What is Psoriatic Arthritis?

August 23, 2024

Psoriatic arthritis (PsA) is a type of chronic arthritis which involves mainly the joints and is associated with Psoriasis. Psoriasis affects approximately 2% of the population and is manifested by the formation of red patches with silvery scales and itching. Even though psoriatic arthritis is not directly linked to psoriasis, about 30% of people who have psoriasis will develop this type of arthritis at some point in their lifetime, which is why it is considered a major issue for sufferers of the skin condition.

Understanding Psoriatic Arthritis

Psoriatic arthritis is classified as spondyloarthropathy and occurs with ankylosing spondylitis and reactive spondyloarthropathy. Spondyloarthropathy is a group of inflammatory diseases that mainly affect the spine and joints. Ankylosing spondylitis is a type of arthritis that primarily affects the spine and Reactive spondyloarthropathy is a group of inflammatory conditions that typically affect the joints in the spine and other areas of the body. Both of these diseases have symptoms like inflammation of the spine and the joints and can also occur in other regions of the body including the eyes, skin, and the digestive tract. However, this form of arthritis is not the same as other types of arthritis since it is accompanied by psoriasis.

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Causes and Risk Factors

In the medical community, the exact cause of psoriatic arthritis remains unclear, but they believe it to be the result of a combination of genetic, immune, and environmental factors:

Genetics

Psoriatic arthritis has a clear genetic predisposition. Research has also established that the occurrence of psoriasis or psoriatic arthritis is hereditary since a person with a family member who has it is more likely to develop it than a person with no family member with the disease. The HLA-B27 test is a medical test that checks for a specific genetic marker called HLA-B27 in your blood. And it has been linked to the condition which indicates that hereditary factors do have a very big role.

Immune System Dysfunction

Psoriatic arthritis is an autoimmune disease, implying that the immune system of the body is against the body tissues. In PsA, the immune system attacks the joints which causes inflammation and structural damage. This is also the case with psoriasis, which is caused by an autoimmune response to a skin infection.

Environmental Triggers

Psoriatic arthritis can develop in genetically susceptible people as a result of certain neurological factors including infections, physical traumas, or stresses. For example, the Koebner phenomenon is where psoriasis occurs at the site of a skin injury and can be a precursor of psoriatic arthritis.

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Symptoms of Psoriatic Arthritis

The symptoms of psoriatic arthritis can vary widely between individuals and may affect different parts of the body. Some of the common signs and effects of psoriatic arthritis are as follows:

Joint Pain and Stiffness

Another common manifestation of psoriatic arthritis is inflammation of the joints, particularly the knees, ankles, fingers, toes and the lower back. The pain is usually associated with stiffness particularly in the morning or after rising from a chair.

Swollen Joints

Joint inflammation can cause the joint to become swollen; the joint feels warm to the touch and is also sensitive to the touch. This swelling is typically irregular, which means that it impacts distinct joints on opposite sides of the body.

Dactylitis

Another feature of psoriatic arthritis is dactylitis or “sausage fingers” in which an entire finger or toe is erythematous (has red skin or mucous membranes) and swollen.

Enthesitis

Enthesitis means inflammation of entheses which are the places where the tendons and ligaments attach themselves to bones. Some of the most affected areas in psoriatic arthritis are the insertion points of tendons and ligaments, such as the Achilles tendon and the plantar fascia in the feet.

Psoriasis Symptoms

Since psoriatic arthritis is related to psoriasis, patients can also have manifestations of psoriasis which includes: silvery, scaly skin rashes, thickened nails and pitting of nails.

Fatigue

Psoriatic arthritis patients develop severe fatigue due to the continuous inflammation and pain in their joints.

Eye Involvement

It is also important to note that uveitis, an inflammation in the eyes, may occur in some patients with psoriatic arthritis; it causes redness, pain and may affect eyesight.

Spinal Involvement

This is a form of arthritis that can also affect the back, particularly the spine, and is referred to as spondylitis. It can result in discomfort and limited mobility in the neck, lower back, and sacroiliac (located in the pelvis) joint regions.

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Types of Psoriatic Arthritis

Psoriatic arthritis is a complex disease which can manifest in various ways. The five main types of psoriatic arthritis are:

Oligoarticular PsA

This is a type of arthritis that impacts fewer than five joints in the body of a person with psoriasis. It is usually mild but may get worse with time and affect other joints too.

Polyarticular PsA

In this form, it affects five or more joints, and typically the joints are symmetrical, just like in rheumatoid arthritis. This type can be more severe and disabling, meaning that patients who have it would be less able to work or perform other activities compared to patients with the less severe types.

Distal Interphalangeal Predominant (DIP) PsA

This type particularly impacts the small joints located on the extremities of fingers and toes; the distal interphalangeal joints. Nail pitting and nail discoloration are present in this type of psoriatic arthritis.

Spondylitis PsA

This form impacts the spine and sacroiliac joints, causing neck and lower back pain and stiffness. It can also contribute to inflammation in other joints.

Arthritis Mutilans

This is the worst and the rarest form of psoriatic arthritis that a patient can develop. It may cause significant joint deterioration and contracture and mainly affects the hands and feet.

Diagnosis of Psoriatic Arthritis

Psoriatic arthritis is one of the most difficult diagnoses to establish because of its variations and similarity with other types of arthritis, including rheumatoid arthritis and osteoarthritis. There is no single test for psoriatic arthritis, so the diagnosis is typically based on a combination of the following:

Medical History

The healthcare provider should seek to know if the patient has a family history of psoriasis or arthritis while diagnosing this condition.

Physical Examination

During the physical examination, one can look for signs of joint inflammation, tenderness in specific areas of the body, skin and nail abnormalities which may indicate psoriasis.

Imaging Tests

Radiographic examination such as X-ray, MRI and ultrasound may be used to assess joint involvement, inflammation and other histological (microscopic characteristics of tissues and cells) features of psoriatic arthritis.

Laboratory Tests

Lab work may be done to rule out other forms of arthritis, for instance, rheumatoid arthritis through determination of rheumatoid factor (RF) as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies. Whilst these markers are generally elevated in psoriatic arthritis, inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate may be raised.

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Treatment Options for Psoriatic Arthritis

At the present, there is no known cure for psoriatic arthritis and the following treatments can be administered to alleviate the manifestations and lessen the inflammation that impairs joint formation. The intervention depends on the presenting symptoms, the stage of the disease, and the general health status of the patient. Common treatment options include:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Ibuprofen and naproxen are examples of non steroidal anti-inflammatory drugs used in management of pain and inflammation in mild psoriatic arthritis.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Methotrexate and Sulfasalazine, which are categorised under DMARDs, are used to slow the progression of Psoriatic arthritis and prevent joint destruction.

Biologic Therapies

Tumour Necrosis Factor (TNF) inhibitors and Interleukin (IL) inhibitors are other types of biologic agents that are relatively newer to the market and work more selectively to dampen the immune response that causes inflammation and destruction of the joints. Some of these include Etanercept, Adalimumab and Secukinumab.

Corticosteroids

Oral administration or intra-articular injection of corticosteroids gives symptomatic relief in inflammation and pain. But due to the side effects related to them, they are normally used for a limited period of time.

It is, however, important to take note that medications and drugs are just a quick-fix solution and only relieve the symptoms temporarily. They do not address the root cause of the problem.

Physical Therapy

One of the major treatments used in the management of psoriatic arthritis is physical therapy and exercises since this helps to maintain joint mobility, flexibility and decrease pain.

Lifestyle Modifications

Lifestyle modifications such as losing weight, exercising, avoiding smoking and drinking alcohol also helps in managing psoriatic arthritis and in preventing flare-ups.

Surgery

In the worst scenario where the joints are severely affected, then the option of surgery like arthroplasty, which involves the reconstruction or replacement of a joint, may be taken.

Living with Psoriatic Arthritis

Psoriatic arthritis can be a difficult disease to manage, although most patients can work, play sports, and enjoy other activities if they receive proper medical care and make the necessary lifestyle adjustments. People with psoriatic arthritis should consult with their healthcare providers to find the most suitable treatment plan for them. Furthermore, family, friends, and patient support groups can be a source of emotional and practical support to the patient with the disease.

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Conclusion

Psoriatic arthritis cannot be regarded as a simple and short-term disease, as it is a serious chronic disorder that can affect a patient’s life considerably. Nevertheless, if the disease is diagnosed at an early stage and the right treatment is provided, many people can keep their symptoms under control and avoid joint deterioration. With continued research on the disease, it is obvious that there will be new treatments and management approaches that will be developed to enhance the quality of life of patients with psoriatic arthritis.

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