Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of inflammatory arthritis[1][2] that will develop in between 6 and 42% of people who have the chronic skin condition psoriasis.[3] Psoriatic arthritis is classified as a seronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27.
Pain, swelling, or stiffness in one or more joints is commonly present in psoriatic arthritis.[4] Psoriatic arthritis is inflammatory, and affected joints are generally red or warm to the touch.[4] Asymmetrical oligoarthritis, defined as inflammation affecting one to four joints during the first six months of disease, is present in 70% of cases. However, in 15% of cases the arthritis is symmetrical. The joints of the hand that are involved in psoriasis are the proximal interphalangeal (PIP), the distal interphalangeal (DIP), the metacarpophalangeal (MCP), and the wrist. Involvement of the distal interphalangeal joints (DIP) is a characteristic feature and is present in 15% of cases.
In addition to affecting the joints of the hands and wrists, psoriatic arthritis may affect the fingers, nails, and skin. Sausage-like swelling in the fingers or toes, known as dactylitis, may occur.[4] Psoriasis can also cause changes to the nails, such as pitting or separation from the nail bed,[4]onycholysis, hyperkeratosis under the nails, and horizontal ridging.[5] Psoriasis classically presents with scaly skin lesions, which are most commonly seen over extensor surfaces such as the scalp, natal cleft and umbilicus.
In psoriatic arthritis, pain can occur in the area of the sacrum (the lower back, above the tailbone),[4] as a result of sacroiliitis or spondylitis, which is present in 40% of cases. Pain can occur in and around the feet and ankles, especially enthesitis in the Achilles tendon (inflammation of the Achilles tendon where it inserts into the bone) or plantar fasciitis in the sole of the foot.[4]
Along with the above noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest. The exhaustion may last for days or weeks without abatement. Psoriatic arthritis may remain mild, or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission. In severe forms, psoriatic arthritis may progress to arthritis mutilans[6] which on X-ray gives a "pencil-in-cup" appearance.
Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended.[7]
The exact causes are not yet known, but a number of genetic associations have been identified in a genome-wide association study of psoriasis and psoriatic arthritis including HLA-B27.[8][9]
There is no definitive test to diagnose psoriatic arthritis. Symptoms of psoriatic arthritis may closely resemble other diseases, including rheumatoid arthritis. A rheumatologist (a doctor specializing in diseases affecting the joints) may use physical examinations, health history, blood tests and x-rays to accurately diagnose psoriatic arthritis.
Factors that contribute to a diagnosis of psoriatic arthritis include:
Other symptoms that are more typical of psoriatic arthritis than other forms of arthritis include inflammation in the Achilles tendon (at the back of the heel) or the Plantar fascia (bottom of the feet), and dactylitis (sausage-like swelling of the fingers or toes).[10]
Magnetic resonance image of the index finger in psoriatic arthritis (mutilans form). Shown is a T2 weighted fat suppressed sagittal image. Focal increased signal (probable erosion) is seen at the base of the middle phalanx (long thin arrow). There is synovitis at the proximal interphalangeal joint (long thick arrow) plus increased signal in the overlying soft tissues indicating oedema (short thick arrow). There is also diffuse bone oedema (short thin arrows) involving the head of the proximal phalanx and extending distally down the shaft.
Magnetic resonance images of the fingers in psoriatic arthritis. Shown are T1 weighted axial (a) pre-contrast and (b) post-contrast images exhibiting dactylitis due to flexor tenosynovitis at the second finger with enhancement and thickening of the tendon sheath (large arrow). Synovitis is seen in the fourth proximal interphalangeal joint (small arrow).
(a) T1-weighted and (b) short tau inversion recovery (STIR) magnetic resonance images of lumbar and lower thoracic spine in psoriatic arthritis. Signs of active inflammation are seen at several levels (arrows). In particular, anterior spondylitis is seen at level L1/L2 and an inflammatory Andersson lesion at the upper vertebral endplate of L3.
Magnetic resonance images of sacroiliac joints. Shown are T1-weighted semi-coronal magnetic resonance images through the sacroiliac joints (a) before and (b) after intravenous contrast injection. Enhancement is seen at the right sacroiliac joint (arrow, left side of image), indicating active sacroiliitis.
There are five main types of psoriatic arthritis:
The underlying process in psoriatic arthritis is inflammation; therefore, treatments are directed at reducing and controlling inflammation. Milder cases of psoriatic arthritis may be treated with NSAIDs alone; however, there is a trend toward earlier use of disease-modifying antirheumatic drugs or biological response modifiers to prevent irreversible joint destruction.
Typically the medications first prescribed for psoriatic arthritis are NSAIDs such as ibuprofen and naproxen, followed by more potent NSAIDs like diclofenac, indomethacin, and etodolac. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding.[11][12] Coxibs (COX-2 inhibitors) e.g. Celecoxib or Etoricoxib, are associated with a statistically significant 50 to 66% relative risk reduction in gastrointestinal ulcers and bleeding complications compared to traditional NSAIDs, but carry an increased rate of cardiovascular events such as myocardial infarction (MI) or heart attack, and stroke.[13][14] Both COX-2 inhibitors and other non-selective NSAIDS have potential adverse effects that include damage to the kidneys.
These are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly and may take weeks or even months to take full effect. Drugs such as methotrexate or leflunomide are commonly prescribed; other DMARDS used to treat psoriatic arthritis include cyclosporin, azathioprine, and sulfasalazine. These immunosuppressant drugs can also reduce psoriasis skin symptoms but can lead to liver and kidney problems and an increased risk of serious infection.
The most recent class of treatment is called biological response modifiers or biologics has been developed using recombinant DNA technology. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDS that affect the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion.
Biologics prescribed for psoriatic arthritis are TNF- inhibitors, including infliximab, etanercept, golimumab, certolizumab pegol and adalimumab, as well as the IL-12/IL-23 inhibitor ustekinumab.
Biologics may increase the risk of minor and serious infections.[citation needed] More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer.[citation needed]
A first-in-class treatment option for the management of psoriatic arthritis, apremilast is a small molecule phosphodiesterase-4 inhibitor approved for use by the FDA in 2014. By inhibiting PDE4, an enzyme which breaks down cyclic adenosine monophosphate, cAMP levels rise, resulting in the down-regulation of various pro-inflammatory factors inlcuding TNF- and the up-regulation of anti-inflammatory factor interleukin 10.
It is given in tablet form and taken by mouth. Side effects include headache, back pain, nausea, diarrhea, fatigue, nasopharyngitis and upper respiratory tract infections, as well as depression and weight loss.
Patented in 2014 and manufactured by Celgene, there is no current generic equivalent available on the market.
A review found tentative evidence of benefit of low level laser therapy and concluded that it could be considered for relief of pain and stiffness associated RA.[15]
Retinoid etretinate is effective for both arthritis and skin lesions. Photochemotherapy with methoxy psoralen and long wave ultraviolet light (PUVA) are used for severe skin lesions. Doctors may use joint injections with corticosteroids in cases where one joint is severely affected. In psoriatic arthritis patients with severe joint damage orthopedic surgery may be implemented to correct joint destruction, usually with use of a joint replacement. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.
Seventy percent of people who develop psoriatic arthritis first show signs of psoriasis on the skin, 15 percent develop skin psoriasis and arthritis at the same time, and 15 percent develop skin psoriasis following the onset of psoriatic arthritis.[16]
Psoriatic arthritis can develop in people who have any level severity of psoriatic skin disease, ranging from mild to very severe.[17]
Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults.[18]
More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterized by nail pitting, separation of the nail from the underlying nail bed, ridging and cracking, or more extremely, loss of the nail itself (onycholysis).[18]
Men and women are equally affected by this condition. Like psoriasis, psoriatic arthritis is more common among Caucasians than Africans or Asians.[19]
Read this article:
Psoriatic arthritis - Wikipedia
- Pharmacist explains best diet to reduce arthritis, inflammation and joint pain - The Mirror - March 10th, 2024
- Teen Raises Funds to Fight Arthritis - Arthritis Foundation - March 10th, 2024
- Is there a higher risk of depression among specific populations of patients with rheumatoid arthritis? - News-Medical.Net - March 10th, 2024
- Here's How to Explain Your Arthritis Pain to Your Doctor So They Actually Get It - Northwest Georgia News - March 10th, 2024
- Despite Their Prevalence, Arthritis, Neck and Back Pain Receive Few Research Dollars, Analysis Finds | BIDMC of ... - Beth Israel Deaconess Medical... - March 10th, 2024
- This Is the Difference Between Rheumatoid and Psoriatic Arthritis - Prescott Daily Courier - March 10th, 2024
- The #1 Early Sign of Arthritis Most People Miss, According to a Rheumatologist - Northwest Georgia News - March 10th, 2024
- The Efficacy and Safety of Apremilast in the Management of Psoriatic Arthritis: A Systematic Review and Meta-Analysis - Cureus - March 10th, 2024
- MU Researchers Participating in International Clinical Study Targeting Prevention of Osteoarthritis - University of Missouri School of Medicine - March 10th, 2024
- Review: Real-World Evidence Confirms Effectiveness and Safety of Adalimumab Biosimilar SB5 - The Center for Biosimilars - March 10th, 2024
- A Gender-Bias-Mitigated, Data-Driven Precision Medicine System to Assist in the Selection of Biological Treatments of ... - Cureus - March 10th, 2024
- Young arthritis cases are on the rise, new research suggests - The Examiner - March 10th, 2024
- Quiz: ACR Guideline for the Treatment of Psoriatic Arthritis - MD Magazine - February 10th, 2024
- Psoriatic arthritis: What to know about medications for children - Medical News Today - February 10th, 2024
- Ancient Egyptian woman had holes on her bones. Experts say its rare case of disease - Miami Herald - February 10th, 2024
- Arthritis and Pregnancy: Fertility, Gestation, Postpartum - Verywell Health - February 10th, 2024
- 3500-year-old burial of Nubian woman reveals 1 of world's earliest known cases of rheumatoid arthritis - Livescience.com - February 10th, 2024
- Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross ... - Nature.com - February 10th, 2024
- IHL-675A: Advancing Towards Innovative Arthritis Solutions, with Mark Bleackley, PhD - MD Magazine - February 10th, 2024
- Insomnia, Shorter Sleep Duration Linked to the Risk of Autoimmune Arthritis - MD Magazine - February 10th, 2024
- Advancements in Psoriatic Arthritis Treatment for Children: A Beacon of Hope - Medriva - February 10th, 2024
- Breakthrough Molecule RvT4 Reverses Inflammation and Clears Arterial Blockages in Rheumatoid Arthritis Patients - SciTechDaily - February 10th, 2024
- Personal Experience with Psoriatic Arthritis and Atopic Dermatitis - Medriva - February 10th, 2024
- EULAR Recommendations on Imaging in Crystal-Induced Arthropathies (CiA) - Medriva - February 10th, 2024
- The Importance of Ultrasound-Guided Synovial Biopsy in the Workup of Seronegative Inflammatory Arthritis: A Case ... - Cureus - February 10th, 2024
- Autoimmune diseases like lupus, MS, and rheumatoid arthritis strike far more women than men. Scientists now think they know why - Fortune - February 2nd, 2024
- Multiple Ulcers in the Ileum and Lymphadenopathy Following the Usage of Methotrexate in a Patient With Rheumatoid ... - Cureus - February 2nd, 2024
- These are the best arthritis creams of 2024, according to health experts - Yahoo Life - February 2nd, 2024
- Do Your Joints Ache When a Storm Is Brewing? Here's What's Really Happening - DISCOVER Magazine - February 2nd, 2024
- Olympic bronze medalist opens up about balancing arthritis with motherhood and triathlon - TRI247 - February 2nd, 2024
- Some Dinosaurs May Have Had Arthritis 90 Million Years Ago - IFLScience - February 2nd, 2024
- 3500-year-old remains of ancient Egyptian suffering from rheumatoid arthritis uncovered - Xinhua - February 2nd, 2024
- Lupus and other autoimmune diseases strike far more women than men. Now there's a clue why - The Associated Press - February 2nd, 2024
- Rheumatoid Arthritis Awareness Day on February 2: What you need to know - CNBCTV18 - February 2nd, 2024
- Rheumatoid Arthritis Awareness Day 2024: Signs, Symptoms, Diagnosis, and Prevention - News18 - February 2nd, 2024
- Improving arthritis in cold weather | Health Smart - WPMT FOX 43 - February 2nd, 2024
- Rheumatoid Arthritis Awareness Day: History, Significance And All You Need To Know - ABP Live - February 2nd, 2024
- Dietary Factors Tied to Osteoarthritis Pain | MedPage Today - Medpage Today - February 2nd, 2024
- Cold-weather coping tips for people with arthritis, osteoporosis and lung diseases - Southernminn.com - February 2nd, 2024
- How to manage arthritis and joint pain: Effective tips for knee pain relief - Health shots - February 2nd, 2024
- New study illuminates the genetics of thumb arthritis treatment - News-Medical.Net - January 25th, 2024
- Rheumatoid arthritis: 30 minutes of walking may lower blood pressure - Medical News Today - January 25th, 2024
- RA Disease Activity Assessed Too Little After Starting TNFi - Medscape - January 25th, 2024
- Lifestyle tips for youth's bone health: Avoid these habits to prevent arthritis - Hindustan Times - January 25th, 2024
- Best arthritis pain relief cream of 2024, according to experts - AOL - January 25th, 2024
- Vasculitis, an Early Unusual Presentation of Rheumatoid Arthritis: A Case Report - Cureus - January 25th, 2024
- Patients with later menarche, earlier menopause have higher risk for rheumatoid arthritis - Healio - January 25th, 2024
- Investigating Maternal Inflammatory Arthritis and Pregnancy Outcomes < Yale School of Medicine - Yale School of Medicine - January 25th, 2024
- Rheumatoid Arthritis and Diabetes: What's the Connection? - Health Central - January 25th, 2024
- Oxidative DNA Damage and Zinc Status in Patients With Rheumatoid Arthritis in Duhok, Iraq - Cureus - January 25th, 2024
- Changes Afoot for the Treatment of Psoriatic Arthritis with Marked Gains in Preference and Utilization of IL-17 Inhibitors - Yahoo Finance - January 25th, 2024
- The Connection Between Potassium and Rheumatoid Arthritis - Health Central - January 25th, 2024
- What Is the ACR20 (American College of Rheumatology) Criteria? - Health Central - January 25th, 2024
- RA Treatment Advances and Where They Are Headed - Health Central - January 25th, 2024
- TMC Medical Minutes- Arthritis & Cold Weather - KXII - January 25th, 2024
- How to deal with joint and arthritis pain in the cold weather - Crossroads Today - January 25th, 2024
- Arthritis: Regular exercises, calcium-rich diet and other habits to keep your bones strong and healthy - Moneycontrol - January 25th, 2024
- Men With Arthritis Have Higher Fertility Rates, Study Finds - Zenger.News - January 25th, 2024
- Pain on Top of Foot: 5 Causes, Swelling, Treatment - Verywell Health - January 25th, 2024
- Understanding Rheumatoid Arthritis in Women: Genetics, Hormones, and Impact - Medriva - January 25th, 2024
- Arthritis | Johns Hopkins Medicine - January 9th, 2024
- Ideal cardiovascular health metrics have better identification of arthritis - BMC Public Health - BMC Public Health - January 9th, 2024
- Acupuncture for Arthritis: Benefits and Risks - Verywell Health - January 9th, 2024
- Why do arthritic horses have more trouble during the winter? - EQUUS Magazine - January 9th, 2024
- Rather than roll over and die, I'm like, 'No, I still want to play': Steve Morse says arthritis diagnosis forced him to ... - Guitar.com - January 9th, 2024
- Top Signs that Your RA Treatment May No Longer Be Working - Health Central - January 9th, 2024
- What Is The Life Expectancy Of Rheumatoid Arthritis? A Review By Doctors - MSN - January 9th, 2024
- Nature Coast Orthopaedics | arthritis care | medicare and most insurance accepted | Beverly Hills, FL | chronicleonline ... - Citrus County Chronicle - January 9th, 2024
- Millions of arthritis patients could struggle to get blockbuster drug, as CVS pulls it from pharmacies - Daily Mail - January 9th, 2024
- What Is Arthritis? | Arthritis Foundation - May 17th, 2023
- Procedure to Surgery for Arthritis Is Recommended After First Failed Non-Operative Therapy - DocWire News - March 29th, 2023
- Higher Prevalence of Sarcopenia Reported in Patients with Rheumatoid Arthritis - Rheumatology Network - October 7th, 2022
- Exploring the Relationship Between Psoriatic Arthritis and Psoriasis - Dermatology Times - October 7th, 2022
- Are Tomatoes Bad For Arthritis? Here's What An MD Has To Say - Women's Health - October 7th, 2022
- Tocilizumab for Treating ICI-Induced Arthritis and Colitis - DocWire News - October 7th, 2022
- Why Arthritis Is A Clear And Present Danger, And How We Can Fight It - CNBCTV18 - October 7th, 2022
- Arthritis: Five cruciferous veg 'block inflammatory process' - backed by 10-year study - Express - October 7th, 2022
- 5 Exercise Habits for Arthritis in Your 50s - Eat This, Not That - October 7th, 2022
- Arthritis: 8 types of fish can cause acid crystals to build up in joints - 'very painful' - Express - October 7th, 2022
- EMA Issues Positive Opinion on the Safety of Filgotinib - Medscape - October 7th, 2022