Doctor's Notes on Psoriatic Arthritis
Psoriatic arthritis is an autoimmune disease that usually affects the skin and joints. Signs and symptoms can range from none or minimal to severe. Minimal signs and symptoms may be just some scaly reddish skin on the scalp, navel, or between the buttocks. Others may have some abnormalities like lines going across nails, pits in the nails, and yellow spots. Usually, skin changes precede (sometimes by years) arthritic symptoms. Some patients develop eye problems (conjunctivitis, iritis). Over time, severe skin symptoms of large scaly patches develop, nails can be lost, and arthritic changes in the joints can make the joints essentially unworkable (some joints may dissolve).
There are several types of psoriatic arthritis with somewhat different signs and symptoms:
- Asymmetrical oligoarticular arthritis: fingers and toes affected randomly with sausage shape appearance and usually less than five arthritic joints
- Symmetrical polyarthritis: arthritis involves similar sites like hands, wrists, feet, and ankles on both sides of the body
- Arthritis mutilans: long-term severely damaged joints especially in hands and feet
- Spondylitis: inflammation of the spinal vertebrae and possibly sacroiliac and hip joints
- Juvenile psoriatic arthritis: occurs more often in 9- to 10-year-old girls, about 50% have only one joint affected but can have bone growth problems in the bone forming the joint
The triggers for the autoimmune reaction that causes the disease are not known. Researchers speculate that a combination of genetic, environmental, and immune factors interact. The inheritance tendency is the strongest risk factor.
What Are the Treatments for Psoriatic Arthritis?
Treatment for psoriatic arthritis involves controlling joint pain and disability as no cure exists for the disease. Medications used are as follows with examples:
- Nonsteroidal anti-inflammatory drugs (NSAID): ibuprofen, naproxen
- Disease-modifying anti-rheumatic drugs (DMARD): methotrexate, sulfasalazine
- Immunosuppressants: azathioprine, cyclosporine
- Biologic response modifiers (biologic agents): adalimumab, secukinumab
- Cellular inflammation: apremilast
Some of the above medications may be combined. In addition to medication, there are other procedures that may be done:
- Joint injections with steroids
- Joint replacement surgery
You and your doctors can decide on your individualized therapy.
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ArthritisArthritis is inflammation of the joints. Arthritis causes include injury, abnormal metabolism (such as gout), inheritance (such as in osteoarthritis), infections (such as in the arthritis of Lyme disease), and an overactive immune system (such as rheumatoid arthritis [RA] and systemic lupus erythematosus). Symptoms of arthritis include pain and limited joint function. Treatment may include pain medications, pain-relieving creams, and dietary supplements.
IritisIritis, or anterior uveitis, is an inflammation on the front part of the eye called the iris. The iris is the colored part of the eye that opens and closes the pupil of the eye. Trauma, infections, or autoimmune problems can all cause iritis. Iritis is typically treated with eyedrops or pills.
Joint PainJoint pain can be caused by injury or disease affecting any of the ligaments, bursae, or tendons surrounding the joint. Pain also occurs with joint inflammation (arthritis) and infection. Joint pain symptoms can be associated with local warmth, swelling, and tenderness. Treatment depends on the cause and can include rest, cold applications, medications, physical therapy, or surgery.
Nail PsoriasisPsoriasis is a common condition. Psoriasis symptoms and signs include patches of raised red skin with silvery scales. Symptoms and signs of nail psoriasis include thickening and pitting. Treatment of nail psoriasis may include medications or removal of the nail.
PsoriasisPsoriasis is a common and chronic skin disorder caused by inflammation that affects 1%-2% of people in the U.S. There are several different types of psoriasis. Clinical types of psoriasis include pustular psoriasis, erythrodermic psoriasis, or guttate psoriasis. Psoriasis is typically found on the knees, elbows, lower back, and scalp. Symptoms and signs include red, raised, scaly areas on the skin that may itch or burn. Treatment may involve topical therapy, phototherapy, and medication.
Psoriasis MedicationsThere are a number of good treatment options to control the skin lesions of psoriasis. Topical agents are practical when treating localized disease. Phototherapy should be considered if the disease covers more than 5%-10% of the total body surface area. Systemic agents should be started only after both topical treatment and phototherapy have been carefully considered.
Pustular PsoriasisPustular psoriasis is an uncommon form of psoriasis. People with pustular psoriasis have clearly defined, raised bumps on the skin that are filled with pus (pustules). Treatment incorporates topical therapy and systemic therapy.
PUVAPUVA stands for psoralen and ultraviolet A. After ingesting psoralen, the patient is exposed to a precise amount of ultraviolet light. PUVA therapy (photochemotherapy) is useful in the treatment of psoriasis, vitiligo and mycosis fungoides. PUVA may cause skin cancer and puts patients at risk for squamous cell carcinoma and melanoma.
Types of PsoriasisPsoriasis is a chronic disease of the skin that affects approximately 5.5 million people in the United States. Typical characteristics of psoriasis are red, dry, patches of skin and inflammation.
What Is Psoriasis?Psoriasis is a skin disease that causes red raised patches of skin covered with silvery thick scales. Environmental factors and injuries may trigger psoriasis flare-ups.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.