Psoriatic arthritis is the name given to joint inflammation that occurs in approximately 15-20% of those with a skin disease called psoriasis. It can affect many joints and the complaints vary from person to person. Psoriatic arthritis causes damage to the joint it is involved in. Therefore, with early diagnosis and treatment, the sooner it is possible to prevent disability due to joint damage.
What is psoriatic arthritis?
Psoriasis, also known as psoriasis among the people; It is a skin disease with rash, which is characterized by redness and peeling of the skin and white scales. Psoriasis is caused by the body’s immune system targeting and attacking the skin. In some psoriasis patients, the immune system attacks the joints as well as the skin, causing inflammation in the joint. Like psoriasis, the symptoms of psoriatic arthritis are accompanied by exacerbations and remissions. Disease symptoms vary from person to person; even in the same person, the joint areas that they hold may change over time.
Psoriatic arthritis can affect any joint in the body. It can affect only one joint, several joints, or multiple joints. It can hold the spine; It can cause pain in the lower lumbar region, back and neck pain, pain in the rib cage. It can affect small joints such as fingers and toes, as well as large joints such as knees and ankles. Sometimes in one of the fingers or toes, it can cause a condition called ‘dactylitis’, which looks like a sausage with swelling and redness throughout. Changes such as pin-like pits (thimble nail) or coarsening of the nail and separation of the nail from the bed can be seen in the nails.
When psoriatic arthritis involves the spine, it causes back or neck pain called spondylitis and difficulty bending over. Psoriatic arthritis can cause tenderness at the points where tendons and ligaments attach to bones. This condition, called ‘enthesitis’, can cause pain in the heel, sole, back of the foot, front of the knee, around the elbow, or other areas. Enthesitis is one of the characteristic features of psoriatic arthritis.
What causes psoriatic arthritis?
It is not known exactly what causes psoriatic arthritis. Up to 40 percent of people with psoriatic arthritis have a history of psoriasis or psoriatic arthritis in a first-degree (and sometimes even second-degree relative) relative. This suggests that heredity plays an important role in the development of the disease. Genetic studies on these patients have shown that many genes may play a role in the development of this disease. It suggests that not only genetic factors but also past infections may play a role in the emergence or exacerbation of the disease by activating the immune system. People with psoriasis who have a widespread skin rash sometimes avoid touching them as if they are contagious. Psoriasis is not contagious. Therefore, please do not hesitate to touch these people.
Who develops psoriatic arthritis?
Psoriatic arthritis usually occurs in people between the ages of 30 and 50, but can also begin in childhood. Men and women are at equal risk. Children with psoriatic arthritis are at greater risk of developing uveitis (inflammation of the middle layer of the eye).
About 15-20 percent of people with psoriasis develop psoriatic arthritis. Usually, skin findings appear first, and then arthritis develops years later. Sometimes both go together. Rarely, joint symptoms develop first and then a rash may appear.
How is psoriatic arthritis diagnosed?
For the diagnosis of psoriatic arthritis, the rheumatologist will look for swollen and painful joints and signs of arthritis and skin and nail changes typical of psoriasis. Direct X-rays are usually taken to look for joint damage. Magnetic resonance imaging (MRI), ultrasound, or CT scans may be done to look at the joints and spines in more detail.
Blood tests; It can be done to differentiate other joint diseases with similar signs and symptoms such as gout, osteoarthritis and rheumatoid arthritis. Blood tests of patients with psoriatic arthritis may reveal inflammation and mild anemia. Sometimes a skin biopsy may be needed to confirm psoriasis.
How is psoriatic arthritis treated?
Treatment of psoriatic arthritis varies from patient to patient and the area of the joint involved.
Non-steroidal anti-inflammatory drugs (such as NSAID-naprosyn, diclofenac, indomethacin) to relieve pain and inflammation in the joint can be taken with a full stomach while protecting the stomach. In single joint involvement, corticosteroid injection can be made into the joint. However, oral (systemic) corticosteroid therapy is not used in psoriatic arthritis; increases skin rashes.
To take the disease under long-term control and to prevent joint damage; rheumatism drugs that change the course of the disease are used. These are methotrexate, leflunomide, sulfasalazine, cyclosporine. Sometimes these drugs can be used in combination with each other. The malaria medication hydroxychloroquine (Plaquenil) may be helpful in treatment, but is usually avoided as it will cause psoriasis flare-ups. Azathioprine can be used alone or in combination with other treatments in severe forms of psoriatic arthritis. In patients resistant to the drugs mentioned above, biologic drugs called anti-tumor necrosis factor (anti-TNF) -adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi) alone or together with methotrexate can be used.
Seriously damaged joints; Restorative surgical treatments such as knee and hip joint prosthesis surgeries can be performed.
Recommendations for patients with psoriatic arthritis:
In summary, psoriatic arthritis is a chronic arthritis with exacerbations and remissions. It causes damage to the joint it is holding. Therefore, early treatment is very important. Involvement due to the disease may differ from person to person or even in the same person over time.
May cause fatigue and anemia in patients. It can negatively affect people psychologically.
People with psoriasis have slightly higher blood pressure, high cholesterol, obesity, gout and diabetes.
It is necessary to be at a healthy weight and to regulate blood pressure and cholesterol levels.
Many people with arthritis develop joint stiffness and weakness in the associated muscle group. Proper exercise is essential for improving your overall health and keeping joints flexible. You can simply do it with the advice of your doctor, such as walking, exercise bike, yoga, pilates, stretching exercises, or by learning some exercises in the presence of a physiotherapist. Swimming and in-pool exercises are also applications that can be done without straining the joint.
Role of the rheumatologist in the treatment of psoriatic arthritis:
Patients with psoriatic arthritis may sometimes be diagnosed with gout, rheumatoid arthritis or osteoarthritis.
As musculoskeletal specialists, rheumatologists can provide these patients with the most appropriate diagnosis and best treatment option.
