Psoriatic Arthritis

Millions experience the pain and physical limitations of arthritis. Arthritis, however, is not a single medical problem but a group of more than 100 conditions that can cause inflammation of joints, muscles, tendons, ligaments and bones.

One of these conditions is psoriatic arthritis, affecting as many as 1 million of the approximately 6 million Americans who have psoriasis. Most are adults in their 30s, 40s and 50s. Children, however, also can have a form of the disease. Psoriatic conditions are chronic diseases characterized by inflammation of the skin (psoriasis) and inflammation of the joints (psoriatic arthritis).

Etiology

The etiology for psoriatic arthritis is unknown. Psoriatic arthritis develops in 10% to 30% of people with psoriasis, but it may also occur on its own. Some in the medical profession think that psoriatic arthritis could be related to immune deficiencies or genetics.

Symptoms

There are several types of psoriatic arthritis, with symptoms ranging from mild to severe. Usually, the disease isn't as crippling as other forms of arthritis, but if left untreated it can cause discomfort, disability and deformity.

Symptoms include:

• Inflamed, scaly skin that is typical of psoriasis
• Swollen, painful joints, especially in fingers and toes
• "Sausage" type of appearance in affected joints
• Pitted and discolored nails
• Inflammatory eye conditions such as conjunctivitis

Psoriatic arthritis sufferers can also develop inflammation in many other areas of the body that may initially not appear to be related to the disease, such as:

• Inflammation of the tendons or cartilage, which can cause tendonitis, including Achilles tendonitis or Costochondritis
• Inflammation and pain in the organs and parts of the body such as the lungs, aorta and iris of the eye (iritis)

Diagnosis

Dermatologists usually diagnose psoriasis by a visual inspection of the skin and joints. Findings of psoriasis or "sausage joints" can be a tell-tale sign. Sometimes a biopsy called arthrocentesis is needed to confirm the diagnosis.

Although there is no lab test to diagnose psoriatic arthritis, it is common to find increased sedimentation which tells the doctor that there is inflammation in the joints and other organs of the body. Rheumatoid arthritis can be ruled out by performing an RA factor blood test. X-rays may show changes of cartilage or bone injury, indicative of arthritis. A blood test for the genetic marker HLA-B27 can be performed to indicate psoriatic arthritis because it is found in about 50% of the patients with psoriatic arthritis and spinal inflammation.

Medical Treatment

The Food and Drug Administration has approved several immune-modulating drugs for the treatment of moderate to severe cases of psoriasis. They include:

• Alefacept (Amevive)
• Efalzumab (Raptiva)
• Etanercept (Enbrel)

• Ice Packs to help reduce inflammation 
• Hot Packs to help relieve pain
• Braces or supports to manage the pain of tendonitis or joint or back pain by providing support and compression
• Topical pain gels, if skin tolerable, to provide temporary relief of joint or muscular pain
  
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