Early Signs Of Psoriatic Arthritis
Some of the symptoms of PsA are similar to those ofosteoarthritis and rheumatoid arthritis.
If you have psoriatic arthritis, you could experience:
- Joint swelling
- Stiffness, especially in the morning or afterlong periods of inactivity
- Swelling of an entire finger or toe in theabsence of trauma
- Lower back pain
Causes Of Psoriatic Arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.
But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
What Is Psoriatic Arthritis
PsA is a form of arthritis affecting individuals who also suffer from psoriasis. Psoriasis is a chronic skin condition affecting 2% of the population. The classic symptoms of psoriasis are red, patchy skin with silvery scaling. PsA is characterized by skin inflammation combined with joint inflammation. Up to 30% of people who have psoriasis will develop psoriatic arthritis according to the National Psoriasis Foundation. In most cases, psoriasis develops first and then PsA develops in later years. However, in approximately 15% of the cases, arthritis develops prior to psoriasis, making diagnosis of PsA very difficult.
The onset of PsA in most individuals occurs in their 40s and 50s. Men and women are about equally affected. While PsA affects individuals worldwide, the prevalence of the condition is greater in North America and Europe.
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Changes In Your Vision Or Other Eye Issues
Any pain, redness, blurry vision, or sensitivity to light can be a major red flag. These are symptoms of uveitis, an eye condition caused by inflammation that affects about 7 percent of people who have psoriatic arthritis, according to the National Psoriasis Foundation . It occurs when the internal structures of the eye become inflamed, says Dr. Gupta, and may result in loss of vision.
Having psoriatic arthritis can increase your risk of developing uveitis. Whats more, if you treat your psoriatic arthritis with corticosteroids, these medications can have debilitating side effects, including cataracts and glaucoma, Gupta notes.
Dont wait for a problem to appear. Schedule regular eye exams to identify issues as soon as possible to preserve your vision.
Epidemiology Etiology And Risk Factors
Estimates of PsA prevalence in the general population vary from 0.3% to 1%, with a higher prevalence of 6% to 42% in patients with psoriasis. The prevalence of spondyloarthropathies, of which PsA is a subset, has been estimated at 1% to 2% of the population. Psoriatic arthritis is more common in those aged 30 to 50 years, and it occurs nearly equally in both sexes. Prevalence studies also suggest a geographic variation, with a higher incidence in people of Northern European descent and a lower incidence in those of Japanese descent.
Genetic factors play a role, as evidenced by the presence of a strong familial association and links with several major histocompatibility complex class I alleles. Up to 40% of patients with PsA have a positive family history of psoriasis or arthritis.
The greatest risk factor for PsA is having psoriasis. Estimates of PsA among those with psoriasis vary from approximately 5% to 30%. Most patients first present with cutaneous involvement, although arthritis predates cutaneous psoriasis in nearly 10% of cases. Psoriasis features associated with higher risk of PsA are scalp lesions, nail dystrophy, uveitis, and intergluteal/perianal skin lesions.
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Could It Be Something Else
Psoriatic arthritis can mimic osteoarthritis , gout or rheumatoid arthritis, but each of these forms of arthritis calls for a different plan of action.
There are some helpful diagnostic criteria to rule out other conditions. For instance, if the inflammation comes on suddenly and severely affects a single joint, gout may be to blame.
On the other hand, if the joint in painful but there is hardly any swelling, its more likely that the problem is osteoarthritis. The bottom line is that it can take some time, and several diagnostic approaches, to find the right diagnosis. Work with a doctor you trust, and communicate openly and honestly to help move the process along.
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Psoriatic Arthritis Treatment Options
There is no cure for psoriatic arthritis. If left untreated, you could end up with severe, permanent joint deformities and bone damage.
Before treatment options can begin, your doctor will need to determine exactly what youre dealing with. Its common to diagnose psoriatic arthritis by doing a physical exam, taking x-rays and doing a blood test to rule out rheumatoid arthritis.
Here are some of the most common treatments to manage symptoms.
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Our Approach To Psoriatic Arthritis
UCSF provides comprehensive evaluations and advanced, personalized care for all forms of arthritis. Because arthritis often involves different systems in the body, our team includes several types of doctors, such as rheumatologists, plastic surgeons who specialize in correcting hand deformities, and orthopedic surgeons who specialize in joint deformities and joint replacement.
When treating arthritis linked to psoriasis, we first try common pain relief medications called nonsteroidal anti-inflammatory drugs. If joint inflammation progresses, we may prescribe stronger medications known as disease-modifying anti-rheumatic drugs. Regular exercise is also a critical part of the treatment plan, helping to strengthen the joints and maintain their range of motion. We may recommend physical therapy.
In addition to caring for patients, our providers conduct clinical trials to evaluate potential new treatments for arthritis. Interested patients may have the option to receive investigational treatments through a clinical trial.
Loss Of Significant Joint Mobility
For example, you were able to flex your wrist 60 degrees, and two years later, you lost 50 percent of that range of motion. Its possible to feel okay and still experience loss of range of motion, says Dr. Domingues. But the idea is to prevent joint damage and to make you have less pain. If you have less pain and are still progressing, that means your treatment could be working better.
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Arthritis In The Toes
Arthritis in the toes is often the result of wear and tear of the cartilage in the toe joints or inflammation of the toe joints. The big toe is most often affected by arthritis, but other toes can also be involved.
Common symptoms of arthritis of the toes may include pain that can take hours or days to resolve and swelling and inflammation in and around the toe joints. Both RA and PsA can cause significant pain and swelling. However, with PsA, the toes become so swollen that they can resemble sausages .
Additional symptoms of arthritis in the toes might include:
- Restricted range of motion due to swelling or cartilage damage
- Development of bone spurs, which can further restrict movement
- Difficulty and pain with bending the toes
- A toe that might bend permanently downward
- Pain that worsens with weight-bearing activityrunning, walking, climbing stairs, etc.
- A bump formation or sore
- Pitted, separated, thickened toenails
- Curling of toeshammertoe or claw toe
How To Recognize Psoriatic Arthritis
For most people, psoriatic arthritis develops years after psoriasis. Tell your dermatologist if you have psoriasis and any of these signs and symptoms:
A very noticeable swollen finger or toe
Swollen and tender joints
Stiffness when you wake up or sit for hours stiffness fades as you move
Nails that are pitted
Nail separating from nail bed
Lower back pain
Swelling on the back of your leg above your heel
People who get psoriatic arthritis often see nail pitting or a nail separating from the nail bed.
Swollen joint, left knee
One of the first signs of psoriatic arthritis is often a swollen joint, most commonly in a hand, foot, or knee.
A swollen and painful Achilles tendon, shown here on the right leg, is often a sign of psoriatic arthritis.
Psoriatic arthritis can cause a finger or toe to swell dramatically. The swollen finger or toe is called a sausage digit.
Some people who have psoriatic arthritis develop intense heel pain. This pain can make walking difficult.
In some people, psoriatic arthritis destroys the joints. Early treatment helps prevent this.
Stiffness is a common symptom. It happens when you wake up or sit still for hours. The stiffness disappears as you move, but it can last 30 to 45 minutes or longer.
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Treatment For Psoriatic Arthritis
Treatment for psoriatic arthritis aims to:
- relieve symptoms
- slow the condition’s progression
- improve quality of life
This usually involves trying a number of different medicines, some of which can also treat the psoriasis. If possible, you should take 1 medicine to treat both your psoriasis and psoriatic arthritis.
The main medicines used to treat psoriatic arthritis are:
- non-steroidal anti-inflammatory drugs
- biological therapies
Developing A Diagnostic Test For Psoriatic Arthritis
Diagnosing psoriatic arthritis is challenging without the aid of a diagnostic test and because symptoms can vary. The National Psoriasis Foundation is working to make it easier to diagnose psoriatic arthritis and is providing funding to aid the development of a diagnostic test. In the meantime, knowing and recognizing the symptoms of psoriatic arthritis and getting an early diagnosis can help prevent joint damage and disability.
Cardiovascular Warning Signs: Chest Pain Weakness
People who have psoriatic arthritis are more likely to die from cardiovascular problems, such as stroke or heart attack, according to both the NPF and a review published in January 2020 in the journal Joint Bone Spine.
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.
What Imaging Tests Are Used In The Diagnosis Of Psoriatic Arthritis
The following imaging tests are used:
- X-rays. Plain X-rays of the affected joints may show changes that are typically found in psoriatic arthritis.
- Magnetic resonance imaging . An MRI uses radio waves and strong magnetic fields that give a detailed view of joints, ligaments and tendons in the body.
- Bone mineral density or BMD test . Psoriatic arthritis and the medications used to treat the condition can cause an increased loss of bone. Your doctor may order this test to know the extent of bone loss. The result indicates your risk of fractures.
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Early Symptoms Of Psoriatic Arthritis Affect Time To Diagnosis
The early signs and symptoms of psoriatic arthritis that a person has can influence the time it takes from seeking medical attention to receiving a diagnosis, according to the results of a patient survey.
A shorter time to diagnosis was reported by psoriatic arthritis patients with early symptoms that included:
- Joint pain
- Sausage like fingers or toes
While a longer time to diagnosis was reported by psoriatic arthritis patients presenting with:
- Enthesitis, including foot problems, tendon and ligament pain
- Back pain
What Are The Signs And Symptoms Of Psoriasis
Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.
While patches of thickened, dry skin are common, psoriasis can cause many signs and symptoms. What you see and feel tends to vary with the:
Type of psoriasis you have
Places psoriasis appears on your body
Amount of psoriasis you have
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Early Psoriatic Arthritis: What Are The First Signs
Psoriatic arthritis is a condition that presents differently in different people, so much so that this form of chronic inflammatory arthritis is categorized into five types and has six key domains. The speed at which people develop symptoms and the severity of these can also vary greatly. Some people slowly develop mild symptoms over time, while others have more severe symptoms that develop quickly.
There is currently no diagnostic test for psoriatic arthritis, so rheumatologists and dermatologists rely on screening questionnaires, skin and joint examinations, x-ray findings and other tests to identify people with this disease.
Early symptom recognition and treatment is thought to be associated with better long-term outcomes in people with psoriatic arthritis, which is progressive and destructive. Even a 6-12 month delay in diagnosis can have an impact on the functional disability and joint damage that people experience.
It is estimated that almost 50 percent of cases of psoriatic arthritis go unrecognized and that significant delays occur during the diagnosis process, which highlights the importance of healthcare providers and their patients becoming more aware of the early signs of the disease.
Swollen And Painful Joints
PsA can lead to pain and swelling in any joint in the body. The joints may also be red and warm to the touch.
PsA often affects the hands, fingers, feet, toes, knees, ankles, and spine. It can also affect the neck and wrists. A person may also experience pain in the lower back.
PsA in the finger usually affects the joint closest to the nail.
Swelling in arthritis happens when either the lining of the joint or the fluid that surrounds the joint increases in volume. When this happens, more blood enters the area around the joint, which increases pressure and causes redness and swelling.
Symptoms can vary in severity between people. In some people, arthritis may affect one or two joints, but others might experience severe changes throughout the body.
Having Inflammation Of Tendons And Ligaments
Enthesitis means inflammation of connective tissue that attaches to bones. These include tendons, ligaments, and bursae. Most cases of enthesitis are due to injury or overuse. Think of a marathon runner with Achilles tendinitis or a tennis player with tennis elbow. In psoriatic arthritis, the immune system attacks these connection points. So you can have someone who leads a fairly sedentary life who suddenly develops Achilles tendinitis on both feet, runners knee, and plantar fasciitis happening all at once, for no good reason.
Past Research And Achievements In This Area
In 2015, research led by our centre for genetics and genomics at the University of Manchester identified genetic variants associated with psoriatic arthritis, but not with psoriasis or rheumatoid arthritis. This helped to establish psoriatic arthritis as a condition in its own right. The findings could lead to the development of drugs specifically for psoriatic arthritis.
Later in the same year, our TICOPA trial looked at the benefits of early aggressive drug treatment for people with psoriatic arthritis followed by an increase in drug dosage if initial treatment isnt working. The trial found that patients treated this way, required fewer hospital- and community-based services than patients receiving the standard care.
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Crohns Disease And Other Digestive Problems
Symptoms such as abdominal pain and cramping, blood in your stool, and diarrhea could be signs of inflammatory bowel disease. People who have both psoriasis and psoriatic arthritis are at risk for developing Crohns disease in particular, according to the NPF. This is likely because the mutations in the genes of people who have psoriatic arthritis and Crohns disease are similar, or it may be related to side effects from treatment.
If you struggle with digestive issues, be sure to visit your doctor for an evaluation.
How Psoriatic Arthritis Is Treated
Psoriatic arthritis is a chronic condition with no cure. But that doesnt mean you have to sit idly by while your joints and your pain worsen over time. There are plenty of treatment options available for PsA sufferers.
Treatments for PsA target the symptoms of the disease. The available treatment options range from oral medications to biologic therapies, which are typically injected. All of these treatments work to reduce inflammation and swelling, slow joint damage, and combat your most concerning and discomforting symptoms.
In order to get the latest and greatest treatments for PsA, youll want to see a rheumatologist. These doctors are specialists who treat all types of arthritis and related conditions, and theyre often experts in psoriasis and psoriatic arthritis. A rheumatologist can help you get the treatment you need and help you discover your available treatment options.
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Depression: A Sadness You Cant Shake
People who have psoriatic arthritis often struggle with emotional distress theyre not prepared to deal with, according to a review published in January 2020 in the journal Acta Dermato-Venereologica.
Persistent sadness or hopelessness, withdrawing from your circle of friends, and loss of interest in activities you once enjoyed are potential symptoms of depression. Signs of depression are common in people who have psoriatic arthritis due to social withdrawal due to skin lesions and the inability to do the tasks they were previously able to do, Gupta says.
The severity of your psoriatic arthritis isnt necessarily related to your risk of developing depression or another mental health issue, he says, but if your psoriatic arthritis is well controlled, it may help with depression.
If youre experiencing symptoms of depression, be sure to talk to your doctor.
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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