Psoriatic arthritis is a type of arthritis that affects some people with the skin condition psoriasis, an autoimmune disease where there are plaques with silvery scales on inflamed skin, commonly at the scalp and skin folds. It typically causes affected joints to become swollen, stiff and painful. Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse. If it’s severe, there’s a risk of the joints becoming permanently damaged or deformed, and surgery may be needed. But if psoriatic arthritis is diagnosed and treated early, its progression can be slowed down and permanent joint damage can be prevented or minimized.

Almost 1 in 3 people with psoriasis also have psoriatic arthritis. It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin related symptoms. Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.

But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not. first. It may occur in anyone, but is more likely among those with a family member with psoriasis. Aside from disease inheritance, being overweight, smoking, stress, and infections (Streptococcus, HIV) have also been shown to increase the likelihood of developing psoriatic arthritis.

Psoriatic arthritis can cause pain, swelling and stiffness in any joint in the body, but it often affects the knees, ankles, hands and feet. The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints. There may be times when your symptoms improve (known as remission) and periods when they get worse (known as flare-ups or relapses). Here’s a quick list of common signs and symptoms: 

• Painful swelling of joints, commonly the knee, ankle, hip, toes, and fingers; may affect 1, a few, or many joints and usually lasts more than 2 weeks or longer if not treated
• Sausage-like swelling of the fingers and toes
• Pain, swelling, tenderness at points of attachment of tendons and ligaments into bones, for example, at the back of the heel (Achilles tendon) or sole of the foot (plantar fascia)
• Lower back pain that is present almost daily, worse after rest, and improves with movement
• Presence of nail changes like pits, crumbling, or separation from the nail bed
• Involvement of other organs- Eye pain, redness, and blurry vision (anterior uveitis); Inflammatory bowel disease: chronic diarrhea of more than or equal to 3 months, rectal bleeding, recurrent abdominal pain, and weight loss

The diagnosis of psoriatic arthritis is based on the findings listed above in the absence of other causes of arthritis (rheumatoid arthritis, gout, infection). A family history of psoriasis is also supportive. A few blood tests and x-rays of the joint may be done to confirm the diagnosis and rule out other causes of arthritis.

Treatment for psoriatic arthritis aims to:

Relieve symptoms

Slow the condition’s progression

Improve quality of life

This usually involves trying a number of different medicines, some of which can also treat the psoriasis. If possible, you should take 1 medicine to treat both your psoriasis and psoriatic arthritis. The main medicines used to treat psoriatic arthritis are:

Non-steroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids

Disease-modifying anti-rheumatic drugs (DMARDs) (ex.Methotrexate) 

Biologic therapies

Physical therapy, exercises, joint supports, and warm or cold compresses may also help
improve function. Treatment for the skin and other diseases that are present is likewise
necessary. Usually, the care from several doctors is needed to address all of the patient’s
concerns.

There is no cure for psoriatic arthritis. However, by understanding the disease and knowing what to expect, you can learn different ways to complete daily tasks or plan activities at times of the day when you are least bothered by its effects. Once you understand and learn to predict the ways in which your body responds to the disease, you can use exercise and therapy to help decrease discomfort, stress and fatigue.

• Exercise that is appropriate for age and over-all function, especially low-impact exercises like tai chi, yoga, swimming, walking
• Physical therapy
• Occupational therapy
• Weight loss for patients who are overweight/obese
• Massage therapy
• Acupuncture
• Smoking cessation

References: National Health Service (NHS) UK

                    Psoriatic arthritis – NHS (www.nhs.uk)

                    2018 American College of Rheumatology Guideline for Treatment the Treatment of Psoriatic Arthritis

                    Firestein and Kelley’s Textbook of Rheumatology 11 th Edition. 2020

        https://creakyjoints.org/education/psoriatic-arthritis-causes-risk-factors/

https://www.hopkinsmedicine.org/health/conditions-and-
diseases/arthritis/psoriatic-arthritis