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Psoriatic Arthritis
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Psoriatic Arthritis

Psoriatic Arthritis is a specific type of arthritis which affects 23% of people with psoriasis. It is characterized by pain and swelling in and around the joints accompanied by scaly patches of skin parts of the body, and has several types. Symptoms of each type vary in severity, and diagnosing the disease in its early stages is vital in preventing disability and deformity due to joint and tissue damage. It usually affects adults in their 30s, 40s and 50s regardless of sex; however there is a more rare form which affects children.

Signs and Symptoms of Psoriatic Arthritis

Most people with psoriatic arthritis also have psoriasis, and may develop the disease at any time. However, because these skin and joint problems do not develop at the same time, patients usually develop psoriatic arthritis about 10 years after the initial appearance of psoriasis. Approximately one in seven patients experience joint pain for many years prior to developing skin lesions.

Psoriatic arthritis causes swelling in the joints outside the spine in 95% of patients, as well as nail lesions in 80% of patients. Symptoms also include pain and swelling in one or more joints, and swelling of fingers and toes causing them to have a sausage-like appearance. Psoriasis patients may have severe psoriasis when joints are relatively pain-free and aching joints when the skin clears because skin and joint problems flare up and go into remission at different times. In its milder types and initial stages, the disease can be difficult to diagnose.

In addition to the scales and inflammation associated with psoriasis, psoriatic arthritis patients experience pain and swelling in the joints. The symptoms include:

  • The development of silver or grey plaques that itch or burn, localized on the knees, elbows, scalp, or lower end of the spine. The skin at the joints may also crack.
  • Joints, especially small joints at the ends of the fingers and toes become painful, red, and swollen, and there will be reduced motion in the joints. It may also affect the joints in the spine and sacrum (sacroiliac joints).
  • Stiffness and tiredness upon waking in the morning.
  • Discolored finger and toenails which may pit (form small indentations in the nail) or lift from the nail beds.
  • Eye inflammation, redness and pain (similar to conjunctivitis).

Causes of Psoriatic Arthritis

Psoriatic arthritis can develop at any time, but it commonly occurs about 10 years after the initial development of psoriasis. For most people it appears between the ages of 30 and 50. It is common opinion that psoriatic arthritis is caused by an immune system malfunction. It might start with more mild symptoms or develop suddenly an early diagnosis is vital in preventing permanent damage. Half of psoriatic arthritis patients will already have bone loss by the time of diagnosis.

Types of Psoriatic Arthritis

There are five distinct types of psoriatic arthritis which may overlap:

  1. Peripheral, which involves the distal interphalyngeal joints (the small joints closest to the nails in the fingers and toes). This is referred to as DIP (Distal interphalangeal joint predominant). Usually affecting a small numbers of patients, mostly men, it will cause nail problems that don't occur with osteoarthritis, a common type of arthritis that psoriatic arthritis is often misdiagnosed as.
  2. Asymmetrical joint type, which involves one to three large joints (hips, knee, ankle or wrist) and primarily affects the hands and feet. It may concentrate on one side of the body or affect different joints on each side of the body causing them to be tender and red. When occurs in hands and feet, the fingers and toes swell due to inflammation in the tendons.
  3. Peripheral symmetrical polyarthritis (symmetric arthritis), which is similar to Rheumatoid arthritis (a common and debilitating form of arthritis). And affects more women than men. Although generally milder than rheumatoid arthritis, it can also result in potentially disabling joint damage. It affects both sides of the body, and involves four or more of the same joints on both sides of your body. Severe psoriasis is associated with this type of arthritic psoriasis.
  4. A spondyloarthropathy (referred to as Spondylitis), which primarily affects the spine and sacroiliac (sacrum) joints. This type is characterized by inflammation at the spine where ligaments and tendons attach, and stiffness and inflammation in neck, lower back, and sacrum. Movement becomes progressively more painful, and patients slowly lose the ability to move.
  5. A severe painful and crippling peripheral type, also known as Arthritis mutilans affecting only a small number of psoriatic arthritis patients. The progression of this type can result in deformity and disability as the bones in the fingers are permanently damaged.

Treatment for Psoriatic Arthritis

There is no cure for psoriatic arthritis; however, through proper medication combined with physical therapy, patients can relieve pain and stop the progression of joint damage.

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