Psoriasis is a noncontagious skin diseases that generates plaques of thickened, scaling skin. Psoriasis usually affects the skin of the elbows, knees and scalp. People with psoriasis are mostly affected by psoriatic arthritis, but sometimes people with no psoriasis can also be affected by psoriatic arthritis.
Psoriatic arthritis is a chronic disease which occurs because of overacting immune system, it causes inflammation in your joints. This disease generally attack between 3rd-5th decades of life. Around 80% of patients of psoriasis develop psoriatic arthritis although this percentage varies. Both of men and women are equally at risk. While in psoriasis the inflammation is mistakenly directed toward the skin, in psoriatic arthritis, the inflammation is directed toward the joints, just like rheumatoid arthritis, causing swelling, redness, pain and stiffness and damage. While rheumatoid arthritis occurs in small joints such as –finger joint psoriatic arthritis occurs in large joints such as- distal joints of the fingers and toes, back and sacroiliac joints of the pelvis etc.
Important Information: Sometimes psoriatic arthritis is misdiagnosed as gout, rheumatoid arthritis, or osteoarthritis which may lead you to wrong treatment.
Symmetric psoriatic arthritis
Symmetric means it affects joints on both sides of the body. It has similarity with rheumatoid arthritis but it is less severe than rheumatoid arthritis.This type of arthritis is much more common in women than men.
Asymmetric psoriatic arthritis
Asymmetric arthritis is the mildest form of psoriatic arthritis. Unlike symmetric arthritis, joints of only one side of the body are affected in this case. Patients of asymmetric arthritis may feel intermittent joint pain
Distal inter-phalangeal (DIP) joint predominant psoriatic arthritis
DIP is a rare type of arthritis. Generally, men are affected more with this type of arthritis. The toe or finger distal joints are typically affected by DIP (the upper joint of the finger, near to the nails). Nails of DIP patient become thick and pitting and discoloration also occurs.
Important information: Sometimes DIP is misunderstood as osteoarthritis.
In case of spondylitis, the patient’s neck, lower back, sacroiliac joints (in the pelvis) or spinal vertebrae are stiff and swollen. Ligaments and tendons joined to the spine may also become swollen. Gradually, the patient may find it difficult to move around.
Arthritis mutilans is a severe destructive type of psoriatic arthritis which deforms the organs and the affected person may become disabled. Small joints of hands and feets are generally affected by this type of arthritis. The patient may feel pain to neck or lower back due to arthritis mutilans. In a study, it has been seen that only 5 percent people are affected by this diseases.
Psoriatic arthritis- signs and symptoms
Signs and symptoms of psoriatic arthritis may be subtle or significant and appear gradually or drastically, actually signs and symptoms vary person to person depending on their distinct condition.
Whatever the condition of appearing the symptoms, the symptoms is always the same for both people who generate the symptoms gradually and who generate it drastically.
Joint swelling is a common symptom of both psoriatic and rheumatoid arthritis. But in case of psoriatic arthritis, a unique type of swelling occurs in your fingers or toes.
In case of psoriatic arthritis, you will notice a “sausage-like swelling” around the affected joint area. This type of swelling is very painful and if not treated this may result in permanent deformities in your fingers and toes.
Although joint pain is a common symptom of both rheumatoid arthritis and Psoriatic arthritis, pain due to psoriatic arthritis is more likely to occur in your tendons. Your tendons connect your muscles to your bones.
Two conditions that can occur due to psoriatic arthritis are-
- Plantar fasciitis and
- Achilles tendinitis.
- Plantar fasciitis
Plantar fasciitis occurs when the tendon that connects your heel to your toes becomes inflamed. It occurs most commonly and causes pain at the bottom of your foot.
- Achilles tendinitis
In case of achilles tendinitis, the tendon that connects your lower calf muscles to your heel bone becomes inflamed. Achilles tendinitis causes pain in heel.
Due to psoriatic arthritis “pitting” or the formation of depressions in your fingernails or toenails occurs. Nail also starts separating from nail bed.
Sometimes nail dysfunctions can also appear which is similar to fungal infections. If your nails on either your hands or feet become discolored or have indentations, this could be a sign of psoriatic arthritis. So, if you notice such symptoms do not late to do the treatment, otherwise in later stages, the nails can be crumbled and may become damaged.
Red skin patches
Approximately, 85 percent people with Psoriatic arthritis experience red skin patches problems associated with psoriasis before noticing joint issues.
A secondary condition, known as- spondylitis may occur in about 20% psoriatic arthritis patient.
Spondylitis causes joint inflammation in two main areas:
- Between your pelvis and spine and
- Between your spine’s vertebrae.
This leads to lower back pain.
Due to psoriatic arthritis you may notice stiffness when you get up from bed in the morning; you may feel stiffness when you stand up first after sitting in one spot for a period of time.
After moving around for some time, you will feel less stiffness. But it can last up to 45 minutes or longer.
Due to the pain and inflammation caused by this immune disorder people with psoriatic arthritis often feel tired. Some arthritis medications may also cause a general fatigue in patient.
Fatigue makes it tougher to conduct daily activities and to stay physically active. This can lead to other problems also, such as obesity and mood changes.
People with psoriatic arthritis feel problems in their eye, such as- dry eye, vision changes, and lid swelling.
If not treated properly, dry eye can cause permanent damage and trigger to glaucoma. According to research, approximately 30 percent of patient with psoriatic arthritis experience inflammation of eye.
Anemia occurs when you don’t have enough red blood cells. People with psoriatic arthritis are often attacked by anemia.
Although psoriatic anemia is a mild type anemia, it may cause further problem such as-
- Shortness of breath
Limitation of movement
Due to the stiffness and pain in joints and the swelling and tenderness in tendons movement of the patient becomes limited. It also depends on how many joints are affected by psoriatic arthritis. Exercising on a regular basis can help you to loosen up your joints.
Psoriatic arthritis – causes and risk factors
Psoriatic arthritis occurs because of faulty immune system. The function of our body’s immune system is to protect our body from the attack of harmful virus, bacteria etc. but in case of faulty immune system, the immune system malfunctions – it thinks its own tissue and cells enemy and attacks healthy cells and tissue. The abnormal immune response causes swelling in your joints and overproduction of skin cells.
Researchers could not find the reason of such malfunctioning of our immune system but it is thought that certain risk factors play a role to develop psoriatic arthritis.
Psoriasis is a common risk factor for developing psoriatic arthritis, as I have said earlier. There are also some other factors work to develop psoriatic arthritis. These factors include:
People with a family history of psoriatic arthritis are more vulnerable to develop the disease than those without a family history. According to a study around 40% of patients with psoriasis or psoriatic arthritis have family members who have psoriasis or psoriatic arthritis.
Children of parents having psoriasis are three times more likely to be affected by psoriasis and have a greater risk of developing psoriatic arthritis than children of parents without psoriasis.
People between 30-50myears old are more susceptible to develop this diseases.
If an identical twin has psoriatic arthritis, the other identical twin is highly likely to also have the disease or to develop it eventually. Many genes that are associated with susceptibility to psoriatic arthritis are also associated with susceptibility to psoriasis. But, not all genes are associated with both diseases.
Sometimes environmental factors trigger to develop psoriatic arthritis.
It is thought that certain infections, especially streptococcal infections is considered a possible risk factor of developing psoriatic arthritis, although the link has not been proven yet.
Psoriatic arthritis diagnosis
Although there is no specific single test to diagnose psoriatic arthritis, doctors generally diagnose it on a clinical basis and by a process of elimination. Analyzing your medical history and after examining your physical condition doctor can suggest you to do blood tests, MRIs and X-rays of the joints to diagnose psoriatic arthritis..
X-rays – X-ray can help to detect change in your bones and joints.
Arthrocentesis- It is a test of the fluid of your joint. A sterile needle is used to withdraw fluid from a swollen joint, typically the knee, and then sent to the lab. If the presence of uric acid crystals are found it is more likely the patient has gout.
Erythrocyte sedimentation rate (ESR or sed rate) – this blood test identifies and monitors inflammation in the body by determining the rate at which red blood cells in a test tube separate from blood serum over a particular time period, becoming sediment in the lowermost part of the test tube.
A high sedimentation rate indicates more inflammation. In other words, if the red blood cells descend to the bottom of the test tube rapidly, it could mean that the patient has an inflammatory condition.
Since many types of arthritis and rheumatic diseases cause inflammation in the body, this test can only ensure the presence of inflammation, so it does not ensure about psoriatic arthritis.
Rheumatoid factor (RF) – It is a protein formed by the immune system. It is usually present in the bloodstream of patients with rheumatoid arthritis, not in the patients with psoriatic arthritis. This test helps the doctor to detect whether the patient has rheumatoid arthritis or psoriatic arthritis.
How to prevent the risk of misdiagnosing psoriatic arthritis?
I have already said it that psoriatic arthritis is sometimes misdiagnosed as gout, osteoarthritis or rheumatoid arthritis. Misdiagnosing may lead to wrong treatment making the situation worse.
Here are some tips to prevent misdiagnosing psoriatic arthritis:
- If a single joint becomes inflamed and extreme pain is felt almost overnight, it is probably gout as gout pain starts rapidly and is intense.
- If there is little or no joint inflammation, pain is felt after some activity, it is probably osteoarthritis.
- If the joint pain is symmetrical, it is probably rheumatoid arthritis although psoriatic arthritis can also be symmetric but it is rare in case of psoriatic arthritis.
- If joint pain is intense for more than a few minutes in the morning, or after inactivity, its chance of being psoriatic arthritis is higher.
- If inflammation involves the full length of the fingers or toes, you may consider it as – psoriatic arthritis. This condition is typically known as -dactylitis, or “sausage fingers.”
- If there are psoriasis symptoms and you feel joint pain preceded by nail pitting psoriatic is likely the culprit, especially if there is joint inflammation.
Psoriatic arthritis treatment
Psoriatic arthritis cannot be cured completely but by taking certain medications or by doing surgery the severances of the symptoms can be reduced.
Medications for psoriatic arthritis
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful to provide you relief from pain and lessen inflammation.
Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). You can get stronger NSAIDs are available by prescription.
Side effects of NSAIDs:
- Irritation of stomach
- Problems of heart
- Liver and kidney damage.
Disease-modifying antirheumatic drugs (DMARDs)
Disease-modifying antirheumatic drugs (DMARDs) can make the progression rate of psoriatic arthritis slow; they protect not only the joints but also other tissues from permanent damage.
Examples of common DMARDs include methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine).
Side effects of DMARDs:
- Damage of liver
- Bone marrow destruction and
- Severe infections of lung.
Immunosuppressants act to control your immune system, which is out of control due to psoriatic arthritis.
Examples of immunosuppressants include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune).
Side effect of immunosuppressants:
- Increases susceptibility to infection.
Tumor necrosis factor-alpha (TNF-alpha) inhibitor
Body of psoriatic arthritis patient produces Tumor necrosis factor-alpha (TNF-alpha) which causes inflammation. TNF-alpha inhibitors reduce inflammation and pain due to inflammation. It is also helpful to reduce morning stiffness, and tenderness.
Examples of TNF-alpha inhibitor include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia).
Side effects of TNF-alpha inhibitor:
- Hair fall and
- Increased risk of serious infections.
Surgery for psoriatic arthritis
If the disease is in a serious stage, no other solution works then surgery can give you relief from pain. Generally synovectomy or arthroplasty are done to get relief from psoriatic arthritis.
Synovectomy refers to the surgical removal of the membrane (synovium) that lines a joint.
The surgical reconstruction or replacement of a joint is known as arthroplasty.
Develop 4 habits to Prevent psoriatic arthritis
- Do some exercise on a regular basis
- Take some rest between heavy, hard and repetitive tasks and light and easy tasks.
- Do not put over stress on your joint rather try to give little stress always.
- Develop a healthy life-style (eat and sleep timely, keep nutritious food in your diet plan)