Psoriatic Arthritis

Psoriatic arthritis (PsA) causes painful and swollen joints. It mostly occurs in people with psoriasis.

Psoriatic arthritis (PsA) causes painful and swollen joints. It mostly occurs in people with psoriasis. Psoriasis causes thick red and silver patches on the skin. Those patches often look like scales. Both are autoimmune diseases. They cause the immune system to attack healthy body parts.

With PsA, the immune system attacks the joints. It mainly affects the joints closest to the fingers and toes. Those are also called distal joints. It can also impact the wrists, knees, ankles, elbows, neck, and lower back.

In the United States, more than seven million people have psoriasis. And about 20% have PsA. Typically, people develop psoriasis before PsA. But some people may first have arthritis symptoms. Pain, stiffness, and swelling are common.

Types

There are five types of PsA. Each type depends on the kind and number of affected joints. They include:

  • Distal interphalangeal predominant: This affects the body's distal joints. Because those joints are close to the nails, symptoms may include nail problems.
  • Asymmetric oligoarticular: This is also called asymmetric PsA. It affects a joint on one side of the body. It rarely affects the counterpart on the other side. It commonly affects fewer than five joints.
  • Symmetric polyarthritis: This is the most common type. It affects the same joint on both sides of the body. Usually, it involves five or more joints.
  • SpondylitisThis affects the spine. It also involves the joints in the lower back, neck, and sacroiliac joints. Sacroiliac joints are between the sacrum and pelvis. Some people may have symptoms in their legs, arms, feet, and hands.
  • Arthritis mutilans: This affects less than 5% of people with PsA. It causes severe inflammation. Often, that deforms the joints and causes problems with mobility. It mainly affects the hands and feet. Bone loss of those joints can shorten the fingers and toes.

Symptoms

Symptoms of PsA may resemble other types of arthritis. Also, symptoms differ between people. That's why PsA can be so hard to pinpoint. But symptoms mainly include:

  • Red and silver patches of skin on the scalp, elbows, or knees
  • Joints that are painful, red, warm, or swollen
  • Stiff joints, mostly while waking up or after being idle
  • Feeling tired
  • Swollen fingers and toes
  • Pain at the back of your heel (Achilles tendinitis)
  • Pain on the sole of your foot (plantar fasciitis)
  • Mobility issues
  • Nails that become pitted, crumbled, or lifted from the nail bed
  • Painful red eyes or blurry vision
  • Neck, lower back, or hip pain
  • Inflammatory bowel disease (IBS)

Symptoms range from mild to severe. In severe cases, joints may become deformed. Also, many people with PsA have flares. Those occur when their symptoms temporarily worsen.

Causes

Experts don't know what exactly causes PsA. It's an immune-mediated disease. That occurs when your immune system attacks healthy body parts. Still, researchers are unsure why that happens. 

But likely, it's a mix of genetics and environmental triggers. For example, suppose you have a parent or sibling with PsA. In that case, your risk increases. Also, environmental triggers may include:

  • Obesity
  • Infection
  • Injury
  • Stress

About 20% of people with psoriasis develop PsA. Most people who develop PsA also have psoriasis. If you have psoriasis, you may notice PsA symptoms about seven to 10 years after you develop red and silver patches of skin.

Diagnosis

There isn't a specific test that detects PsA. So, healthcare providers will look at your medical history. One of the first questions they may ask is whether you have psoriasis. Also, they may ask about your symptoms. Keep track of what joints are painful or swollen.

Next, they may give you a physical exam. They may look at your joints for swelling or tenderness. Or they may keep an eye out for red and silver patches of skin. Nail problems are also signs of PsA. 

Blood tests can detect similar disorders. Your healthcare provider may order a blood test for rheumatoid arthritis (RA). Imaging tests also help rule out other ailments. Those include x-rays, ultrasounds, or magnetic resonance imaging (MRI). Imaging tests can also detect joint damage.

Early diagnosis is essential. Beginning treatment sooner rather than later can help you avoid severe joint damage.

Treatment

There is no cure for PsA. But some medications can treat symptoms and fight inflammation. The type of medication depends on the severity of your symptoms. They include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These help to reduce swelling and pain. Some include Advil and Motrin (ibuprofen), and Aleve (naproxen).
  • Corticosteroids: These are steroid injections that reduce inflammation.
  • Disease-modifying antirheumatic drugs (DMARDs): These keep your immune system from attacking healthy cells. Some include Trexall (methotrexate) and Arava (leflunomide).
  • Biologic therapies (TNF-alpha blockers): These help slow the progression of the disease and prevent further joint damage.Some include Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab).

Try staying active, reducing stress, and eating well. Some mild cases of PsA are treatable with rest and other healthy habits. In contrast, severe joint damage may need surgery to replace joints.

Your primary care physician can treat PsA. Still, it may help to consult a team of different healthcare professionals. Depending on your goals, they may include:

  • Rheumatologist: This is a healthcare provider who specializes in arthritis.
  • Dermatologist: This healthcare provider specializes in skin, hair, and nails. If you have psoriasis, a dermatologist may help treat your symptoms. 
  • Physiatrist: This healthcare provider helps with exercise.
  • Occupational therapist: This healthcare provider can help with joint pain. They can advise against certain activities that place stress on your joints. 
  • Physical therapist: This healthcare provider can help with mobility.
  • Dietitian: This healthcare provider can help with eating healthy. That can help with managing your weight.

Prevention

There are no methods for prevention PsA. If you have psoriasis, you can take steps to decrease your risk. Some factors, like genetics, are unmodifiable. But you can manage other factors, like:

  • Weight: Losing weight can fight inflammation and reduce pressure on your joints. Eating healthy and staying active are vital to managing your weight. 
  • Skin damage: Some evidence suggests that skin damage increases your risk. Ensure that you are properly cleaning and caring for any wounds. That helps avoid infections.
  • Stress: Cortisol is a hormone your body releases in times of distress. High amounts of cortisol may bring on the inflammation that causes pain. So, reducing stress may decrease your risk of PsA.

Living With Psoriatic Arthritis

PsA causes painful and swollen joints that may impact your daily activities. The following healthy habits can help reduce flares of PsA symptoms:

  • Staying active: Light exercise may help with mobility. Try walking, yoga, or Tai Chi. But consult your healthcare provider before making any changes to your routine. 
  • Maintaining your weight: Extra pounds can worsen PsA symptoms. A healthy body weight can reduce pressure on the joints.
  • Reducing stress: Stress may worsen symptoms. Talking to a mental health counselor may help reduce stress. Also, consider building a support group. Family, friends, or others with PsA can help your condition feel less overwhelming.
  • Quitting smoking: Smoking may worsen symptoms. Consult your healthcare provider about how to quit smoking
  • Decreasing strain on joints: Avoid unnecessary pressure on your painful or swollen joints.
  • Eating a balanced diet: Cut back on dairy, high-sugar, and highly-processed foods. Instead, fill your plate with whole grains, fatty fish, nuts, and fresh produce.

PsA can be a painful condition. But making healthy lifestyle changes may help reduce discomfort and prevent flares. Even with PsA, you can live an active life.

Summary

Psoriatic arthritis (PsA) causes painful and swollen joints. About 20% of people with psoriasis develop PsA. Several types of PsA range from mild to severe discomfort. 

Some forms of PsA require lifestyle changes to treat pain. Your healthcare provider may prescribe medications for pain and inflammation. And people with severe joint damage may need surgery. 

There is no way to prevent PsA. But you can take steps to reduce your risk. Obesity, skin damage, and stress are common risk factors. Managing weight, eating healthy, staying active, and reducing stress prevent flares. 

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Sources
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