Understanding the Symptoms and Treatments of Psoriatic Arthritis
Psoriasis is an autoimmune disorder that is most commonly associated with itchy, flaking skin rashes. However, this autoimmune disease can also affect an individual’s joints in a condition referred to as psoriatic arthritis or PsA.
The Arthritis Foundation estimates that roughly 30 percent of people with psoriasis will develop PsA as well. The resulting joint pain and inflammation can cause significant discomfort and even long-lasting tissue damage if left untreated. However, there are treatment options available that can help to reduce the severity of symptoms and help to combat the long-term damage it can cause.
How Is Psoriatic Arthritis Diagnosed?
There is no specific blood test or other diagnostic procedure that can definitively diagnose psoriatic arthritis. Instead, doctors will usually arrive at a diagnosis through a process of elimination, utilizing a patient’s medical history and symptoms to arrive at the most likely explanation.
If you are experiencing joint pain, it’s important to reach out to a doctor to identify the cause. Your doctor may wish to examine a variety of things, including:
- Your medical history
- A physical examination of the affected joints
- MRIs or X-rays of the symptomatic joints
These tests will be used to identify inflammation and rule out other arthritic conditions such as gout or rheumatoid arthritis. For example, people with rheumatoid arthritis will have a specific antibody called a rheumatoid factor present in their blood. This rheumatoid factor will be absent in a person with psoriatic arthritis even if the external symptoms appear the same.
If you have a history of psoriasis, this is important information to bring up to your doctor. The presence of psoriasis and an absence of any other clear cause for joint pain is usually sufficient to attain a diagnosis of psoriatic arthritis.
Signs and Symptoms
As with all forms of arthritis, psoriatic arthritis generally presents in the form of joint pain and stiffness. Any joint in the body can be affected, but some of the most commonly affected areas include the neck, back, fingers and toes. Swelling and inflammation in these joints is common and may be especially visible around the knuckle joints of your fingers and toes.
Depending on the location of the affected joints, PsA can be divided into five general types:
- Symmetric Psoriatic Arthritis: Making up about half of all reported cases, this type of PsA affects joints on both sides of the body simultaneously. In other words, a person may have pain in both hands or both feet rather than just one.
- Asymmetric Psoriatic Arthritis: Usually considered a milder version of the disorder, this makes up around 35 percent of PsA cases. This affects just one side of the body or body part rather than being mirrored on the other side.
- Distal Psoriatic Arthritis: This type of PsA specifically affects the extremities, especially the end joints of both the fingers and toes. People with distal PsA will often exhibit visible problems with their nails as well.
- Spondylitis: This refers to arthritis that affects the spine, especially in the neck.
- Arthritis Mutilans: Considered to be the rarest and most severe type of PsA, this causes severe inflammation and bone deformity in the joints. It primarily affects the small joints in the hands and feet and can destroy the joint entirely over time.
- The presence of psoriasis is a good indication that a person may have PsA if they are experiencing symptoms. Psoriasis is a skin rash typified by scaly, flaking skin that may bleed or scab over. The rash commonly appears on the forearm or elbow area, but it can occur throughout the body as well. Psoriasis also affects fingernails and toenails. Pitting, discoloration and nail thickening are all commonly seen with this disorder.
- Like many other types of autoimmune conditions, psoriatic arthritis is known to spread to joints in other areas of the body or to become systemic. Additionally, the pain and ongoing inflammation can result in feelings of fatigue. Some inflammatory conditions are sometimes seen more commonly alongside PsA patients than those without the disorder.
- While organ involvement is not typically associated with PsA, some patients may experience eye-related complications. The condition, known as uveitis or iritis, causes eye inflammation. If you suffer from psoriasis or psoriatic arthritis — both classified as systemic diseases — and discover severe redness in one or both eyes, this sign should not be ignored. Uveitis that goes untreated can lead to permanent vision loss.
Arthritis of any kind can cause permanent damage to the joints and surrounding tissue if left untreated, and psoriatic arthritis is no different. In addition to being systemic, PsA is a progressive disorder, which means that symptoms will continue to worsen over time if not managed.
Long-term effects of psoriatic arthritis may include:
- Loss of flexibility or range of motion in joints
- Bone and tissue damage in and around the affected areas
- Joint deformity
- Persistent fatigue and low energy levels
Psoriatic arthritis cases vary in severity, and not every person with PsA will experience these more severe symptoms in the long-term. There is, however, an increased risk of physical limitation or disability associated with arthritic joint damage.
One of the most severe effects of psoriatic arthritis that is unique to the disorder when compared to other forms of arthritis is the so-called “pencil in a cup” deformity. This occurs when the bone in a joint erodes down to a sharpened point, like that of a pencil.
In addition to joint degradation and disability, psoriatic arthritis is associated with several comorbid conditions, according to the National Psoriasis Association. These are health problems that are not directly caused by psoriasis but are linked in some way. Although the exact relation between these conditions and PsA is still being investigated, the National Psoriasis Foundation suggests that people with psoriatic arthritis are more likely to develop these conditions:
- Cancer: People with psoriatic disorders have an increased risk of cancer, especially skin cancer and some lymphomas.
- Cardiovascular Disease: Individuals with severe psoriasis are 58 percent more likely to develop cardiovascular disease. These risks are increased by smoking and obesity.
- Crohn’s Disease: Inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis, occur in about 10 percent of patients with psoriasis. This is more common among women than men.
- Diabetes: Type 2 diabetes is 30 percent more common among people with severe psoriasis.
- Metabolic Syndrome: A term referring to a cluster of conditions typified by obesity, high blood pressure and heart disease, metabolic syndrome affects about 40 percent of people with psoriasis.
- Osteoporosis: A degradation of bone density and strength, osteoporosis is more common in people with psoriatic disease.
- Uveitis: As mentioned earlier, some people with PsA also develop uveitis, or an inflammation of the eye.
- Liver Disease: The development of nonalcoholic fatty liver disease is more prominent among people with psoriatic conditions, especially those who are overweight or obese.
- Hearing Loss: It’s estimated that 31.7 percent of people with psoriatic arthritis may develop some form of hearing loss or inner ear damage.
- Depression: As a result of the long-term pain and fatigue associated with arthritis, a number of PsA patients develop depression. Treating the symptoms of psoriatic arthritis can help to alleviate depression as well.
It’s important to note that these conditions are not necessarily caused by psoriatic conditions. In some cases, they may share a common cause or risk factor. For example, obesity is frequently seen alongside liver disease, diabetes, heart disease and a host of autoimmune conditions. It’s also not uncommon for a person to have more than one type of autoimmune disorder at a time.
Causes and Risk Factors of Psoriatic Arthritis
In general, autoimmune disorders occur when the body’s natural defense mechanisms are turned inward. When faced with a pathogen, the body naturally responds by sending T cells to the affected area as a way to isolate and destroy the invading organism. In the case of an autoimmune disease, this protective reflex is turned toward the body’s own cells, leading to destructive results.
It’s not clear what causes autoimmune conditions to occur. According to conclusions reached by the Centre of Prognosis Studies in The Rheumatic Disease, there is a clear genetic element to the inheritance of PsA, with a roughly 30% rate of recurrence between first-degree relatives. Other possible causes, including severe childhood illness and environmental factors, which may play a role where an obvious genetic link is not present.
A history of psoriasis or a family history of psoriatic disorders puts you at a much higher risk of developing PsA. Other risk factors for psoriatic conditions include:
- Family history
- Serious viral and bacterial infections, especially in childhood
- High levels of stress
In general, anything that places a significant amount of stress on the body can cause or aggravate an autoimmune condition.
Not everyone who has psoriasis or psoriatic arthritis will experience symptoms all the time. For some people, the condition comes and goes in waves. Certain individuals may have specific triggers that cause a more severe outbreak or worsening of symptoms. Stress, illness, injury, certain medications and vitamin deficiencies can all contribute to psoriatic episodes. Identifying and eliminating triggers is an important part of symptom management for some people.
Traditional Medical Approach and Treatment
Autoimmune conditions like psoriasis are generally chronic and incurable, but medical intervention can help to manage symptoms and even send the disorder into a period of remission. Through a combination of medical treatment and lifestyle changes, people with psoriatic arthritis can experience a dramatic improvement in their quality of life and minimize the risk of developing more dangerous outcomes.
Joint pain and inflammation is the primary symptom that doctors will treat when handling a PsA case. The type of medication used will vary depending on the severity of joint pain. Common options include:
- NSAIDs: Non-steroidal anti-inflammatory drugs block inflammation within the body, reducing pain. Many NSAIDs are available over the counter. However, they are not always a good choice for long-term treatment due to their side effects.
- DMARDs: Disease-modifying antirheumatic drugs are designed specifically to counteract the symptoms of arthritis. They work to halt or slow down inflammation and prevent tissue damage. They take time to work, so results are not fast-acting, but they can be taken over a longer period of time with fewer side effects than NSAIDs.
- Biologics: A newer form of DMARD, these medications work by blocking specific proteins responsible for inflammation in the body. These drugs can cause a reduced immune response, which may place you at risk for some infections.
- Steroids: Corticosteroids, such as Prednisone, are common treatments for autoimmune disorders. They are very powerful and work quickly to counteract inflammation. However, they can have serious side effects when used over a long period of time.
A combination of medication and lifestyle changes may be recommended for people with psoriatic arthritis. Many patients have the best results when combining traditional medicine with complementary therapies and integrative treatments.
Choosing a Doctor
Individuals with psoriasis may start out with a dermatologist. However, once symptoms of arthritis appear, it’s usually best to seek out the expertise of a rheumatologist, which is a doctor specializing in arthritic conditions.
When choosing a doctor, it’s important to work with someone who is experienced in autoimmune conditions and knowledgeable about the most current and up-to-date treatment methods. Your personal comfort with the physician is also important. You should be able to communicate with them and feel comfortable discussing your healthcare needs.
If you have additional conditions, such as diabetes or cardiovascular problems, you will most likely have a team of specialists working on each aspect of your care. Having a primary care physician who can help you to manage the various aspects of your case and help you to coordinate your care will help to relieve stress and ensure the best results. If you already work with a doctor you trust, asking for a referral to a specialist that your doctor recommends is often the best place to start.
Complementary and Integrative Health Treatment Options
Integrative health treatment refers to a combination of non-medical treatments that can help to improve quality of life and reduce symptoms. These non-traditional treatments are most effective when used in conjunction with traditional medicine, hence the term “integrative.” Before seeking any sort of complementary treatment, be sure to discuss your options and limitations with your doctor. Some treatments may be contraindicated or otherwise harmful.
Many other treatments have been shown to be effective in the reduction of symptoms, however. Some popular treatments and therapies for psoriatic arthritis include the following:
This treatment’s roots trace back thousands of years to ancient China, and it is shown to be effective in counteracting a number of inflammatory conditions.
Acupuncture is the practice of inserting tiny hairpin needles into specific meridians on the body. Although there have been no formal scientific conclusions behind acupuncture’s effectiveness, clinical trials conducted on cancer patients show a noteworthy reduction in pain after being treated with acupuncture. This study, conducted at Memorial Sloan Kettering Cancer Center, is specific to cancer patients, but in practice, PsA sufferers who’ve undergone acupuncture treatment report some benefits.
Because acupuncture is non-medicinal, there are no known side effects or risks when performed by a knowledgeable and experienced practitioner.
Massage involves the manipulation of muscles and soft tissue. While it cannot help with joint pain directly, a 2006 study conducted by the Touch Research Institute at the University of Miami showed that regular hand massages are capable of decreasing pain related to hand arthritis. Additional findings suggest that it may also help to improve grip strength and reduce night disturbances caused by arthritis pain.
Massage is sometimes combined with techniques such as the application of heat and cold. These can further aid in reducing inflammation and restoring flexibility to affected areas. Beware, however, that arthritic joints can be delicate; discuss your condition with the therapist before pursuing treatment so as to avoid the potential of injury or worsening symptoms.
Some herbal treatments have been proven effective in reducing the outward symptoms of psoriasis. Some may also help with psoriatic arthritis, although the link is not as clear.
The herb turmeric is especially well-studied for its effectiveness as an anti-inflammatory and antioxidant. In addition to eating it in food, turmeric can be taken in pill form as a natural supplement.
Other supplements that may be applied topically to affected joints or taken orally include:
- Capsaicin, which can demonstrate pain relieving effects is commonly used by RA sufferers
- Wintergreen oils can potentially help, given their anti-inflammatory properties
- Fish oil, a great source of omega-3s, is often used to help with joint health and inflammation
- Gamma Linolenic Acid can remedy many symptoms of arthritis, including pain, stiffness, and swelling
- Cat’s Claw is an anti-inflammatory that is capable of reducing joint pain and swelling
Before taking any sort of herbal supplement, be sure to consult with your physician. Just because a supplement is natural or derived from herbs does not necessarily mean that it will be safe or free of drug interactions with your other medications.
In addition to medication and alternative therapies, some lifestyle changes may help to alleviate symptoms of psoriatic conditions. For some people, this may mean identifying and avoiding known triggers of outbreaks. For example, some people may experience more severe symptoms after eating specific foods; identifying these triggers and avoiding them can improve your quality of life.
Regular gentle, low-impact exercise can also help with alleviating joint pain and improving flexibility. Exercises such as stretching and yoga can help to improve joint health without placing undue stress on the affected body part. Swimming can also be a helpful way to add low-impact activity into your routine, but be wary around water that has been treated with chlorine. Although chlorine won’t inflame your psoriatic arthritis, sufferers of various skin disorders – including psoriasis – report mixed reactions to the known irritant.
Before adding any sort of diet or exercise changes to your lifestyle, it’s a good idea to discuss your plans with your physician. He or she can help you to develop a plan tailored to your specific needs and health limitations to ensure the best results without risk of injury or other problems.
Psoriatic arthritis can be a painful and damaging condition, but it does not need to control your life. If you have joint pain or inflammation happening alongside psoriasis or a family history of psoriasis, reach out right away to an experienced physician. Through a combination of treatment and lifestyle choices, you can achieve better quality of life and alleviate the pain before joint damage becomes severe.