What Is Psoriatic Arthritis

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What Is Psoriatic Arthritis

Arthritis psoriatic arthritis is a disease characterized by an inflammation chronic joint. As the name suggests, it is often associated with psoriasis; in particular, it affects about 30% of people with this inflammatory skin disease. In this article, we will give you a complete guide about what is psoriatic arthritis.

Psoriatic arthritis can affect any joint in the body and typically presents with limited symptoms, such as pain, swelling, and joint stiffness. Early identification, diagnosis, and treatment are therefore essential to control inflammation and limit joint damage.

What is psoriatic arthritis: Causes

What are the causes of psoriatic arthritis?

The exact causes of psoriatic arthritis are not yet known. However, some factors have been identified that may be involved in its pathogenesis. In particular, it is believed that the immune system of genetically predisposed subjects can attack the joints and other healthy tissues. It is causing the onset of an inflammatory process, such as certain environmental factors (prolonged exposure to sunlight), trauma, surgery, infections, etc.

Psoriatic arthritis is typically associated with psoriasis and related familial predisposition. Recall that psoriasis is a chronic inflammatory skin disease, neither infectious nor contagious, characterized by abnormal and often incomplete keratinization. At the affected skin areas, reddened, delimited, and: raised patches to arise, covered with silver-colored or opalescent desquamations ( plaques ).

The sites most commonly affected by psoriasis are elbows, knees: the palm, sole, lumbar region, scalp, and nails. In most cases, this skin disease precedes the onset of psoriatic arthritis; less frequent is the opposite situation (start of the joint condition at the same time as psoriasis or before it). Most patients develop psoriatic arthritis between the ages of 30 and 50. However, the disease can occur at any age and is unusual in children.

What is psoriatic arthritis: Signs & Symptoms

Psoriatic arthritis: how does it manifest itself?

Psoriatic arthritis can progress gradually, with mild symptoms, or rapidly, into a severe form. Clinical signs can affect specific or different joints on the same or both sides of the body. Psoriatic arthritis generally involves one or more joints of the hands and feet. And occurs mainly at the distal level (i.e., at the ends of the fingers, near the nail ). However, it can also affect the wrists, elbows, knees, ankles, and spine.

Generally, at least one of the following symptoms appear in psoriatic arthritis:

  • Generalized fatigue.
  • Pain, swelling, and stiffness (especially in the morning) in one or more joints sometimes.
  • Homogeneous swelling of a finger or toe due to inflammation of the tendons and joints ( dactylitis)
  • Pain in and around the feet and ankles, especially tendonitis in the Achilles tendon or plantar fasciitis in the sole of the foot.
  • Nail changes (psoriatic onychopathy): separation of the nail from the nail bed, streaks and cracks, or loss of the nail itself ( onycholysis ).
  • Pain in the sacrum area (lower back, above the tailbone ).
  • Movement reduction.
  • Headache and pain in the jaw.
  • Talalgia (heel pain) and Achilles tendonitis.
  • Bursitis (inflammation of the serous bags).
  • Enthesitis (inflammation of the bone insertion point of the tendons).
  • Ocular involvement (example: conjunctivitis, with redness and itching of the eyes ).

Main common Symptoms 

The impact of psoriatic arthritis on quality of life depends on the joints affected and the severity of the symptoms. In both psoriasis and joint condition, phases of active disease can alternate with periods of remission. Persistent inflammation can cause damage to the joints involved and, in the most severe forms, can develop into a disabling disease. Early diagnosis and available treatments are essential to avoid or slow down the effects of the condition.

Typical symptoms of psoriatic arthritis are pain, swelling, and stiffness in the joints. The joints most affected are those of the hands and the spine. Symptoms can be mild or severe and, as in psoriasis, can alternate with periods of remission. Which arthritis resolves spontaneously. Thus appearing more similar to the symptoms of rheumatoid arthritis. But in most cases, the most typical manifestations I’m:

  • pain and swelling in the fingers and toes, with a sausage-like appearance ( dactylitis ).
  • Lumbar pain with the inflammatory character or buttock pain is related to the formation of inflammation of the joints between the vertebrae ( spondylitis ) and of the sacroiliac joints ( sacroiliitis ).
  • Both psoriasis and what is psoriatic arthritis are chronic diseases in which periods in which symptoms worsen (flare) alternate with periods in which the condition is in remission.
  • Psoriatic arthritis can also affect other organs in the body, such as the eyes, heart, lungs, and kidneys.

Humanitas has a great interest in psoriatic arthritis and prepares courses dedicated to the disease alongside laboratory research studies to discover its cause. Furthermore, Humanitas participates in clinical trials for new and modern drugs for the treatment of the disease and in the international group for the study and treatment of psoriatic disease.

What is psoriatic arthritis: Classification

Forms of Psoriatic Arthropathy

Based on the joints involved, five different types of psoriatic arthritis can be distinguished:

  • Asymmetric oligoarthritis: affects about 70% of patients; typically, it is mild and involves fewer than three large and small joints.
  • Rheumatoid-like arthritis (symmetrical polyarthritis): represents about 25% of cases and is disabling in about 50% of cases; it affects the joints of the body in a balanced way, with inflammation that simulates rheumatoid arthritis.
  • Mutilating arthritis: it is aggressive and deforming arthritis, characterized by osteolysis (destruction of bone structures). This rare condition can progress over the course of months or years, causing severe damage to the joints.
  •  But can also affect the hands and feet, similar to symmetrical arthritis.

Diagnosis

Psoriatic arthritis: how is it diagnosed?

Diagnosis is made primarily on a clinical basis, but prior exclusion of other similar conditions is desirable. A rheumatologist can accurately define the patient’s clinical picture using medical history, physical exams, blood tests, and imaging techniques ( magnetic resonance and x-rays ), including gout, osteoarthritis, and rheumatoid arthritis. In patients with what is psoriatic arthritis, blood tests may reveal mild anemia (decreased hemoglobin and red blood cells ).

Factors that help confirm the diagnosis of psoriatic arthritis include:

  • Overt psoriasis (often, the skin disease precedes psoriatic arthritis).
  • Positive family history of psoriasis or what is psoriatic arthritis (especially if the patient has a close family member with one of the conditions).
  • A positive result for high sedimentation rate (indicates the presence of an inflammatory process) and C reactive protein (highlights the presence of acute inflammation ).
  • Involvement of the distal interphalangeal joints (NOT characteristic of rheumatoid arthritis).
  • Typical skin and nail changes characteristic of psoriasis and psoriatic arthritis (psoriatic onychopathy).

Some characteristic manifestations allow us to distinguish psoriatic arthritis from other arthropathies; these hallmarks include dactylitis (the so-called “sausage finger” ) and enthesitis—inflammation of the bony insertion site of tendons and ligaments. The latter condition occurs most frequently in the Achilles tendon (in the back of the heel) or in the plantar fascia (in the lower part of the feet).

MRI and ultrasound of symptomatic joints can be helpful in detecting in detail signs of inflammation in different joint structures. The X-rays conventional are not generally useful for diagnosis in the early stages of the disease. But showed characteristic changes after months or years after the onset of symptoms.

Treatment

Psoriatic arthritis treatment helps relieve pain, reduce swelling, protect joint function, maintain mobility, and prevent further damage. Medical therapy depends on the type of psoriatic arthritis in progress, its severity, and reaction to treatment.

But there is a tendency to use disease-modifying antirheumatic drugs (DMARDs) or biological response modifiers (MRDs), which are useful for preventing irreversible joint degeneration. Reasonable psoriasis control can be helpful in the treatment of what is psoriatic arthritis.

Non-steroidal anti-inflammatory drugs (NSAIDs)

 Typically, the first therapeutic approach involves prescribing NSAIDs, such as ibuprofen and naproxen.  Long-term use of NSAIDs can lead to stomach and intestinal disorders. Other potential adverse effects include damage to the kidneys and cardiovascular system.

Disease-modifying antirheumatic drugs (DMARDs)

If arthritis is severe and unresponsive to NSAIDs, disease-modifying antirheumatic drugs (DMARDs) may be prescribed. DMARDs help slow the progression rather than reducing pain and inflammation. This class of drugs helps limit the extent of damage to bones, tendons, ligaments, and cartilages.

Most DMARDs act slowly and can take weeks or up to 4-6 months to produce a full effect. Sometimes, you may need to take a combination of these medicines. These immunosuppressive drugs can also reduce the skin symptoms of psoriasis.

Biological Response Modifiers (MRBs)

Recently, using recombinant DNA technology, a new class of drugs, called biological response modifiers (MRBs), has been developed.

Biological response modifiers prescribed for this are TNF-α inhibitors – including infliximab, golimumab, etanercept, adalimumab, certolizumab – administered by intravenous injection. Other drugs used to treat what is psoriatic arthritis are: ustekinumab (IL-12 and IL-23 antagonist ) and secukinumab (IL-17 inhibitor).

MRB drugs act on specific targets with a different mechanism of action from traditional DMARDs. Which instead impacts the entire immune system. 

  • Psoriatic arthritis did not respond to at least two different types of DMARDs.
  • Side effects include skin reactions at the injection site, increased susceptibility to infections, nausea, fever, headache, and, more rarely, nervous system disorders, blood disorders, or some cancers.

For further information: Drugs for the treatment of psoriatic arthritis.”

Other treatments

In some cases, the doctor may proceed with a corticosteroid injection to help temporarily reduce inflammation in a joint. Surgery can correct the malformations and mutual destruction by replacing the affected joint with an artificial prosthesis.

Many people with arthritis develop joint stiffness and muscle weakness due to lack of use. L ‘ exercise helps keep joints flexible and improves overall health. Maintaining a healthy weight and managing associated conditions (example: hypertension ) are equally important aspects of treatment for psoriatic arthritis. A walking aid supports and insoles can help protect joints and avoid undue stress on the feet, ankles, or knees affected.

FAQ- Question Answer

What are the causes of psoriatic arthritis?

The causes are not entirely clear. It is thought that a common autoimmune mechanism is at the basis of both skins and joint manifestations, although specific autoantibodies have not been identified to date, all with the sharing of genetic and environmental factors.

What are the symptoms of psoriatic arthritis?

The symptoms of psoriatic arthritis are those of joint inflammation ( pain, stiffness, and swelling of the joints ). Although this disease can, in some cases, resemble a lot of rheumatoid arthritis, there are some factors that distinguish it:

  • joint involvement is often asymmetrical
  • there may be involvement of the spine (typical are lumbar pain upon awakening).

How can psoriatic arthritis be detected?

The diagnosis is made on the basis of symptoms and physical examination, obviously taking into account the patient’s clinical history (familiarity with psoriasis).

Since there are no specific blood tests for diagnosis, the rheumatologist usually uses imaging tests such as ultrasound and MRI. However, blood tests will be necessary before starting treatment to check for any caution or contraindications.

How can psoriatic arthritis be treated?

If you have psoriasis and you experience pain in the joints. Especially when young (remember that in the elderly, even with psoriasis. The painful joint symptoms are generally of arthritic origin ), it is essential to visit a doctor.

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