Psoriatic arthritis refers to the inflammation of joints that occurs in people who have psoriasis, an autoimmune disease in which the skin cells divide uncontrollably producing silvery scales on red patches. While psoriasis typically develops before the joint inflammation, people with the disease may experience the joint problems first before the skin problems occur.
Just as in psoriasis, the body’s antibodies attack its own tissues in psoriatic arthritis – in this case, the joints are the primary targets. The immune system attacks and damages the joint structures, causing inflammation and the corresponding symptoms.
The cause of this immune attack on the body’s own tissue is largely unknown; however, certain factors have been found to increase your risk of getting psoriatic arthritis. These include a current history of psoriasis, family history of psoriasis and psoriatic arthritis, excessive weight, and immune diseases such as HIV.
Symptoms of Psoriatic Arthritis
Psoriatic arthritis, like psoriasis, is a chronic disease with symptoms that progress over time. Some days may be good with minimal or no symptoms and other days could see you in severe discomfort from your joint symptoms.
Common symptoms of psoriatic arthritis include:
- Joint pain: Psoriatic arthritis can affect joints on one side or both sides of your body, and it can affect any joint. The most common symptom of the disease is joint pain. If it affects the ankle or foot joints, it causes foot pain; and if it affects the spine, it causes severe low back pain in a condition called psoriatic spondylitis.
- Joint swelling: Psoriasis often causes swelling of your fingers and toes. This results from inflammation in the small joints that connect your finger and toe bones – the interphalangeal joints. The swelling gives an awkward appearance to your hands and feet.
- Reduced range of motion: With psoriatic arthritis, your joints and the muscles around them become rigid, and this makes them difficult to use. In addition to the deformity that occurs, the pain also limits movement across the joint.
- Other symptoms: Psoriatic arthritis causes other symptoms that do not arise from the joints. The most common of these are nail changes. These changes include:
- Cracking of the edge of the nail
- Oil spots on the nail
- Separation of the nail from the nail bed
- Discoloration of the nails
- Abnormal horizontal ridges across the nails
- Bleeding beneath the nail
- Pits within the nail.
These nail changes occur in about 80 percent of people with psoriatic arthritis. In fact, in some people, it may be the only initial complaint.
Other symptoms of psoriatic arthritis that do not arise from the joints include fatigue, eye redness, eye pain, and a flaky scalp.
The Pattern of Psoriatic Arthritis Symptoms
The course of the disease differs between individuals. Some may only experience mild to minimal symptoms and others, severe and recurrent joint symptoms. Also, some people may experience a faster progression of joint symptoms than others.
Furthermore, the symptoms do not necessarily occur at the same time in the same person. The presence and kind of symptoms you experience depend on the stage of the disease.
Psoriatic arthritis may occur in three stages:
- Moderate stage, and
During the early stage of the diseases, you may only experience mild symptoms including joint pains and swelling. These symptoms are easily treated with over-the-counter pain relief medicines. These symptoms worsen in the moderate stage of the diseases, with the joint problems become increasingly resistant to over-the-counter pain medicines.
In the late stage of psoriatic arthritis, the bones of the joints are severely damaged and the symptoms are recalcitrant to treatment. In this situation, your doctor may consider surgical treatment.
Triggers of Psoriatic Arthritis Flare-ups
You may experience minimal symptoms of psoriatic arthritis in one day, and the next day the symptoms become surprisingly worse. Certain factors can cause these flare-ups and they differ between individuals.
Common triggers of a psoriatic arthritis flare-up include:
- Dry skin
- Infections such as upper respiratory tract infection.
- Cuts to the skin
- Heavy alcohol intake
- Cold, dry weather
- Medications, such as beta-blockers and antimalarial drugs.
To find out what your triggers are, keep a symptom diary in which you note down what you were doing when your symptoms began. Also note other changes, such as any new medication or recent stressful activities.
How to Lower your Symptoms of Psoriatic Arthritis
There is no established cure for psoriatic arthritis, therefore the goal of treatment is to improve the symptoms and prevent complications.
There are different treatment options for psoriatic arthritis and the treatment plan that is suitable for you depends on your preference and the stage of the disease. The treatment options include medicines, lifestyle and diet modifications, and surgery.
Medicines used in treating psoriatic arthritis include the following:
Nonsteroidal Anti-inflammatory Drugs: These drugs, including ibuprofen (Advil) and diclofenac, improve joint pain and swelling. These medicines are available in oral and topical forms.
Disease-Modifying antirheumatic drugs (DMARDs): Examples of DMARDs include methotrexate (Trexalll) and sulfasalazine (Azulfidine). These drugs work by lowering inflammation and slowing the progression of the disease.
Steroids: Steroids reduce the activity of the immune cells, thereby, lowering inflammation. Examples of steroids used in treating psoriatic arthritis include prednisolone and triamcinolone.
Immunosuppressants: These drugs are the mainstay for treating autoimmune diseases. They work by lowering immune activity. Examples include azathioprine (Imuran) and cyclosporine (Gengraf).
Biologic Drugs: Biologic drugs work by inhibiting the chemicals that promote inflammation in the body. Examples of these include adalimumab (Humira) and Etanercept (Enbrel)
New Therapies: New therapies are being developed to treat psoriatic arthritis more effectively. An example of this is light therapy, which uses bright light emitted from a portable device to treat joint symptoms.
Lifestyle and Diet Modifications in Psoriatic Arthritis
These are home remedies that can help to improve your symptoms. These include:
Regular exercise: Exercising every day relieves the stiffness in your joints and muscles, reducing the pain consequently. Furthermore, physical activity helps to burn extra calories, keeping your weight in check. Do low-impact exercises such as biking, swimming, and walking, as these are milder on the joints.
As part of your exercise routine, your physical therapist may also train you on some techniques to make the joints and muscles around them flexible and less painful.
Quit Smoking: If you smoke, quit; and if you do not smoke, don’t start. Smoking has been established as a trigger for psoriatic arthritis flare-ups.
Manage Stress: Stress is a common trigger factor for psoriatic arthritis flare-ups. Limit stress as much as you can by practicing mindfulness exercises, such as yoga and meditation.
Avoid Pro-inflammatory Foods: If you have psoriasis, eating foods that cause or exacerbate inflammation, such as red meat, refined sugars, refined grains, and saturated fat, may not be a good idea.
Eat less of these foods and more of diets that are rich in anti-inflammatory nutrients including vitamins, minerals, and antioxidants. These foods include fresh fruits, vegetables, fatty fish, nuts, and seeds.
Furthermore, you may also consider spices such as turmeric, ginger, and garlic, which have been shown to lower the symptoms of psoriatic arthritis.
Surgery is considered for psoriatic arthritis if other treatment methods fail. Surgery for psoriatic arthritis is of three types: joint replacement; joint fusion, where the bones that make up the joint are fused together to relieve the pain, and; Synovectomy where only the damaged joint lining is removed to ease the symptoms.
Psoriatic arthritis is a common joint problem in people with psoriasis. Its symptoms may range from mild to extremely severe. However, since there is no cure for it, people with the condition have to take proactive steps to improve the symptoms and prevent complications.