Psoriatic arthritis (PsA) is a chronic inflammatory condition that affects both the skin and joints. It belongs to a group of diseases known as spondyloarthropathies, which are characterised by inflammation primarily in the spine and pelvis. Psoriatic arthritis typically occurs in individuals with psoriasis, a chronic skin condition characterised by red, scaly patches of skin, but it can also develop in those without psoriasis.
Symptoms of Psoriatic Arthritis
Psoriatic arthritis can affect any joint in the body, but it most commonly involves the peripheral joints (e.g., fingers, toes, knees, ankles) and the axial skeleton (e.g., spine, sacroiliac joints). Symptoms of PsA may vary widely among individuals and can include:
- Joint Pain and Stiffness – Persistent pain, swelling, and stiffness in the affected joints, often worse in the morning or after periods of inactivity.
- Enthesitis – Inflammation at the sites where tendons or ligaments attach to the bones, leading to pain and tenderness.
- Dactylitis – Swelling of an entire finger or toe, giving it a “sausage-like” appearance.
- Skin and Nail Changes – Psoriatic arthritis may be accompanied by psoriatic skin lesions, including red, scaly patches of skin and pitted or ridged nails.
- Fatigue – Generalized tiredness and malaise, often associated with active inflammation.
- Eye Inflammation – In some cases, PsA can cause inflammation of the eyes (uveitis or iritis), leading to eye pain, redness, and sensitivity to light.
Causes and Risk Factors for Psoriatic Arthritis
The exact cause of psoriatic arthritis is not fully understood, but it is believed to involve a combination of genetic predisposition, immune system dysfunction, and environmental triggers. Risk factors for PsA include:
- Family History – Having a family history of psoriasis or psoriatic arthritis increases the risk of developing the condition.
- Psoriasis – Individuals with psoriasis are at a higher risk of developing psoriatic arthritis, although not everyone with psoriasis will develop PsA.
- Age – Psoriatic arthritis typically develops between the ages of 30 and 50, but it can occur at any age.
- Gender – Psoriatic arthritis affects men and women equally, although certain patterns of joint involvement may vary between genders.
Diagnosis of Psoriatic Arthritis
Diagnosing psoriatic arthritis involves a combination of clinical evaluation, laboratory tests, and imaging studies:
- Medical History and Physical Examination – A healthcare provider assesses symptoms, medical history, and performs a physical examination to evaluate joint involvement, skin lesions, and nail changes.
- Blood Tests – While there is no specific blood test for PsA, elevated levels of inflammatory markers (e.g., C-reactive protein, erythrocyte sedimentation rate) may be present.
- Imaging Studies – X-rays, ultrasound, or MRI scans may be used to detect signs of joint inflammation, damage, or enthesitis.
Psoriatic Arthritis Treatment
The goals of treatment for psoriatic arthritis are to alleviate symptoms, control inflammation, prevent joint damage, and improve overall quality of life. Treatment options may include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – NSAIDs can help relieve pain and inflammation in mild to moderate cases of PsA.
- Disease-Modifying Antirheumatic Drugs (DMARDs) – These medications may be prescribed to slow disease progression and prevent joint damage.
- Biologic Therapies – Biologic medications, including tumour necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, and IL-12/23 inhibitors, target specific components of the immune system to reduce inflammation and control symptoms.
- Corticosteroids – Intra-articular corticosteroid injections may be used to reduce inflammation and pain in affected joints.
- Physical Therapy – Physical therapy can help improve joint mobility, strengthen muscles, and reduce stiffness.
- Lifestyle Modifications – Maintaining a healthy weight, getting regular exercise, practising stress management techniques, and avoiding smoking can help manage symptoms and improve overall health.
Complications of Psoriatic Arthritis
If left untreated or poorly managed, psoriatic arthritis can lead to various complications, including:
- Joint Damage – Progressive inflammation can lead to joint damage, deformity, and disability.
- Enthesitis – Chronic inflammation at tendon and ligament insertions can cause pain, stiffness, and loss of function.
- Uveitis – Psoriatic arthritis may be associated with inflammation of the eyes (uveitis or iritis), which can cause eye pain, redness, and blurred vision.
- Cardiovascular Disease – Individuals with PsA have an increased risk of developing cardiovascular diseases such as heart attack and stroke.
- Osteoporosis – Chronic inflammation and immobility associated with PsA can increase the risk of osteoporosis and fractures.
Management and Support
Managing psoriatic arthritis involves ongoing care, regular follow-up visits with a rheumatologist or healthcare provider, and adherence to treatment recommendations. Supportive measures, such as joining support groups or seeking counselling, can also help individuals cope with the challenges of living with PsA and maintain a positive outlook on their health and well-being.
Psoriatic arthritis is a chronic inflammatory condition that affects both the skin and joints, leading to pain, stiffness, and swelling. Early diagnosis and prompt treatment are essential to control symptoms, prevent joint damage, and improve overall quality of life for individuals with PsA. With a multidisciplinary approach that combines medication, physical therapy, lifestyle modifications, and support, many individuals with psoriatic arthritis can effectively manage their condition and lead active, fulfilling lives.
