How Is Psoriatic Arthritis Diagnosed
There is no single test to diagnose psoriatic arthritis. Healthcare providers make the diagnosis based on a patient’s medical history, physical exam, blood tests, and X-rays of the affected joints. Magnetic resonance imaging is generally not needed except in unusual circumstances.
Laboratory tests that may be helpful in diagnosis or used to monitor disease activity include:
- Rheumatoid factor and anti-CCP – types of blood tests to help diagnose rheumatoid arthritis.
- HLA-B27 – blood test to help diagnose, may also be indicated with a family history of psoriasis or psoriatic arthritis.
- Sedimentation rate and C-reactive protein – may indicate inflammation.
X-rays are not usually helpful in making a diagnosis in the early stages of the disease. In the later stages, X-rays may show changes that are more commonly seen only in psoriatic arthritis. One such finding is called the “pencil-in-cup,” which describes the finding where the end of the bone gets whittled down to a sharp point. This finding indicates more severe inflammatory changes to joints, which may require more aggressive treatment.
Who Is At Risk For Psoriatic Arthritis
Psoriasis affects 2-3 percent of the population or approximately 7 million people in the U.S. and up to 30% of these people can develop psoriatic arthritis. Psoriatic arthritis occurs most commonly in adults between the ages of 35 and 55 however, it can develop at any age. Psoriatic arthritis affects men and women equally.
It is possible to develop psoriatic arthritis with only a family history of psoriasis and while less common, psoriatic arthritis can occur before psoriasis appears. Children of parents with psoriasis are three times more likely to have psoriasis and are at greater risk for developing psoriatic arthritis. The most typical age of juvenile onset is 9-11 years of age.
Can Lifestyle Changes Help
Certain lifestyle changes can help keep your psoriatic arthritis from getting worse and help your treatment plan be more effective:
- If youâre overweight or obese, talk to your doctor about the best ways to lose weight. Losing excess pounds will reduce stress on your joints. Studies have shown it can also help the drugs you take for your psoriatic arthritis may work better.
- Find exercise you like thatâs not too hard on your joints. It helps ease pain, decrease fatigue, and improve your mobility. Possibilities include walking, cycling, swimming, yoga, and tai chi.
- If you smoke, make a plan to quit. Some studies suggest that the less people smoke, the less their joints hurt.
Psoriatic arthritis can also take a toll on your mental health, especially when your symptoms are serious. To improve your quality of life, find mental and emotional support. You might join a support group, or get professional counseling. Your doctor can refer you to a therapist who can help.
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Chronic Nature Of Psoriatic Arthritis
Psoriatic arthritis is an autoimmune condition in which the immune system mistakenly attacks healthy tissue, leading to pain and inflammation. PsA is chronic, which means that it is persistent and long-lasting, with no current cure. PsA requires ongoing medical attention and may require you to limit your daily living activities.
PsA symptoms can come and go and tend to vary from mild to severe. The onset of symptoms is called a flare, or flare-up. If left untreated, PsA inflammation can cause health problems, including damage to the joints, uveitis , gastrointestinal problems, lung problems, weak bones, and damage to the cardiovascular system.
What Are The Treatment Options For Psoriatic Arthritis
The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:
- Splinting.
- Surgery.
Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.
DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.
Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.
Exercise
Heat and cold therapy
Splinting
Surgery
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How Do You Find A Treatment That Works
Thereâs no single best way to treat psoriatic arthritis at any stage. When one approach doesnât work, you and your doctor can try another. You may need to try several different medications. You might use more than one drug, and your doctor could frequently adjust your doses.
When deciding what treatment to use, your doctor will also consider your personal preferences and circumstances, such as:
- Whether you want to avoid shots or have trouble getting to a clinic for frequent infusions
- Whether your insurance fully covers certain drugs
- Whether you have other health conditions, such as diabetes or heart disease, that limit or complicate your options
Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else.
Psoriatic arthritis can be classed as a disability if it:
- makes daily tasks difficult
- lasts for more than 12 months.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
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Conventional Or Traditional Disease
DMARDs are indicated for the treatment of moderate to severe or refractory cases of PsA. Patients with active disease, defined globally as one or more tender and swollen joints and poor prognostic factors, particularly those with elevated acute phase reactants, radiographical damage or clinically relevant extra-articular manifestations, who have failed to respond to NSAIDs within 3 months, should be treated with DMARDs.
Delay in the start of DMARDs may lead to worse outcome. MTX, sulfasalazine and leflunomide can be effective for peripheral but not for axial disease, enthesitis or dactylitis. Observational controlled studies with sulfasalazine have shown no reduction in long-term joint damage. Similarly, the use of antimalarials and gold salts is not recommended, and there is little convincing evidence regarding the efficacy of cyclosporine in PsA. It has been shown that the probability of continuing to take cyclosporine is significantly lower and the rate of adverse events is higher when compared with MTX or antimalarials .
Before starting DMARD therapy patients should be screened and have regular blood monitoring, usually every 3 months, including blood counts, liver function tests and serum creatinine .
Treatments For The Arthritis
Non-steroidal anti-inflammatory drugs
NSAIDs, or non-steroidal anti-inflammatory drugs, can reduce pain, but they might not be enough to treat symptoms of psoriatic arthritis for everyone.
Some people find that NSAIDs work well at first but become less effective after afew weeks. If this happens, itmight help to try a different NSAID.
There are about 20 different NSAIDs available, including ibuprofen, etoricoxib, etodolac and naproxen.
Like all drugs, NSAIDs can have side effects. Your doctor will reduce the risk ofthese, by prescribing the lowest effective dose for the shortest possible period of time.
NSAIDs can sometimes cause digestive problems, such as stomach upsets, indigestion or damage to the lining of the stomach. You may also be prescribed a drug called a proton pump inhibitor , such as omeprazole or lansoprazole, to help protect the stomach.
For some people, NSAIDs can increase the risk of heart attacks or strokes. Although this increased risk is small, your doctor will be cautious about prescribing NSAIDs ifthere are other factors that may increase your overall risk, for example, smoking, circulation problems, high blood pressure, high cholesterol, or diabetes.
Some people have found that taking NSAIDs made their psoriasis worse. Tell your doctor if this happens to you.
Steroid treatment
Steroid injections into a joint can reduce pain and swelling, but the effects do wear off after a few months.
Disease-modifying anti-rheumatic drugs
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Pregnancy Fertility And Breastfeeding
Psoriatic arthritis wont affect your chances of having children. But if youre thinking of starting a family, its important to discuss your drug treatment with a doctor well in advance. If you become pregnant unexpectedly, talk to your rheumatology department as soon as possible.
The following treatments must be avoided when trying to start a family, during pregnancy and when breastfeeding:
- leflunomide
- retinoid tablets and creams.
Theres growing evidence that some other drugs for psoriatic arthritis are safe to take during pregnancy. Your rheumatology department will be able to tell you which ones.
It will help if you try for a baby when your arthritis is under control.
Its also important that your arthritis is kept under control as much as possible during pregnancy. A flare-up of your arthritis during pregnancy can be harmful for you and your baby.
Psoriasis and psoriatic arthritis can run in families. If you have either condition, you could pass on genes that may increase your childrens risk though its difficult to predict.
As treatments continue to improve, people with psoriatic arthritis in years to come can expect a better outlook. If you have any questions or concerns, talk to your doctor.
Treatment For Psoriatic Arthritis
There are many treatments available for psoriatic arthritis. Your PsA treatment plan may include medications, physical therapy and/or occupational therapy, exercise, rest, and complementary therapies like massage and acupuncture. Following your treatment plan can help reduce the symptoms of the disease and prevent joint damage caused by arthritis.
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How To Prevent Psoriatic Arthritis
Though there is no way to completely prevent psoriatic arthritis, one can prevent the condition from flaring up or progressing.
1. Consult your doctor to identify your trigger factors. This helps to prevent psoriatic arthritis flare-ups.
2. Take precautionary measures to reduce the chances of infection. In case of infection, resort to immediate treatment.
3. Continue your prescribed treatment. Do not halt the treatment abruptly.
4. Avoid stress, as it is a well known trigger for psoriatic arthritis.
Odds Of Going Into Remission
Remission in PsA means that there are no signs of disease activity, including inflammatory blood markers and symptoms. In PsA, the two types of remission are:
- Drug-induced: Low disease activity when you are actively taking medications, such as biologics
- Drug-free: Low disease activity, relief from symptoms without medication, or both
The standard treatment approach for PsA is a treat to target strategy, with the goal being minimal disease activity. This typically involves adjusting medication over time to achieve remission. The process is ongoing and may require you to have close contact with your healthcare provider over time so they can closely monitor your condition and responses to medication. They may adjust your therapies/medications so you can achieve remission or low disease activity.
You and your healthcare provider will come up with a treatment plan to get you into remission. How quickly remission occurs depends on how mild or severe your PsA is. Most experts agree that an early and accurate diagnosis and starting treatment as early as possible increase the chances of remission and make it last.
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What Are The Types Of Psoriatic Arthritis
There are different types of psoriatic arthritis, which tend to affect different parts of the body. These include:
- asymmetric arthritis usually affects one side of the body, or different joints on each side
- symmetrical polyarthritis often affects several joints on both sides of the body
- distal interphalangeal arthritis affects the joints closest to the fingernails and toenails
- spondylitis affects the spine, particularly the lower back
- arthritis mutilans a rare condition that severely affects the bones in the hands
There is also a type of psoriatic arthritis that affects children, although the symptoms are usually mild.
Where Research Is Now
Psoriatic arthritis is a multifaceted disease that affects both the skin and joints. Researchers are currently working to understand the causes of PsA and the multiple ways it affects the body. Other studies are working to identify biomarkers for PsA that can be used to predict a persons response to certain medications. Also, new medications may be developed that can better treat the disease and promote long-term remission.
The knowledge gained from this research may lead to better diagnostics, improved treatments, ways to prevent PsA, and a potential cure. For now, the goal is to help PsA patients achieve long-term remission.
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Dendritic Cells And Macrophages
Immature and mature dendritic cells and macrophages are present in inflammatory infiltrates of skin and synovium of patients with psoriasis and PsA, where they present antigens to T cells, remove necrotic/apoptotic cells, and most importantly, they can be a source of a multitude of cytokines and chemokines such as CCL19. Several regulatory molecules are involved in this process, such as intercellular adhesion molecule 1 , lymphocyte function-associated antigen 3 and cluster differentiation -80/86 in DCs and LFA-1, CD2 and CD28 in T cells. In addition, plasmacytoid DCs , a main source of type I interferon , are also present in the skin. Myeloid dermal DCs are also increased in psoriatic lesions and induce autoproliferation of T cells as well as production of type 1 helper T cell cytokines. Keratinocytes are responsive to DC-derived and T-cell-derived cytokines, including IFNs, tumor necrosis factor , interleukin -17, and IL-20 family of cytokines, and in turn they produce proinflammatory cytokines and chemokines . Participation of cell-mediated immune responses in the pathogenesis of PsA is suggested by the demonstration in synovial fluid and peripheral blood lymphocytes of different natural killer surface markers and / T-cell receptor antigen . Endothelium may also play a role in the pathogenesis of longstanding PsA as evidenced by the increased expression of certain adhesion molecules in PsA synovium related to the disease duration .
Is There A Test For Psoriatic Arthritis
Although there is no one test for psoriatic arthritis, your doctor may do the following to see if you have the condition:
- Ask if you have a family history of psoriasis or psoriatic arthritis.
- Talk to you about your symptoms and give you a physical exam.
- Take a blood sample to check for other conditions.
- Order imaging tests.
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What Are The Symptoms Of Psoriatic Arthritis
If you are experiencing joint pain and have a history of psoriasis, it may be a good idea to visit a doctor to see if you have psoriatic arthritis. In addition to joint pain, some of the more common symptoms of psoriatic arthritis include:
- Swollen and red joints
- Joints that are warm to the touch
- Nail pitting and other changes such as nails lifting from the nail bed
- Stiff joints, especially when first waking up or after long periods of rest
- A general feeling of fatigue or malaise
- Sausage-like fingers and toes
- Plantar fasciitis, which refers to pain in ball of foot
- Conjunctivitis which may commonly be referred to as pink eye
There are many types of psoriatic arthritis. The sub-type of arthritis you are diagnosed with depends on where the symptoms occur and how many joints are affected. Currently, five types of psoriatic arthritis have been identified:
- Symmetrical polyarthritis psoriatic arthritis that affects multiple joints with comparable severity on both sides of the body
- Asymmetric oligoarticular psoriatic arthritis that affects few joints on one side of the body
- Spondylitis psoriatic arthritis affecting joints in the lower back and near the spine
- Distal interphalangeal psoriatic arthritis in the joints of the fingers and toes
- Arthritis mutilans a severe form of psoriatic arthritis that causes deformation of the joints, especially in the hands and feet
Eat: Olives And Olive Oil
Extra-virgin olive oil is another must-add to an anti-inflammatory diet. Olive oil contains monounsaturated fat , antioxidants, and oleocanthal, a compound that can lower inflammation and pain similarly to ibuprofen, a nonsteroidal anti-inflammatory drug . Oleic acid can reduce inflammatory markers like C-reactive protein.
Along with snacking on green and black olives, add two to three tablespoons of extra-virgin olive oil when cooking or in salad dressings each day.
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