Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
If you have psoriatic arthritis, your condition probably falls into one of the patterns below.
Asymmetrical oligoarticular arthritis (arthritis that involves a few joints
but not necessarily the same joints on both sides of the body or other similar
joints on the same side of the body):
Usually, the fingers and toes are affected first. The fingers may have a "sausage" appearance (called dactylitis). This occurs in 35% of people with psoriatic arthritis.
Usually, fewer than five joints are affected at any particular time.
Symmetrical polyarthritis (arthritis that involves similar joints on both sides of the body, much like rheumatoid arthritis)
is one of the most common types:
The hands, wrists, ankles, and feet may be involved.
Distal interphalangeal arthropathy (arthritis in the joints at the ends of the fingers and toes):
Involvement of the joints at the ends of the fingers and toes occurs in only 5% to 10% of people with psoriatic arthritis, most commonly men. (Involvement of the joints at the ends of the fingers and in the big toe can occur in osteoarthritis, but osteoarthritis is much less inflammatory than psoriatic arthritis.) The nail may be involved. The skin around the edges of your nail may be inflamed (called
Arthritis mutilans (a long-term form of destructive psoriatic arthritis in which the joints are severely damaged and deformities can be seen, especially in the hands and feet):
This may occur in as many as 16% of people with psoriatic arthritis and can be severe.
The bone may soften and become absorbed by surrounding tissues (called osteolysis), and the joint may dissolve.
If the fingers and wrists become shortened with skin folds around them, the condition is called "opera glass hand." This occurs more often in men than in women.
Spondylitis (inflammation of the vertebrae in the spine) with or without sacroiliitis (inflammation of the sacroiliac joint in the pelvis) and inflammation of the hip:
This occurs in about 5% of people with psoriatic arthritis, usually men.
People who have other psoriatic arthritis patterns may also have this condition.
The typical symptom is stiffness of the lower back in the morning, but not everyone has this. It can occur without involvement of the pelvis/hip joints, which often occurs on only one side of the body. Sometimes a person's symptoms do not seem to match the findings on
The vertebrae are not affected evenly. A joint in the neck may be affected and not a lower spine joint.
Your doctor may notice unusual features on X-rays, such as bony growths on ligaments.
Juvenile psoriatic arthritis (psoriatic arthritis that affects children):
Juvenile psoriatic arthritis accounts for 8% to 20% of cases of arthritis in children.
This often occurs in 9- to 10-year-old girls. It is usually mild, but occasionally it is severe and lasts into adulthood.
In half of affected children, only one joint is affected. The joints at the ends of the fingers or toes are involved in about half of affected people as well.
The tendons are inflamed in 30% of affected children. Nails are involved in 71% of affected children, and little pits can often be seen on the nails.
Bone growth problems and shortening due to inflammation may occur in 47% of affected children.
Sacroiliitis (inflammation of the sacroiliac joint in the pelvis) or arthritis of the hip occurs in 28% of affected children.
Onset of psoriasis and arthritis at the same time occurs more often in children than adults. Arthritis occurs before psoriasis in 52% of affected children.