Psoriatic Arthritis

Definition

Psoriatic arthritis is a long-term problem of the joints. It causes pain and swelling in the joints. Over time, it can be damaging to the joints and lead to disability.

Psoriasis

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Causes

Psoriatic arthritis is linked to a skin condition called psoriasis. Not everyone with psoriasis will develop psoriatic arthritis. The exact cause is not known. A combination of genes and factors in the environment may play a role.

The damage to the joints is caused by the body's own immune system. The immune cells target and attack joint tissue. Conditions like this are called auto-immune diseases. It is not clear why it happens in some people.

Risk Factors

The risk of psoriatic arthritis is increased with:

• Psoriasis for 5 to 12 years
• Psoriasis with symptoms such as lesions on the scalp and pitted or dented nails
• Certain genetic factors
• A family member with psoriatic arthritis

Symptoms

Psoriasis is often present. Symptoms of psoriatic arthritis include:

• Joint pain and tenderness in one or more joints (usually feet and hands but can be any other joint)
• Joint swelling
• Joint stiffness, especially in the morning
• Red or warm joints
• Swelling of fingers or toes
• Changes in fingernails and toenails (pitting in the nails, crumbling nails, or nails separating from the nail bed)
• Pain and inflammation of tendons where they join muscles
• Back pain
• Fatigue
• Redness and pain of the eye

Diagnosis

You will be asked about your symptoms and health history. The doctor may ask about psoriasis history. A physical exam will be done. Your doctor will rule out other joint problems with the physical exam.

To look for signs of inflammation and a cause your doctor may order:

• Blood tests
• Test of the fluid in the joints

Images of the joint may also be done to look for damage. Tests may include:

• X-rays
• Ultrasound
• MRI scan

Treatment

The goal of treatment is to ease symptoms and slow damage to the joint. Options may include:

Medicine

Medicine may help to manage symptoms and flare ups. It can also slow damage to joint. Options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—to decrease pain and inflammation
• Steroid medicine to ease inflammation—may be pills or injections into joints
• Disease-modifying anti-rheumatic drugs (DMARDs)—to treat more severe symptoms and slow the progression of the disease
• Tumor necrosis factor (TNF) inhibitors—to treat more severe symptoms

Other Treatment

Physical or occupational therapy may help with movement of the joint. They can also help to find better methods for everyday tasks that cause pain.

Too much weight can cause more stress on joints. A dietitian can help to make healthy meal plans to lose weight.

Long term painful conditions can be stressful. Mental health therapy may be helpful to ease stress and anxiety.

Surgery

Surgery may be needed for severe pain and disability. It may help to remove damaged tissue and improve function of hands.

Prevention

There are no current guidelines to prevent psoriatic arthritis.