Psoriatic arthritis

There are at least five types of psoriatic arthritis, depending on which joints are affected by it and the severity of the disease:

• Symmetric psoriatic arthritis affects multiple joints on both sides of the body. For example, the elbows and knees of both the right and left arm.
• Asymmetric psoriatic arthritis affects the joints on one side of the body. It can affect one joint (asymmetric monoarthritis) or multiple joints on either side of the body (asymmetric oligoarthritis).
• Distal interphalangeal psoriatic arthritis affects the fingers and the toes—the joints nearest to the nails.
  • Psoriatic onycho-pachydermo-periostitis is a variation of psoriatic arthritis which also affects the nails (psoriatic nails) and fingers/toes. Other signs of this condition include thickening of connective tissue above the distal phalanx (tips of fingers and toes) and erosion of the bones of the distal phalanges (last sections or tips of fingers and toes).
• Spondylitis psoriatic arthritis affects the spine, though it can also affect the hands, arms, feet, legs and hips. This form of psoriatic arthritis can be painful, and it can make even movements hurt.
• Psoriatic arthritis mutilans is a rare but severe condition that affects the hands and feet though it can also cause neck pain and back pain. This types of arthritis can affect the small bones and deform/shorten the fingers and toes. In fact, some of the better-known manifestations of psoriatic arthritis—like pencil-in-cup deformity (the tip of a bone in the finger becomes like the pointy end of a pencil) and telescoping fingers (when the soft tissues can't support the fingers properly and they look pulled in)—occur in this condition.

Some patients may have mild symptoms while others may have more severe disease. The symptoms can also vary in the same individual: they may feel okay on some days but poorly when the symptoms return.

The symptoms and which parts of the body they affect can vary depending on the type of psoriatic arthritis. Having said that, the following are some of the general symptoms of psoriatic arthritis:

• Swelling and pain in the joints
• Joint stiffness, especially in the mornings
• Muscle pain and pain in the tendons (the connective tissue that connects muscle to bones)
• Scaly, red patches on the skin worsen when the joint pain and swelling is worse
• Inflammation of the conjunctiva (tissue on the inner side of the eyelid and over the whites of the eye) or uvea (the layer just below the whites of the eye)
• Nail pitting, or the formation of pits (dents) in the nails where they have lost cells. In case of nail psoriasis, the nails may become discoloured, detached from the nail bed (onycholysis), thicker (onychomycosis), or they may crumble and/or develop lines (Beau's lines) all over.
• Inflammation in the sacroiliac joint where the spine and pelvis connect (sacroiliitis)
• People with psoriatic arthritis could also face issues with cardiac rhythm and inflammation in other parts of the body such as:
  • Inflammatory bowel disease
  • Urethritis
  • Prostatitis
  • Balanitis
  • Cervicitis
  • Vaginitis
• Depending on the type of psoriatic arthritis, patients may also experience foot pain, especially heel pain and pain in the soles of their feet, or back pain
• Psoriatic arthritis often affects the hands and feet. In these cases, the symptoms could include:
  • Inflammation in the area where the tendons and ligaments join the bone (enthesitis) and marginal bone erosions
  • Bone proliferation in some areas
  • Joint subluxation or partial dislocation of a joint which may resolve on its own
  • A fusion of bones in the fingers or toes (interphalangeal ankylosis) which makes it harder to move them
  • Dactylitis or swelling in the soft tissue of the entire digit (finger or toe); also known as sausage fingers or sausage toes
  • Periostitis or inflammation in a layer of connective tissue surrounding the bones
  • Ivory phalanx: A rare but important symptom of psoriatic arthritis, marked by increased density of the bone that is observable in scans

Psoriasis and psoriatic arthritis are autoimmune conditions, meaning they are caused when the body's immune system makes a mistake and starts attacking healthy cells. Doctors don't yet know why this happens, but they suspect that genetics may have something to do with it. Additionally, in people who are genetically prone to this disease, environmental factors such as a viral or bacterial infection could trigger psoriatic arthritis.

Some of the risk factors of psoriatic arthritis are:

• Psoriasis: Psoriasis typically begins as a skin condition, but it can also cause inflammation inside the body too. When this inflammation affects the bones and connective tissues, it can result in psoriatic arthritis.
• Family history: Having a family history of psoriasis or psoriatic arthritis can make one more prone to the condition.
• Age: Psoriatic arthritis can occur at any age but it is frequently seen in people aged 30-50.

(Consult a doctor with doctor consultation app)

A skin specialist is usually the first to catch the signs of psoriatic arthritis in patients who have psoriasis. This is because psoriasis typically presents as overproduction of skin cells which appear scaly and red and shed very fast.

Based on the symptoms described by the patient and a physical examination of the joint that may be painful or swollen, the doctor may recommend a few tests to confirm their suspicions:

• An X-ray can help see whether the joint is inflamed
• An MRI or magnetic resonance imaging test can do the same but at a much higher resolution
• CT scan to study the bone erosion and bone proliferation associated with psoriatic arthritis

The doctor may also order a few tests to rule out other conditions, such as:

• Joint fluid test to rule out gout, which would be suggested by the presence of uric acid crystals in the small amount of fluid extracted from the joints for this test.
• Rheumatoid arthritis factor blood test to rule out rheumatoid arthritis, which can have similar symptoms to psoriatic arthritis, like telescoping of fingers.

Though it isn't entirely possible to prevent psoriatic arthritis, it is possible to slow it down and manage its symptoms by maintaining a healthy weight and managing your psoriasis with medicines.

If you have psoriasis, regular checkups are also important to diagnose any complications of psoriasis—including psoriatic arthritis—early on and start management.

Psoriatic arthritis and its symptoms can be managed with a combination of drugs and therapies including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for pain relief and to reduce inflammation
• Disease-modifying antirheumatic drugs (DMARDs) like methotrexate to slow down disease progression and damage to the joints
• Immunosuppressants like azathioprine and cyclosporine to stop the immune system from attacking healthy cells in an autoimmune condition (read more: Cyclosporine test)
• Biologics or biologic response modifiers such as abatacept, adalimumab, infliximab and tofacitinib to target specific parts of the immune system for reducing inflammation and slowing down disease progression
• Steroid injections may be given to reduce inflammation quickly
• Joint replacement surgery may be recommended to patients if the joints are severely damaged
• In their day-to-day life, patients should include exercises for psoriatic arthritis and heat-and-cold therapy to improve mobility and reduce inflammation