Psoriatic arthritis

What is Psoriatic arthritis?

Psoriatic arthritis is an autoimmune inflammatory disease involving the ligaments, tendons, fascia, and joints. It is diagnosed in a small percentage of persons with psoriasis. Genetic and environmental factors (trauma) predispose the development of psoriatic arthritis.

Psoriatic arthritis is characterized by greater involvement of the joints of the upper limb, especially the hands. Small joints of the feet, and large joints of the legs, such as hips, knees, and ankles, may be also involved. Unlike other types of arthritis, most joints are spared with only a few being affected at one time.

How is it diagnosed?

History of psoriasis is present. In addition, stiffness, arthritis, and contractures, mostly of small joints of the hand and feet, occur. The individual complains of nonspecific foot pain, elbow pain, or pain in the ankle and spine (tenosynovitis and enthesopathy).

Physical exam: Swelling, and in severe, chronic cases, deformity of the joints, especially on the fingers, can be observed. Nails may be pitted or crumbling, and characteristic psoriatic changes may be seen elsewhere on the skin.

Tests: No currently recognized laboratory findings are diagnostic of psoriatic arthritis. The erythrocyte sedimentation rate is increased, and nonspecific anemia of chronic disease may be present. X-ray and CT scanning are required for diagnosis.

How is Psoriatic arthritis treated?

Treatment includes nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs and variety of other medications, as well as phototherapy and physical therapy. Surgery (hip or knee replacement) is indicated in severe cases.

Medications

Imuran (Azathioprine), Motrin (Ibuprofen), Arava (Leflunomide), Celebrex (Celecoxib), Voltaren (Diclofenac), Indocin (Indomethacin), Rheumatrex (Methotrexate), Azulfidine (Sulfasalazine)

Activity

Rest inflamed joints during flare-ups, then resume your normal activities gradually. Try to increase outdoor activity in sunshine.

What might complicate it?

Development of severe destructive arthritis may complicate psoriatic arthritis. Also, side effects of drugs used in therapy of psoriatic arthritis may cause liver and lung damage.

Predicted outcome

Psoriatic arthritis is a chronic disease, lifelong and recurrent.

Alternatives

When there is no evident psoriasis, the clinical features of psoriatic arthritis strongly resemble rheumatoid arthritis or ankylosing spondylitis.

Appropriate specialists

Rheumatologist and general surgeon.

Last updated 8 August 2015