Psoriatic arthritis

Psoriatic arthritis occurs in about 15% of patients with psoriasis and can lead to damage of any joint in the body. It can occur in patients without psoriasis, particularly if they have relatives with psoriasis. It can attack one, several or many joints in the body, usually in an unequal or nonsymmetric distribution.

Affected fingers and toes can swell like sausages, called dactylitis, which is diagnostic if present. The site of inflammation is at the enthesis or where tendon and ligaments attach to bones near joints, and persistent enthesitis can destroy the joint over time. Heredity plays a role as 40% have a family member with psoriasis or psoriatic arthritis. Infection might trigger the activation of the immune system attack, but there is no persistent infection. It often starts between the ages of 30 and 50, but can start at any age, and is equally in women and men.

Children with psoriatic arthritis have a higher risk for uveitis than adults. Imaging tests can help establish the diagnosis, while blood tests are used for looking for other possible diseases.

A skin biopsy might be needed to establish psoriasis. Treatment is determined by the inflammation level of the joints involvement. NSAIDs are the initial treatment, but usually Azulfidine, Methotrexate, Neoral, Arava, Plaquenil, Imuran, Otezla, Enbrel, Humira, Cimzia, Simponi, Remicade, Simponi Aria, and Stelara can be used to control the disease. Corticosteroid injections can help swollen joints, and hopefully damaged joints that need surgery can be prevented.

Psoriatic arthritis patients are slightly more likely to develop metabolic syndrome, which should be treated. Exercise and therapy are important to maintain function and good range of motion in the joints. The National Psoriasis Foundation is available for more information.

Exercise and therapy are important to maintain function and good range of motion in the joints.