Can Psoriasis Lead to Psoriatic Arthritis?

• Psoriasis causes new skin cells to develop too fast so that the shedding cannot counterbalance the formation. This results in skin cells accumulating, resulting in a thick, scaly rash that can be painful to move. 
• Psoriatic arthritis causes inflammation of the joints causing various difficulties such as stiffness, pain in the joints, and swollen skin around the joints, and may even damage the joints in the long run.

Doctors commonly suspect that genetics have a role in determining susceptibility to autoimmune illnesses, with environmental factors contributing, but the specifics of how or why are unknown. Both disorders are chronic diseases that can fluctuate between periods of remission with little symptoms and flare-ups with severe symptoms.

Psoriasis skin symptoms usually appear first followed by psoriatic arthritic symptoms. However, in 15 percent of people, symptoms of psoriatic arthritis occur months, if not years, before identifying the presence of psoriasis and its associated skin issues. Psoriasis may go undetected in some people for over a long period because of the presence of skin changes in locations such as the buttocks or back of the scalp. 

This makes it difficult to diagnose, and usually, psoriatic arthritis is misdiagnosed as other forms of arthritis such as rheumatoid arthritis. This results in improper treatment approaches. Just as psoriasis skin plaques worsen and then improve, symptoms of psoriatic arthritis may sometimes come and go.

If you are diagnosed with psoriasis, it is crucial to keep an eye out for any joint symptoms of psoriatic arthritis, such as swelling, discomfort, or stiffness. Psoriatic arthritis is a progressive condition, which means it will worsen with time. If you are identified with psoriatic arthritis early on, your doctor can prescribe various treatment options to reduce the course of the disease and help preserve your joints.

Because there is no one clinical or laboratory evidence that firmly supports a diagnosis of psoriatic arthritis, distinguishing psoriatic arthritis from other types of arthritis is crucial. 

The diagnosis of psoriatic arthritis is based on the following set of symptoms and clinical findings.

• Psoriasis: Psoriasis normally occurs 10 years before the beginning of psoriatic arthritis. In about 15 percent of individuals, symmetric rash and one or both-sided arthritis are present together or arthritis is presented before the rash.
• Psoriatic arthritis: Psoriatic arthritis is often one-sided and affects four joints. Unlike rheumatoid arthritis, it usually affects the distal joints of the fingers and toes, and every joint in a finger may be affected while adjoining fingers are spared. Sacroiliitis (inflammation of sacroiliac joints of the pelvis) and spinal involvement are common in 50 percent of people. Bone loss, joint space narrowing, eccentric erosions, and periosteal new bone development that does not contain osteophytes are all signs of joint illness on X-ray.
• Psoriatic nail disease: You must remember that those fingernails and toes are often affected by various systemic skin disorders, including psoriatic arthritis. Pitting of nails and onycholysis (separation of the nail from the nail bed) are found in 80 to 90 percent of people with psoriatic arthritis.
• Enthesitis: Along with bone inflammation, psoriatic arthritis can cause enthesitis. Enthesitis is an inflammation of the area in which a tendon or ligament attaches to a bone. It affects 30 to 50 percent of people with psoriatic arthritis. People may experience tendonitis (inflammation of the tendons) for a long period before a diagnosis of psoriatic arthritis. Enthesitis is most commonly found in the ankles, heels, and soles of the feet, but it can also occur in the knees, elbows, shoulders, hips, and any other joint affected by arthritis.
• Dactylitis: Dactylitis is the generalized swelling of a toe or finger. Dactylitis can be acute or chronic, and it affects 40 to 50 percent of people with psoriatic arthritis. The third and fourth toes are the most usually affected although the fingers are affected. Dactylitis is linked to a more severe disease progression.

Doctors may prescribe nonsteroidal anti-inflammatory drugs such as acetaminophen, ibuprofen, or even opioid drugs in cases of severe pain.

They may prescribe glucocorticoids to resolve acute episodes.

Disease-modifying antirheumatic drugs (DMARDs) such as Trexall and Otrexup (methotrexate), Arava (leflunomide), and Azulfidine (sulfasalazine) may be used in advanced cases to reduce inflammatory progression.

Biologic agents such as Humira (adalimumab), Cimzia (certolizumab), Enbrel (etanercept), Simponi (golimumab), Remicade (infliximab), Stelara (ustekinumab), Cosentyx (secukinumab), Taltz (ixekizumab), Tremfya (guselkumab), and Orencia (abatacept) may be prescribed.

A new drug called Otezla (apremilast) controls the activity of inflammation within the cells. Apremilast is used for people with mild to moderate psoriatic arthritis who do not want or cannot be treated with DMARDs or biologic agents.

Surgical and other procedures include steroid injections in affected joints and joint replacement surgeries.