PSORIATIC ARTHRITIS
Psoriatic arthritis is a type of arthritis that often occurs with psoriasis of the skin.
Causes, incidence, and risk factors
Psoriasis is a common, chronic skin condition that causes red patches on the body. About 1 in 20 people with psoriasis will develop arthritis with the skin condition. In most cases, psoriasis comes before the arthritis.
The cause of psoriatic arthritis is not known, but genes may play a role. In general, people who have psoriasis have a higher rate of arthritis than the general population.
Symptoms
The arthritis may be mild and involve only a few joints, particularly those at the end of the fingers or toes. In some people the disease may be severe and affect many joints, including the spine. When the spine is affected, the symptoms are stiffness, burning, and pain, most often in the lower spine and sacrum.
People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.
Signs and tests
During a physical exam, the health care provider will look for:
· Joint swelling
· Skin patches (psoriasis) and pitting in the nails
· Tenderness
Joint x-rays may be done.
Treatment
Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce pain and inflammation of the joints.
More severe arthritis needs to be treated with more powerful drugs called disease-modifying antirheumatic drugs (DMARDs), such as:
· Leflunomide
· Methotrexate
· Sulfasalazine
New medications that block an inflammatory protein called tumor necrosis factor (TNF) are becoming the treatment of choice for psoriatic arthritis. These include:
· Adalimumab (Humira)
· Etanercept (Enbrel)
· Golimumab (Simponi)
· Infliximab (Remicade)
Occasionally, very painful joints may be injected with steroid medications.
In rare cases, patients need surgery to repair or replace damaged joints.
Your doctor may suggest a healthy mix of rest and exercise. Physical therapy may help increase the movement of specific joints. You may also use heat and cold therapy.
Expectations (prognosis)
The disease is often mild and affects only a few joints. A few people will have severe psoriatic arthritis in their hands, feet, and spine that causes deformities.
In people with severe arthritis, treatment can still relieve pain and prevent joint destruction, especially if it is started early.
Complications
Repeated episodes may occur.
Calling your health care provider
Call for an appointment with your health care provider if arthritis symptoms develop along with psoriasis.
Prevention
There is no known prevention.
References
1. Gottlieb A, Korman NJ , Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58(5):851-864.
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