Psoriatic Arthritis by Dr. Humeira Badsha

We think of Psoriatic Arthritis as a cousin of rheumatoid arthritis, which is treated quite similarly.
What is Psoriasis?
Psoriasis is a skin condition characterized by red, silver scaly patches in the affected areas. The word “psoriasis” comes from a Greek word meaning itchy. This is caused by excessive growth of the superficial layer of the skin (epidermis). There may be associated nail changes and joint disease. The patches usually affect the scalp, behind the elbows, over the knees, but in extensive psoriasis the whole body can be affected.
What is Psoriatic Arthritis?
Arthritis means inflammation of the joint and describes a painful, hot, red, swollen joint that does not move easily. Psoriatic arthritis therefore is arthritis that is associated with psoriasis. About 7% of patients with psoriasis have arthritis. The exact cause of psoriasis is unknown but genes and environmental factors are responsible. The immune system is affected as well. It is not a contagious disease.
How Does Psoriatic Arthritis Manifest?
There are several forms of psoriatic arthritis and the patient can present with any form. One form affects mainly the joints of arms and legs. As in all arthritis, the affected joints will be red, swollen, hot, painful and difficult to use. The last joints of the fingers next to the finger nails are typically involved. Usually, the finger nails are also affected at the same time. When all the joints and soft tissue of the same finger are affected, the entire finger is swollen and is called a ‘sausage digit’. The other joints like wrists, elbows, shoulders, hips, knees, ankles, feet and toes can also be affected. Two or three joints may be affected at the same time. Unlike rheumatoid arthritis, the joint involvement of one side of the body is not equal to the other side (asymmetrical). There is one group of patients with arthritis that is difficult to distinguish from rheumatoid arthritis. In about 3% of patients, the backbone is involved.
This tends to affect men and they sometimes have a genetic marker called the HLA B27. Their main complaints are back stiffness and backache.
When you consult a doctor for the problem of joint pain with psoriasis, he will take a history of your illness, the relationship to the skin condition, any past medical history, and family history. He will do a thorough physical examination which will include a full rheumatologic examination. He may order some blood tests and X-rays if he suspects that the disease has affected the bones.
How is Psoriasis Treated?
Although there is no miracle cure for psoriatic arthritis, much can be done to improve the patient’s quality of life. Just like the skin, the arthritis in psoriatic arthritis waxes and wanes. Depending on the severity of the condition, the doctor will recommend treatment.
Treatment of the condition involves both non-drug and drug therapy. During exacerbation of the condition, the patient should rest as much as he needs. Fortunately, tiredness is much less common than in rheumatoid arthritis. In addition, the patient should also do some range-of-motion exercises to ensure that the joints do not become stiff and crooked, and the muscles become weak. The physiotherapist will help to design a program suitable for the patient. Care of the skin is very important and includes keeping it from becoming too dry. Strong soaps should be avoided. Sunlight is beneficial for the skin lesions. The dermatologist will recommend specific medication, skin creams and light therapy for the patient. For the joint pain, the doctor may initially prescribe a non-steroidal anti-inflammatory drug (which is an aspirin-like medicine which reduces the inflammation of the joint). Methotrexate and other drugs which suppress the immune system are sometimes used (same treatment as rheumatoid arthritis). The doctor will carefully explain the possible side effects like liver damage, lung damage and the need for regular blood and urine tests if he were to start the patient on these drugs. When the joint is mechanically destroyed, the orthopaedic surgeon can help to correct deformities and bring back some function. Operations to replace damaged joints with artificial ones have been done successfully.
Psoriatic arthritis is a chronic disease which can cause a lot of medical, social and financial problems for the patient. By working closely with his doctor, the patient can learn to live his life to the fullest despite his illness.
This is one of a set of articles by Dr. Humeira Badsha, Specialist Rheumatologist, for patient awareness.

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