Psoriatic Arthritis: Symptoms and Treatment
Many people are aware of the physical and psychosocial effects of the very visual cutaneous disease of psoriasis, however the arthritic component of the disease is often poorly understood.
Psoriatic arthritis is the major associated systemic manifestation of psoriasis. Psoriatic arthritis occurs in 5-30% of patients with cutaneous psoriasis.
Some 10-15% of patients can have symptoms of psoriatic arthritis prior to any involvement to the skin.
Symptoms of Psoriatic Arthritis
There are several presentations of joint pain and inflammation caused by psoriatic arthritis. The most common being asymmetric (one-sided) oligoarthritis (one joint) of the small joints of the hands and feet and morning stiffness.
Some may present with arthritis confined to the distal interphalangeal joints. Commonly psoriatic nail involvement, often confused with fungal infections of the nail, occurs with this presentation of psoriatic arthritis.
It is also possible to have a rheumatoid arthritis-like presentation. With this presentation one may have symmetrical polyarthritis (more than one joint) that involves small and medium sized joints. Most commonly these include the wrists, ankles, and elbows. Most patients with this type have a negative rheumatoid factor.
The least common variant of psoriatic arthritis is arthritis mutilans. This type has a rapid onset with severe inflammation that can lead to destruction of the joint causing permanent deformity.
Lastly, patients may present with spondylitits and sacroiliitis. This type of arthritis involves the sacroiliac joint. The sacroiliac joint is a firm, small joint that lies at the junction of the spine and the pelvis. The knees may also be affected.
Diagnosing Psoriatic Arthritis
Generally, psoriatic arthritis can be determined by your dermatologist or rheumatologist during a complete history and physical exam. Joint X-rays may be ordered.
Psoriatic Arthritis Treatment
Unlike the psoriatic plaques with psoriasis, the arthritic component cannot be alleviated with topical creams or ointments. In the past many doctors have had to rely solely on powerful drugs called disease-modifying anti-rheumatic drugs (DMARDs). These drugs can often be associated with unwanted side effects and potential drug interactions.
Fortunately, there are multiple drugs available now to treat psoriatic arthritis, including Cimzia®, Cosentyx®, Enbrel®, Humira®, Ilumya®, Simponi,® Skyrizi®, Stelara®, Taltz®, Tremfya® and Remicade®. These drugs, called TNF alpha inhibitors or “biologic” medications, are self-injectable medications that block the responsible inflammatory protein called tumor necrosis factor or TNF.
The blockade of this protein curtails arthritic symptoms and over time may prevent permanent joint degeneration. These medications concomitantly treat the disfiguring psoriatic plaques on the skin associated with psoriasis.