Psoriasis is generally thought of as a condition that affects the skin and for the most part, it is. But did you know that 15 to 30 percent of individuals living with psoriasis will come to develop a type of inflammatory arthritis known as psoriatic arthritis? The same inflammatory process that causes the skin changes associated with psoriasis can also impact joints, causing a myriad of unpleasant symptoms.
8 Symptoms of Psoriatic Arthritis
- Joint Pain and Stiffness
- Swollen Fingers and Toes
- Ankle and Foot Pain
- Lower Back Pain
- Red Scaly Skin Patches
- Changes to Nail Beds
- Eye Problems
What is Psoriatic Arthritis?
Psoriatic arthritis (PsA) is an inflammatory type of arthritis that appears in association with psoriasis. Psoriasis is a chronic autoimmune disorder found in two to four percent of the population worldwide and is generally characterized by the appearance of discolored patches of scaly skin. These patches, blotchy in appearance, range from red to purple depending on skin color. They can be small and localized or cover vast swaths of the body, and they appear most often on the knees, elbows, and scalp.
This scaly rash caused by psoriasis is also known as a plaque. Plaques are the result of skin cells maturing at a faster than normal rate, thus accumulating on the skin’s surface. This plaque-forming type of psoriasis is the most common, accounting for as many as 90 percent of reported cases. Psoriasis occurs in men and women equally. Although juvenile psoriasis exists, psoriasis is most prevalent in the adult population aged 30 to 55.
You may be wondering, How can a skin rash cause arthritis? In short, psoriatic arthritis refers to the inflammation in the joints and surrounding connective tissue caused by the same autoimmune disorder which affects the skin. The skin symptoms of psoriasis usually appear before the development of PsA, often many years prior. A small proportion of individuals, however, do experience joint pain and stiffness right out of the gate, preceding the appearance of any skin symptoms. Some individuals develop psoriatic arthritis without any skin changes at all, though this is fairly uncommon.
PsA is most likely to appear in those experiencing psoriatic fingernail changes like pitting, crumbling and discoloration. While psoriatic arthritis can rear its ugly head and attack any joint of the body, some joints are more likely to be affected than others.
5 Types of Psoriatic Arthritis
There are actually five different types of psoriatic arthritis, depending on which areas of the body are impacted and the severity of symptoms. The five distinctive types of psoriatic arthritis are:
1. Symmetric Polyarthritis
This common type of PsA occurs bilaterally, meaning it affects the same joints on both sides of the body. For this reason, it can resemble rheumatoid arthritis (RA).
2. Asymmetric Oligoarticular
Unlike symmetric polyarthritis, asymmetric oligoarticular arthritis can strike any joint in the body without apparent balance or symmetry. For example, joints on the right hand may be affected, while the left hand feels fine. This type of PsA is common and corresponds with a high likelihood of developing enlarged “sausage-like” fingers and toes.
3. Distal Interphalangeal Predominant (DIP)
Distal Interphalangeal Predominant is a form of psoriatic arthritis which affects the joints closest to the nails of the fingers and toes. Because of the location of affected joints, it can resemble rheumatoid arthritis (RA).
The term spondylitis means inflammation of the spine. Spondylitis is a common cause of back and neck pain among the general population. Not surprisingly, those with PsA are especially at risk. The inflammatory response of psoriatic arthritis can take hold of any of the vertebral joints, causing pain at any point from the neck all the way down to the base of the spine. A small subset of those living with PsA– approximately 5 percent of people– will develop a fusion of the bones in the spine called ankylosing spondylitis.
5. Arthritis Mutilans
Arthritis mutilans is considered to be the most severe form of psoriatic arthritis, affecting five percent of PsA sufferers. Arthritis mutilans wreaks havoc on the nails and small joints at the end of the fingers and toes. This causes severe swelling and stiffness and is capable of destroying joints completely. Bone loss associated with arthritis mutilans may lead to a shortening of the toes and fingers known as telescoping.
What Causes Psoriatic Arthritis?
Researchers and healthcare professionals can’t say precisely what causes someone to develop psoriasis or psoriatic arthritis. Some cases could be hereditary, as roughly 30 percent of psoriasis patients report a family history of the condition. Scientists have isolated a small number of genes in the DNA sequence that increase the probability of developing psoriasis. However, according to the National Psoriasis Foundation, only a minority of cases can be explained by genetics.
The most widely accepted cause of psoriasis has been dubbed the “shotgun theory.” In this theory, a person’s DNA “loads the gun” and something in the environment “pulls the trigger,” activating the disease. Researchers in the medical community have established a number of lifestyle risk factors known to be a likely trigger: obesity, extreme stress, cigarette smoking, heavy alcohol use, and poor dietary choices. Psoriatic arthritis is a condition prone to flaring up; those already living with PsA will recognize many of these factors as likely to cause a flare-up. For instance, periods of stress are likely to be accompanied by an increase in psoriasis symptoms. Other triggers include cold weather, injuries, and infections of the skin. Occasionally, psoriasis can be triggered by an adverse reaction to a prescription medication.
How Does Psoriatic Arthritis Differ from Rheumatoid Arthritis and Osteoarthritis?
Psoriatic arthritis symptoms can be similar to the signs and symptoms of osteoarthritis (OA) and rheumatoid arthritis (RA). Both RA and PsA sufferers are likely to experience fatigue and disease flare-ups. A feeling of morning stiffness and soreness following periods of rest is associated with both osteoarthritis and psoriatic arthritis. Healthcare providers look for the skin and nail changes unique to psoriasis to help confirm a diagnosis. There is no definitive test for diagnosing PsA, so doctors rely on the information gleaned from a patient’s physical examinations, blood tests, imaging tests, and family history to differentiate PsA from other types of arthritis.
One common example of this would be the use of a blood test to check for an antibody called rheumatoid factor which is found in the blood of those with rheumatoid arthritis. Since this antibody is not typically found in the blood of those with psoriatic arthritis, testing for rheumatoid factor can help the doctor distinguish between psoriatic arthritis and rheumatoid arthritis.
Healthcare providers are also able to differentiate between psoriatic arthritis and RA based on how and where the swelling affects the joints. Swelling that is localized around the tips of the fingers is a symptom associated not only with PsA but also gout– a form of inflammatory arthritis that typically affects only one joint. This can lead to a misdiagnosis, at least initially. A joint fluid test can be utilized to check for uric acid crystals, the presence of which would lead to a diagnosis of gout.
8 Psoriatic Arthritis Symptoms to Watch Out For
The symptoms of psoriatic arthritis tend to come and go. Many psoriasis sufferers find that keeping a symptom-tracking journal can help determine what triggered a flare-up. It’s important to keep an eye out for these eight most common symptoms of psoriatic arthritis.
1. Joint Pain and Stiffness
Joint pain can range from mild to severe. You’ll notice a feeling of stiffness, which tends to be more pronounced in the morning or after periods of rest. A reduced range of motion is likely, and joints may feel warm to the touch. Pain left untreated may quickly become disabling.
2. Swollen Fingers and Toes
Your fingers and toes may swell, sometimes so severely they resemble sausages. When extreme swelling occurs, the condition is known as dactylitis. This symptom is more typical of psoriatic arthritis than any other form of arthritis and can be quite painful.
3. Ankle and Foot Pain
Psoriatic arthritis is known to cause pain where tendons and ligaments attach to bones, particularly in the Achilles tendon (back the heel) and soles of the feet. When left untreated, it can create difficulties walking. The most painful time of day will likely be the morning when you stand up after getting out of bed.
4. Lower Back Pain
Pain often centralized around the area of the lower back just above the tailbone (this area is known as the sacrum). There are many different causes of lower back pain. If this is your only symptom, the chances you have psoriatic arthritis are more unlikely, though it’s important to seek medical attention to determine the cause.
5. Red, Scaly Skin Patches
Known also as plaques, these patches of irritated skin with flaky, white scales tend to be dry and itchy. The severity of psoriasis skin disease is not directly proportional to the likelihood of developing psoriatic arthritis.
6. Changes to Nail Beds
Ridging and pitting of the fingernails and toenails (called onycholysis) are closely associated with an individual’s risk of developing psoriatic arthritis. More than 80 percent of PsA sufferers experience these psoriatic nail lesions.
Extreme weariness is a common symptom associated with psoriatic arthritis. Bouts of fatigue tend to last for days or weeks. During this time, extra rest or sleep is typically an ineffective treatment.
8. Eye Problems
Due to the nature of the autoimmune disorder, psoriatic arthritis sufferers are more susceptible to eye problems. The most common eye diseases are conjunctivitis (pink eye) and uveitis, a condition that causes painful, red eyes and blurry vision.
Psoriatic Arthritis Treatment
The first step in treating psoriatic arthritis is setting an appointment to see a board-certified rheumatologist, a doctor who specializes in diseases of the bones, joints and connective tissue. The inflammation of the joints that define PsA can result in permanent damage that may worsen over time, so a prompt and accurate diagnosis is essential. Although psoriasis and psoriatic arthritis cannot be cured, treatments are available to help manage the symptoms and slow progression. Many individuals incorporate natural remedies into their arthritis-fighting arsenal.
The pharmaceuticals prescribed to manage pain and inflammation include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids given by injection, and a class of medications called TNF-alpha inhibitors. Immunosuppressive medications like methotrexate and disease-modifying antirheumatic drugs (DMARDs) are prescribed to slow down the disease and prevent joint damage. Research has shown the use of topical creams to be very effective in treating arthritis symptoms. Products like Arthritis Wonder Cream are formulated to penetrate the skin quickly and effectively, offering almost immediate pain relief that lasts the entire day.
Living with psoriatic arthritis can be very uncomfortable and often painful. Quality of life is often compromised and for an unlucky few, disability can result. It is recommended for those living with psoriatic arthritis to establish a supportive network of individuals available to step in and assist physically and emotionally when needed. Mental health professionals, such as counselors and therapists, may also be helpful in assisting sufferers and their families to establish coping mechanisms. Stress reduction is especially important for those living with PsA because the chemicals released by the body during periods of high stress is likely to aggravate symptoms. We don’t know exactly what causes psoriatic arthritis, nor can we cure it at the present time. Fortunately, symptoms can be managed through prescription medications, topical cream, and healthy lifestyle choices.