Psoriatic Arthritis
Psoriasis is a chronic skin disease mediated by the immune system that appears as patches of thick, inflamed red, scaly silvery plaques. More than 40% of people with psoriasis also develop psoriatic arthritis. PSA is a type of arthritis that affects men and women equally and causes pain, swelling, and stiffness of the joints.
Risk factors for PSA
The exact cause of psoriatic arthritis is not yet known but it is believed to be due to a combination of genetic, immunologic and environmental factors. More than 7.5 million Americans have psoriasis and PSA. About 40 percent of people with psoriasis or psoriatic arthritis have family members with psoriasis or psoriatic arthritis. This means that a close relative of a patient with psoriatic arthritis is about 50 times more likely to develop the disease than an unrelated person.
Signs and symptoms
Pain, stiffness (morning stiffness more than 30 minutes) and immobility in the joints and back. Arthritis in the distal end joints of the fingers and toes as well as symmetric or asymmetric inflammatory arthritis with active synovitis. Arthritis mutilans (deforms and destroys the joints). Spondyloarthropathy (affects the joints of the spine). Enthesitis (swelling in the areas where tendons attach to bones) including the Achilles tendon, plantar fascia. Tenosynovitis when the sheaths surrounding certain tendons, mostly those in the hands and arms, become swollen. Dactylitis, when an entire finger or toe swell, also known as sausage finger or toe. Eye inflammation with eye pain and redness. There are no specific blood tests for this condition.
Treatment
Nonsteroidal anti-inflammatory medications (NSAIDs) are used to reduce the inflammation in the joints, and subsequently to relieve the pain. NSAIDs do not reduce the long term damaging effects of psoriatic arthritis on the joints (do not stop the disease progression). Disease-modifying antirheumatic drugs (DMARDs) may reduce the inflammation of PSA and can slow disease progression and prevent joint damage. Drugs in this class include methotrexate, sulfasalazine or azathioprine. This medication act slowly, in several weeks to months. The biologic medication is an advanced therapeutic option for severe PSA, working as a down-regulator of the immune system to prevent tissue damage. Anti-TNF agents bind the immune cytokine molecule named tumor necrosis factor (TNF) and include: Etanercept (Enbrel), Adalimumab (Humira), and Infliximab (Remicade). Steroidal medication is generally not recommended unless it is for a short treatment course for severe inflammatory arthritis. Narcotic analgesics such as codeine, oxycodone, and hydrocodone are generally not recommended long term, because of the risk of dependence and addiction.