Psoriatic Arthritis.
Last updated Monday, December 27, 2004
AboutBasics of psoriatic arthritis Psoriatic arthritis is a common form of arthritis that affects both joints and skin.Prognosis Generally, psoriatic arthritis is a mild condition. With proper
treatment and help from others, you can relieve joint pain and
stiffness and keep skin problems under control. Some people, however,
have a more serious disease and require combinations of medications to
control symptoms and prevent joint damage.
Psoriatic arthritis is a chronic (long-lasting) condition. Lethality Psoriatic arthritis is not a fatal form of arthritis. It affects the
skin and joints but does not affect the vital organs. Rare reactions to
medications or infections may be more serious but the disease itself is
not fatal.Curability Psoriatic arthritis is treatable, but not curable.Incidence Approximately 10% of people who have the skin condition known as
psoriasis will develop an associated inflammatory arthritis.
Inflammatory forms of arthritis are those that cause prolonged
stiffness in the night and morning along with joint swelling and pain
and are generally better with activity.
Psoriatic arthritis affects about 300,000 people in the United
States. It affects men and women of all races. It usually occurs
between the ages of 20 and 30, but it can occur at any age. It affects
about five to eight percent of people who have psoriasis. Symptoms
In general, symptoms of psoriasis and psoriatic arthritis include:
- scaly red patches that can appear on the scalp, elbows, knees,
and/or the lower end of the backbone (Often, psoriasis may only be a
small patch in the scalp. In some people, the rash may cover a good
deal of the body.)
- pitting and/or discoloration of fingernails and/or toenails
- pain and swelling in one or more joints, usually the last joints of
the fingers or toes, the wrists, knees, or ankles. Some people with
psoriatic arthritis may have only one joint affected while in others it
may resemble rheumatoid arthritis. The sacroiliac joints and the spine
can also be involved. Because of this, psoriatic arthritis belongs to a
group of disorders known as the spondyloarthropathies (spondylo =
spine; arthropathy = joint disease)
- swelling of fingers and/or toes that gives them a "sausage" appearance
Psoriatic arthritis can develop over a long period of time, or it can
appear quite suddenly. The psoriasis usually develops months to years
before the joint swelling and pain.Causes The cause of psoriatic arthritis is not yet known. Since it is known
to run in families, it may be partly inherited. But it is not
contagious, so you can't catch it from anyone. Like other forms of
arthritis, the body's immune system and the environment may also play a
role in the disease.
Diagnosis To find out if you have psoriatic arthritis, your doctor will ask
you about your symptoms and will perform a physical examination.
Since the symptoms of this type of arthritis are similar to other forms of arthritis, such as gout, Reiter's syndrome, and rheumatoid arthritis, the doctor may also perform some or all of the following tests:
- X-rays to look for changes in your bones and joints
- blood tests to rule out other diseases, such as rheumatoid arthritis and document the presence of inflammation
- joint fluid tests to rule out gout, another arthritis-related
disease that may resemble psoriatic arthritis. The joint fluid in most
people with psoriatic contains many inflammatory cells and although the
absence of uric acid crystals may rule out gout, many other
inflammatory forms of arthritis will have a similar number of white
cells in the fluid. The knee is the easiest joint from which to obtain
joint fluid for analysis and can only be removed by putting a needle in
the joint (the procedure is called arthrocentesis) if the joint is
swollen.
It may take some time to determine if you have psoriatic arthritis.
Usually, if your nails and skin are affected along with your joints, a
concrete diagnosis can be made. In general, a rheumatologist (a
physician trained in the diagnosis and treatment of arthritis) can
recognize the features of psoriatic arthritis noted above in the
setting of psoriasis and make a diagnosis. A firm diagnosis will have
to wait the development of the skin disease. The skin disease or the
arthritis may appear first. Treatment Treatment for psoriatic arthritis depends on how severe your condition is and what areas of the body are affected.
The goals of treatment are to reduce joint
pain and swelling, control the skin patches, and to slow down or
prevent joint damage. Treatment may include one or a combination of
skin care, medications, and other treatments. Self-management Take good care of your skin, especially during the winter. This can
help reduce the dryness and skin sores caused by the psoriasis. Keep
your skin from becoming dry by following these tips:
- Use a lotion or lanolin cream.
- Use non-deodorant soaps.
- Put baby oil in your bath water or rub it on your skin after showering.
- Use a humidifier in the winter.
- Avoid using strong soaps or chemicals.
Sit in the sun for moderate periods of time. Because sunlight slows
down cell growth, it can help improve your psoriasis. Too much sunlight
can damage your skin, however, so take steps to avoid sunburn.
Psoralen and ultraviolet light, type A (PUVA) is a combination of
medicine (psoralen) and light (type A ultraviolet light) that can help
clear up skin problems and some joint problems. For this treatment, you
are given psoralen in pill form. This makes your skin sensitive to
ultraviolet light, type A. Then you are exposed to ultraviolet light
for several minutes. You may need at least 20-30 treatments over
several weeks. Talk to your dermatologist (skin doctor) about the
benefits and side effects of this treatment.
Corticosteroid
or steroid creams can be very effective but should be used under the
direction of your health care provider. The more powerful creams can
cause atrophy or thinning of the skin if used improperly. There are
also vitamin D based creams that can be used by some people. Health care team People with psoriatic arthritis may be treated by their family doctor,
a skin specialist (dermatologist) or an arthritis specialist
(rheumatologist). The type of doctor you see will depend on your
symptoms. Other health care workers, such as a nurse, occupational
therapist, or physical therapist may also help you manage your
condition.Exercise and therapy Exercise
The pain and swelling of arthritis can make your joints stiff and hard
to move. If this happens, your doctor or physical therapist may
recommend special exercises to keep your joints strong and flexible. In
addition, general exercise, such as walking, can help improve your overall health.
Rest
Generally, a normal amount of rest and sleep will be enough for you. In
a very few people, however, psoriatic arthritis may cause extreme fatigue.
If this happens, you may need to rest more than usual and learn how to
use your energy wisely throughout your daily activities.
Medications Some medications
can help relieve joint pain and swelling and can help slow down the
joint damage. Your health care provider may recommend one of the
following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs):
These help reduce mild joint pain and swelling. You may need to take
these for a few days or weeks or for a longer time, depending on your
condition. Examples include ibuprofen and aspirin.
- Corticosteroids:
These are synthetics forms of a hormone your body makes. They are
sometimes helpful when injected into a painful joint and can be used in
small doses by mouth. Reducing your dose of these medicines too quickly
may cause the skin disease to become much worse.
- Sulfasalazine: This is a medication developed to treat rheumatoid arthritis and can be very helpful in people with arthritis. It does not treat the skin disease.
- Methotrexate: This is a very powerful medicine. It can help slow
down the disease and prevent further joint and skin damage in some
cases.
- Cyclosporin A: This is a powerful medicine sometimes used to treat
people who have had organ transplants. In recent studies, it has been
shown effective in treating the skin and joint problems of psoriatic
arthritis. When studies are completed, this medicine may be used to
treat psoriatic arthritis.
- Gold shots: This therapy was first used in people with rheumatoid arthritis but has been successful in psoriatic arthritis as well.
- Etanercept: Still experimental, this agent has been used in people
with psoriatic and psoriasis with success. It is under review of
approval for this disease by the FDA.
These medications work differently in different people. Talk to your
doctor about the risks and benefits of taking these medicines since all
of them have potential side effects. The strongest medications are
reserved for those with the most serious disease.
Surgery If your joints are severely damaged from psoriatic arthritis, your doctor may recommend joint replacement surgery.
In this surgery, joints damaged by arthritis are replaced with
artificial joints. If this surgery is needed, your doctor will discuss
this with you.Splints or braces Splints may be useful if you have severe joint problems. Splints help
rest your joints. This helps decrease joint pain, swelling, and
stiffness. Your doctor, physical therapist, or occupational therapist
can help you find the best splint for you.Alternative remedies Heat and cold treatments
These treatments may help relieve pain and reduce swelling in
your joints. Examples include soaking in a warm tub and placing a
heating pad or cold pack on the painful joint. Talk to your doctor
about what treatments may be best for you.
Asking for help People with psoriatic arthritis can turn to their health care providers, their families, and special organizations for help and support.Resources
For more information, contact the National Psoriasis Foundation, 6600 SW 92nd Ave., Suite 300, Portland, OR 97223-7195, (503) 244-7404, toll-free (800) 723-9166Credits Some of this material may also be available in an Arthritis Foundation
brochure. Contact the Washington/Alaska Chapter Helpline: (800)
542-0295. If dialing from outside of WA and AK, contact the National
Helpline: (800) 283-7800.
Edited by Gregory C. Gardner, M.D., Division of Rheumatology, and
Frederick Matsen, M.D., Chairman, Department of Orthopaedics,
University of Washington. Based on a pamphlet originally produced by
the Arthritis Foundation.
|