Psoriatic Arthritis and Its Management

Psoriatic Arthritis and Its Management

Psoriatic arthritis (PsA) is a type of inflammatory arthritis (chronic disease) that affects people who have a skin disorder called psoriasis. Psoriasis is a skin condition wherein the patient gets red patches on skin topped with silvery scales. It mostly occurs over the elbows, knees, ankles, feet, and hands. Ones who have psoriasis lesions on their nails are more likely to develop PsA.

In most cases, people get psoriasis first and are later diagnosed with psoriatic arthritis. People with psoriatic arthritis may have symptoms of both psoriasis and arthritis. The joint problem may begin before the skin lesions appear. PsA can be mild, or severe and involve one or many joints. Disease flares up maybe alternate with periods of remission.

PsA mostly happens in adults between age 30-50. It could be genetic. Physical trauma or some viral or bacterial infection may trigger psoriatic arthritis in people with an inherited tendency.

Psoriatic Arthritis and Its Management
Psoriatic Arthritis and Its Management

Types of Psoriatic Arthritis

There are five types of Psoriatic Arthritis, these are listed below:

1. Symmetric PsA

Symmetric PsA is more like rheumatoid arthritis but milder than it. In this, the same joints on both sides of the body get affected. It can be disabling and leading to loss of function.

2. Asymmetric PsA

Asymmetric PsAinvolves one to three joints on one side of the body, it could be large or small joints. It does not affect the same pairs of joints and is usually mild. The joints feel sore and turn red.

3. Distal Interphalangeal Predominant PsA

This involves the small joints in the fingers and toes closest to your nails called distal joints.

4. Spondylitis PsA

A condition called spondylitis develops as a result of psoriatic arthritis. It affects the spinal column and may cause stiffness in the neck, lower back, spinal vertebrae and pelvic region making it difficult to move. Hands, feet, legs, arms, and hips may get affected.

5. Psoriatic Arthritis Mutilans

This type of PsA is rare but most severe, destructive and deforming. It affects the small bones of hands and feet. It makes the fingers and toes deformed and hard to move. They also get shorten due to bone loss. It may cause pain in the neck and lower back. It leads to lost function of the involved joints.

Symptoms of PsA

  • Pain in the joints, stiffness, tenderness, and swelling of joints are the main symptoms of PsA. One may experience sore muscles, achy shoulders too.  It is very painful and may lead to deformities of hands and feet. Fingers and toes sometimes get so puffy that they resemble sausages.
  • PsA causes pain at the joints where tendons and ligaments attach to the bones like back or sole of the foot. There are morning stiffness and tiredness. If the pain is at the back of the heel, it is called Achilles Tendinitis and if the bottom of foot hurts, it is called plantar fasciitis.
  • Other symptoms include nail changes (nail separates from the nail bed and mimic fungus infections). Tiny pits in the nails are visible.
  • There are redness and pain in the eye is called Uveitis. It may lead to blurred vision. There is scalp psoriasis, the condition that causes red, scaly patches on the scalp.
  • There could be a problem in turning your head due to pain in the neck.
  • PsA also affects the cardiovascular system of the patient and if the inflammation spreads to the lungs, it can cause interstitial lung disease. It can cause scarring of lungs which is irreversible and may lead to breathing problems.

Diagnosis of PsA

A doctor may do a complete physical examination, check the symptoms, go through the medical history and do some blood work, imaging tests to determine PsA. X-rays and Bone density tests are also done.

Treatment of PsA

  • PsA affects inside as well as outside the body.
  • PsA treatment includes exercises especially stretching/swimming/walking/cycling, joint protection from further damage by changing the ways the everyday tasks are done and taking medicines to relieve pain and control inflammation. Resting and relaxing whenever necessary is the key to faster recovery.
  • It is very important to lose weight as fat tissues release proteins that cause swellings.  One should limit fats, sugars and carbohydrates intake, limit salt intake and eat a well-balanced healthy diet that includes fruits, vegetables, lean meats, and low-fat dairy items.
  • An anti-inflammatory diet should be consumed by the patients. This includes carrots, sweet potatoes, spinach, kale, and blueberries.
  • It is very important to opt for a gluten free diet. So, one should avoid wheat and barley.
  • Food cooked in extra virgin olive oil helps the psoriasis patients due to the presence of omega 3s, and oleocanthal that relieves swellings.
  • To get some quick relief, it is recommended to use ice packs over the swollen areas. For foot pain, one may roll the foot back and forth on a frozen water bottle.
  • A warm bath or use of heating pad is also recommended to bring swelling down and improve the blood circulation. Add oatmeal or dead sea salts to ease the itching and inflamed skin.
  • Stress triggers and flareups. It is very important to stay stress-free. Practice Yoga and Meditation to overcome stress. Acupuncture is also a good way to manage PsA pain as the tiny needles helps the body to release serotonin that kills the pain. Also, take adequate sleep. Find the right shoes for yourself to help with swollen toes.
  • PsA is an autoimmune condition and causes the body to attack its own joints, tendons, and skin.
  • There is no permanent cure of PsA but the symptoms can be managed effectively. In severe cases, steroid injections and joint replacement surgery is the only option. One should undergo the treatment right when PsA is diagnosed in order to prevent disabling and stop the progression of the disease. If left untreated, PsA can cause permanent joint damage.
  • PsA also impacts persons mental and emotional health and lead to anxiety and depression. It is important for the patient to get a lot of support from family and friends at this time.

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