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Psoriatic arthritis basics
From January/February 2006 Psoriasis Advance
Picture this scenario: Over the course of a few days, you notice your index finger has swollen to the size of a sausage. Thinking that you must have injured it, you wait a week or two to see if it will get better on its own.
But if you have psoriasis, you could be experiencing the first symptoms of psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints. Symptoms may also include morning stiffness and fatigue; pitted, discolored nails that may separate from the nail beds; and eye inflammation. Because of their visibility, these symptoms are well-recognized as possible signs of psoriatic arthritis.
Other signs—muscle and back pain—may be easier to miss because people may not associate them with arthritis. Atul Deodhar, M.D., rheumatologist and associate professor of medicine at Oregon Health & Science University in Portland, says that "people assume arthritis is just joint pain, but if they have psoriasis, then any pain in the soft tissue, tendons, back or joints might be related to psoriatic arthritis."
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Psoriatic arthritis—who develops it?
About 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis. While it is possible to have psoriatic arthritis without skin symptoms, skin disease precedes
joint disease in about 85 percent of patients.
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Soft tissue pain might include sore feet caused by enthesitis, which involves inflammation at the attachment of the tendons and ligaments to the bone. Back pain is also overlooked as a symptom because there is no visible swelling.
Get an early diagnosis
It's important to get an early diagnosis because psoriatic arthritis may cause ongoing, irreversible damage if left untreated. According to a five-year study published in the June 2003 issue of Rheumatology, patients had the highest rate of joint damage within the first year of diagnosis of psoriatic arthritis.
That's why it's important to voice any new symptoms to your dermatologist or general practitioner. They'll be able to refer you to a rheumatologist—a specialist who treats joint and soft tissue (muscle, tendon or ligament) disease.
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Other common arthritic diseases
Bursitis: Inflammation of a bursa, a small sac of fluid that cushions and lubricates an area between tendon and bone or around a joint
Tendonitis: Inflammation of a tendon, a ropelike fiber that connects muscle to bone
Gout: Disease caused by deposits of uric acid crystals in the joints; characterized by pain, swelling, redness, heat and stiffness in a joint or joints
Reactive arthritis: Form of arthritis that, in addition to joints, can affect the eyes; typically is triggered by an infection
Rheumatoid arthritis: Inflammation of membranes or tissues lining the joints; over time, the inflammation may destroy the joints
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How is psoriatic arthritis diagnosed?
The doctor diagnoses psoriatic arthritis by examining the affected areas. The doctor and
medical staff may use your medical history, physical examination, and when necessary, blood tests, MRIs and X-rays of the joints that have symptoms to diagnose psoriatic arthritis.
How is it treated?
After diagnosis, the rheumatologist typically starts with a treatment based on the type of psoriatic arthritis and its severity. Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further tissue damage.
Treatments can be divided into these categories:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs decrease inflammation, joint pain and stiffness. They include over-the-counter medications such as aspirin and ibuprofen as well as prescription products.
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs attempt to reduce the painful symptoms of psoriatic arthritis. Some traditional examples include methotrexate, sulfasalazine, cyclosporine, antimalarials and steroids.
- Biologics: These are drugs that are based on compounds found in living cells. Biologics approved to treat psoriatic arthritis may relieve skin and joint symptoms and prevent joint damage caused by psoriatic arthritis. Biologics that are FDA-approved for psoriatic arthritis include Enbrel (generic name etanercept), Remicade (generic name infliximab) and Humira (generic name adalimumab).
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Effect on quality of life
Psoriatic arthritis carries the additional burden of psoriasis, adding a double-whammy to its impact on quality of life. A study published in the August 2001 issue of the Journal of Rheumatology found that although the joint damage in rheumatoid arthritis may be greater, the effect on quality of life was the same for both rheumatoid and psoriatic arthritis patients. The researchers concluded that the psoriasis skin disease may account for this difference.
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What's on the horizon
Dr. Deodhar is optimistic about the treatments available that may lead to an improved quality of life and renewed confidence—and also help researchers to uncover reasons behind psoriasis development. Biologics for psoriatic arthritis, for example, are being used by researchers to study the underpinnings of psoriatic arthritis and psoriasis. More medications that target the diseases are on the way, along with the hope of a cure.
The January/February 2006 Psoriasis Advance includes an article about assistive devices that may aid daily living. Also, read the January/February 2005 Psoriasis Advance for information about exercise for psoriatic arthritis, including tai chi, yoga and swimming. Both issues are available for download.
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