Summary about Disease
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that affects people who have psoriasis, a skin condition that causes red, scaly patches. However, some individuals may develop PsA before psoriasis appears, or only have subtle skin symptoms. PsA can cause pain, swelling, and stiffness in the joints. It can affect any joint in the body, and its severity can vary widely from person to person. The condition is chronic, meaning it's long-lasting, and doesn't currently have a cure, but treatments can help manage symptoms and prevent joint damage.
Symptoms
Symptoms of psoriatic arthritis can vary but commonly include:
Joint pain, stiffness, and swelling: This is the most common symptom and can affect any joint, including fingers, toes, wrists, ankles, and spine.
Dactylitis: Swelling of entire fingers or toes, giving them a "sausage-like" appearance.
Enthesitis: Pain and inflammation where tendons and ligaments attach to bone, particularly at the heel (Achilles tendinitis) or the bottom of the foot (plantar fasciitis).
Skin psoriasis: Red, scaly patches on the skin, often on the elbows, knees, scalp, and around the nails.
Nail changes: Pitting, thickening, or separation of the nails from the nail bed.
Fatigue: Feeling tired and lacking energy.
Eye inflammation: Uveitis, which can cause eye pain, redness, and blurred vision.
Reduced range of motion: Difficulty moving joints freely.
Morning stiffness: Joints are stiff and painful in the morning and improve with movement.
Spinal inflammation (spondylitis): Back pain and stiffness.
Causes
The exact cause of psoriatic arthritis isn't fully understood, but it's believed to be a combination of genetic and environmental factors.
Genetic predisposition: People with certain genes are more likely to develop PsA. If you have a family member with psoriasis or psoriatic arthritis, your risk is higher.
Immune system dysfunction: PsA is an autoimmune disease, meaning the immune system mistakenly attacks healthy tissues, causing inflammation in the joints and skin.
Environmental triggers: Infections, trauma, or stress may trigger the disease in people who are genetically predisposed.
Medicine Used
Treatment for psoriatic arthritis aims to control inflammation, relieve pain, and prevent joint damage. Medications used include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen or naproxen, to reduce pain and inflammation.
Disease-modifying antirheumatic drugs (DMARDs): Such as methotrexate, sulfasalazine, leflunomide, and apremilast. These medications suppress the immune system and slow the progression of the disease.
Biologic agents: These are DMARDs that target specific parts of the immune system. Examples include TNF inhibitors (etanercept, infliximab, adalimumab, golimumab, certolizumab pegol), IL-17 inhibitors (secukinumab, ixekizumab, brodalumab), IL-12/23 inhibitors (ustekinumab), and T-cell inhibitors (abatacept).
Targeted synthetic DMARDs: Such as Janus kinase (JAK) inhibitors (tofacitinib, upadacitinib, filgotinib) which target specific intracellular pathways involved in inflammation.
Corticosteroids: Such as prednisone, to reduce inflammation. These are typically used for short-term symptom relief.
Pain relievers: Such as tramadol or codeine, to manage pain.
Is Communicable
Psoriatic arthritis is not communicable or contagious. It cannot be spread from person to person through contact, air, or bodily fluids. It's an autoimmune disease, meaning it arises from within the individual's own immune system.
Precautions
While there's no guaranteed way to prevent PsA, certain precautions can help manage the condition and reduce the risk of flares:
Follow your doctor's treatment plan: Adhere to prescribed medications and therapies.
Maintain a healthy lifestyle: Eat a balanced diet, exercise regularly, and get enough sleep.
Manage stress: Practice relaxation techniques like yoga, meditation, or deep breathing.
Avoid triggers: Identify and avoid triggers that worsen symptoms, such as smoking, alcohol, and certain infections.
Protect your joints: Use assistive devices, maintain good posture, and avoid activities that put excessive strain on your joints.
Maintain a healthy weight: Excess weight can put additional stress on joints.
Promptly treat infections: Infections can trigger flares.
Sun exposure: Sunlight can help improve psoriasis symptoms, but excessive exposure can damage the skin. Use sunscreen and protective clothing.
How long does an outbreak last?
The duration of a psoriatic arthritis outbreak (flare) varies greatly from person to person and can depend on several factors, including the severity of the disease, the individual's overall health, and the effectiveness of treatment.
Untreated flares: Can last for weeks, months, or even longer if left untreated.
Treated flares: With appropriate treatment, flares can be controlled within a few weeks. However, some individuals may experience persistent symptoms despite treatment.
Chronic, ongoing inflammation: In some cases, PsA can cause chronic, ongoing inflammation, rather than distinct flares. In these instances, symptoms may be present continuously.
Remission: Periods of remission (minimal or no symptoms) can occur, but PsA is often characterized by cycles of flares and remissions.
How is it diagnosed?
Diagnosing psoriatic arthritis involves a combination of:
Physical Examination: A doctor will examine your joints for swelling, tenderness, and range of motion. They will also look for signs of psoriasis on your skin and nails.
Medical History: The doctor will ask about your symptoms, family history of psoriasis or arthritis, and any other relevant medical conditions.
Imaging Tests:
X-rays: Can help detect joint damage.
MRI (magnetic resonance imaging): Provides more detailed images of the joints and soft tissues.
Ultrasound: Can help detect inflammation in the joints and tendons.
Blood Tests:
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): These tests measure inflammation in the body.
Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP): These tests are usually negative in psoriatic arthritis but are used to rule out rheumatoid arthritis.
HLA-B27: This genetic marker is sometimes associated with psoriatic arthritis, particularly spondylitis.
Joint fluid analysis: Removing fluid from an affected joint to test for infection or crystals.
Timeline of Symptoms
The timeline of psoriatic arthritis symptoms can vary significantly, but a general progression might look like this:
Early Stages:
Mild joint pain and stiffness, often mistaken for other types of arthritis.
Skin psoriasis may be present or develop concurrently. Nail changes may appear.
Enthesitis may occur early on.
Progression:
Joint pain and swelling become more persistent and widespread.
Dactylitis may develop, affecting fingers and toes.
More significant skin psoriasis outbreaks.
Fatigue becomes more pronounced.
Later Stages (If Untreated):
Joint damage and deformity.
Reduced range of motion and functional limitations.
Chronic pain and fatigue impacting daily life.
Possible development of other complications, such as uveitis.
Variable Factors: Some individuals may experience a rapid onset of symptoms, while others have a more gradual progression. The presence and severity of skin psoriasis can also vary. The specific joints affected and the degree of inflammation can differ among individuals.
Remission and Flares: The disease course is often characterized by periods of remission and flares, meaning symptoms may improve temporarily and then worsen again.
Important Considerations
Early diagnosis and treatment: Crucial to prevent joint damage and improve long-term outcomes.
Individualized treatment plans: Treatment should be tailored to the individual's specific symptoms, disease severity, and other medical conditions.
Comorbidities: People with psoriatic arthritis are at increased risk of other health problems, such as cardiovascular disease, metabolic syndrome, and depression. These conditions should be monitored and managed appropriately.
Lifestyle modifications: Healthy lifestyle choices can play a significant role in managing symptoms and improving overall well-being.
Mental health: Chronic pain and disability can impact mental health. Seeking support from therapists, support groups, or mental health professionals can be beneficial.
Regular monitoring: Regular follow-up appointments with a rheumatologist and dermatologist are important to monitor disease activity, adjust treatment as needed, and screen for complications.
Pregnancy and breastfeeding: Certain medications used to treat psoriatic arthritis may not be safe during pregnancy or breastfeeding. Discuss treatment options with your doctor if you are planning to become pregnant or are breastfeeding.
Multidisciplinary approach: Optimal management of psoriatic arthritis often requires a multidisciplinary approach involving rheumatologists, dermatologists, physical therapists, and other healthcare professionals.