Psoriatic Arthritis

Psoriasis is an autoimmune disease, meaning the body’s own immune system is working against itself, which leads to the formation of psoriatic lesions on the skin that take the shape of red plaques with silvery scales.  In addition to skin plaques, the disease manifests in the nails resulting in pitting, deformation, thickening, loosening and discoloration.  Although it cannot be prevented, it can be managed with the use of topical medications, oral medications or injections by your Dermatologist, Podiatrist or Rheumatologist. 

We are going to focus on Psoriatic Arthritis.  This form of arthritis develops in approximately 30% of patients with psoriasis, and is typically diagnosed after the diagnosis of psoriasis secondary to skin lesions is made.  It falls into a category of arthritic diseases that are Rheumatoid Factor positive; other such arthridities include Rheumatoid Arthritis, Reiters Syndrome and Ankylosing Spondylitis. 

The primary symptoms in a patient with psoriatic arthritis include pain, swelling and stiffness that affect most commonly the joints of the hands and feet in addition to the spine.  Patients may also notice swelling of the fingers or toes (sausage digits) due to inflammation surrounding tendons that insert near the joints.  In addition, psoriatic arthritis tends to induce “enthesopathies.”  Although the term is fancy, it simple means that at areas of tendon insertion, especially at the insertion of the achilles tendon (posterior heel) and the plantar fascia (plantar heel) you will have pain secondary to pull on the heel bone by such tendons. 

Destruction is first detected in the hands and feet through x-rays that show signs of “whittling” at the distal joints (those closest to the tips of the fingers and toes).  An x-ray of the spine can show changes and fusions (joining) of the joints of the spine, leading to decreased bending at the waist that typically occur after psoriatic arthritis has been detected in the hands and feet.  Thus, early diagnosis is key in slowing progression and limiting spine involvement. 

The diagnosis is typically made by your physician, who will have a high index of suspicion of such arthritis due to your already existing diagnosis of psoriasis.  However, as mentioned x-rays and often blood work, can help to definitively rule-in psoriatic arthritis, and thus medical intervention and management of the disease can be started. The earlier the diagnosis of psoriasis and psoriatic arthritis are made, the better chance you and your physician have in slowing the process of destruction and resultant symptoms within your joints.

Psoriatic arthritis flare-ups, much the same as flare-ups of psoriatic skin plaques, can occur with periods of symptomatic relief.  Although psoriatic arthritis has no cure, it can also be controlled and managed with medications, helping to decrease joint complications, preserve mobility, and slow progression.  In addition to what you may already be taking for management of your psoriatic skin plaques, you may be prescribed a non-steroidal anti-inflammatory drug (NSAID) such as Aspirin or Ibuprofen to help control both pain and swelling at the joints essentially decreasing stiffness and increasing mobility.  Other medications include Disease-modifying antirheumatic drugs and/or immunosuppressant medication, all of which can be discussed with your physician who will select medications that will work best for you. 

Psoriatic arthritis secondary to psoriasis and its skin manifestations is not an easy diagnosis to handle, however, by working together with your Podiatrist and Dermatologist to manage skin and nail manifestations, your Rheumatologist can help control your arthritic symptoms.  It is also extremely important that you help yourself by eating right, staying active, and knowing when to take a break! 

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