Psoriatic Arthritis (cont.)

How does the doctor diagnose psoriatic arthritis?

Psoriatic arthritis is a diagnosis made mainly on clinical grounds, based on a finding of psoriasis and the typical inflammatory arthritis of the spine and/or other joints. There is no laboratory test to diagnose psoriatic arthritis. Blood tests such as sedimentation rate may be elevated and merely reflect presence of inflammation in the joints and other organs of the body. Other blood tests such as rheumatoid factor are obtained to exclude rheumatoid arthritis. When one or two large joints (such a knees) are inflamed, arthrocentesis can be performed. Arthrocentesis is a office procedure whereby a sterile needle is used to withdraw (aspirate) fluid from the inflamed joints. The fluid is then analyzed for infection, gout crystals, and other inflammatory conditions. X-rays may show changes of cartilage or bone injury indicative of arthritis of the spine, sacroiliac joints, and/or joints of the hands. Typical x-ray findings include bony erosions resulting from arthritis. The blood test for the genetic marker HLA-B27, mentioned above, can be found in over 50% of patients with psoriatic arthritis who have spine inflammation.

How is psoriatic arthritis treated?

The treatment of the arthritis aspects of psoriatic arthritis is discussed below. The treatment of psoriasis and the other involved organs is beyond the scope of this article.

Generally, the treatment of arthritis in psoriatic arthritis involves a combination of anti-inflammatory medications (NSAIDs) and exercise. If progressive inflammation and joint destruction occur despite NSAIDs treatment, more potent medications such as methotrexate (Rheumatrex, Trexall), corticosteroids, and antimalarial medications are employed.

Exercise programs can be done at home or with a physical therapist and are customized according to the disease and physical capabilities of each patient. Warm-up stretching, or other techniques, such as hot shower or heat applications are helpful to relax muscles prior to exercise. Ice application after the routine can help minimize post-exercise soreness and inflammation. In general, exercises for arthritis are performed for the purpose of strengthening and maintaining or improving joint range of motion. They should be done on a regular basis for best results.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that are helpful in reducing joint inflammation, pain, and stiffness. Examples of NSAIDs include aspirin, indomethacin (Indocin), tolmetin sodium (Tolectin), sulindac (Clinoril), and diclofenac (Voltaren). Their most frequent side effects include stomach upset and ulceration. They can also cause gastrointestinal bleeding. Newer NSAIDs called Cox-2 inhibitors (such as celecoxib or Celebrex) cause gastrointestinal problems less frequently.

Next: Disease-Modifying Medicines »