Information on Psoriatic Arthritis
Psoriatic arthritis is related to the skin condition psoriasis. It causes pain and swelling in some joints and scaly skin patches on a number of places on the body. About 10 to 30 percent of people who have psoriasis will develop this type of arthritis. Psoriatic arthritis can occur at any age in men and women, but it is more common in people between the ages of 20 and 50.The term “psoriatic arthritis” denotes a heterogenous group of arthritides ranging from peripheral monarticular, oligoarticular and polyarticular disease, to axial skeletal involvement. Yet, despite this apparent clinical heterogeneity, these various presentations are unified in their occurrence in individuals with cutaneous manifestations of psoriasis, rheumatoid factor sero-negativity, similar human leukocyte antigen (HLA) associations and radiographic similarities.
Causes
The cause of psoriatic arthritis is currently unknown. A combination of genetic and immune as well as environmental factors are likely involved. In patients with psoriatic arthritis who have arthritis of the spine, a gene marker named HLA-B27 is frequently, but not always, found. Blood testing is now available to test for the HLA-B27 gene. Several other genes have also been found to be more common in patients with psoriatic arthritis. Certain changes in the immune system may also be important in the development psoriatic arthritis.
The cause of psoriatic arthritis is unknown. As in psoriasis, genetic factors appear to be involved. People with psoriatic arthritis are more likely than others to have close relatives with the disease, but they are just as likely to have relatives with psoriasis but no joint disease. Researchers believe genes increasing the susceptibility to developing psoriasis may be located on chromosome 6p and chromosome 17, but the specific genetic abnormality has not been identified.
Symptoms
Pain in joints on both sides of your body. Symmetric psoriatic arthritis usually affects four or more of the same joints on both sides of your body. More women than men have symmetric psoriatic arthritis, and psoriasis associated with this condition tends to be severe.
Pain in your finger joints. Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. DIP affects the small joints closest to the nails (distal joints) in the fingers and toes.
Symptoms associated with psoriatic arthritis vary in how they occur (i.e. symmetrical or asymmetrical) and what joints are affected. Any joint in the body can be affected. When psoriasis causes pitting and thickened or discolored fingernails, the joints nearest the fingertips are likely to become arthritic.
Treatments
The underlying process in psoriatic arthritis is inflammation, therefore treatments are directed at reducing and controlling inflammation. NSAIDs such as diclofenac and naproxen are usually the first line medication. Other treatment options for this disease include joint injections with corticosteroids - this is only practical if a few joints are affected. If acceptable control is not achieved using NSAIDs or joint injections then second line treatments with immunosuppressants such as methotrexate are added to the treatment regimen. An advantage of immunosuppressive treatment is that it also treats the psoriasis in addition to the arthropathy.
If your doctor prescribes a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin, Ibuprin, Advil, Excedrin IB), and you have morning stiffness, the best time to take the drug may be in the evening after dinner and again when you wake up. Taking these medications with food will reduce stomach upset. Do not take them within an hour of bedtime.
