breaths, meditation and visioning your happy place can help.
Smoking and drinking are bad habits of overall health and can affect our skin. Quitting smoking can be done with support groups. Many insurance plans offer help. Alcohol can contradict with certain medications, increase side effects or lead to weight gain. Ask your doctor if alcohol consumption is safe.
Do you have psoriatic arthritis? What type and how do you manage it?
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https://www.healthline.com/health/psoriatic-arthritis accessed 08/20/2020
https://www.arthritis.org/diseases/psoriatic-arthritis accessed 08/20/2020