Psoriatic Arthritis: Signs & Treatment

Psoriatic arthritis—one of the many different types of arthritis—is a chronic, autoimmune disease that causes inflammation of the skin and the joints. 

Psoriasis is a skin disease characterized by red, flaky, inflamed patches of skin around the body. Arthritis is an umbrella term that describes the inflammation of joints within the body.  There are various types of arthritis, such as rheumatoid arthritis (including Seronegative Rheumatoid Arthritis), osteoarthritis, and psoriatic arthritis. When a person has psoriatic arthritis, they experience both symptoms: inflamed skin and inflamed joints.

Psoriasis and arthritis are both autoimmune, inflammatory diseases. This means they result from the body’s immune system attacking healthy organs and tissues, in and around the body. 

(When an autoimmune disease is present, the immune system is mistaking healthy cells around the body for harmful intruders, like viruses and foreign bodies. The immune system perceives these healthy cells as dangerous, so it produces antibodies that set out to attack and destroy these healthy cells.)

So, when psoriatic arthritis is present, the immune system is attacking the skin and the joints. This results in a mixture of swollen joints, severe joint pain, and dry, inflamed skin. 

This disease manifests in the areas where the ligaments and tendons converge with the bone. (The ligaments are responsible for connecting the bones to form the joints, and the tendons are responsible for connecting the muscle to the bones.) 

There are different manifestations of psoriatic arthritis, including spondylitis, enthesitis, and dactylitis. Each type of psoriatic arthritis affects different joints and areas of skin around the body. 

Though many people who have psoriasis will also develop psoriatic arthritis, not everyone with psoriasis will be affected by psoriatic arthritis. An estimated 10% to 30% of people who have psoriasis of the skin will also develop psoriatic arthritis of the joints. 

Who is at risk of psoriatic arthritis?

Psoriatic arthritis commonly develops in adults over the age of 30, but it can develop at any age. Both males and females can develop psoriatic arthritis; neither is at a higher risk than the other. 

Having a pre-existing psoriasis condition does place a person at a higher risk for developing arthritis, but it can still develop in people who don’t have psoriasis. Psoriasis often precedes arthritis in about 80% of affected people, but arthritis only precedes psoriasis in about 15% of people. 

Signs of Psoriatic Arthritis

The signs and symptoms of psoriatic arthritis vary, depending on the type of psoriatic arthritis, the location of the affected joints, and the rate of progression of the disease.

Each person is different, so each person’s immune reaction to this disease will differ from the next. Different immune responses elicit different signs and symptoms of the disease.

Early Signs of Psoriatic Arthritis

If you have psoriasis, or psoriasis runs in your family, it’s important to remain vigilant by listening to your body and identifying any common signs of psoriatic arthritis. If you don’t have psoriasis or a family history of psoriasis, it’s still important to be mindful of the common signs of this disease.

• Joints are visibly red or warm to the touch: When the tissues become inflamed, small blood vessels widen to transfer blood to the affected joint. This blood transfer produces heat and creates a reddened appearance.
• Joint stiffness: As the joints are attacked, the cartilage and synovial tissue become inflamed, which limits the range of mobility, causing stiffness. 
• Muscle fatigue and weakness: The body releases cytokine proteins in the blood as an inflammatory response, which causes stress on the body, resulting in fatigue and weakness. 
• Swollen fingers and toes: Inflammation of the joints located in the fingers and toes can cause them to swell, which is called “dactylitis”.
• Lower back pain, around the tailbone or along the spine: Inflammation commonly occurs in the spinal joints (called spondylitis), which reduces mobility in the spine, causing pain and stiffness in the affected areas. 
• Nail pitting: Psoriatic inflammation can cause skin cells to build-up on the nail beds, which can result in pitting, or depressions, on the nails.
• Reduced range of motion: As inflammation occurs, mobility and range of motion decrease. The cartilage and synovial tissue between the joints swell, which inhibits the joints from moving with their normal agility.
• Eye conditions: Psoriatic arthritis can cause inflammation in and around the eyes, which can lead to dry eye, pink eye, poor vision, and redness. 

Knowing the signs of psoriatic arthritis is critical for early detection. If we can detect this disease early on, we can slow its progression or stop its progression altogether. The earlier we diagnose psoriatic arthritis, the more effective the treatment methods will be. The further psoriatic arthritis progresses, the greater irreversible damage is done to the bones and joints.

Symptoms of Psoriatic Arthritis

The symptoms of psoriatic arthritis often intensify during flare-ups (temporary increases in the skin and joint conditions). Any of the common signs of psoriatic arthritis, like eye conditions, swollen fingers, and lower back pain, may be increasingly prevalent during symptom flare-ups. 

Common symptoms of psoriatic arthritis include:

• Increased fatigue: When the immune system goes into overdrive to attack healthy cells during flare-ups, the body goes into a state of stress, which results in fatigued muscles and joints.
• Skin rashes: When symptoms flare-up, inflammation often manifests on the skin as red, thick, flaky rashes that may be warm to the touch. 
• Increased joint pain: Joints all around the body may swell and feel achy. They sometimes have an elevated temperature and can be painful, and difficult to move or bend.

Symptoms may flare-up when a person is experiencing an increase in stress, is eating unhealthy foods or living a sedentary lifestyle, is not taking medications to manage the symptoms, or incurs an injury or illness.

Psoriatic arthritis flare-ups can be especially difficult to manage without medication because this disease manifests on the skin and the joints—not one or the other. 

How Psoriatic Arthritis Inhibits Regular Activity

Psoriatic arthritis can have considerably debilitating effects on everyday life. A study among people with psoriatic arthritis showed that 80% of people reported being partially or completely unemployed as a result of having psoriatic arthritis. 

Out of the people who are employed and have developed psoriatic arthritis, many of them have to make accommodations at work, work from home, or switch jobs due to painful joints and mobility restrictions. 

With this disease, it can be difficult for people to stand for long periods of time, complete physical tasks, show up to work every day, and maintain the productivity levels they once had prior to the progression of the disease. 

The symptoms of psoriatic arthritis come in waves. One day they can feel manageable; the next day the symptoms may feel unbearable. It can be incredibly difficult to maintain a normal routine. 

How Psoriatic Arthritis is Diagnosed

When diagnosing psoriatic arthritis, it’s important to find a quality rheumatologist who’s highly experienced in the detection of psoriatic arthritis signs and the available treatment methods to manage symptoms. 

There is no specific test to diagnose psoriatic arthritis. The diagnosis is based on physical examinations of the nails, skin, and joints to identify common signs of the disease. Your rheumatologist may assess the body for swelling, redness, and any visible inflammation. 

X-rays, MRIs, and blood tests can also be performed to identify psoriatic arthritis. Although there is no specific blood test to confirm the presence of this disease, a rheumatoid factor (RF) blood test can be performed to rule out the possibility of rheumatoid arthritis. 

It’s difficult to diagnose psoriatic arthritis because there are hundreds of different types of arthritis with similar symptoms. This is why it’s so important to choose a rheumatologist, like Dr. Maria Farooq, with years of experience in the treatment and management of rheumatology disorders.  

How to Treat Psoriatic Arthritis

Just as there is no specific test to diagnose psoriatic arthritis, there is, unfortunately, no treatment either. Psoriatic arthritis cannot be reversed, but there are certain medications, treatment methods, and lifestyle changes that one can undergo to reduce pain and manage symptoms.

Medication

Medications, specifically NSAIDs (nonsteroidal anti-inflammatory drugs), can be taken to reduce inflammation and relieve associated pain. Various medications, such as Advil, Motrin, and Aleve, are available as over-the-counter NSAIDs.

Steroids

If NSAIDs don’t reduce the inflammation, steroids can be taken orally or through injections to alleviate pain and swelling. Common steroid options include prednisone, cortisone, triamcinolone, betamethasone, and methylprednisolone.

Exercise

Because psoriatic arthritis limits mobility and joint function, exercise, and physical therapy are also effective methods for relieving symptoms. Exercise, such as swimming, biking, and yoga can help to reduce joint stiffness and increase range of motion. 

Hot and Cold Therapy

To reduce inflammation, hot and cold packs can be applied to the affected joints to minimize the redness, swelling, and pain. Psoriatic arthritis symptoms can be reduced by alternating between cold compresses or ice packs and heat wraps or heating pads.

Maintain Healthy Weight

Excess weight on the joints can amplify symptoms, increase inflammation, and exacerbate pain and soreness. Losing weight can relieve some pressure from the joints and reduce the number of inflammatory molecules around the body. 

For patients who have psoriatic arthritis, we can help them to manage the symptoms or minimize the symptoms. We offer intra-articular injections to reduce inflammation and increase range of motion. In our UCF Rheumatology Services department, it is our goal to formulate a treatment plan that increases our patients’ quality of life and maximizes their joint functionality. 

Our rheumatologist, Dr. Maria Farooq, has managed a wide array of complex diseases, including rheumatoid arthritis, psoriatic arthritis, gout, and lupus amongst other rheumatologic conditions. She is passionate about bringing her patients relief with minimal discomfort, using precision techniques.

Sources:

https://www.psoriasis.org/psoriatic-arthritis/know-the-signs