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Psoriatic Arthritis

What Is Psoriatic Arthritis?

Psoriatic arthritis is a chronic condition that is characterized by inflammation of the skin and joints. Psoriasis is a common skin condition affecting approximately 2% of the population, this skin condition is characterized by patchy, raised, red areas of skin inflammation with scaling. Psoriasis can affect any part of the body, but most often affects the tips of the elbows and knees, the scalp, the navel, and around the legs, hands and nails. Approximately 5 – 7% of psoriasis patients also develop an associated inflammation of their joints, a condition we know as psoriatic arthritis. Patients who have inflammatory arthritis and psoriasis together, are diagnosed as having psoriatic arthritis.

The onset of psoriatic arthritis most often occurs when a person is in their forties of fifties, and males and females can both be equally affected. Both the psoriasis and the arthritis often appear separately. In fact, the skin disease precedes the arthritis in nearly 80% of patients. However, the arthritis may precede the psoriasis in up to 15% of patients. It can be very difficult to diagnose psoriatic arthritis, because both arthritis and psoriasis may occur in a patient but may manifest many years apart.

Psoriatic arthritis is a particular form of arthritis sometimes associated with other auto-immune diseases, such as ankylosing spondylitis, reactive arthritis (Reiter’s syndrome), and arthritis associated with inflammatory bowel disease (IBD) such as Crohn’s disease and ulcerative colitis. All of these autoimmune conditions can cause inflammation in the spine and other joints, and the eyes, skin, mouth, and various organs.

What Causes Psoriatic Arthritis?

The interesting point with auto-immune conditions is that there are “no known causes” as far as conventional medicine is concerned, and the cause of psoriatic arthritis is currently unknown. A combination of genetic, immune, and environmental factors are likely involved. There is a gene involved, and the HLA-B27 gene is found in over half of those who have arthritis of the spine, and recently a blood-test has become available to quickly test for this marker. With ankylosing spondylitis, HLA-B17 is also apparent.

Some experts believe that there are infectious agents responsible for auto-immune conditions such as psoriatic arthritis, because certain changes in the immune system may be important in the development of psoriatic arthritis. For example, a reduction in the number of immune cells called helper T cells in people with AIDS may play a role in the development and progression of psoriasis and psoriatic arthritis in these patients.

How Does The Doctor Diagnose Psoriatic Arthritis?

Psoriatic arthritis is a diagnosis made mainly on clinical grounds, based on a finding of psoriasis and the typical inflammatory arthritis of the spine and/or other joints. There is no laboratory test to diagnose psoriatic arthritis. Blood tests such as sedimentation rate may be elevated and merely reflect presence of inflammation in the joints and other organs of the body. Other blood tests such as rheumatoid factor are obtained to exclude rheumatoid arthritis. When one or two large joints (such a knees) are inflamed, arthrocentesis can be performed. Arthrocentesis is an office procedure whereby a sterile needle is used to withdraw (aspirate) fluid from the inflamed joints. The fluid is then analyzed for infection, gout crystals, and other inflammatory conditions. X-rays may show changes of cartilage or bone injury indicative of arthritis of the spine, sacroiliac joints, and/or joints of the hands. Typical X-ray findings include bony erosions resulting from arthritis. The blood test for the genetic marker HLA-B27, mentioned above, is often performed. This marker can be found in over 50% of patients with psoriatic arthritis who have spine inflammation.

What Does The Future Hold For Patients With Psoriatic Arthritis?

The future treatment of psoriatic arthritis will evolve as more effective and safe medicines are developed. Recently, it has been shown that vitamin D might actually improve the arthritis of psoriatic arthritis. Other areas of research involve treatment with medications that can alter the immune system of patients with psoriatic arthritis. As the immune system changes and genetics are better defined in this illness, the efficacy of these medical treatments will improve.

  • About one in 10 people with psoriasis also develop inflammation of joints (psoriatic arthritis).
  • The first appearance of the skin disease (psoriasis) can be separated from the onset of joint disease (arthritis) by years.
  • Psoriatic arthritis belongs to a group of arthritis conditions that cause inflammation of the spine (spondylo-arthropathies).
  • Patients with psoriatic arthritis can develop inflammation of tendons, cartilage, eyes, lung lining, and, rarely, the aorta.
  • The arthritis of psoriatic arthritis is treated independently of the psoriasis, with exercise, ice applications, medications, and surgery.

Psoriatic Arthritis Signs and Symptoms

Psoriatic arthritis is a condition which affects those with psoriasis, and only a small percentage of psoriasis sufferers with psoriatic arthritis. In most cases, the psoriasis will almost always precede the arthritis anything from a few months to several years. Psoriatic arthritis is a very of painful arthritis which frequently involves the knees, ankles, and joints of the feet. In most cases, only a few joints are inflamed at any one time. The inflamed joints can become very painful, swollen, hot, and red – just like in rheumatoid arthritis, also an auto-immune condition.

Joint Inflammation

Joint inflammation can range from mild to most severe, and at times it can even make a finger or toe joint swell up to the point that it almost looks like a sausage. The most common time for a person with psoriatic arthritis to notice joint pain, swelling and inflammation will be in the morning soon after waking.  Any joint can be affected in this condition, and psoriatic arthritis can also cause inflammation of the larger joints, such as the spine (causing a condition known as spondylitis) as well as the sacrum, causing pain and stiffness in the upper back, neck, the lower back and even the buttocks.

Patients with psoriatic arthritis can also develop inflammation around the cartilage areas and also of the tendons (called tendinitis). Inflammation of the tendon behind the heel leads to pain when the person climbs or walks up or down the stairs. A condition known as costochondritis can develop which is inflammation of the chest wall and of the cartilage that links the ribs to the breastbone (known as the sternum).

Inflammation May Occur Such As Iritis, Pleuritis and Aortitis

Psoriatic arthritis can also cause inflammation in other areas of the body such as the lungs, the eyes and even the aorta, one of the largest blood vessels in the body. Iritis may occur, which is inflammation in the iris of the eye, a most painful condition that can be aggravated by bright light (called photo phobia). Light has an effect of either opening (light) or closing (darkness) the pupil, which affects the iris and can bring about a tremendous amount of pain in some people with psoriatic arthritis. Common medical treatments often include a corticosteroid injection directly into the eye to decrease severe inflammation and prevent blindness. Inflammation in and around the lungs (pleuritis) causes shortness of breath and severe chest pain, especially with deep breathing. Shortness of breath and even heart failure may occur due to inflammation of the aorta (aortitis) caused by a leakage of the aortic valve valves.

Acne And Nail Problems

Many psoriatic patients I have seen over the years have different forms of acne and nail changes. Pitting and ridges are seen in fingernails and toenails of 80% of patients with psoriatic arthritis. Interestingly, only a minority of psoriasis patients who do not have arthritis have nail changes. Acne has been noted to occur in higher frequency in patients with psoriatic arthritis.

SAPHO Syndrome

A new syndrome (SAPHO syndrome) as been described, characterised by inflammation of the joint lining (synovitis), acne and pustules on the feet or palms, thickened and inflamed bone (hyperostosis), and bone inflammation (osteitis).

Psoriatic Arthritis Treatment

The conventional treatment of the arthritis symptoms of psoriatic arthritis is based on pharmaceutical drugs. Generally, the treatment initially involves a combination of anti-inflammatory medications (NSAIDs) and exercise. If progressive inflammation and joint destruction occurs despite NSAIDs treatment, more potent medications such as methotrexate, corticosteroids, and antimalarial medications (such as hydroxychloroquine, or Plaquenil) are used.

Exercise May Help

Exercise can be done at home (a good occupational therapist or physiotherapist can help significantly here) and is customised according to suit each patient. Warm-up stretching, or other techniques, like a hot shower or heat packs (wheat bags are good) are helpful to relax muscles prior to exercise. Ice application after the routine can help minimise post-exercise soreness and inflammation. The best forms of exercises for those with psoriatic arthritis are performed for the benefit of strengthening and maintaining or improving joint range of motion. Exercises should be done on a regular basis, and in my clinical experience, for the very best results and you may also want to consider Tai Chi or a gentle form of yoga.

NSAIDs (Nonsteroidal anti-inflammatory drugs) are a group of pharmaceutical drugs that can be helpful in reducing joint inflammation, pain, and stiffness, but they come at a price of often causing unwanted side-effects. Examples of NSAIDs include aspirin, indomethacin (Indocin), and diclofenac. The problem with drugs are the inherent side-effects, and the most frequent side effects include stomach upset and ulceration, but these drugs can also cause more serious side effects such as gastrointestinal bleeding and even stroke. I am not a big fan of pharmaceutical drugs at all, and will explain in the booklet called Psoriasis, Special Foods, Supplements, Herbs and Teas the different natural options available to you.

Skin and joint symptoms linked

While the relationship between the skin disease and joint disease is not clear, many clinical cases have revealed that there is an improvement of the arthritis simultaneously with clearing of the psoriasis. Patients with psoriasis can benefit by direct sunlight exposure and ocean water.

My advice is to follow the dietary advice given in the comprehensive Psoriasis Diet book, which you will find in The Psoriasis Program.

Surgery Last Option

Patients who have severe destruction of the joints may benefit from orthopedic surgical repair. Total hip-joint replacement and total knee-joint replacement surgery are now commonplace in many hospitals throughout the Western world.