Psoriatic Arthritis- Types, Symptoms, Diagnosis, and Treatment

Psoriatic arthritis is a disorder that combines the orthopaedic condition of Arthritis with the Autoimmune condition of Psoriasis. Psoriasis is referred to an autoimmune disorder that disturbs the life cycle of skin cells due to which, scale, reddish skin starts to develop on the skin and the scalp. Additionally, joint problems like stiffness, lack of movement and pain in joints would occur due to arthritis.

What happens first? Well, there have been cases where signs of psoriasis appear first, and then the arthritic symptoms take the highlight. However, there also have been instances where the joint issues start to crop up even before visible signs of psoriasis arrive.

The state of symptoms of psoriatic arthritis goes from mild to moderate from time to time. To that end, one might experience intense symptoms one time, and at others, there would be a period of remission. As of this movement, no cure discernable cure exists for this chronic disease. Therefore, the treatments are focused on increasing the aforementioned periods of remission.

Variants of Psoriatic arthritis

There are five types of Psoriatic Arthritis (PsA) that exist:

1. Symmetric:

This nature of PsA affects same joints of both the sides of the body. To exemplify it better, consider both your hands developing PsA. Symmetric Psoriatic arthritis is a milder variant. However, it can disable an individual. 50 % of cases that have been found were of this variant of the disease.

2. Asymmetric:

As the name might suggest, this variant of the disease effects either one of the sides of the body. Also known as distal joints, there have been 35 % of cases where this disease was held responsible.

3. Distal Interphalangeal predominant PsA:

This particular variant occurs to the joint that is closest to the fingernails. These joints are referred to as distal joints, and about 10 % of people have this particular variant of the titular disease.

4. Spondylitis PsA

Involving the entirety of the spine, the regions affected extend from the neck to the lower neck. Due to its nature, it causes movements to be extremely debilitating and painful. Furthermore, when you consider that, organs like hands, feet, legs, arms and hip are affected as well. In worst case scenarios, the debilitations pain can even be akin to paralytic.

5. Psoriatic Arthritis Mutilans

This variant is considered to be the most deforming type of Psoriatic arthritis. There only have been 5% of the cases will now that exhibited this variant of the disease. It primarily affects the hands and feels. However, it can also be debilitating to the lower back of the body.

Symptoms of Psoriatic Arthritis

PsA is a Chronic disease. To that end, there is a period where the symptoms would either enter remission or your state would improve. However, there are also periods of time where the symptoms can get even worse at times. We further established the multiple types of this disorder. This variance is a focal matter of concern. The reason for this is different types of PsA have some general, some exclusive symptoms.

1. Swollen and painful joints: the primary organs that are affected by this particular disease are ankles, knees, lower back and toes. The reason for the irradiating pain that happens in the lower back is due to Ankylosing spondylitis. This particular condition is a form of the inflammatory disease that causes the vertebrae to merge somewhat. The fingers might swell too. Due to the surprisingly hard nature of swelling, the condition can easily be mistaken as gout.
2. Morning Stiffness: Either during early morning or after a prolonged period of rest, there would be stiffness. The same issue can be attributed to rheumatoid arthritis.
3. Fingers that are swollen enough to feel like sausages: People with PsA can also develop a condition called dactylitis. It causes sausage-like swelling in the entire fingers and toes.
4. Fatigue: A symptom also prevalent in rheumatoid arthritis, fatigue is also common with PsA.
5. Reduced range of motion: Due to the stiffness that we highlighted in the second point of this list, the range of motion of the body is debilitatingly limited.
6. Eye issues: People with PsA have also been known to develop inflammation in the eyes. Consequently, they suffer irritation and disturbed vision. These symptoms are similar to the pink eye or to be scientifically accurate conjunctivitis.
7. Skin rashes and Nail changes: Psoriatic Arthritis is a conjunction between psoriasis and arthritis. To that end, there are also symptoms where certain patches of skin become riddled with rashes, redness and irritation. When such patches occur near nails, they can lift the nailbed completely.

If you have kept a close eye on the above symptoms, you would have noticed that excluding the last symptom, the rest of them point to conventional arthritis. Then how does a doctor differentiate between Osteoarthritis or Rheumatoid Arthritis from PsA? Fortunately, the next point of this article is going to delve into this particular matter.

Diagnosis for Psoriatic arthritis

There are three types of diagnostic measures employed for the dermatologist to rule out or rule in PsA. These are

1. Physical examination:
   1. Joint examination: The joints are closely examined to check for signs of tenderness or swelling.
   2. Fingernail examination: Checking the fingernails for flaking, pitting or any other sort of abnormality.
   3. Sole examination: The dermatologist presses the soles of the feet to see if there are any tender areas around the heels.
2. Imaging examination:
   1. X rays: X Rays are used to produce images that can point to the changes of joints due to Psoriatic PsA that cannot occur in any other form of arthritis.
   2. Magnetic Resonance Imaging: The MRI scan makes the use of radio waves to produce detailed images of the body’s autonomy. Whether it is the soft or hard tissues of the body, it can scrutinise all. MRI is done to check changes in tendons or ligaments.
3. Laboratory examination:
   1. RF Test: RF test of Rheumatoid Factor test is a form of a blood test. The purpose of this test is to look for markers that are exclusive to rheumatoid arthritis. If such markers are present, it becomes evident that the case is not regarding Psoriatic arthritis.
   2. JF Test: The Joint Fluid test uses extracted fluid from the affected joints as the sample for scrutiny. The goal of this test is to rule out Psoriatic arthritis by looking for uric crystals. If the case were to be of uric crystals, then this would implement that it is the case of gout, and hence PsA can be ruled out.

As you can observe, out of the three test categories, two of them are dedicated to differentiating between common arthritis from PsA.

Treatment of Psoriatic arthritis

As we discussed in the introduction, the goal of the treatment for this disease is not towards curing it, for there is no cure to be found yet. Therefore, the focus of treatment is shifted towards more fruitful endeavours, to control and manage the symptoms of this disease. There are three schools of thought as far as treatment is concerned:

1. Medicative treatments: These are the drugs that are used to treat PsA. These entails:
   1. DMARDS: DMARDs refer to Disease-modifying Antirheumatic drug. Considering that the disease has no cure, this provides an interesting approach towards treatment. Its goal is to slow down the progress of PsA. However, there are some long-term side effects to this approach.
   2. Immunosuppressants: These medications are to suppress the immune system of the body. However, they leave the body vulnerable to infections.
   3. TNF Alpha Inhibitors: This is anti-inflammatory substances that can help reduce swelling and pain in joints. However, they can increase the risk of infection as well. However, it is a form of Biologic and is worth looking into.
   4. Recent medications: Recent medications are focused on plaque psoriasis. However, they are also effective against the signs and symptoms of PsA as well.
2. Surgical treatment: if the arthritic symptoms have reached their zenith levels, then there is a need to consider surgical options as well.
   1. Joint replacement surgery: at peak levels, PsA damages the joints in a significant way. The only treatment for this is grafting prosthetics.

However, as the treatments are focused on managing the symptoms, there is another school of thought focuses on lifestyle.

1. Make sure that you conduct everyday tasks in a way that the joints are protected.
2. Make sure to maintain a healthy weight to prevent strain on the joints.
3. Exercise on a regular basis to keep your joints flexible at all times.
4. While you don’t need to be inactive, you need your proper rest as well.
5. You can follow a proper diet plan to keep psoriatic arthritis in check.

Take the aforementioned points to heart and believe that despite your issues, it is easy to lead a painless and charismatic life.

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