What is Psoriatic Arthritis Treatment?
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that occurs in some patients who have psoriasis, a chronic skin condition that causes scaling and inflammation. Psoriatic arthritis typically causes pain, stiffness and swelling in and around the joints. It is estimated that approximately 30% of people with psoriasis will develop psoriatic arthritis.
Common Symptoms of Psoriatic Arthritis Treatment
The most common symptoms of psoriatic arthritis include joint pain and swelling. The joints most commonly affected early in the disease are those in the fingers and toes. Other symptoms may include:
- Stiffness in the joints, especially in the morning or after prolonged rest
- Fatigue
- Nail changes such as pitting or nail separation from the nail bed
- Low back pain and buttock or heel pain
- Eye inflammation (conjunctivitis or uveitis)
- Swelling of veins under the skin (sausage-like swelling)
Causes of Psoriatic Arthritis
While the exact cause of psoriatic arthritis is unknown, it is believed to be an autoimmune disease where the immune system mistakenly attacks healthy cells in the body. Genetics also seem to play a role, as those with a family history of psoriasis or psoriatic arthritis have an increased risk. Additionally, stress and injuries to the skin or joints may trigger psoriatic arthritis flares in some individuals.
Diagnosing Psoriatic Arthritis
There is no single test to Psoriatic Arthritis Treatment. The diagnosis is made based on a patient's medical history, symptoms, physical examination and imaging tests of the joints. A rheumatologist will examine the affected joints and determine if they show signs of inflammation typical of psoriatic arthritis versus other types of arthritis. X-rays may reveal new bone formation near joints. Blood tests can detect inflammation but are not definitive for diagnosis. A skin examination may also show plaques or scaly patches typical of psoriasis.
Treatment Options for Psoriatic Arthritis
Treatment focuses on reducing joint pain, swelling and inflammation. Milder cases may be treated with over-the-counter pain relievers and joint protection/rest. For more severe psoriatic arthritis, disease-modifying anti-rheumatic drugs (DMARDs) are commonly used. These include methotrexate, sulfasalazine, leflunomide or immunosuppressants. Recent research has led to newer biologic medications that block tumor necrosis factor (TNF) or interleukin proteins responsible for inflammation. Examples include etanercept, adalimumab, infliximab and newer drugs like secukinumab and ixekizumab. The goals of treatment are to reduce joint symptoms, prevent further joint damage and improve physical function and quality of life. Treatment of psoriasis with topical therapy, phototherapy or oral medications can also help control psoriatic arthritis.
Prognosis and Management of Psoriatic Arthritis
With effective treatment of joint symptoms and inflammation early on, most patients see improvements in pain and mobility. However, psoriatic arthritis is a chronic disease so ongoing management and close monitoring by a rheumatologist is important. While outcomes have significantly improved, some joint damage may still occur if joints remain inflamed over many years. To help slow progression and maximize treatment response, lifestyle modifications like maintaining a healthy weight, not smoking, low impact exercises and joint protection also play key roles in prognosis. Regular follow up care allows for adjustments to medication if needed. With a treatment plan guided by a rheumatologist, people with psoriatic arthritis can effectively manage their disease.
Subtypes of Psoriatic Arthritis
There are five main subtypes of psoriatic arthritis based on the location of joint involvement:
Asymmetric oligoarthritis- Involves 4 or fewer joints but not the same joints on both sides of the body. Common first joints affected are the knees, ankles, elbows.
Symmetric polyarthritis- Involves 5 joints or more on both sides of the body. Resembles rheumatoid arthritis.
Arthritis mutilans- Severe bone and cartilage destruction leads to appearance of deformed fingers and toes.
Spondylitis- Inflammation of places where spine bones connect. Can cause back pain and stiffness.
Distal interphalangeal predominant arthritis- Mainly involves fingers and toes closest to the nails. Fingers may develop sausage-like swelling called dactylitis.
Psoriatic arthritis manifests in several forms and stages of severity. Prompt evaluation and treatment tailored to each patient's manifestations can help improve outcomes and quality of life. With proper long-term management guided by a rheumatologist, people with PsA have many effective options available.
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