Psoriatic Arthritis

  • Psoriasis is skin disease in which there are many scaly red and white patches develop on the skin.
  • Some of them also develop psoriatic arthritis, manifested by painful and swollen joints. The skin and joint symptoms sometimes become very active known as “flare” and sometimes subside known as “Remission”.
  • The arthritis may vary from person to person, and even change locations in the same person over time. If not treated in time may lead to deformity
  • Psoriatic arthritis usually occurs in people with skin psoriasis although this is not always correct.
  • It can occur in people who have relatives with psoriasis Psoriatic arthritis is a chronic arthritis.
  • Arthritis can be mild in some people, In other people, it is continuous and can cause joint damage if it is not treated.
  • Early diagnosis is important to avoid damage to joints.
  • Psoriatic arthritis can affect joints in 4-5 different patterns. Typically, this affects the large joints, especially those of the lower extremities, but it can also affects distal joints of the fingers and toes. It can cause low back pain and involve sacroiliac joints of the pelvis.
  • With appropriate treatments, most patients can lead a normal pain free life and maintain mobility. Physical activity helps maintain joint movement.
  • The most common features of patients with psoriatic arthritis are Fatigue, painful stiff and swollen joints. There will be morning stiffness and tiredness
  • There may be Tenderness, pain and swelling over tendon attachment sites to bones known as Enthesitis. Enthesitis, can result in pain at the back of the heel, the sole of the foot, around the elbows or in other areas.
  • Sometimes there is Swelling of whole fingers and toes known as Dactylitis because they resemble sausages.
  • Nails may be affected in psoriatic arthritis patients. The most common is presence of pits, yellow nails or nail destruction.
  • Likewise, eyes may be involved. Children with psoriatic arthritis are also at risk to develop uveitis (Red eye).
  • Depending on type and number of joint involvements, there are 5 types of psoriatic arthritis.
    • symmetrical (both sides of the body)
    • Asymmetric and few joints (Mainly in lower limb)
    • Spondylitis (Affection of spine causing neck and back pain)
    • Distal interphalangeal joints (Usually involve nail as well)
    • Arthritis mutilans (Very deforming hand arthritis)
  • The exact cause of Psoriatic Arthritis is not known
  • This is an autoimmune disease where there is inflammation of joint synovium because of Immune attack
  • Normally our Immune system attack outside invading organism like bacteria and Viruses etc and designed to protect our own body parts like Joints. In Psoriatic Arthritis, immune system become dysregulated and attacks one’s own joints and skin. Usually this arthritis is triggered by infection.
  • There is a strong hereditary (genetic) tendency. For example, there is a strong association with a gene called HLA-B27. About 4 out of every 10 people with Psoriatic Arthritis have this gene compared with less than 1 out of every 10 in the general population.
  • – However, having only HLA B27 gene does not mean that you will automatically develop Psoriatic Arthritis. Most people with this gene do not develop Psoriatic Arthritis
  • Most cases of Psoriatic Arthritis can be diagnosed clinically by certain patterns of arthritis, and associated skin and nail changes typical of psoriasis.
  • Imaging modalities like X-rays are taken to look for joint damage and other modalities like MRI, ultrasound or CT scans can be used to look at the joints in more detail
  • Blood tests like Rheumatoid factor, uric acid etc may be done to rule out other types of arthritis including gout, rheumatoid arthritis, osteoarthritis etc
  • Other blood tests may reveal high levels of inflammation like ESR and CRP
Usually Psoriatic Arthritis treatment depends on the type of Psoriatic Arthritis.
  • If the joints are very much swollen and painful, the doctor may advise for joint aspiration and giving a steroid injection which is very effective to decrease pain and inflammation
  • You may be prescribed with pain killers (NSAIDs) which has to be continued for many months as they are the 1st line treatment for most arthritis patients
  • All patients are different, and some may respond to a particular drug whereas others don’t feel any benefit. Some drugs may cause severe gastritis or other complications whereas they don’t cause any problems in others. So, the drug response and side effects differ in different patients and it has to be continued under supervision of a trained rheumatologist
  • The drugs that are useful in treating Psoriatic arthritis are known as DMARDs(Disease modifying antirheumatic drugs). They Include Methotrexate, sulfasalazine, leflunamide, cyclosporin etc. They are particularly useful for knee or ankle joint swelling and skin psoriasis but not for upper or lower back problems or nail changes.
  • Hydroxycholoroquine which is used for other type of arthritis is usually avoided as it may cause aggravation of psoriasis skin leisions.
  • These drugs should be prescribed and taken under supervision of a rheumatologist as they are trained to periodically monitor your blood test to look for any side effects of these drugs.
  • If taken properly under supervision, these drugs helps to control joint inflammation and give patient a normal life
  • Biological drugs are new drugs that target specific molecules like TNF and other cytokines like IL 17 which incite inflammation in Psoriatic Arthritis. They are very effective drugs but because of high costs, usually given after failure of other drugs.
  • Biologic drugs that are effective in Psoriatic Arthritis include – Eternacept, Adalimumab, Infliximab, Golimumab, Secukinumab etc.
  • If the disease deformity is irreversible and there is severe functional limitation, patient may be advised joint replacement surgery
  • With Proper treatment, a Psoriatic Arthritis patient can lead a normal life without pain and deformity.
  • But if not treated properly from an early stage, there may be erosion of bones leading to loss of natural movements and severe joint deformity
  • This may increase risk of heart attack
  • The hip joint may be fused for which the patient will be unable to walk or sit and may require joint replacement therap.
  • At OARC, we offer holistic care to patients suffering from all kind of arthritis and autoimmune diseases by our renowned rheumatologist.
  • Because of chronic illness of the disease, we spend some time with the patient helping them to know about their disease, and demystify the myths regarding the disease and treatment.
  • We have collaboAStion with NABL accredited laboAStory where all kind of blood tests can be done at reasonable costs.
  • We also have patient support system where patient can approach in case of any emergency.
  • We believe in a friendly relation with patients so that they can share all their sufferings and get the best possible treatment.