PSORIATIC ARTHRITIS

INTRODUCTION

Psoriatic arthritis is a form of joint pain and inflammation that may affect patients suffering from psoriasis ( a condition that causes red, scaly patches on the skin, triggered by underlying immune disorder). Often time psoriasis is diagnosed first with the joint problems starting later, but in a few cases it may be the other way around, with joint problems manifesting earlier than the skin lesions.

Both psoriasis and psoriatic arthritis are conditions that eventually worsen over time, and complete cure is yet unavailable. The characteristic of these conditions is flare-ups and remissions. Psoriatic arthritis can affect joints on one side of the body as well as both sides of the body, and may mimic rheumatoid arthritis to some extent.

SIGNS AND SYMPTOMS

In addition to joint pain and silvery patches on skin, some of the other symptoms of psoriatic arthritis include:

swollen fingers and toes: patients often complain of sausage-like swelling of fingers and toes.

foot pain: this happens in areas where the ligaments and tendons attach to the bone, especially at the back of the heel (Achilles’ tendon), or sole of the foot.

lower back pain: Some people may develop lower pack pain resulting from chronic inflammation between joints of the spine, especially in the lower back. This is called spondylitis.

CAUSES

Psoriatic arthritis occurs when the body’s immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in the joints as well as overproduction of skin cells.

It’s not entirely clear why the immune system turns on healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Although developing psoriatic arthritis in any age is possible, it is most common in adults between the ages of 30 years and 50 years.

COMPLICATIONS

A small percentage of people with psoriatic arthritis develop arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in your hands, especially the fingers, leading to permanent deformity and disability.

People who have psoriatic arthritis sometimes also develop eye problems such as pinkeye (conjunctivitis) or uveitis, which can cause painful, reddened eyes and blurred vision. They also are at higher risk of cardiovascular disease.

MANAGEMENT

Drugs used to treat psoriatic arthritis include:

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation.  Side effects may include stomach irritation, heart problems, and liver and kidney damage.

Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

Immunosuppressants. These medications act to tame your immune system, which is out of control in psoriatic arthritis. Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune). These medications can increase your susceptibility to infection.

TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia). Potential side effects include nausea, diarrhea, hair loss and an increased risk of serious infections.

Newer medications. Some newly developed medications for plaque psoriasis can also reduce the signs and symptoms of psoriatic arthritis. Examples include apremilast (Otezla), ustekinumab (Stelara) and secukinumab (Cosentyx).

Surgical and other procedures

Steroid injections. This type of medication reduces inflammation quickly and is sometimes injected into an affected joint.

Joint replacement surgery. Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic.

 

Dr. Annie

Physician, mom and wife

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