What Causes Psoriatic Arthritis
PsA is an autoimmune disease. This is where the immune system mistakenly attacks healthy tissues, leading to inflammation and damage.
What exactly causes the immune system to behave this way in people with PsA isnt clear. Its believed that a complex combination of genetic and environmental influences may play a role.
About of people with PsA have at least one close relative that has either psoriasis or PsA. Additionally, several genes associated with PsA have been identified.
Environmental factors that may contribute to the development of PsA include things like infections or physical trauma.
Six Symptoms You Shouldnt Ignore
The symptoms of psoriatic arthritis can vary in severity, from person to person and can even come and go . Here are six symptoms you should watch out for.
1. Its hard to move in the morning
Psoriatic arthritis can make getting up in the morning a challenge, especially after you havent moved around for a while. It can cause stiffness and pain in one or more joints, from your toes to your fingers. It can even cause pain and swelling in the tendons and surrounding structures that connect to your bone, a condition called enthesitis.
2. Your fingers look like warm sausages
About 30 to 50 percent of patients with psoriatic arthritis will experience the symptoms of dactylitis, or extreme swelling in their fingers and toes, Dr. Aquino said. This is when the entire fingers and toes swell to resemble sausages.
You may notice your swollen joints feel warm to the touch because inflammation and swelling cause heat.
3. You have lower back pain
When you think of psoriatic arthritis, you typically think about skin symptoms, but many people experience lower back pain as well. About 20 percent of those with psoriatic arthritis will develop a subtype called spinal involvement or psoriatic spondylitis, which may result in pain and stiffness in the back and hips, Dr. Aquino said.
4. Your nails have grooves and ridges
5. You experience eye problems
6. Youre always tired
Articles On Types Of Psoriasis
Knowing which kind of psoriasis you have helps you and your doctor make a treatment plan. Most people have only one type at a time. Sometimes, after your symptoms go away, a new form of psoriasis will crop up in response to a trigger.
In general, most types of psoriasis result from the same triggers:
Here’s how you can spot the 7 types of psoriasis and what you can do to treat them.
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Flexural Or Inverse Psoriasis
Flexural or inverse psoriasis often appears in skinfolds, such as under the breasts or in the armpits or groin area. This type of psoriasis is red or purple and often shiny and smooth.
The sweat and moisture from skinfolds keeps this form of psoriasis from shedding skin scales. Sometimes, its misdiagnosed as a fungal or bacterial infection. The skin-on-skin contact can make inverse psoriasis very uncomfortable.
Most people with inverse psoriasis also have a different form of psoriasis in other places on the body.
Classification Of Psoriatic Arthritis
The simple and highly specific Classification Criteria for Psoriatic Arthritis , developed by a large international study group, has a sensitivity and specificity of 98.7% and 91.4%, respectively. The criteria consist of established inflammatory articular disease with at least 3 points from the following features:
- Current psoriasis
- A history of psoriasis
- A family history of psoriasis
- Juxta-articular new-bone formation
- RF negativity
- Nail dystrophy
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Who Does It Affect
It affects men, women and children alike. It can appear at any age in varying degrees but usually between the ages of 10 and 30. The severity of the disease varies enormously, from a minute patch to large patches covering most body areas. Psoriasis can also run in familiesand it is known that the disease is multi-genetic and therefore children may not necessarily inherit psoriasis. It is estimated that if one parent has psoriasis then there is a 3 out of 20 chance that a child will develop the condition. If both parents have psoriasis this increases to about 15 out of 20 . Interestingly, if a child develops psoriasis and neither parent is affected there is a 1 out of 5 chance that a brother or sister will also get psoriasis. This is because the condition is known to skip generations, so somewhere there will be a familial link to a relative via one or both parents.
How Is Each Type Of Psoriatic Arthritis Treated
The type of treatment your doctor will recommend for PsA will depend on a variety of factors, including:
- The severity of your symptoms or the type of PsA
- How many joints are affected
- The affected joints
- The extent of damage to affected joints
- Previous responses to treatment
- Personal preferences
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Causes Of Psoriatic Arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.
But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
What Can Prevent Someone From Getting A Second Type Of Psoriasis
Most types of psoriasis cannot be prevented.
That said, if you already have plaque psoriasis, it may be possible to reduce your risk of developing another type of psoriasis on your skin. Dermatologists recommend taking the following precautions:
Protect your skin to prevent sunburn
Take medication as directed and speak with your dermatologist before stopping a medication
Treat your psoriasis so that its well-controlled
Watch your weight so that you stay at a weight thats recommended for your age and height
Watching your weight may help prevent inverse psoriasis. This type of psoriasis is more common in people who are 20 or more pounds overweight.
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Red Patches With Silvery Scales: Plaque Psoriasis
Plaque psoriasis can appear as inflamed, flushed skin with raised, silvery scales. On different skin tones, this can appear as purple inflamed skin and grey scales. The plaques happen due to a buildup of skin cells. The inflammation can be painful and itchy.
Plaque psoriasis can also present as nails and nail beds showing pitting or lifting up from the skin. Joints can be swollen and painful. Individual or multiple fingers or toes can become visibly swollen.
The Clinical Manifestation Of Psa
In the 60s and 70s five clinical forms of PsA were distinguished by Moll and Wright:
X-ray of hands: The destructive form of psoriatic arthritis . Numerous destructive changes in joints of both hands. Ankylosis of the right wrist. Typical for PsA changes called pencil-in-cup involving metacarpophalangeal joints.
A group of diseases with similar clinical manifestation called seronegative spondyloarthropathies has also been defined . The group includes:
To support the diagnosis of seronegative spondyloarthropathies, the European Spondyloarthropathy Study Group created some clinical criteria. Basing on these criteria the assessment includes the following features:
Patient with PsA X-ray of forefoot. Shows a form of the disease involving distal interphalangeal joints. Margin erosions and periostosis in DIP joint of the first finger of the left foot are visible.
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Living With Psoriatic Arthritis
There is no cure for psoriatic arthritis. However, by understanding the disease and knowing what to expect, you can learn different ways to complete daily tasks or plan activities at times of the day when you are least bothered by its effects. Once you understand and learn to predict the ways in which your body responds to the disease, you can use exercise and therapy to help decrease discomfort, stress and fatigue.
There is a significant list of comorbidities related to PsA. These include these 11 conditions:
Treatments For The Arthritis
Non-steroidal anti-inflammatory drugs
NSAIDs, or non-steroidal anti-inflammatory drugs, can reduce pain, but they might not be enough to treat symptoms of psoriatic arthritis for everyone.
Some people find that NSAIDs work well at first but become less effective after afew weeks. If this happens, itmight help to try a different NSAID.
There are about 20 different NSAIDs available, including ibuprofen, etoricoxib, etodolac and naproxen.
Like all drugs, NSAIDs can have side effects. Your doctor will reduce the risk ofthese, by prescribing the lowest effective dose for the shortest possible period of time.
NSAIDs can sometimes cause digestive problems, such as stomach upsets, indigestion or damage to the lining of the stomach. You may also be prescribed a drug called a proton pump inhibitor , such as omeprazole or lansoprazole, to help protect the stomach.
For some people, NSAIDs can increase the risk of heart attacks or strokes. Although this increased risk is small, your doctor will be cautious about prescribing NSAIDs ifthere are other factors that may increase your overall risk, for example, smoking, circulation problems, high blood pressure, high cholesterol, or diabetes.
Some people have found that taking NSAIDs made their psoriasis worse. Tell your doctor if this happens to you.
Steroid injections into a joint can reduce pain and swelling, but the effects do wear off after a few months.
Disease-modifying anti-rheumatic drugs
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Does This Mean I Will Have Psoriasis For Life
In the absence of a cure you will always have psoriasis, but this does not mean that the signs will always be visible. Normally, the rash tends to wax and wane . There will be periods when your skin is good, with little or no sign of psoriasis. Equally, there will be times when it flares up. The length of time between clear skin and flare-ups differs for each individual and is unpredictable. It may be weeks, months or even years.
Distal Interphalangeal Predominant Psoriatic Arthritis
Distal interphalangeal predominant psoriatic arthritis may sound complicated, but it simply means that the distal joints of the phalanges are affected.
This type of psoriatic arthritis is characterized by pain and stiffness near the tips of the fingers or toes. When viewed on an X-ray, the ends of the bone will often appear narrowed like a pencil tip, while the adjacent joint will have a compressed, cup-like appearance.
Nail changes, including pitting, thickening, and lifting , are also common.
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What Are The Treatment Options For Psoriatic Arthritis
The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:
Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.
DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.
Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.
Heat and cold therapy
Five Clinical Presentations Of Psoriatic Arthritis
Diagnosis of psoriatic arthritis may often be delayed since there are no identified biomarkers at this time. If left untreated psoriatic arthritis may lead to severe physical limitations and disability. Early diagnosis is critical to slow the progression of the disease with medications.
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Is There A Cure For Psoriasis
There is no cure at the moment. However, as a consequence of current research, our understanding about what happens in psoriasis is growing and new drugs are being developed. In the meantime, there are a number of treatments that are effective in keeping psoriasis under control.
The art of treating psoriasis is finding the best form of treatment for each individual. There is no single solution that is right for everyone.
When To Get Medical Advice
See a GP if you have persistent pain, swelling or stiffness in your joints even if you have not been diagnosed with psoriasis.
If you’ve been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let the doctor know if you’re experiencing any problems with your joints.
Types Of Psoriatic Arthritis
There are five different types of psoriatic arthritis, determined by which parts of the body are affected as well as the extent and severity of inflammation:
Symmetric arthritis usually affects the same joints on both sides of the body. Usually multiple pairs of joints, such as the right and left knees or right and left elbows, are affected. This type of psoriatic arthritis resembles rheumatoid arthritis, but its generally milder.
Asymmetric arthritis doesnt typically affect the same joints on both sides of the body. Usually, it affects the fingers and toes first, which can lead to an enlarged and sausage-like appearance. Sometimes a larger joint, like the knee, is also affected.
Distal interphalangeal predominant
DIP affects the joints in the fingers and toes closest to the nail nail changes are common.
Spondylitis refers to inflammation of the spinal column. Many people with psoriatic arthritis will have stiffness in the neck, lower back, or spinal vertebrae, making motion painful and difficult.
Arthritis mutilans is a severe, deforming, and destructive form of psoriatic arthritis. It usually affects the small joints at the ends of the hands and feet.
What Should You Do If You Develop Another Type Of Psoriasis
Life-threatening signs and symptoms, such as redness that covers most of your body, fever, and chills, require immediate medical care.
When signs and symptoms are not life threatening, you should see a board-certified dermatologist for a diagnosis. Youll find pictures of the different types of psoriasis and learn more about the possible signs and symptoms at Psoriasis: Signs and symptoms
ImagesImage 1: Getty ImagesImage 2: J Am Acad Dermatol 2013 69:245-52.
ReferencesBrummer GC, Hawkes JE, et al. Ustekinumab-induced remission of recalcitrant guttate psoriasis: A case series. JAAD Case Rep. 2017 3: 4325.
Egeberg A, Thyssen JP, et al. Prognosis after hospitalization for erythroderma. Acta Derm Venereol. 2016 96:959-92.
Gottlieb A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: Overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008 58:851-64.
Gudjonsson JE and Elder JT. Psoriasis. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine. McGraw Hill Medical, New York, 2008:178-81.
Khosravi H, Siegel MP, et al. Treatment of Inverse/Intertriginous Psoriasis: Updated Guidelines from the Medical Board of the National Psoriasis Foundation. J Drugs Dermatol. 2017 16:760-6.
Navrotski BRF, Nihi FM, et al. Wet wrap dressings as a rescue therapy option for erythrodermic psoriasis. An Bras Dermatol. 2018 93:598-600.
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Treatment For Psoriatic Arthritis
Treatment for psoriatic arthritis aims to:
- relieve symptoms
- slow the condition’s progression
- improve quality of life
This usually involves trying a number of different medicines, some of which can also treat the psoriasis. If possible, you should take 1 medicine to treat both your psoriasis and psoriatic arthritis.
The main medicines used to treat psoriatic arthritis are:
- non-steroidal anti-inflammatory drugs
- biological therapies
Who Gets Psoriasis That Affect The Joints
Years after developing psoriasis on their skin, some people get a type of arthritis called psoriatic arthritis, which affects the joints. Its also possible to develop psoriatic arthritis before getting psoriasis on your skin.
Its not possible to predict who will get psoriatic arthritis. For this reason, its important for people who have psoriasis to pay attention to their joints.
Without treatment, psoriatic arthritis can worsen and damage joints. This damage is irreversible and can cause a lifelong disability. Treatment can prevent psoriatic arthritis from worsening.
Early warning signs of psoriatic arthritis include:
A swollen and tender joint, especially within a finger or toe
Swelling on the back of your leg, just above your heel
Stiffness in the morning that fades during the day