Psoriatic
arthritis is a form of arthritis that affects some people who have psoriasis a condition that features red patches of skin
topped with silvery scales. Most people develop psoriasis first and are later
diagnosed with psoriatic arthritis, but the joint problems can sometimes begin
before skin lesions appear.
It usually develops when
people are between 30 and 50 years old, but it can begin in childhood. Men and
women seem to be equally affected by psoriatic arthritis. There is an increased
risk of developing the condition if someone has parents or siblings with the
disease. It is important to recognize the signs and symptoms of psoriatic
arthritis so a doctor can perform a physical examination and recommend proper
treatment.
Psoriatic arthritis symptoms occur in variable
patterns and with variable intensity. The symptoms may even change in the same
person over a period of time. Psoriatic arthritis symptoms can occur at any
time, flare up, and then disappear.Thought at one time to be mild and
non-progressive, some psoriatic arthritis patients have persistent inflammation.
No cure for
psoriatic arthritis exists, so the focus is on controlling symptoms and
preventing damage to your joints. Without treatment, psoriatic arthritis may be
disabling.
Common Psoriatic Arthritis Symptoms
Common, general symptoms
associated with psoriatic arthritis include:
- Pain and swelling in one or more joints, often
the wrists, knees, ankles, and joints at end of fingers and toes
- Foot pain like swelling of fingers and toes causing them to
appear sausage-like
- Lower
back pain. Some people develop a
condition called spondylitis as a result of psoriatic arthritis.
Spondylitis mainly causes inflammation of the joints between the vertebrae
of your spine and in the joints between your spine and pelvis (sacroiliitis).
- Silvery or grayish scaly spots often on scalp,
elbows, knees, lower end of backbone
- Pitting of fingernails or toenails
- Fatigue
- Morning stiffness of joints
- Tendinitis
- Conjunctivitis
Five Types of Psoriatic Arthritis
The five types or patterns of
psoriatic arthritis may evolve from one to another and they
Asymmetric
psoriatic arthritis
. Most psoriatic arthritis is
first noticed in this stage. Asymmetric psoriatic arthritis involves a few
joints of the extremities randomly (e.g., left elbow and right knee). It
affects about 30 to 50 percent of psoriatic arthritis patients.
Symmetric
psoriatic arthritis
Many times, the asymmetric form
eventually evolves into symmetric psoriatic arthritis, which is characterized
by pain and swelling in joints on both sides of the body. The fingers and toes
are often affected. This type is the most common form of psoriatic arthritis,
affecting 30 to 50 percent of psoriatic arthritis patients.
Distal
interphalangeal predominant psoriatic arthritis
This form mostly involves joints
closest to the nails of the fingers and toes. Changes in the nails, including
pitting, splitting, degeneration and other nail mainfestations are common.
Other joints may also be affected. This type of psoriatic arthritis accounts
for 25 percent of cases.
Arthritis
mutilans
Arthritis mutilans is a rare (5
percent of all cases), painful, and destructive type of psoriatic arthritis.
It is characterized by a
condition called enthesitis (inflammation where tendons and ligaments attach to
bone) and also is characterized by resorption of phalangeal bones.
Psoriatic spondylitis or axial arthritis
This form is characterized by
sacroiliitis (inflammation of the pelvic area where the sacrum joins the ilium
bone) and spondylitis (inflammation of one or more vertebrae) occurring
separately or together. It affects between 30 and 35 percent of psoriatic
arthritis patients.
According to the American College
of Rheumatology, about 15 percent of psoriasis patients develop psoriatic
arthritis. Arthritis may develop before psoriasis in some patients.
When to see a doctor
If you have psoriasis, be sure to tell your doctor if
you develop joint pain. Psoriatic arthritis can come on suddenly or develop
slowly, but in either case it can severely damage your joints if left untreated.
Tips:
- Respect symptoms and seek the advice of a rheumatologist.
- Keep a diary or journal to document changes in
symptoms so you can accurately report significant matters to your doctor.
- Be compliant with your treatment plan.
- Your quality of life can still be good with
proper disease management.
Causes
The exact causes are not yet
known, but a number of genetic associations have been identified in a
genome-wide association study of psoriasis and psoriatic arthritis including HLA-B27
Psoriatic arthritis
occurs when your body's immune system begins to attack healthy cells and
tissue.
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.
Risk
factors
Several
factors can increase your risk of psoriatic arthritis, including:
·
Psoriasis: Having psoriasis is the single greatest
risk factor for developing psoriatic arthritis. People who have psoriasis
lesions on their nails are especially likely to develop psoriatic arthritis.
·
Family history: Many people with psoriatic arthritis
have a parent or a sibling with the disease.
·
Age: Although anyone can develop psoriatic
arthritis, it occurs most often in adults between the ages of 30 and 50.
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.
Treatments
The underlying
process in psoriatic arthritis is inflammation; therefore, treatments are directed at reducing
and controlling inflammation. Milder cases of psoriatic arthritis may be treated with NSAIDs alone; however, there is a trend toward earlier use of disease-modifying antirheumatic drugs or biological response modifiers to prevent irreversible joint
destruction.
·
Nonsteroidal anti-inflammatory drugs.
·
Disease-modifying antirheumatic drugs.
·
Biological response modifiers.
·
Disease-modifying
antirheumatic drugs (DMARDs).
·
Immunosuppressants.
·
TNF-alpha
inhibitors.
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.
Home remedies
There is
no cure-all for every possible symptom. However, some natural remedies can help
temporarily ease these effects.
Omega-3
Fatty Acids
The body
converts omega-3 fatty acids into anti-inflammatory chemicals. Studies involving people with rheumatoid arthritis (RA)
and other inflammatory diseases indicate that fish oils may decrease
inflammation and stiffness in joints.
Healthy fish oils are found in salmon,
mackerel, tuna, herring, halibut, and cod. According to the Arthritis
Foundation, pregnant women should avoid king mackerel and eat no more than 8
ounces of albacore tuna each month, due to potentially harmful mercury levels.
Fish oils are also available as a
dietary supplement. High levels can interfere with some medications, so talk to
your doctor before taking fish oil supplements.
Vitamin D
Vitamin D deficiencies are common in people with
psoriatic arthritis, a 2011 study found, but it wasn't clear why. (Because sun
exposure ups the body's vitamin D, spending time indoors can lead to a
deficiency.)
The same study found that vitamin D levels didn't seem to affect disease
activity.
In another study of just 10 patients, seven of the people who took vitamin D
reported a decrease in joint pain, but there was no placebo group for
comparison.
More research needs to be done to determine whether vitamin D is beneficial for
psoriatic arthritis patients.
Vitamin K
Although vitamin K—which is found in green, leafy
vegetables such as kale, spinach, and broccoli, as well as canola and olive
oils—is important for joint health, it has not been studied in psoriatic
arthritis.
However, one report found that low vitamin K levels were associated with more
severe osteoarthritis in a group of almost 700 patients.
It's not clear whether vitamin K could help osteoarthritis, much less psoriatic
arthritis. But it can't hurt to eat more leafy greens.
Vitamin B12
Like vitamin D, one study found that vitamin B12
deficiencies were more common in people with psoriatic arthritis than those
without it.
But again, like vitamin D, B12 doesn't seem to be a primary treatment option,
says Dr. Fiocco, who is also the director of rheumatology at Scott & White,
in Temple, Texas.
Vitamin B12 is found in clams, trout, fortified breakfast cereals, and yogurt.
Willow bark
Sometimes referred to as "herbal aspirin,"
willow bark contains salicin, which is a chemical similar to aspirin
(acetylsalicylic acid).
A 2001 study found that willow bark extract equivalent to a dose of 240
milligrams of salicin a day relieved pain better than a placebo in a group of
78 patients with osteoarthritis.
It's possible the effects could extend to people with psoriatic arthritis as
well.
Turmeric
Some patients
find that turmeric, an herb in the ginger family, may ease psoriasis and
psoriatic arthritis flare-ups. According to the National Psoriasis Foundation, the anti-inflammatory
properties of turmeric are a frequent topic of study. You can add a touch of
turmeric to almost any dish. It’s also available as a dietary supplement. Ask
your doctor or naturopathic practitioner to advise you about the correct
dosage.
Traditional Chinese medicine
Certain herbs used in Chinese medicine have shown some
benefit in people with arthritis.
For example, extracts of the plant Tripterygium
wilfordii (TwHF) are thought
to have anti-inflammatory effects. One study completed by the National
Institutes of Health found that patients taking TwHF along with steroids and
nonsteroidal anti-inflammatory drugs (NSAIDs) did better than patients taking
the drug Azulfidine (sulfasalazine) with steroids and NSAIDs.
Overall, though, Dr. Fiocco feels the impact of these herbs has not been
"very impressive."
Regular Rest and Relaxation
Getting a good night’s sleep will help
you fight fatigue. Try to go to bed at the same time each night and get up at
the same time each morning. If you have trouble falling asleep, try taking a
soothing warm bath before going to bed.Also, make some time to rest and relax
during your busy day. Need a suggestion? Put your feet up and read or listen to
your favorite music for 20 minutes or so.
Naturopathy
A naturopathic doctor is one who
concentrates on lifestyle factors and natural therapies to help patients manage
illness and chronic diseases. They may help you improve your diet and suggest
alternative therapies, as well as discuss therapies that are complementary to
conventional treatment. These may include homeopathy, psychology, and
spirituality. Many doctors will work in partnership with naturopathic
practitioners to provide you with a whole body approach to health. Trying these
natural remedies and lifestyle changes can help with your psoriatic
arthritis.
Lifestyle
·
Protect your joints. Changing the way you carry out everyday
tasks can make a tremendous difference in how you feel. For example, you can
avoid straining your finger joints by using gadgets such as jar openers to
twist the lids from jars, by lifting heavy pans or other objects with both
hands, and by pushing doors open with your whole body instead of just your
fingers.
·
Maintain a healthy weight. Maintaining a healthy weight places less
strain on your joints, leading to reduced pain and increased energy and
mobility. The best way to increase nutrients while limiting calories is to eat
more plant-based foods — fruits, vegetables and whole grains.
·
Exercise regularly. Exercise can help keep your joints
flexible and your muscles strong. Types of exercises that are less stressful on
joints include biking, swimming and walking.
·
Use cold and hot packs. Because cold has a numbing effect, it
can dull the sensation of pain. You can apply cold several times a day for 20
or 30 minutes at a time. Heat can help relax tense muscles and relieve pain.
·
Pace yourself. Battling pain and inflammation can leave
you feeling exhausted. In addition, some arthritis medications can cause
fatigue. The key isn't to stop being active entirely, but to rest before you
become too tired. Divide exercise or work activities into short segments. Find
time to relax several times throughout the day.
Sources:
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis
http://www.healthline.com/health/psoriatic-arthritis/natural-remedies
http://www.health.com/health
Psoriatic Arthritis. American College of Rheumatology. Accessed
03/10/16.
Psoriatic Arthritis. Johns Hopkins Arthritis Center. Accessed 03/10/16.
Kelley's Textbook of Rheumatology. Elsevier. Ninth Edition. Chapter 77.
Psoriatic Arthritis.
