Psoriatic Arthritis

Psoriatic arthritis (PsA) is a type of autoimmune inflammatory arthritis that predominantly affects people with the chronic skin condition psoriasis. PsA causes inflammation in many different joints as well as tendons, muscles and some organs. PsA has 5 different subtypes, a couple of which behave quite similarly to rheumatoid arthritis. There is no cure for PsA, but there are many symptom treatment option available that can greatly improve quality of life.

How Common is PsA?

Psoriasis (an autoimmune skin condition) affects about 2-3% of the American populous. PsA affects up to 30% of people who have psoriasis. Some people develop PsA before skin symptoms appear but this is not the norm. While it is a relatively uncommon disease, PsA is still more prevalent than many other types of arthritis, but less prevalent than osteoarthritis or rheumatoid arthritis. PsA is more common in people over the age of 30, but can strike any age, including children.

What Are Some of the Symptoms PsA?

As the disease is systemic and autoimmune in nature, it often affects the entire body causing diverse symptoms that may vary from patient to patient. Such symptoms may include:

• General fatigue
• Symmetrical or asymmetrical joint pain
• Inflammation of the joints, muscles, tendons and other parts of the body
• Spikes in uric acid (that may be mistaken for gout)
• Severe chest pain similar to that of costochondritis
• Stiffness (especially in the morning or evening)
• Tendonitis and bursitis
• Foot pain similar to plantar fasciitis
• Inflammation and severe pain of the achillies tendon
• Eye problems such as conjunctivitis
• Swelling of the lungs, aorta or other organs (this may be hard to detect)
• Very swollen ‘sausage fingers’ or toes
• Lower back or pelvic pain and inflammation

As with many types of chronic conditions, PsA is often cyclical, causing frequent or infrequent “flare-ups” followed by periods of symptom remission.

Why Is The Doc Concerned With Your Nails?

Up to 80% of PsA sufferers wear telltale signs of the disease on their nails. Nail psoriasis is yet another manifestation of this all-encompassing disease. A rheumatologist will examine the persons nails for pitting (small horizontal dents), transverse ridges and crumbling or separation of the nail against the finger. Other PsA patients may have what resembles fungus on their nails as well which is another indicator of the disease.

What Does the Diagnostic Process Include?

It can be tricky to obtain a PsA diagnosis as it mimics many other conditions. PsA shares many common traits with Lupus, another pervasive, systemic autoimmune disease. It is also often mistaken for other types of arthritis such as rheumatoid or gouty arthritis. To make things trickier, gout is often comorbid with PsA, so the patient may have both types of arthritis. To diagnose PsA, a rheumatologist will:

1. Examine the patient for signs such as those listed above.
2. Investigate the patient’s family history (PsA and psoriasis have a significant genetic component).
3. Conduct blood tests such as the rheumatoid factor test to rule out other diseases and look for signs of inflammation
4. X-rays or MRIs of effected joints such as the lower back may be taken to look for any damage
5. It may take several appointments to diagnose PsA

PsA Treatments

There are many medications on the market such as DMARD (disease modifying anti-rheumatic drugs) or NSAIDS (non-steroidal anti-inflammatory drugs) that can help modify and control PsA symptoms. Doctors also suggest lifestyle changes such as losing extra weight and healthy eating (check out our article on anti-inflammatory foods). It is also important to lower stress levels, as stress has been cited as a cause and trigger of psoriasis and PsA.

What is the Prognosis of PsA?

While PsA can be a very serious type of arthritis which can lead to crippling disability if left untreated, if it is detected early and managed well with appropriate medications and lifestyle changes, sufferers can lead happy, healthy, symptom-controlled lives.

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