Psoriatic Arthritis
What is Psoriatic Arthritis?
According to the National Psoriasis Foundation, Psoriatic Arthritis is a type of inflammatory arthritis that affects around 30% of people who are suffering from the chronic skin condition called Psoriasis. It is also referred to as arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy.
Psoriatic Arthritis can develop even in children, but is more common in people between the ages of 30 and 50. Men and women are equally affected by this disease. In rare cases the arthritis symptoms may occur before any skin condition manifests itself.
Symptoms of Psoriatic Arthritis
Psoriatic Arthritis is a chronic disease characterized by inflammation of the skin (psoriasis) and joints (arthritis). Psoriasis is a skin condition where patchy, raised, red areas of skin inflammation with scaling develop; affecting elbows, knees, scalp, navel, anus and around the genitals. Psoriatic Arthritis is difficult to diagnose, as sometimes, patients may have arthritis for over 20 years before psoriasis appears and vice versa.
Some of the symptoms of Psoriatic Arthritis are:
1. Pain in the joints like knees, ankles and joints in the feet and toes
2. itching and redness of the skin; inflammation of the spine (spondylitis)
3. discoloration of nails or lesions on nails (pitting and ridges of nails)
4. pain and stiffness in the lower back, buttocks, neck and upper back
5. and in rare cases joints at the ends of digits (dactylitis)
6. inflammation of the heels (Achilles tendinitis)
7. inflammation of the breastbone
8. inflammation in the eyes (iritis)
9. inflammation of the aorta
10. inflammation of the lungs (pleuritis)
Diagnosis of Psoriatic Arthritis
Blood test: There is no laboratory test to specifically diagnose Psoriatic Arthritis. After physical examination of the inflamed joints and skin lesions, certain blood tests to check sedimentation rate will be undertaken. The blood tests merely show presence of inflammation in the joints and other organs of the body. Other blood tests such as rheumatoid factor are obtained to eliminate the possibility of Rheumatoid Arthritis. The blood test for genetic marker HLA-B27 would be required to rule out spinal inflammation.
Arthrocentesis: Arthrocentesis is a procedure where a sterile needle is used to draw fluid (aspirate) from the inflamed joints. This is carried out when one or two large joints, like knees, are inflamed. The fluid is then analyzed for infection, gout crystals and other inflammatory conditions.
X-rays: X-rays would show changes of cartilage or bone injury indicative of arthritis of the spine, sacroiliac joints or joints of the hands. The X-ray would also indicate bony erosions resulting from arthritis. .
Causes of Psoriatic Arthritis
Just like in the case of Psoriasis, the actual cause of Psoriatic Arthritis is open to debate. But Psoriatic Arthritis is said to occur more commonly in patients with tissue type (Human Leukocyte Antigen B27) HLA-B27. Immuno-environmental factors also affect the onset of this disease. Also, decline in the number of immune cells (T- cells) in AIDS patients plays a role in the progression of psoriasis in these patients.
Types of Psoriatic Arthritis
There are five main types of Psoriatic Arthritis:
Asymmetric: This type is mild and affects around 35% of the patients. It does not necessarily occur in symmetric joints of the body and usually occurs only in less than 3 joints.
Symmetric: This type accounts for around 50% of cases. It affects joints on both sides of the body simultaneously. This type is most similar to Rheumatoid arthritis and is disabling.
Spondylitis: Spondylitis pertains to stiffness of the spine or neck, but can also affect the hands and feet.
Arthritis mutilans: This is a severe, deforming and destructive form of the disease and is rare. It affects less than 5% of patients. This condition can progress over years causing severe joint damage.
Distal interphalangeal predominant: This type is found in about 5% of patients. It is characterized by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail damage often occurs.
SAPHO syndrome: Another type of Psoriatic Arthritis can be described by its symptoms, i.e. inflammation of the joint lining (synovitis), acne and pustules on the feet or palms, thickened and inflamed bone (hyperostosis), and bone inflammation (osteitis). This syndrome is also called SAPHO syndrome.
Treatment of Psoriatic Arthritis
The treatment of Psoriatic Arthritis is undertaken on two fronts – the treatment of psoriasis and the treatment of arthritis.
A) Topical treatments: Over the counter (OTC) or prescription topical medications applied to the skin are used for treating psoriasis. Topical treatment entails drugs which slow down or normalize excessive cell reproduction, hence reducing the inflammation. There are many effective topical treatments like salicylic acid, steroids, anthralin or tar which are in the form of shampoos and bath solutions. Tar not only helps slow the rapid proliferation of skin cells but also helps reduce inflammation, itching and scaling.
B) Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, indomethacin and tolmetin sodium are given for relieving pain from the arthritis. Certain immuno-suppressants such as methotrexate or leflunomide can treat the psoriasis in addition to the arthropathy. Sulfasalazine, an oral sulfa-related medicine and oral/injectible corticosteroids are also used in some cases.
C) Biologics: Biologic medications are developed from living sources such as human or animal proteins (e.g. vaccines and insulin). Enbrel, Humira and Remicade have been approved by the Food and Drug Administration (U.S.) for the treatment Psoriatic Arthritis.
D) Phototherapy: Ultraviolet B (UVB) rays and psoralen UVA (PUVA) therapy is used in severe cases. The skin it exposed to these rays (specific wavelength) under medical supervision for a fixed length of time and on regular schedules. Also, Excimer laser emits a high-intensity beam of UV light which helps to treat Psoriasis.
E) Alternative therapy: This would include diet and climate change. A survey released in May 2004 conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics found that in 2002, 36% of U.S. adults were consuming some form of complementary and alternative medicine.
Acupuncture: According to Traditional Chinese Medicine, most of the painful diseases are caused by an imbalance or a blockage of energy circulating in the body. Acupuncture is used to restore the balance of energy- flow in the body. In an acupuncture treatment, sterile needles which are very thin are inserted at specific points on the body. Acupuncture has few known side effects. Studies have shown that acupuncture helps relieve pain.
Chinese herbal medicine: “Traditional Chinese Medicine” is a complex healthcare system that includes acupuncture, herbs, massage, nutrition and exercise. Practitioners tailor a treatment regimen for each patient. Herbs are combined in unique formulations for each individual patient and are for primary treatments. In the treatment of psoriasis, oral and topical herbal treatments are used.
Exercise and heat: Regular exercise programs that can be done at home or with a physical therapist can help with the disease. Stretching and other techniques like hot showers or heat applications are helpful to relax muscles prior to exercise. Ice application after this routine will help minimize post-exercise soreness and inflammation.
Ayurvedic (herbal) medication: Prevention is the key to Indian Ayurvedic medicine. This herbal medicinal science encourages restoration of balance in the body through diet, herbs, lifestyle and positive thinking. Hence, treatment would change according to the individual’s health, age, severity of disease, tolerance to medications, environment, allergies, etc. But on the whole, the treatment would involve topical application of certain oils, such as sesame or mustard; fasting and other dietary guidelines; elimination of stress; and regular physical exercise.
Caution: Some herbal topicals make the skin more sensitive to ultraviolet light, while other oral herbs may interact with prescriptions or medications being taken for other diseases. They must be used under strict professional supervision.
Chiropractic treatment: Chiropractic medicine is the practice of manipulating the spine for therapeutic benefit. It is a widely recognized alternative treatment for Psoriatic Arthritis which affects the spine.
Homeopathic medicine: Homeopathy is a school of medicine which believes that substances causing adverse symptoms in a healthy person can cure the same symptoms in a sick person. Homeopathic remedies are usually so diluted that they will not cause major side effects.
Naturopathy: Naturopathic medicine is a distinct system of primary health care which focuses on natural products, identification of the root cause of disease and curing that cause, prevention of disease, etc. But these techniques are normally used as supplementary line of treatment and not primary.
Massages: Massage therapy is used to cure chronic and acute arthritic 
pain, reduce stress and ease muscle tension, thus inducing relaxation. Different types include Swedish massage, deep tissue massage, reflexology, shiatsu and acupressure. These should also be undertaken under proper professional supervision.
Balneotherapy: Balneotherapy is a general term used for water-based treatments involving natural thermal springs, hot springs, mineral water or seawater.
Climatotherapy: This involves change in air and water conditions. There are a lot of clinics for the treatment of Psoriasis and Psoriatic Arthritis near the Dead Sea, where the level of mineral salts is very high. The air and water combination at this location is the most effective in the world for the treatment of Psoriatic Arthritis.
Living with Psoriatic Arthritis
Psoriatic Arthritis has many symptoms which reduce the quality of life of the person. The constant pain causes discomfort. The lesions and itching of the skin cause discomfort and mar the appearance of the person. If the cause of the psoriasis is depression and anxiety, the condition would get worse and result in low self-esteem and lack of confidence. Also, the joint pain would adversely affect the daily life of the person. Certain methods of treatment are necessary to cure the disease but have side effects. In severe cases, the lengthy treatment proves expensive.
Prevention of Psoriatic Arthritis
Just like Psoriasis, Psoriatic Arthritis too cannot really be prevented because studies have shown that heredity plays a large part. Also, certain nutritional deficiencies can also aggravate the condition. But a few measures can be taken to reduce the chances of being afflicted by this disease:
01) Maintain a balanced diet that is low in fat but high in iron, proteins, fruits, leafy vegetables, water, etc.
02) Avoid foods containing hydrogenated fats to prevent heart disease, strokes and cancer.
03) Lose weight as studies have shown improvement in the condition when the patient loses weight.
04) Avoid overuse of NSAIDs if they are prescribed for another ailment.
05) Avoid environmental factors that aggravate the condition like too much exposure to sun, stressful activities, etc.
06) Quit smoking completely.
07) Stop consumption of alcohol.
08) Avoid coffee, refined sugar and refined flour.
The Psoriasis Foundation, which studies Psoriatic Arthritis, has heard from many of its members that eliminating items like caffeine, alcohol, sugar, white flour and products containing gluten helped to improve their Psoriasis and Psoriatic Arthritis.
