The National Psoriasis Foundation describes psoriatic arthritis (PsA) as a chronic, inflammatory condition that affects the joints and entheses, or the points where tendons and ligaments join bone.
PsA shares comorbidities with psoriasis, which are related medical diseases. Children may be affected, and it can begin at any age.
Typically, the illness strikes between the ages of 30 and 50. Many people begin to experience it around 10 years after psoriasis appears, while some people experience it earlier or without ever recognising psoriasis.
Although there is no cure, there is an expanding array of therapeutic options that can help slow the disease’s course, relieve pain, safeguard joints, and maintain range of motion.
Working with a rheumatologist (a physician who specialises in how the immune system affects joints, bones, and muscles) to develop the best treatment strategy is crucial if you have PsA or believe you could have it.
The substantial joint damage that can develop in later stages of PsA can be avoided or limited by early diagnosis, therapy, and awareness of the disease.
Psoriatic arthritis patients report having issues with their skin and joints, according to Healthline. Depending on the circumstance, symptoms may change.
Typically, skin problems appear first, followed by arthritis. Joint issues, however, can occasionally appear without psoriatic symptoms. There is no known treatment for psoriatic arthritis. However, there are several options to assist with managing the pain and joint deterioration.
A wide variety of symptoms can be brought on by psoriatic arthritis. Some persons with the disease have more severe problems than others, and not everyone with the disease experiences the same problems.
According to the Mayo Clinic, symptoms can consist of rigid, painful joints, inflammation, heat, or swelling in the tissues surrounding the cartilage, red skin with silvery-white, rough patches, itchiness or burning of the skin, nails that fall apart, become damaged, or lifting from the nail beds, ‘’sausage-like’’ toes and fingers, hand malformations, foot, neck or spinal column pain, difficulty stretching and decreased flexibility, discomfort of the eyes, which can cause irritation and fatigue.
Everyday Health reports that although doctors are unsure of the actual aetiology of psoriatic arthritis, they do know that it manifests when the body’s immune system begins to target healthy tissue.
Your joints will get inflamed and your skin will overproduce skin cells as a result of this flawed process.
Experts think that the immune system’s failure may be related to both inherited and environmental factors. Several elements that could raise your risk include:
Having psoriasis: The highest risk factor for psoriatic arthritis is having a psoriasis diagnosis.
Family history: Around 40% of persons with psoriatic arthritis have psoriasis or arthritis in their family.
An infection: In some individuals, having a viral or bacterial infection can stimulate the immune system and cause psoriatic arthritis.
Age: Although anybody can develop psoriatic arthritis, people between the ages of 30 and 50 are more likely to do so.
Obesity: Being obese causes tendons to wear down more quickly, which can lead to inflammation and psoriatic arthritis.
Unfortunately, according to the National Psoriasis Foundation, there is no conclusive diagnostic test for PsA. The majority of the diagnosis is determined by your doctor’s observations and an elimination process.
PsA symptoms, for instance, are comparable to those of reactive arthritis, gout, and rheumatoid arthritis.
Your doctor will discuss your medical history with you and might order a physical exam, blood tests, an MRI, and X-rays.A skin biopsy may occasionally be necessary to confirm a psoriasis diagnosis.
There are 5 different forms of psoriatic arthritis, according to data from WebMD:
Symmetric Psoriatic Arthritis
As the name suggests, this kind simultaneously affects the joints on both sides of your body. The symmetric form of psoriatic arthritis affects about 50% of patients.
Asymmetric Psoriatic Arthritis
Problems don’t arise in the same joints on both sides of the body with the asymmetric form. About 35% of those who have the condition experience it, and it frequently results in milder symptoms.
Spondylitis
In this type of psoriatic arthritis, the neck and spine experience pain and stiffness.
Arthritis Mutilans
Deformities in the tiny joints at the tips of the fingers and toes are a symptom of arthritis mutilans. Although this type of psoriatic arthritis is thought to be the most severe, only around 5% of those who have the disorder have it.
Distal Psoriatic Arthritis
It also affects the nails and results in swelling and stiffness towards the ends of the fingers and toes.
Psoriatic arthritis is regarded as a chronic condition by Cleveland Clinic. Over time, symptoms usually get worse, but you could also go through periods of recovery or remission. These improvements are frequently cut short by flares, or spells of worsened symptoms.
Flares could appear and go. Flares can occur frequently for some people while they hardly ever do for others. According to the Arthritis Foundation, knowing what causes your flares can help you avoid certain situations in the future.
Common causes include stress, forgetting to take medications, eating specific foods, getting sick or hurt, and getting too little sleep.
Your disease’s severity and general state of health will determine your treatment strategy. According to Everyday Health, several treatments for psoriatic arthritis include:
Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
These can aid in reducing pain and inflammation. Although you can buy these medications over-the-counter (OTC), your doctor might be able to prescribe a stronger version for you.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
If NSAIDS don’t help your issue, they are frequently advised. They may be able to stop the disease’s spread and stop permanent joint damage.
Janus Kinase (JAK) Inhibitors
According to Healthline, tofacitinib (Xeljanz) was the first medication in this class to be licensed for PsA. Using these medications may increase your chance of developing an infection, heart problems, or some malignancies because they suppress the immune system.
TNF-Alpha Inhibitors
These medications aid in reducing the body’s production of tumour necrosis factor (TNF), which is an inflammatory agent. They can reduce joint swelling and relieve discomfort.
Immuno-suppressants
These influence the immune system to work. The National Psoriasis Foundation cites cyclosporine (Gengraf, Neoral, Sandimmune) and azathioprine (Imuran, Azasan) as two examples.
Steroids
Quickly reducing inflammation is possible with steroids. They may be ingested or occasionally injected directly into the painful joint.
Selective Co-stimulation Modulators
Immuno-modulators include abatacept (Orencia), according to WebMD. It functions by preventing the activation of T-cells, an immune cell type.
Phosphodiesterase Inhibitors
The medication apremilast reduces the activity of the phosphodiesterase 4 (PDE4) enzyme in your body by acting inside inflammatory cells. It lessens pain and edema.
Topicals Treatments
Topical therapies for psoriasis help reduce scaly, itchy rashes when applied directly to the skin. These treatments are available as ointments, creams, lotions, shampoos, gels, or sprays.
Light Therapy
The skin is subjected to UV radiation while receiving phototherapy, also known as light therapy. It may lessen the symptoms of psoriasis.
Surgery
In some instances, surgery may be required to replace or repair severely damaged joints caused by psoriatic arthritis. The damaged joint is removed during joint replacement surgery, and the artificial prosthesis is then implanted in its place.
Psoriatic arthritis is particularly difficult for Black, Indigenous, and People of Colour (BIPOC) populations.
According to a study published in Clinical Rheumatology, although black people were less likely than Caucasians to develop psoriatic arthritis, their skin involvement was more severe, and the condition had a bigger psychological impact on them as well as a lower quality of life.
The study’s black participants had a lower likelihood of receiving biologic drugs than its white ones, the researchers discovered.
Doctors who are not educated to recognise the skin symptoms of psoriasis in patients of colour may not be alert to the presence of psoriatic arthritis in those patients, missing possibilities for a diagnosis and course of therapy.
According to the American Academy of Dermatology, psoriasis typically manifests as red or pink with a silvery-white scale in white patients, but it can also be salmon-coloured with the same scale in patients with lighter skin tones, violet with a grey scale or dark brown in black patients.
