psoriatic arthritis
Although the exact cause of psoriatic arthritis is unknown, researchers believe it involves a complex mechanism of genetics, environmental factors, and the immune system.

What exactly causes psoriatic arthritis (PsA) remains unknown. There is a complex mechanism that involves genetics, environmental factors, and the immune system.

There are some common mechanisms involved in the development of psoriasis and psoriatic arthritis. However, some differences do exist because not all medications that work in psoriasis work for psoriatic arthritis. Nearly 40 percent of patients with either of the two conditions have a family history of either of them.

  • Genetics plays a major role in the development of psoriasis and psoriatic arthritis. The HLA-B*27 antigen present on chromosome 6 is affected and has an increased expression in PsA patients, which hints at genetically mediated immune dysfunction.
  • Trauma can increase the risk of psoriatic arthritis because many patients identified trauma before developing joint pain in psoriatic arthritis. Heavy lifting and increased body weight may increase the risk of psoriatic arthritis.
  • Studies suggest that patients with psoriatic arthritis have an increased level of a substance called tumor necrosis factor (TNF) in their joints. These increased levels alter the immune system, which may lead to the development of psoriatic arthritis.
  • Disturbances in the good bacterial colonies in the gut harm immunity, especially the T cells. Altered composition and function of gut and skin microorganisms are linked to diseases including spondyloarthritis, psoriasis, and inflammatory bowel diseases.
  • Studies suggest that certain infections may cause psoriasis and psoriatic arthritis. The human immunodeficiency virus and streptococcal infection have been reported to trigger psoriatic episodes.

What does psoriatic arthritis pain feel like?

Psoriatic arthritis pain may be felt more if the affected joint is just touched or pressed. This sign is called tenderness of joints.

Other signs and symptoms include:

  • Joint stiffness
  • Joint swelling
  • Swelling over the joints
  • Swollen fingers or toes
  • Patches of red, itchy skin
  • Thick silver or gray scaly areas (flakes) on the skin, especially on the joints
  • Pitting of fingernails or toenails
  • Redness and swelling in the eye

A study published in the journal PLoS One (2015) found that the joint pain and fatigue reported by patients with psoriatic arthritis was significantly greater than that reported by people with rheumatoid arthritis.

How is psoriatic arthritis treated?

Psoriatic arthritis is a chronic condition, and it has no cure. However, getting it treated and following certain precautions can certainly help reduce the severity of its signs and symptoms.

It is ideal to consult a rheumatologist, who is a doctor who specialized in treating the condition of the bones, joints, ligaments, and tendons affected by the immune system.

By looking at the medical history and existing signs and symptoms, the specialist will design a customized plan that involves:

  • Medications
  • Physiotherapy
  • Occupational therapy
  • Massage
  • Rest
  • Devices to support the joints (orthotic devices such as braces and splints)
  • Surgery

Massage, occupational therapy, and physiotherapy can help relieve the pain and stiffness and restore joint mobility.

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What is the best drug for psoriatic arthritis?

There is not a single drug that is universally best for all patients. The doctor may initially try various medications in the treatment of psoriatic arthritis. After the doctor finds out which medications work best, one can expect a major improvement in joint pain and inflammation within a year.

Some medications help reduce the swelling and pain, whereas others help prevent relapses and further damage to the joint.

2 medications for rapid relief of pain and swelling

  1. Nonsteroidal anti-inflammatory drugs (NSAIDs)
  2. Steroids

4 stronger medicines for psoriatic arthritis

  1. Disease-modifying antirheumatic drugs (DMARDs)
  2. Immunosuppressants
  3. Biologics (tumor necrosis factor-alpha inhibitors)
  4. Newer drugs

Studies suggest that the medications a doctor prescribes for psoriatic arthritis can help prevent the development of other inflammatory conditions, such as high cholesterol or hyperlipidemia, heart disease, and diabetes.

Do not be tempted to discontinue the medications even after experiencing considerable relief in joint pain. Remember, a disease-free period does not mean that psoriatic arthritis has been gone completely. Stopping treatment without consulting the doctor can lead to the recurrence of the previous signs and symptoms within a few months.

When these measures fail to provide adequate relief from psoriatic arthritis, surgeries that help repair the joints may be the only option left.

How is psoriatic arthritis diagnosed?

The doctor will ask about your symptoms and their duration. They will examine the joints and overall body and look for signs and symptoms.

There is no such test that can confirm a diagnosis of psoriatic arthritis. The doctor will first try to rule out other joint conditions such as rheumatoid arthritis. It is only through analysis of physical examination, medical history, blood tests, and imaging tests that a diagnosis of psoriatic arthritis can be made.

Blood tests

  • Rheumatoid factor (RF). Having a high RF level may indicate rheumatoid arthritis and not psoriatic arthritis.
  • Uric acid levels. High blood levels of uric acid are seen to be elevated in patients with gout.
  • Erythrocyte sedimentation rate (ESR or sed rate). High ESR levels coupled with symptoms, such as painful and swollen joints, point toward an inflammatory joint condition.
  • C-reactive protein (CRP). An elevated level of CRP points toward a diagnosis of psoriatic arthritis.
  • Anti-cyclic citrullinated peptide (CCP) antibody. A high level of anti-CCP antibody indicates rheumatoid arthritis.
  • HLA-B27. About 60 to 70 percent of people with psoriatic arthritis-associated spine problems (spondylitis) are positive for HLA-B27.
  • Joint fluid test. The doctor inserts a needle into one of the affected joints (mostly the knee) to remove a small sample of the fluid from the joint. The sample is sent to the laboratory and is viewed under a microscope. The presence of uric acid crystals in the fluid indicates gout.

Imaging tests

  • X-rays. Changes characteristic of psoriatic arthritis may be found in the X-rays of the affected joints.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and strong magnetic fields to provide detailed images of joints, ligaments, and tendons in the body.
  • Bone mineral density or BMD test (dual-energy X-ray absorptiometry or DEXA scan). Psoriatic arthritis and medications used to treat the condition increase the risk of developing thin and brittle bones, a condition called osteoporosis. Osteoporosis increases the chances of fracture on sustaining falls.

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Medically Reviewed on 3/29/2022
References
Image Source: iStock Images

Hammadi AA. Psoriatic arthritis. Medscape. https://emedicine.medscape.com/article/2196539-overview

Gladman DD, Ritchlin C. Pathogenesis of psoriatic arthritis. UpToDate. https://www.uptodate.com/contents/pathogenesis-of-psoriatic-arthritis?search=psoriatic%20arthritis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3