by Kimberly Allen, RN
Psoriatic arthritis is a form of chronic inflammatory arthritis. Most people that develop psoriatic arthritis already have psoriasis. In fact in 70% of the cases people that develop psoriatic arthritis develop psoriasis first. Generally psoriatic arthritis will manifest around 10 years after the onset of psoriasis. Psoriatic arthritis and psoriasis has also been reported to develop simultaneously in approximately 15% of the cases, while in the other 15% of the cases people develop psoriatic arthritis before developing psoriasis. Though psoriatic arthritis affects both men and women and can strike at any age it is more common in adults than children. Most cases of psoriatic arthritis are diagnosed between 30 to 55 years of age. just as with psoriasis, psoriatic arthritis is more common in Caucasians than Asians or Africans.
There are five different types of psoriatic arthritis, each with it’s own characteristics.
1. Symmetrical psoriatic arthritis most resembles rheumatoid arthritis. It affects “matching joints”, in other words if the knee’s are affected it’s both knee’s not just one. This type can be very progressive causing joint destruction and loss of function in 50% of the cases.
2. Asymmetrical psoriatic arthritis does not affect the joints in matching pairs. Instead it usually affects from 1 to 3 joints ranging from small joints like the ones in the fingers and toes to the large joints like the knee’s.
3. Distal interphalangeal predominant or DIP primarily involves the small joints of the fingers and toes, especially those that are the most distal or closest to the nail bed. This type of psoriatic arthritis is frequently misdiagnosed as osteoarthritis.
4. Spondylitis is a form of psoriatic arthritis that affects the spine. It can also affect the connective tissue as well as lead to arthritis in the joints of your arms, hips and legs as well as your feet.
5. Arthritis mutilans is probably the most severe and destructive form of psoriatic arthritis causing deformities and disabilities and fortunately the most rare type. It affects the most distal small joints of the fingers and toes next to the nail beds. This type of psoriatic arthritis has also been associated with neck and lower back pain.
Though doctors do not completely understand why the immune system would turn and attack healthy tissue they do believe that both environmental and genetic factors play a significant role in the development of psoriatic arthritis. Physical trauma or an infection can trigger the symptoms of psoriatic arthritis as well as other factors that may trigger psoriasis like prolonged exposure to sunlight causing a sunburn. There are also a variety of medications that can trigger psoriatic arthritis including Lithium, Beta- blockers and anti malarials.
Depending on the type of psoriatic arthritis you have you will probably experience inflammation as well as pain and stiffness in the joints of your hands and feet as well as your knee’s and ankles. If you have symmetrical psoriatic arthritis the joint pain ans stiffness you experience will be similar to that of RA. Low back pain is also common in psoriatic arthritis.
As with most forms of arthritis there is no “cure” for psoriatic arthritis. Treatment focuses on managing the symptoms including the pain and swelling as well as preventing joint damage and disability. In the past that usually meant the use of NSAID’s, however, today there are disease modifying anti rheumatic drugs or DMARD’s like methotrexate and TNF alpha inhibitors like Enbrel and Humira available that have been found to be more effective and can even provide periods of remission. However, some of these medications can produce serious side effects so it’s important to discuss all the potential options with your doctor to decide whats best in your particular case.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.