Psoriatic Arthritis (PsA)

What Is Psoriatic Arthritis (PsA)?

• Psoriatic arthritis is a chronic disease characterized by a form of inflammation of the skin (psoriasis) and joints (inflammatory arthritis) that features red patches of skin topped with silvery scales and nail abnormalities. Psoriatic arthritis can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis.
• Psoriatic arthritis can develop at any time, but it most commonly appears between the ages of 30 and 50. Genes, the immune system and environmental factors are all believed to play a role in the onset of the disease.
• It occurs when your immune system mistakenly starts attacking healthy joints and the skin, causing symptoms that may range in severity from patient to patient. Like psoriasis, psoriatic arthritis symptoms flare and subside, vary from person to person, and even change locations in the same person over time.
• No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling. Early diagnosis is important to avoid damage to joints. Physical activity helps maintain joint movement.

There are 5 types of psoriatic arthritis:

• Symmetric arthritis
• Spondylitis
• Asymmetric arthritis
• Arthritis mutilans
• Distal interphalangeal predominant

What Are The Causes Of Psoriatic Arthritis?

• Cause of psoriatic arthritis is not known exactly.
• Psoriatic arthritis can also result from an infection that activates the immune system. While psoriasis itself is not infectious, it might be triggered by a streptococcal throat infection.

Science Of Psoriasis

• A normal immune system protects the body against “invaders” by destroying bacteria, viruses and other foreign proteins. In the person who has psoriasis, the immune system “misfires” and inappropriately causes inflammation and an accelerated growth of skin cells.
• Immune cells are activated and produce too much of a protein such as tumor necrosis factor -α(TNFα),this protein causes inflammation in the skin, which can cause skin cells to grow too quickly.

Symptoms Of Psoriatic Arthritis?

• Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.
• Swollen fingers and toes- Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. Distal interphalangeal predominant psoriatic arthritis involves primarily the small joints in the fingers and toes closest to the nail.
• Foot pain- Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
• Discomfort, stiffness, pain, throbbing, swelling, or tenderness in one or more joints.
• Reduced range of motion in joints.
• Morning stiffness and fatigue.
• Silver or gray scaly spots on the scalp, elbows, knees, or the lower spine.
• Inflammation or stiffness in the lower back, wrists, knees, or ankles, or swelling in the small joints in the fingers and toes closest to the nail, giving these joints a sausage-like appearance (dactylitis).
• Pitting (small depressions) of the nails.
• Detachment of fingernails or toenails.
• Tenderness, pain, or swelling where tendons and ligaments attach to the bone (enthesitis).
• Inflammation of the eye.

How Does Your Doctor Diagnose PsA?

• There is no single test for psoriatic arthritis. However, it is easier to diagnose if you have psoriasis along with red, swollen fingers or toes, and if your nails and skin are affected along with your joints.
• The symptoms of PsA can be similar to other forms of inflammatory arthritis. In order to rule out other forms of arthritis, your doctor will perform a physical examination and order other tests, such as blood work and X-rays to help confirm the diagnosis. MRI, ultrasound or CT scans can be used to look at the joints in more detail.
• Establishing an accurate diagnosis is very important because there are many treatment options to manage the symptoms of PsA. Occasionally skin biopsies (small samples of skin removed for analysis) are needed to confirm the psoriasis

Psoriatic Arthritis Treatment

Psoriatic arthritis can be treated with a number of different medicines.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
• Corticosteroids
• Disease-modifying antirheumatic drugs (DMARDs) like methotrexate
• Topical skin treatments
• Phototherapy

But if you’re still experiencing joint pain and red, scaly skin patches called plaques , you may want to talk with your doctor about biologics. Exemptia (contains adalimumab) is a biologic disease-modifying antirheumatic drug, also called a biologic DMARD, or simply biologic which blocks TNF-α which causes inflammation and tissue damage, Exemptia works on the immune system to help slow the growth of excess skin cells and to reduce joint pain and inflammation