Psoriatic Arthritis

Psoriatic arthritis is a condition characterized by inflammation of skin and joints. About 15-25% of the people with skin inflammation or psoriasis have joint inflammation too. 

Most of the people with psoriatic arthritis develop psoriasis before the symptoms of arthritis, but in some rare cases arthritic symptoms may precede skin inflammation. 

As in other forms of arthritis, pain, swelling, and stiffness of joints are the main symptoms of psoriatic arthritis. Symptoms range from mild to severe and affect different parts of the body. 

Symptomless periods may alternate with disease flares. There is no complete cure for the disease, but treatment helps to control symptoms like pain, inflammation, and damage to joints.

Psoriatic arthritis is a progressive disease and the symptoms worsen with time. Short duration of symptomless period alternates with disease flares. 

Symptoms may be seen on joints of one side or both sides of the body. Pain, swelling, warmth, and stiffness of joints are the most common symptoms of this condition. 

Swelling is often seen as sausage-shaped protrusion on fingers and toes. Some patients develop deformities in fingers and toes before other joints are affected. 

Achilles tendinitis causes pain that is felt at the region where the tendons and ligaments attach to the bones at the back of the heel. In plantar fasciitis, another symptom, the pain is felt in the sole of the foot. 

Spondylitis, characterized by inflammation of vertebral joints and also between spine and pelvis, is also caused by psoriatic arthritis.

Psoriatic arthritis is caused by autoimmune condition in which the immune system attack body’s healthy tissues. This leads to inflammation of the joints. The actual cause for the autoimmune response is not known. 

A combination of genetic and environmental factors are implied in the abnormal immune response. In some cases, psoriatic arthritis is found to run in families. Certain genetic makeup is also associated with this form of arthritis. 

Environmental factors like trauma and infection may cause psoriatic arthritis in people who have the genetic makeup. 

The risk of psoriatic arthritis increases with: 

• Psoriasis – having psoriasis is a great risk for developing arthritis. 
• Family history – people with a family history of this condition tend to be more susceptible to develop psoriatic arthritis
• Age – it is most commonly found in people in the age group of 30-50 years. 

Diagnosis of psoriatic arthritis is based on the signs and symptoms. Erythrocyte sedimentation rate (ESR) reveals higher values characteristic of inflammation. 

Other blood tests like rheumatoid factor test helps to differentiate the symptoms due to rheumatoid arthritis. 

Arthrocentesis is a procedure in which the fluid from the joint is withdrawn and analyzed for the presence of inflammation, uric acid crystals, or infection. 

This test helps to differentiate psoriatic arthritis from other conditions with similar symptoms. Changes in cartilage and bones are visualized using imaging techniques like x-ray. 

Erosion of joints is revealed in MRI.

Treatment for psoriatic arthritis helps to control the symptoms and to improve the range of motion of the affected joint. Medications, physical therapy, and surgery are the treatment options available for psoriatic arthritis. 

Medications help in reducing pain and inflammation. Acetaminophen is useful in reducing mild to moderate pain. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium are also recommended to reduce pain associated with osteoarthritis. 

Duloxetine, an anti-depressant, is prescribed to alleviate chronic pain. 

Disease-modifying anti-rheumatic drugs (DMARDs) block abnormal immune function in which the system attacks healthy tissues. Methotrexate and hydroxychloroquine are common DMARDs. 

Biologic response modifiers are medications that target the proteins involved in the abnormal immune response. 

Immunosuppressants like azathioprine and cyclosporine controls the abnormal functioning of the immune system, one of the causes for the development of psoriatic arthritis. 

Tumor necrosis factor –alpha (TNF-alpha) inhibitors block the action of TNFs, reducing pain, inflammation, and stiffness of joints. Etanercept, adalimumab, and infliximab are commonly used TNF-alpha inhibitors. 

Corticosteroids suppress the immune system and control symptoms like pain and inflammation. These are usually given as injections in the affected joints.

The damaged part of the joint is removed and replaced with prosthesis in a joint replacement surgery. 

There is no sure way to prevent psoriatic arthritis. Treatments help to prevent the recurrence of the disease.

A few alternative and homeopathic remedies exist for psoriatic arthritis.

Vitamin D supplements are considered to be effective in improving the symptoms, and is beneficial for both skin and joint problems. 

Kali carbonicum, rhus toxicodendron, natrum muriatricum, Sulphur, thuja occidentalis, sepia, and silica are prescribed in homeopathy based on the specific symptoms and overall health of the patient. 

Yoga and tai chi combines breathing, stretching, and strengthening exercises which helps to relieve stress and to improve the flow of blood to the affected joints. 

Herbal remedies like aloe vera, apple cider vinegar, capsaicin, oats, tea tree oil, and turmeric, may help with psoriatic arthritis.

Acupressure is a procedure that uses gentle pressure on the key healing points to relieve pain and to boost the immune system. It may be beneficial for reducing pain in psoriatic arthritis. 

Acupuncture, massage and reiki are also used in controlling symptoms of this condition. All alternative therapies should be used with caution as most of them lack solid scientific evidence.

Lifestyle changes are important in controlling symptoms of psoriatic arthritis. This includes: 

• Maintaining a healthy body weight
• Protecting the joints from injuries
• Regular exercise
• Using cold and heat packs on the affected area

It is important not to drain yourself out with activities. Psoriatic arthritis causes considerable amount of mental and physical pain. 

Support of family and friends helps to face the challenges of dealing with the chronic pain and disability. 

Support groups also offer considerable benefit, particularly if one is worried about troubling the family. Learning coping strategies helps to reduce stress. 

A severe, painful disability, called arthritis murilans, is a complication associated with psoriatic arthritis. This condition may destroy the small bones in the fingers, causing deformity. It may also affect the way the person carries out daily activities.