Psoriatic arthritis (PsA) is an autoimmune disorder in which the body's immune system mistakenly attacks healthy cells and tissues in the joints and skin. For those genetically predisposed, a triggering event—perhaps an infection or a skin injury—sparks the immune system into overreaction. It perceives healthy skin and joint cells as "foreign" and dangerous and mounts an inflammatory counterattack.
The inflammation caused by this autoimmune response leads to joint swelling, pain, and damage. The disease can affect joints on one or both sides of the body and often resembles rheumatoid arthritis in its symptoms. PsA develops in people who already have a skin condition called psoriasis, in which inflammation causes rapid turnover of skin cells leading to scaly red patches.
PsA is a progressive disease that can worsen over time, but symptoms may improve or go away temporarily. Treatments target soothing the immune response and reducing inflammation. The goal is to slow down the assault on healthy joints and skin.
What are The Symptoms of Psoriatic Arthritis?
Joint pain, stiffness, and swelling. The joints of the arms and legs are most often affected, including knees, ankles, elbows, and wrists. The hands and neck can also be involved. The pain and stiffness tend to come and go, with flare-ups followed by periods of remission.
Skin patches. Rough, scaly red patches on the skin, especially on the knees, elbows, scalp, hands, feet, or nails. These skin lesions are a hallmark sign of psoriasis.
Nail changes. Thick, pitted, or ridged fingernails and toenails are common. Nails may loosen from the nail bed.
Swelling of fingers or toes. This occurs in about half of all people with psoriatic arthritis. Can make hands and feet feel clumsy and less dexterous.
Enthesitis. Inflammation where tendons and ligaments attach to bones. Can cause pain at sites like the Achilles tendon in the heel or plantar fascia in the sole of the foot.
Fatigue. Feeling very tired is a common symptom due to the effects of inflammation in the body and joints.
Eye inflammation. Some people develop a painful, inflamed eye condition called uveitis which requires treatment by an ophthalmologist to avoid complications.
Reduced range of motion. Joint inflammation and pain can make it difficult to move joints freely and fully. Loss of mobility and flexibility can develop over time without treatment.
What Are The Causes and Risk Factors of Psoriatic Arthritis?
Psoriatic arthritis develops in some people with psoriasis, an autoimmune skin condition. Certain factors make psoriasis more likely to progress to joint inflammation and psoriatic arthritis.
Genetics plays a significant role. Psoriatic arthritis seems to run in families, and certain HLA gene variants have been linked to a higher risk.
Smoking cigarettes is a major risk factor. Smokers have a higher likelihood of developing psoriatic arthritis, and their symptoms tend to be more severe. Quitting smoking can help improve symptoms and slow disease progression.
Obesity also contributes to inflammation and joint damage in psoriatic arthritis. Losing excess weight has considerable benefits for both joint and skin health.
Alcohol use may exacerbate signs and symptoms, so limiting or avoiding alcohol is advised.
Stress can trigger flare-ups of psoriasis and joint swelling. Stress management through yoga, meditation, or exercise may help prevent inflammation.
Digestive issues like inflammatory bowel disease increase the likelihood of psoriatic arthritis. An unhealthy gut microbiome may play a role in developing aberrant immune responses.
Trauma or injury to joints may trigger the onset or progression of psoriatic arthritis. Even minor injuries could potentially activate the inflammatory process.
How is Psoriatic Arthritis Diagnosed?
Psoriatic arthritis is diagnosed based on several factors. The first step is a physical exam to look for swollen or tender joints, as well as the characteristic skin lesions of psoriasis.
Blood tests may be requested to check for inflammation and rule out other types of arthritis. X-rays or MRI scans can detect joint damage and other signs specific to psoriatic arthritis.
However, the key diagnostic tools are the symptoms reported by the patient along with the physical exam. Psoriatic arthritis often affects the joints of the fingers and toes, causing a "sausage digit" appearance. It may also impact larger joints like the knees, ankles, elbows, hips, and spine.
Patients frequently experience pain, stiffness, and swelling in the joints. The presence of psoriasis skin lesions, especially on the nails or scalp, also helps confirm the diagnosis.
What Are The Treatments for Psoriatic Arthritis?
There are several effective treatments for PsA. The main goals of treatment are to reduce inflammation, relieve pain, inhibit joint damage, and improve physical function and quality of life. Early diagnosis and prompt treatment can help prevent permanent joint damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen to reduce inflammation and relieve pain.
Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate to slow joint damage. Can be taken orally or by injection.
Steroid injections to reduce inflammation in specific joints.
Biologic therapies or targeted immune system inhibitors such as:
Tumor necrosis factor (TNF) blockers: Enbrel, Humira, Remicade
Interleukin inhibitors: Cosentyx and Taltz
T-cell inhibitors: Orencia and Rinvoq
Joint replacement surgery to repair severe joint damage and restore mobility.
Lifestyle changes:
Lose excess weight
Exercise and physical therapy
Reduce stress
Quit smoking
Occupational therapy to improve joint mobility and flexibility
What Are The Complications and Prognosis of Psoriatic Arthritis?
Although psoriatic arthritis is a chronic lifelong condition, the prognosis today with advanced treatment options is good for well-managed patients. With proper treatment and management, most patients can control symptoms, prevent joint damage, and maintain quality of life and independence.
Close monitoring by a rheumatologist is needed to quickly modify or change treatment as needed to keep the disease in remission or prevent flares.
Some of the potential complications include:
Joint damage and permanent joint deformity. Without treatment, the inflammation from PsA can damage joints and surrounding tissues, causing deformities that limit the range of motion and mobility.
Severe pain. For some patients, PsA pain can become severe, chronic, and disabling without effective treatment. Controlling inflammation and managing pain are important to the quality of life.
Comorbid conditions. Patients with PsA are at higher risk of obesity, diabetes, high blood pressure, and cardiovascular disease. These comorbid conditions need to be monitored and managed to optimize prognosis.
Difficulty with daily activities. As the disease progresses without treatment, inflammation, and joint damage can make it difficult to walk, climb stairs, dress, and do household/personal care activities. Treatment helps prevent loss of function and independence.
Psoriatic Arthritis Treatment in Orange County
If you are suffering from the pain, swelling and skin rashes of psoriatic arthritis, OC Rheumatology & Arthritis understands what you're going through and we are here to help. Psoriatic arthritis is a serious autoimmune disease that can cause permanent joint damage and disability without proper treatment. But there is hope—new treatment options offer relief from symptoms and the ability to stop disease progression.
At OC Rheumatology & Arthritis, our board-certified rheumatologists have specialized training and years of experience specifically treating PsA and other inflammatory arthritic conditions in Orange County. We stay on the cutting edge of the latest treatment protocols to provide the most advanced care. Don't wait for your joints to deteriorate and pain robs you of mobility and quality of life. Call us now at 714-825-0891
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