What Is Psoriatic Arthritis Video
Psoriatic arthritis can cause pain, swelling and stiffness inand around your joints.
It usually affects 3 in 10 people who already have the skin condition psoriasis .
Psoriasis causes patches of red, flaky skin which is covered with silvery-like patches.
Some people may develop psoriatic arthritis before the psoriasis is even present. In rare cases people have psoriatic arthritis and never have any noticeable patches of psoriasis.
Psoriatic arthritis and psoriasis are both autoimmune conditions, caused by a fault in the immune system.
Our immune system protects us from illness and infection. But in autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body, often causing inflammation.
Psoriatic arthritis is a type of spondylarthritis. This is a group of conditions with some similar symptoms.
Spinal Arthritis May Contribute To Other Issues In The Spine
Spinal arthritis may cause bone spurs overgrowths on the edges of the bones. In the spine, bone spurs particularly affect facet joints, making them grow larger. This condition is called facet joint hypertrophy. Although bone spurs on their own are not harmful, they may narrow the passages for the spinal cord and the nerves exiting the spine. This may lead to two painful conditions:
Spinal stenosis compression of the spinal cord inside the spinal canal
Radiculopathy pinching of the peripheral nerves as they exit the spine
Ankylosing spondylitis may also cause additional problems such as:
Stress fractures in places where new bone has formed
A spinal deformity called kyphosis
What Are The Symptoms Of Psoriatic Arthritis
Psoriatic arthritis can cause several different symptoms around the body. People will often have two or more of these symptoms, and they can range from mild to severe.
Some of the main symptoms include:
- swelling in one or more joints
- joint stiffness which feels worse when you get up after a rest and lasts longer than 30 minutes.
These symptoms are caused by inflammation inside a joint. This is known as inflammatory arthritis.
Any joint can be affected in this way. See below for the most commonly affected joints.
Psoriatic arthritis can cause pain and swelling along the bones that form the joints. This is caused by inflammation in the connective tissue, known as entheses, which attach tendons and ligaments to the bones. When they become inflamed its known as enthesitis.
Enthesitis pain can spread over a wider area rather than just inside a joint. Affected areas can feel tender if you touch them or if theres just a small amount of pressure on them. It commonly occurs in the feet. This can happen at the back of the heel or on the bottom of the foot near the heel. In some cases, this pain can make standing or walking difficult.
The knees, hips, elbows and chest can also be affected by enthesitis.
People with psoriatic arthritis can have swollen fingers or toes. This is known as dactylitis, or sausage digit, because it causes the whole finger or toe to swell up. It most commonly affects one or two fingers or toes at a time.
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Beyond Joints: How Psoriatic Arthritis Affects The Body
This autoimmune, inflammatory disease can reach beyond skin and joints to attack organs and more.
Joint pain is a big part of living with psoriatic arthritis . But the inflammation that affects your joints can cause problems for other organs and tissues, too, and comorbidities, or conditions that often occur with PsA, including obesity and diabetes, bring additional effects not directly related to joints. Youll probably think of skin issues first, but your eyes, heart, lungs, gastrointestinal tract , liver and kidneys may also be affected.
Skin. Psoriasis appears first in 60% to 80% of patients, usually followed within 10 years but sometimes longer by arthritis. Some people are diagnosed with both diseases at the same time, and 10% to 15% have psoriatic arthritis symptoms before psoriasis. Psoriasis creates thick, reddish, inflamed patches of skin, often with silvery-white scales. These patches, which sometimes itch and burn, may appear anywhere on the body, but are most common on the elbows, knees, scalp, back, face, palms and feet. Its considered severe when more than 10% of the body is covered.
Lungs. The inflammation that causes PsA may also harm your lungs, causing a condition known as interstitial lung disease that leads to shortness of breath, coughing and fatigue. This condition occurs less frequently with PsA than with certain other rheumatic diseases, such as rheumatoid arthritis.
Last reviewed 4/21/2021
How Painful Can Psa Get
In a 2018 review of research, scientists found that people with PsA report high levels of pain and functional disability. This affects their ability to work and do day-to-day activities. It may also have an impact on their sleep, levels of fatigue, and overall quality of life.
When scientists asked people from 13 countries to rank the impacts of PsA, they ranked pain as the most impactful. PsA may cause pain in the joints, the skin, and other body parts.
Pain and other symptoms tend to worsen during a flare, which is when the condition is active. Flares may last for a few days or months.
In PsA, the immune system attacks healthy tissues. This causes inflammation and tissue damage. Some common symptoms include:
- joint swelling, stiffness, tenderness, and pain
- painful swelling of entire fingers or toes
- back pain and limitation of motion
- pain in the heel or sole of the foot
Chronic inflammation can eventually cause permanent joint damage and disability.
Many people with PsA also have symptoms of psoriasis, including itchy and painful skin lesions.
People with PsA are also at increased risk of inflammation in other body parts, including the eyes and the digestive system. This can add to their discomfort.
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Typical Symptoms For Hips & Psoriatic Arthritis
Symptoms of PsA in the hips include:
- Pain in the hip joint, which may include pain in the groin, outer thigh, or buttocks
- Pain or stiffness, especially first thing in the morning or after a period of rest
- Difficulty walking, or walking with a limp
- Stiffness or reduced range of motion2,3
- Sexual intercourse may be painful, especially for women with PsA that affects the hips.7
Asymmetrical Joint Pain And Swelling
With psoriatic arthritis, stiffness, pain and throbbing of your joints is par for the course. Typically psoriatic arthritis will present asymmetrically in your joints: one joint may flare up but not the other. For instance, my left sacroiliac joint and knee and my right wrist and elbow are most commonly affected. Each psoriatic arthritic patient will have different joints affected, so be on the lookout for which of your joints are your main culprits.
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Can Psoriatic Arthritis Attack Other Organs Of The Body
Apart from the skin, nails and joints, increased cardiovascular morbidity is considered part of psoriatic disease, as is the association with inflammatory bowel disease. An itchy, red eye due to conjunctivitis is more common in people with psoriatic arthritis and some people occasionally develop a painful, red eye caused by inflammation around the pupil of the eye, which is called iritis or uveitis. Anaemia may also be found but this is the result of long-term inflammation and is not a specific feature of psoriatic arthritis.
What Are The Symptoms Of Psoriasis
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
It can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Psoriasis can cause small round dents in finger and toe nails, this is known as pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.
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Psoriatic Arthritis And Heart Arrhythmia
Up to 30 percent of people with psoriasis will eventually develop psoriatic arthritis. One study linked psoriasis to increased risks of heart arrhythmia. This is an indication of heart problems. The study concluded that psoriatic arthritis carries a higher risk of arrhythmia.
People who have severe forms of the skin disease and are under age 60 are more likely to develop heart disease, according to findings published in the American Journal of Cardiology.
Psoriasis can mean an increased risk of heart problems. But you can strengthen your heart through diet, exercise, and stress reduction.
Will Drug Treatment Help
Various medications can help manage PsA, depending on the severity of the symptoms and how they affect the individual.
Drug options for treating PsA include disease-modifying anti-rheumatic drugs . These can reduce inflammation and may help prevent flares, manage symptoms, and delay or prevent joint damage.
Types of DMARDs for PsA include:
- methotrexate, taken by mouth
- biologics, such as adalimumab , etanercept , and infliximab , taken by injection or infusion
- targeted DMARDs, taken by mouth
DMARDs affect the immune system, which can increase the risk of infection. They may not be suitable for everyone.
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Nail Changes: A Sign Of Psoriasis
Up to 80 percent of people living with psoriatic arthritis experience some type of nail issue, according to a study published in 2017 in the journal Reumatologia. Evidence suggests that nail psoriasis is a strong predictor of joint disease and may show up years before arthritis symptoms.
The study notes that pitting is the most common sign of nail psoriasis. Pitting looks like superficial depressions in the nail.
Another type of nail change that can occur is known as onycholysis, or a separating of the nail from the nail bed.
Many people find the appearance of nail symptoms psychologically distressing, says Dr. Gupta. Extensive cases may confer significant morbidity and functional impairments. Therefore, managing nail psoriasis is an integral part of psoriatic arthritis therapy.
Treatment options for nail psoriasis include topical ointments as well as systemic therapies.
Weight Gain Or Changes In Appetite And Thirst
Psoriatic arthritis increases your risk for metabolic syndrome, which is the term for a group of risk factors, including belly fat and high blood pressure, that increase your risk of developing health conditions such as heart disease and type 2 diabetes. The more severe your psoriatic arthritis, the greater your risk for metabolic syndrome.
Get your blood pressure checked regularly and work with your doctor to lose weight, especially if youre carrying extra pounds around your midsection.
See your doctor right away if you experience telltale signs of type 2 diabetes, such as feeling constantly hungry, thirsty, or fatigued.
Know the warning signs of a heart attack, which include discomfort or pain in the chest, extreme fatigue, shortness of breath, and pain in the upper body, according to the National Heart, Lung, and Blood Institute.
Stroke warning signs include drooping on one side of the face, arm weakness , and difficulty speaking, notes the American Stroke Association.
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Will Symptoms Worsen Over Time
Some people with mild symptoms find their symptoms do not worsen over time and they can continue to function in their daily life. Others, however, may experience progressive, long-term damage.
The impact may be
- has erosive disease or dactylitis
- has highly active or rapidly progressing disease
- has symptoms that affect their ability to use one or more joints
An effective treatment plan can often prevent progressive damage and help manage symptoms.
In the early stages, however, it can be difficult to predict the course of the disease.
How Is Psoriatic Arthritis Diagnosed
Psoriatic arthritis is easier to confirm if you already have psoriasis. If you donthave the skin symptoms, diagnosis is more difficult. The process starts with a healthhistory and a physical exam. Your healthcare provider will ask about your symptoms. Youmay have blood tests to check the following:
- Erythrocyte sedimentation rate . This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the bloods proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- Uric acid. High blood uric acid levels can be seen in psoriatic arthritis but are not used for diagnosis or monitoring.
- Imaging. X-rays, CT scans, ultrasound, MRI, and skin biopsies may all be used to help diagnosis.
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Symptoms Of Psoriatic Arthritis
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 and periods when they get worse .
Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.
How Is Arthritis Treated
Theres no cure for arthritis, but there are treatments that can help you manage the condition. Your treatment plan will depend on the severity of the arthritis, its symptoms and your overall health.
Conservative treatments include:
- Medication: Anti-inflammatory and pain medications may help relieve your arthritis symptoms. Some medications, called biologics, target your immune systems inflammatory response. A healthcare provider may recommend biologics for your rheumatoid or psoriatic arthritis.
- Physical therapy: Rehabilitation can help improve strength, range of motion and overall mobility. Therapists can teach you how to adjust your daily activities to lessen arthritic pain.
- Therapeutic injections: Cortisone shots may help temporarily relieve pain and inflammation in your joints. Arthritis in certain joints, such as your knee, may improve with a treatment called viscosupplementation. It injects lubricant to help joints move smoothly.
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Problems With Old Assessments
After diagnosis, the level and progression of RA need to be monitored and tracked. Prior to RASS, doctors combined results from a physical examination with factors reported by the patient, such as pain level, and inflammatory blood markers, to estimate RA severity.
Doctors also used the Health Assessment Questionnaire , in which patients rated their own level of pain. Of course, everyone has a different threshold for pain, which can make these assessment models inaccurate. These assessment methods were also complicated by a close relationship between pain and depression.
Depression can be a significant component of RA. But there are challenges with using it to measure disease severity, including:
- some patients may be more depressed than others
- some patients may feel particularly depressed at the time of examination
- some patients may not acknowledge they are depressed
While depression can be an element of RA, measuring it is not helpful for disease activity assessment. The RASS is completed by your doctor and based on the visible signs of the disease. Its not based on your individual emotional assessment.
Its important to know what type of RA you have to get an accurate assessment of disease activity. There are three types of RA:
- rheumatoid factor positive
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Skipping Out On Sleep
A good nights sleep can be hard to come by when you have psoriatic arthritis. Theres decreased sleep quality due to inflammation, and then there are sleep disturbances due to generalized pain and anxiety, says Efthimiou. Though a lack of sleep can make it harder to manage your condition and keep symptoms in check.
Aim to get seven or eight hours of sleep each night. Your mattress should be comfortable and support your hips and shoulders to keep you in alignment. Make sure your pillow supports your neck properly. Wear something comfortable to bed, and make sure your sheets and blankets arent constricting.
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Stop Avoiding Mobility Aids
A cane, walker, or wheelchair may be necessary for some people with arthritis to stay independent and get around on their own. Understandably it can be tough to think about needing some sort of mobility aid, but if you do need one and donât use it you risk missing out on things you would enjoy.
A cane or wheelchair doesnât define who you are, and no one will judge you or think less of you for using one. In fact, youâll probably be admired for getting out there and having fun in spite of needing a little help.
What Is The Knee Joint
Three bones come together to form your knee joint. They include the:
A smooth substance called cartilage covers the ends of each bone. Its a cushion between the bones that keeps them from rubbing together. The synovial membrane, a type of tissue that surrounds the joint, lubricates the cartilage.
Arthritis of the knee causes pain and swelling in the joint
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Treatments For Your Skin
If your psoriasis is affecting your quality of life, or your treatment is not working, you may be referred to a dermatologist.
There are a number of treatment options for psoriasis.
Ointments, creams, and gels that can be applied to the skin include:
- ointments made from a medicine called dithranol
- steroid-based creams and lotions
- vitamin D-like ointments such ascalcipotriol and tacalcitol
- vitamin A-like gels such astazarotene
- tar-based ointments.
For more information about the benefits and disadvantages of any of these talk to your GP, dermatologist, or pharmacist.
If the creams and ointments dont help, your doctor may suggest light therapy, also known as phototherapy. This involves being exposed to short spells of strong ultraviolet light in hospital.
Once this treatment has started, youll need to have it regularly and stick to the appointments youve been given, for it to be successful. This treatment is not suitable for people at high risk of skin cancer or for children. For some people, this treatment can make their psoriasis worse.
Retinoid tablets, such as acitretin, are made from substances related to vitamin A. These can be useful if your psoriasis isnt responding to other treatments. However, they can cause dry skin and you may not be able to take them if you have diabetes.
Some DMARDs used for psoriatic arthritis will also help with psoriasis.