Psoriatic Arthritis

What is psoriatic arthritis? Psoriatic arthritis (PsA)  is a chronic inflammatory disease that occurs when your immune system mistakenly starts attacking healthy joints, skin and nails. The faulty immune response causes inflammation that can trigger joint pain, stiffness and swelling, as well as red, scaly skin patches called plaques. Psoriatic arthritis is a type of arthritis. It causes joint pain, swelling and stiffness along with other symptoms. Many people with psoriatic arthritis first develop psoriasis with its trademark red, patchy and silvery-scaled skin. Psoriasis may be the first visible effect of these co-conditions, but joint problems often start even before the skin lesions appear. About one third of psoriasis sufferers develop psoriatic arthritis. The swelling, pain and stiffness of joints associated with psoriatic arthritis can occur within any part of the body. Many people experience problems with their fingertips and back first. There is no cure for this chronic form of arthritis. The condition can become disabling without treatment, which is usually focused upon symptom control and prevention of permanent damage to joints. Over time, psoriatic arthritis can cause degenerative joint damage in some patients, so the earlier you receive a diagnosis, the better. It encompasses a heterogenous group of arthritides, ranging from a peripheral symmetric polyarthritis sometimes clinically indistinguishable from rheumatoid arthritis (RA) to an asymmetric oligoarthritis of mostly the lower extremities to an axial spondyloarthritis with enthesitis and dactylitis.  The latter clinical presentation explains the frequent classification of PsA in the group of rheumatic diseases known as the seronegative spondyloarthropathies.

Onset of Psoriatic Arthritis Symptoms

Symptoms range from mild to intense as part of a relapsing and remitting disease pattern. Psoriatic arthritis symptoms will flare up for a period of time, then become milder or disappear before flaring again. Some people experience symptoms on only one side of their body, while others are fully affected on both sides. Although the condition of psoriatic arthritis affects people of all ages, most experience their first flare up between the ages of 30 and 50 years. Both men and women get the disease, with about one million people in the United States presently afflicted.

Specific Symptoms of Psoriatic Arthritis

The symptoms of psoriatic arthritis can appear very much like rheumatoid arthritis. Both conditions cause the joints to swell, feel painful and even become warm to the touch. Other symptoms of psoriatic arthritis include:

  • Tendon Inflammation: The muscle connects to the bones with tendons, which can become inflamed. This causes pain during walking and climbing of stairs, as well as during other activities.
  • Damage to Nails:For many afflicted with psoriatic arthritis, fingernails and toenails become dented, ridged and pitted.
  • Painful Eyes: Bright light can become painful to people whose irises become inflamed. The iris is the colored part of the eye. Although light will hurt most, the pain can start in a more general manner.
  • Joint Problems: Swelling in ankles, hands, feet and knees is common. There may be swelling in multiple joints at once, in more than one region of the body. This swelling can be painful, cause puffiness and sometimes feels hot to the touch. Joints can even become red. Toes and fingers may swell to a point of resembling sausages. Stiff joints will be at their worst in the morning and may affect both sides of the body at the same time, such as in hips, knees, elbows or ankles. Psoriatic arthritis in spine and hip joints can cause pain and stiffness in the upper and lower back, neck or buttocks. Some people suffer rapid damage of the joints at the ends of their toes and fingers. This creates problems with balance and makes standing, walking or working with hands difficult
  • Vital Organ Problems:Psoriatic arthritis can cause some chest organ problems, such as chest pain and breathing problems. This is caused when the cartilage at ribs and the breastbone become inflamed within the chest wall. The lungs and aorta can also be affected, although this is rarer.

  • Prognosis: The severity of arthritis at the time of presentation of PsA and the subsequent disease course may be correlated.  Polyarthritis in the presence of elevated acute phase reactants, radiographic evidence of joint erosions, and inadequate response to initial pharmacotherapy predict a more severe disease course.  As seen in RA, PsA can significantly impact physical functioning and health-related quality of life.  Without prompt therapeutic  intervention, joint destruction may occur rapidly. Other factors that are associated with a worse prognosis include extensive cutaneous involvement, young age at disease onset, and a strong family history of psoriasis.