What
Is Psoriatic Arthritis?
Psoriatic arthritis is a kind of arthritis
associated with the skin disease, psoriasis. In the majority of cases, psoriasis
precedes the arthritis. Psoriasis is a skin disease causing a lot of scaling and
peeling as well as deep redness and a purplish discoloration of the skin. Refer
to PersonalMD's section on psoriasis
for more information.
Psoriatic arthritis belongs to a group of disorders
collectively termed the spondyloarthropathies. These disorders are characterized
by arthritis of varying degree and a genetic risk factor by carrying the gene
HLA-B27. Other diseases in this group of disorders include Reiter's syndrome (reactive
arthritis), ankylosing spondylitis and colitic arthritis, which is associated
with inflammatory bowel disease.
How Does It
Occur?
Psoriasis occurs when there's an abnormally high turnover
of skin cells. It's believed that this occurs as a result of a malfunction by
the immune system leading to chronic inflammation of the skin. How this skin disease
leads to arthritis is not well understood, but the immune system is believed to
be involved. There seems to be a familial pattern, meaning you are more likely
to get the disease if another family member has it. Certain genes such as HLA-38
and HLA-B27 are believed to be the markers for developing the disease.
What
Are The Symptoms?
The term "arthritis" is used to
denote inflammation within a joint. The signs of an inflamed joint could include
pain, redness, swelling and limited movement. The presentation of the disease
varies widely. In over 75 percent of cases, psoriasis precedes the development
of arthritis. In the remaining balance, psoriasis and arthritis can appear at
the same time or the arthritis can even precede psoriasis. The pattern of joint
involvement may range from one joint to multiple joints. Some of the more common
joints involved include the knee and fingers. Up to one third of the patients
will develop lower spine arthritis. Other findings may include tendonitis, nail
changes (discoloration, divots in nails) and red eyes from conjunctivitis or uveitis.
How Is It Diagnosed?
The doctor
will ask a series of questions to obtain the history and progression of the disease,
with a focus on history of psoriasis. Psoriasis is usually diagnosed based on
your history, physical examination and skin biopsy. The diagnosis of psoriatic
arthritis is more complicated. The doctor may order some blood tests to look for
markers of inflammation and may also do some genetic testing. X-rays to look for
joint inflammation and destruction may also be obtained.
How
Is It Treated?
Treatment begins with patient education of the
disease and physical therapy to maintain joint function. First line medication
treatment of psoriatic arthritis is usually non-steroidal anti-inflammatory drugs
(NSAID). If NSAIDs fail, then drugs such as methotrexate, sulfasalazine or hydroxychloroquine
may be tried. Each of these medications has potential serious side effects needing
close monitoring with blood tests by a physician. For treatment of the psoriasis
skin disease, please refer to PersonalMD's article on psoriasis. Usually, some
type of steroid cream is prescribed.
How Can
I Take Care Of Myself?
It's important to comply with the prescribed
medications and see the doctor regularly. Exercises to maintain joint mobility
should be taken seriously. Patients should realize that even with perfect compliance
to proposed treatments the disease might worsen, as prognosis of this condition
remains unpredictable.
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