Psoriatic Arthritis

Psoriatic arthritis is an autoimmune disease, which means the body's immune system turns on itself, in this case leading to inflammation of the joints.Most people who develop this type of arthritis also have the skin condition psoriasis, another autoimmune disease which causes raised red patches on the skin.More than seven million people in the United States have psoriasis, and 30 percent of them may eventually develop psoriatic arthritis. Usually, people develop psoriasis before psoriatic arthritis, but some people may get the arthritis symptoms first.

Psoriatic arthritis is a type of arthritis that typically develops in people who have skin psoriasis. Both are autoimmune diseases, meaning they cause the immune system to attack parts of the body. With psoriatic arthritis, the immune system attacks the joints and tends to affect the distal joints (those closest to the nails) in the fingers and toes, although it can also affect the wrists, knees, ankles, elbows, neck, and lower back.

There are four types of psoriatic arthritis, which are defined by which joints are affected, and how many. Here's an explanation of each:

* Asymmetric oligoarticular psoriatic arthritis or asymmetric psoriatic arthritis affects a joint on one side of the body but not always the counterpart on the other side. This form of psoriatic arthritis usually affects fewer than five joints.

* Symmetric polyarthritis is the most common type of psoriatic arthritis and affects the same joint on both sides of the body. Usually five or more joints are affected.

* Distal interphalangeal predominant psoriatic arthritis affects the body's distal joints (those at the ends of the fingers or toes). Because these joints are close to the nails, symptoms can also include nail problems.

* Spondylitis affects the spine, as well as the joints in the lower back, neck, and sacroiliac joints (those between the sacrum and pelvis). In some people with spondylitis, joints in the legs, arms, feet, and hands are also affected.

Many psoriatic arthritis symptoms closely resemble other types of arthritis, including osteoarthritis and rheumatoid arthritis. This is why psoriatic arthritis can be so difficult to diagnose. Symptoms can vary from person to person, but usually include painful, swollen, stiff joints. The joints may also be red or warm. Symptoms can come on suddenly or slowly and be mild or severe. Many people have flares of psoriatic arthritis symptoms, followed by times of relative calm.

Psoriatic arthritis can affect different joints in the body. The small joints in the fingers and toes are often affected and may develop dactylitis, when the fingers and toes swell up. Many people also have pain in the lower back and the foot, such as the back of the heel. People who experience stiff joints often report that their symptoms are usually worse in the morning.

Nail changes are another classic symptom of psoriatic arthritis. These changes can include nail discoloration, nail beds that start separating, or pitting.

Many people with psoriatic arthritis also experience chronic fatigue. And some experience symptoms in an unexpected part of the body: the eyes.This can show up as conjunctivitis (aka pink eye) as well as pain and redness.

In severe cases, joints affected by psoriatic arthritis may become visibly deformed.

Symptoms:

• Joints that are painful, red, warm, and/or swollen.
• Stiff joints, especially in the morning.
• Fatigue.
• Fingers and toes that are so swollen they look like sausages.
• Pain at the back of your heel (Achilles tendinitis).
• Pain on the sole of your foot (plantar fasciitis).
• Difficulty moving.
• Changes in the nails, which can become pitted or lift up from the nail bed.
• Conjunctivitis in the eye.
• Lower back pain.

Experts don't know exactly what causes psoriatic arthritis, but many believe it's likely a combination of a person's genetics and environment.Experts believe that people diagnosed with psoriasis at a young age may be more likely to get psoriatic arthritis. If you have a parent or sibling with psoriatic arthritis, you're more likely to get this type of arthritis too—but usually only if you also have psoriasis.

Ultimately, the biggest risk factor is having skin psoriasis and nail psoriasis. In fact, 80 percent of people with psoriatic arthritis have some kind of nail psoriasis. In addition, most people develop symptoms for the first time when they're between 30 and 50 years old.

While psoriatic arthritis can't be prevented or cured, medications and lifestyle changes can help ease symptoms and prevent further inflammation.

It's not easy to predict who will get this painful joint condition, but if you're at risk, it makes sense to watch for early symptoms such as swollen and painful fingers and toes. Most important: Getting treatment sooner rather than later can help you avoid permanent joint damage.

Since there isn't a test to diagnose psoriatic arthritis, doctors instead will do a physical exam and look at your medical history. The first question your doctor will probably ask you is whether or not you have skin psoriasis. Your doctor will want to know about your symptoms and which joints are painful or swollen.

Lab and imaging tests might help eliminate other conditions. While there is no blood test for psoriatic arthritis, there are blood tests that can eliminate other similar-seeming conditions, such as rheumatoid arthritis.

Like many other autoimmune diseases, symptoms of psoriatic arthritis tend to come and go, alternating between flares and periods of remission, often for reasons that are unknown. Some flares can affect specific joints, while others can make you feel poorly all over. Some flares are mild, others more severe. And some you may be able to manage on your own, while others may require a doctor.

If your flare is not very different from what you normally feel, or if you know what triggered it (such as stress or not getting enough sleep), you may be able to handle it on your own with rest and other lifestyle changes. But if you're not sure exactly what caused the trigger, or if the flare is severe or long lasting, contact your doctor—you may need a change in medication. Even when your flare is under control, it's a good idea to follow up with your doctor after four or six weeks.

Your doctor may prescribe medications for your psoriatic arthritis. These can include nonsteroidal anti-inflammatory drugs (NSAIDs), which help to reduce swelling and pain. If you have mild psoriatic arthritis, over-the-counter or prescription NSAIDs may be enough to manage your condition. Steroid injections are also available to reduce inflammation.

Both NSAIDs and steroids only treat symptoms of psoriatic arthritis. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and cyclosporine can help slow the progression of the disease and prevent further joint damage from occurring. TNF-alpha inhibitor drugs such as such as adalimumab (Humira) and etanercept (Enbrel) also help prevent pain and swelling. There are other, newer biologic therapies available as well. Joint replacement surgery is also an option for people with very severe joint damage.

Lifestyle changes may also help ease symptoms, such as moderate exercise, stress-reduction techniques, and eating a healthy diet.

Psoriatic arthritis medications

• NSAIDs such as ibuprofen (Advil and Motrin) and naproxen (Aleve).
• Corticosteroids.
• DMARDs such as methotrexate (Trexall) and leflunomide (Arava).
• Biologic therapies (TNF-alpha blockers) such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).
• Immunosuppressants such as cyclosporine (Neoral, Gengraf, Sandimmune) and azathioprine (Imuran).

It's not clear if stress can increase the risk of psoriatic arthritis, but emotional events such as divorce, moving, or losing a job can aggravate any condition, and psoriatic arthritis is no exception. It's a good idea to reduce stress in your life, even if you don't have psoriatic arthritis. The Arthritis Foundation recommends exercises such as walking, swimming, or yoga; eating a balanced diet; and keeping your weight at a normal level because extra pounds can worsen psoriatic arthritis symptoms by putting additional pressure on the joints.

Consider cutting back on sugary foods, red meat, soda, and processed foods. Some people with psoriatic arthritis also report worsened symptoms after eating a lot of dairy products. Instead, fill your plate with whole grains, fatty fish like salmon and mackerel (they're packed with omega-3 fatty acids and protein), nuts, and fresh produce.

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