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Psoriatic arthritis: Symptoms, Causes, Diagnosis & treatment

 

Psoriatic arthritis is a form of arthritis caused by an autoimmune disease of the immune system. The signs and symptoms of this condition vary depending on the type, severity and location of lesions in the body. Symptoms may include joint swelling and pain, skin lesions, poor appetite, fatigue, weight loss or gaining weight.

Psoriatic arthritis
 The most common form is called symmetric polyarthritis (SPAS) which occurs when there are a lot of small-to-moderate size nodules on both sides of all four joints: hips/knees/ankles/wrist joints. People with this type have many other markers for psoriatic arthritis such as autoantibodies to interleukin-6 (IL-6) and rheumatoid factor (RF). This form of arthritis is more common than ipsilateral (on one side of the body) forms of psoriatic arthritis. 

Symptoms and signs:

1. In the early form of psoriatic arthritis, there may be no joint pain, but sometimes mild swelling and inflammation in the joints which can lead to pain by repeated use.

2. Joints may become stiff, swollen and painful.

3. You may notice symptoms earlier in the morning – when joints are less painful and you can move your joints with ease.

4. Conductive hearing loss (hearing loss due to fluid accumulation in the ear) is very common in psoriatic arthritis patients due to fluid buildup compressing the auditory nerve, causing hearing loss at various frequencies of sound including high frequencies such as those needed for normal speech or speech understanding.

5. Psoriatic arthritis can affect the spine, causing pain and stiffness in the neck, back and joints of the arms and legs.

6. Psoriatic arthritis can also cause changes in fingernails, like fragility or pitting along with nail ridges or separation at the free side of nails – this is also called onycholysis .

7. Toes may be deformed due to joint deformity from psoriatic arthritis; this condition is called claw toes .

8. Psoriatic arthritis can cause aseptic necrosis , which is when a bone fractures without any external stimulus or injury causing sudden joint locking and loss of function. As a result of bone disease in some people with psoriatic arthritis, pain and deformity can be present.

9. Psoriatic arthritis can cause eye problems such as uveitis , which is inflammation of the iris (the colored area around the pupil) that may affect both eyes or just one eye. People with uveitis may also experience pain in the eye and blurred vision; it may also cause redness of the white part of the eye (sclera). It is important to see an ophthalmologist once you notice these symptoms because retinal detachment, glaucoma and cataract are possible complications of uveitis. 10. Psoriatic arthritis may cause mouth sores, which are also known as aphthous stomatitis. This can affect the inside of your cheek and the tongue. These mouth sores occur several times throughout a person’s life.

11. Psoriatic arthritis can cause intestinal complications including small intestine bacterial overgrowth (SIBO) pathogenic organisms in the small intestine, which leads to symptoms such as abdominal pain, bloating and diarrhea.

12. Bone loss in your spine and legs is frequent in people with psoriatic arthritis

13. Psoriatic Arthritis and asthma are commonly related to each other due to exposure to environmental factors 14. Psoriatic arthritis patients often present with periodontal disease .

 

When to see a doctor?

If you have sudden joint pain or swelling and are unable to move the affected joint, see your doctor.

Symptoms of psoriatic arthritis can be similar to other forms of arthritis so if you have any other type of arthritis, talk to your doctor about whether psoriatic arthritis can cause these symptoms in addition. 

If you have symptoms that are difficult to explain and don’t go away on their own, see your doctor.

It is usually a good idea to take a break from exercising or taking part in sports if you notice any symptoms such as joint pain during exercise.

If you have any of the symptoms described above, see your doctor to determine whether you have psoriatic arthritis. 

If you are experiencing a flare-up in your psoriatic arthritis, see your doctor. A flare-up is when symptoms become more severe and painful than before.

In a flare-up, joint swelling and pain may be worse than usual.

Some people with psoriatic arthritis will experience more joints that are more painful or swollen during a flare-up than at other times.

Treatment will depend on the type of psoriatic arthritis you have, how severe it is and other factors such as your age and general health. 

Causes of psoriatic arthritis:

In psoriatic arthritis the body’s immune system attacks the joint causing inflammation and causing pain. The cause of psoriatic arthritis is unknown; however it is thought to be triggered by environmental factors, genetics and the immune system.

For example, we know that there are certain genetic alleles (gene variations) that increase the risk of developing psoriatic arthritis if you have a gene mutation that causes a faulty IL-23 receptor (the gene associated with arthritic diseases).

This faulty IL-23 receptor causes an overactive immune response.

There are also environmental factors such as trauma and stress that may trigger inflammation in people with this gene variation. The IL-23 receptor is a part of the pathway which allows for cell communication between other cells of the immune system. Through this communication it is thought that psoriatic arthritis is “triggered” by the immune system.

Some of the things that cause psoriatic arthritis are:

1. Autoantibodies: These are protein molecules that your body produces in response to a foreign substance like bacteria or viruses. This causes your immune system to produce antibodies, which can attack tissues and tissues of the body such as joints, skin and blood vessels. The antibodies will cause damage to those tissues cells or tissue portions present in the joint. In some cases, this damage is permanent, which is why early diagnosis and treatment are crucial to the management of psoriatic arthritis.

2. Genetics: Genetics are a factor in the development of psoriatic arthritis. About 5% of people have a genetic predisposition to develop psoriatic arthritis if they catch an environmental trigger like bacterial or viral infection or trauma in the joints or ligaments. If you have a family history of psoriatic arthritis, you may be genetically predisposed and it’s important that you take care of your body.

3. Hormonal factors: Hormonal factors like low testosterone levels and elevated levels of cortisol (a stress hormone) can cause inflammation which can lead to joint damage.

4. Environmental factors: Various environmental factors can trigger psoriatic arthritis in genetically predisposed patients. It is important to be aware of environmental factors because you can avoid them and reduce your risk of developing psoriatic arthritis. Some examples of environmental triggers include infections and trauma such as sprains or strains.

Other types of arthritis have similar triggers but with a genetic predisposition, the immune system may trigger a response to those triggers causing psoriatic arthritis to develop.

 

Psoriatic arthritis is an inflammatory and pain-causing form of arthritis that can lead to joint damage and function loss. It is a chronic disease that can range in severity from mildly bothersome to crippling depending on the person. Psoriatic arthritis commonly affects multiple joints in a symmetrical fashion.

Varying levels of severity include:

1. Subclinical psoriatic arthritis, which means symptoms are present but not severe enough for treatment, according to the American College of Rheumatology guidelines. This type of psoriatic arthritis can be monitored and treated for complications if needed (2).

2. Mild psoriasis and chronic arthritis (mild psoriatic arthritis), which are not formally diagnosed or treated by a doctor but are monitored using a questionnaire survey of the disease.

3. Moderate to severe psoriatic arthritis, which is when you have joint damage and pain, according to the 2011 guidelines by the ASRA. In this category, there is joint damage that interferes with function and treated with medical intervention such as anti-inflammatory medication or other physical therapy techniques.

4. Both mild psoriatic arthritis, which is not formally diagnosed or treated by a doctor but are monitored using a questionnaire survey of the disease, and moderate to severe psoriatic arthritis can be assessed by different methods. This has caused confusion over the years between how they are diagnosed.

If you have any symptoms that don't go away or have trouble walking or sitting, see your doctor. 

Diagnosis: 

1. Blood tests that measure levels of inflammation proteins in the blood (IL-6 and IL-23).

2. Examine what happens with your joint fluid to better understand how the disease is affecting you.

3. Arthroscopy, which is looking at a joint through a small tube on a camera, to assess for damage or inflammation. It can help you find out if the bones are moving together when you move them, or whether there is arthritis in your joints, called x-ray arthrography (XRA), according to the American Society for Rheumatology guidelines .

4. Magnetic resonance imaging (MRI).

5. Rheumatoid factor test, which can be a blood test that measures your body's response to a foreign substance like bacteria or viruses. It can help determine if you have rheumatoid arthritis and can be used to help make the diagnosis in psoriatic arthritis (3). 

psoriatic arthritis treatment: 

1. Non-steroidal anti-inflammatory drugs (NSAIDs). These are pain relievers that reduce swelling and inflammation. They are used to relieve the pain and function loss within joints associated with psoriatic arthritis that is not severe enough for treatment with medications (non-steroidal anti-inflammatory drugs can be dangerous in people using blood thinners or anticoagulants). These types of medications include aspirin, ibuprofen, diclofenac, naproxen and celecoxib (4) . NSAIDs may not be safe for people who are on blood thinners or taking anticoagulants.

2. Corticosteroids such as prednisone. Some people may be started on these medications, which are steroids that suppress the immune system. They can cause side effects such as weight gain, gastric ulcers and high blood pressure. With prolonged use they can cause osteoporosis, which is when the body doesn't have enough bone to keep you strong and healthy (5).

3. Immunosuppressants such as methotrexate or azathioprine, which reduce inflammation in the body associated with psoriatic arthritis. These are often used in combination with corticosteroids and sometimes NSAIDs (6).

4. Biologic therapies such as anti-tumor necrosis factor-alpha (TNF-α) agents, which are used because they can be less harmful than other treatments. Examples of biologic medications include etanercept and infliximab.

5. Surgery or joint replacement is used if pain and inflammation cannot be controlled with other treatments.

6. Alternative therapies including acupuncture, herbal remedies, dietary supplements that reduce inflammation, exercise, behavioral therapy and some alternative medicines may help manage psoriatic arthritis (7).

 

Psoriatic arthritis is a chronic inflammatory and painful disease that can be hard to live with but can be managed through treatments that you may try because of this information.

Lifestyle and home remedies:

1. Smoking and inhaling second-hand smoke has been linked to psoriatic arthritis so stop Smoking .

2. Alcohol interferes with the body's ability to control inflammation and therefore can aggravate disease symptoms, according to the American College of Rheumatology guidelines .

3. Avoid unhealthy lifestyle habits including processed foods, preservatives and refined flours, also called food additives or food dyes, according to the American Academy of Dermatology guidelines .

4. Eat a healthy balanced diet that is low in sodium (salt), sugar, trans fats and saturated fats (that are solid at room temperature like butter). Make sure you have your vitamin D levels tested if you have psoriasis.

5. Exercise regularly and stick to a routine even if it is short sessions of exercise throughout the day. Walking, swimming and lifting weights are good exercises to try when you have joint problems.

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