Psoriatic arthritis is a type of inflammatory arthritis that appears in some patients with psoriasis, around 15% of these patients, and can involve any joint in the body. It’s chronic. It affects men and women equally and although it usually manifests itself between the ages of 30 and 50, it can also appear in childhood. The available treatments, which are not specific but control, are usually effective.
Causes of psoriatic arthritis
Autoimmune origin
Psoriatic arthritis, like psoriasis, has its origin in an attack by the autoimmune system and hereditary factors may also have an influence. It is also noted that it could be triggered by an infection. In this case it manifests itself with pain, stiffness and inflammation in the joints. It can damage any joint in the body and affect one or several. Children with psoriatic arthritis are at risk of developing inflammation of the middle layer of the eye (uveitis).
Possible consequences of psoriatic arthritis:
– Spondylitis. It affects the spine causing stiffness in the back or neck.
– Enthesitis. Appearance of tender points at the junction of the tendons and ligaments with the bones.
– Dactylitis. Swollen fingers and toes. The nails are also affected.
– Sacroiliitis. Inflammation of the joints of the spine and pelvis.
Symptoms of psoriatic arthritis
Swollen fingers and toes and skin changes
Psoriatic arthritis affects the joints on one or both sides of the body and its symptoms are very similar to those of rheumatoid arthritis. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis.
The most common symptoms:
– Swollen fingers and toes “like sausages”.
– Changes in the skin and nails typical of psoriasis.
– Pain, inflammation and heat in the affected joint or joints.
– Pain in the points where the tendons and ligaments attach to the bones of the foot (Achilles tendinitis and plantar fasciitis).
– Lumbar pain.
Diagnosis of psoriatic arthritis
Physical examination, analysis and imaging tests
To diagnose psoriatic arthritis on physical examination, the rheumatologist will look for changes in the skin and nails, swollen joints, and patterns of arthritis. You may order blood tests to look for rheumatoid antibodies and rule out other types of arthritis such as rheumatoid arthritis, osteoarthritis, and gout. Another type of analysis is that of the joint fluid of the affected joint.
Skin tests may also be performed to confirm psoriasis by removing a tissue sample. And it can also be confirmed by imaging tests such as x-rays, MRI, ultrasound or computed tomography.
Psoriatic arthritis treatment and medication
Inflammation control
There is no specific treatment for psoriatic arthritis. Initially, the drugs of choice are non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen. If there is no response to these, disease-modifying antirheumatic drugs may be prescribed, alone or in combination, such as sulfasalazine, methotrexate, cyclosporine and leflunomide. In severe forms, immunosuppressants such as azathioprine are prescribed.
Tumor necrosis factor-alpha inhibitors can help reduce pain, morning stiffness, tenderness, and joint swelling. Some of them are etanercept, adalimumab, golimumab, certolizumab and infliximab.
Separately, there is the biological injection with secukinumab. In inflamed joints, corticosteroid injections may be helpful.
Finally, joint replacement surgery (prosthesis) can be considered in cases of severely damaged joints.
Prevention of psoriatic arthritis
Without prevention
There are no specific prevention measures except avoiding streptococcal infections, protecting the joints by avoiding unnecessary efforts from gestures and lifting weights. Maintain an appropriate weight, exercise regularly, avoid stress and try to find moments of relaxation several times a day.
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