Psoriatic arthritis is a type of inflammatory arthritis that affects almost 30% of people suffering from the chronic skin condition, psoriasis. It occurs more commonly in patients with tissue type HLA-B27. Seventy percent of people who have psoriatic arthritis first show signs of psoriasis on the skin. Others develop both skin and joint disease at the same time, or develop skin symptoms later. Psoriatic arthritis appears about ten years after the first signs of psoriasis, the majority being between the ages of 30 and 55, but can also affect children. Men and woman are affected equally by this condition. Psoriasis and psoriatic arthritis is more common in Caucasians than African or Asian Americans. More than eighty per cent of people with psoriatic arthritis will have nail lesions, separation of the nail from the nail bed, cracking, or even loss of the nail.
The cause of psoriatic arthritis is unknown but a combination of genetic, environmental, and immune factors are involved. Blood testing is available to track the genes that are responsible. Immune system malfunction may also be a factor in the development of psoriatic arthritis; the decline in the number of immune cells called helper T cells in people with aids. Infectious agents and environmental factors are being explored in the cause of psoriatic arthritis. It usually involves the knees, ankles, and the joints of the feet, with only a few joints inflamed at the same time.
The inflamed joints are painful, hot, swollen, and red, often causing swelling of the entire digit. In the morning, joint stiffness is worse. Psoriatic arthritis is also known to attack the spine (spondylitis) and the sacrum, causing pain and stiffness in the lower back, buttocks, neck, and upper back. Inflammation can also occur in the chest wall, tendons (tendinitis), eyes, lungs, aorta, and the iris (iritis), the colored portion or the eye. If the iris is inflamed, it can be aggravated by bright light as the iris opens and closes the opening of the pupil.
To decrease inflammation and prevent blindness, corticosteroids are sometimes necessary, and are injected into the eyes. Pleuritis (inflammation of the lungs) may also occur, causing chest pain and shortness of breath. Inflammation of the aorta (aortitis) can cause leakage of the aortic valve, leading to shortness of breath and heart failure. Nail changes, such as pitting and ridges, are also commonly seen in psoriatic arthritis. SAPHO Syndrome is also occurring with psoriatic arthritis. This new syndrome is derived from the following; inflammation of the joint lining (synovitis), acne and pustules on the feet or palms, thickened and inflamed bone (hyperostosis), and bone inflammation (osteitis).
There is no laboratory test to diagnose psoriatic arthritis although blood tests may reflect the presence of inflammation in the joints and other organs in the body. Blood tests for the gene HLA-B27, is often performed and can be found in over fifty per cent of patients with psoriatic arthritis who have spine inflammation. When a large joint is inflamed, arthrocentesis can be performed. This is an office procedure whereby a sterile needle is used to withdraw fluid from the joint. The fluid is then analyzed for inflammatory conditions. X-rays may also show changes in cartilage or bone indicating some form of arthritis.
Treatment of psoriatic arthritis consists of a combination of anti-inflammatory medications (NSAIDs) and exercise. If inflammation and joint destruction continue more potent medications are employed such as; methotrexate, corticosteroids, and antimalarial medications. Exercise programs can be done with a physical therapist or at home. The exercise regimen is customized according to the disease and physical capabilities of each individual. Stretching, heat applications, and a hot shower are helpful to relax muscles before exercising. After the routine ice application can help minimize soreness and inflammation. Exercises are performed for the purpose of strengthening and improving joint range of motion and should be done on a regular basis.
NSAIDs are a group of medications that are helpful in reducing joint inflammation, pain, and stiffness from psoriatic arthritis. These include aspirin, indomethacin, tolmetin, sulindac, and diclofenac. Side effects could include stomach upset, ulceration, and gastrointestinal bleeding. Newer NSAIDs called celebrex or celecoxib cause gastrointestinal problems less frequently. Disease-modifying medications are important to prevent progressive joint destruction and deformity, in patients with psoriatic arthritis. These medications include methotrexate, which can be given by injection on a weekly basis or taken orally. It can cause liver damage and bone marrow suppression with long term use. Liver blood tests and regular monitoring of blood counts should be done during therapy with methotrexate. There are a number of medications that can be prescribed for psoriatic arthritis and psoriasis. Another way of treatment is homeopathic therapy. It has been proven to benefit many diseases naturally, with detoxing side effects.