What are the other Names for this Condition? (Also known as/Synonyms)

• Arthritic Psoriasis
• PsA (Psoriatic Arthritis)
• Psoriatic Arthropathy

What is Psoriatic Arthritis? (Definition/Background Information)

• Psoriatic Arthritis (PsA) is a type of arthritis that affects some individuals who have psoriasis - a condition in which there are red skin patches topped with silvery scales. In some cases,  joint involvement can occur before the skin symptoms are evident
• It is possible for the condition to affect any joints of the body, and this varies based on the type of Psoriatic Arthritis. Sometimes, the organ tissues may also experience inflammation
• Psoriatic Arthritis treatment depends on many factors, which also include the type of condition an individual is affected with. A combination of medications, conservative therapy, and surgery, if required, may be used. The prognosis is generally good when early diagnosis and treatment are provided
• There are five types of Psoriatic Arthritis, and each of them has different effects on the types of body joints affected. These include:
  • Asymmetrical type is usually mild and occurs in different joints on both sides of the body
  • Symmetrical type accounts for 50% of all PsA cases and simultaneously affects both sides of the body
  • Distal interphalangeal dominant type affects joints on the fingers and toes. It may cause nail deformity and sometimes lead to swollen fingers or toes
  • Spondylitis type causes pain and stiffness, particularly in the spine and neck
  • Arthritis Mutilans is the most severe form and affects about 5% of the population with PsA. The damage occurs to small joints in the toes or fingers and may cause the affected body joints/parts to become deformed and decrease functionally

Who gets Psoriatic Arthritis? (Age and Sex Distribution)

• Psoriatic Arthritis is thought to occur in around 10-15% of the population diagnosed with psoriasis
• Individuals with psoriasis of all ages, genders, racial groups, and ethnicities may develop this condition
• Adults in the 30-50 years age group are more likely to be affected than individuals belonging to any other age group

What are the Risk Factors for Psoriatic Arthritis? (Predisposing Factors)

The following are the risk factors of Psoriatic Arthritis (PsA):

• The most important risk factor for PsA to develop is having a positive family history of psoriasis or Psoriatic Arthritis
• Patients with nail signs and symptoms, such as ridges and pitting, are particularly prone to developing the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Psoriatic Arthritis? (Etiology)

• Joint damage due to Psoriatic Arthritis (PsA) is caused by an autoimmune response within the body
  • The abnormal autoimmune response in the body is that healthy synovial tissues get attacked
  • The synovial tissues are soft tissues located in the body joints and are responsible for the production of the synovial fluid, which keeps joints lubricated
  • When synovial tissue is under attack, it begins to produce excess synovial fluid that leads to joint swelling and erosion of the cartilage
  • Once the cartilage begins to erode, the bones within a joint rub against each other, causing damage and pain in the affected area
• Psoriatic Arthritis has been found to be linked with certain genetic markers (HLA-B27).  Individuals, who have HLA-B27 genes are at an increased risk
• In some individuals, the mere presence of HLA-B27 does not increase the risk, but environmental factors, such as infections, may activate these genes, resulting in PsA

What are the Signs and Symptoms of Psoriatic Arthritis?

The signs and symptoms of Psoriatic Arthritis (PsA) include:

• Arthritis commonly involves the knees, ankles, and other foot joints. The joints become painful, red, hot, stiff, and swollen
• The range of motion within the affected joints is limited
• Joint stiffness may occur, which is noticed especially in the morning
• Deformed nails that may be pitted or elevated from the nail bed
• Sometimes, an entire digit may be swollen, giving the appearance of a sausage (called dactylitis)
• Enthesitis - swelling located at the part of the joint where tendons attach to the bones
• Usually, the skin lesions of psoriasis appear before the onset of arthritic symptoms. Hence, having psoriasis is often associated with the presence of PsA but is not a necessary factor
• Like psoriasis, arthritis too may appear and disappear with phases of remission (times with no symptoms)
• A very destructive (though rare) form of arthritis called ‘mutilans’ can cause rapid damage to the joints

How is Psoriatic Arthritis Diagnosed?

The diagnosis of Psoriatic Arthritis could involve the following diagnostic tools:

• Physical examination with study of medical history, including family history
• X-ray examinations may indicate the difference between the different types of Psoriatic Arthritis and arthritic variations
• Magnetic resonance imaging (MRI) scans may be used to identify problems within the ligaments and tendons
• Blood tests for rheumatoid factor (RF) can help rule-out rheumatoid arthritis
• Blood tests for C-reactive protein (CRP) may show elevated CRP levels, which is a sign of inflammation
• Sometimes, the joint fluid may be removed (by a process called arthrocentesis) and tested. This allows the physicians to exclude gout or other infections as a possible cause of inflammation
• Blood test for the genetic marker HLA-B27 will be positive in approximately 50% of affected patients
• Skin biopsy to confirm findings of psoriasis

In summary, Psoriatic Arthritis is diagnosed using a combination of physical exams, blood tests, radiological studies, and skin biopsy.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Psoriatic Arthritis?

In case of severe Psoriatic Arthritis, joint damage is a major complication.

• Sometimes, organ inflammation may also occur
• A wide variety of body systems can be affected

How is Psoriatic Arthritis Treated?

The treatment of Psoriatic Arthritis (PsA) depends on many factors, including the subtype of the condition. These measures may include:

• Medications are used only when necessary and in moderation to reduce inflammation and joint damage
• Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to control inflammation
• Medications listed below are potent and have a  risk of significant side effects. Hence, they are only used when a physician determines that the benefits outweigh the risks and with the informed consent of the patient or guardians. The medications include:
  • Disease-modifying anti-rheumatic drugs (DMARDs) may be administered to limit the amount of joint damage that occurs
  • Immunosuppressing drugs are used in severe cases to weaken the abnormally active immune system that is responsible for attacking healthy tissues (autoimmune antibodies)
• The following drugs are used for Psoriatic Arthritis based on prior extensive usage, off-label, or with specific FDA approval:
  • Tofacitinib
  • Baricitinib
  • Upadacitinib
  • Inflixumab
  • Golimumab
  • Guselkunumab
  • Abatacept
  • Adalimumab
  • Secukinumab
  • Apremilast
  • Ixekizumab
  • Cyclosporin
  • Etanercept
  • Leflunomide
  • Meloxicam
  • Nabumetone
  • Sulfasalazine
• Pain may be managed by slightly changing one’s day-to-day activities, such as:
  • Open doors with one’s body instead of using hands
  • Pick up objects with both hands instead of just one
• Maintain a healthy weight to reduce the strain applied to the affected joints
• Regular amounts of low-impact exercising, such as walking, cycling, swimming, or other aquatic exercises, will promote flexible joints and stronger muscles
• Cold packs may be used frequently to reduce inflammation and pain
• Heat may be applied frequently in order to relax the stiff muscles and joints
• Leave plenty of time to relax throughout the day to reduce excessive fatigue
• Sometimes, surgery is used to replace and restore joints damaged from years of arthritis

How can Psoriatic Arthritis be Prevented?

Currently, Psoriatic Arthritis is a condition that cannot be prevented but managed through adequate treatment.

What is the Prognosis of Psoriatic Arthritis? (Outcomes/Resolutions)

• The outcome of Psoriatic Arthritis (PsA) is favorable when the condition is identified and treated in its early stages. Also, generally, PsA is mild and affects only a few joints at a time
• A small proportion of the population will experience higher levels of arthritic activity that results in deformity. However, even extreme cases respond well when treated and managed appropriately

Additional and Relevant Useful Information for Psoriatic Arthritis:

Psoriasis is a common chronic inflammatory skin disease. It occurs due to a genetic defect, which causes the skin to grow faster than normal, resulting in white scaly patches and plaques on the skin.

The following article link will help you understand psoriasis:

https://www.dovemed.com/diseases-conditions/psoriasis/