Psoriatic arthritis is an inflammatory disease of the joints that is usually accompanied by psoriasis. Thus, about 5 to 15 percent of those affected by psoriasis develop this form of arthritis, the underlying cause of which has not yet been determined.
What is psoriatic arthritis?
Psoriatic arthritis is the name given to an inflammatory disease of the joints, which manifests itself primarily by means of painful swellings in the joints of the hands and feet and the adjacent tendons. Psoriatic arthritis or inflammatory joint disease is usually preceded by psoriasis. The most common form of this disease is the so-called asymmetric psoriatic arthritis, in which the smaller joints of the hands and feet in both halves of the body are affected differently. In addition, the so-called distal interphalangeal form of psoriatic arthritis primarily affects the terminal joints in the fingers and toes, which also often show nail changes.
Causes
The underlying causes of psoriatic arthritis have not yet been conclusively determined. A genetic predisposition (disposition) is suspected, although certain trigger factors must also be present for the disease to manifest (erupt). These include febrile infectious diseases (angina tonsillaris, measles, bronchitis), hormonal changes during puberty or menopause, as well as certain medications (ACE inhibitors, chloroquine) and psychological factors such as stress at work or in the family. These factors can not only contribute to the manifestation of the disease, but also trigger new episodes of the disease. It is considered certain that a dysregulation of the immune system (autoimmune processes) as a result of a bacterial infection can lead to the body’s own structures such as the skin areas at joints being attacked. This triggers the inflammatory reactions characteristic of psoriatic arthritis, which can successively spread to the underlying joints, their tendons, cartilage, and bones.
Symptoms, complaints, and signs
The disease psoriatic arthritis typically manifests symptoms of both psoriasis (psoriasis) and arthritis (inflammation of the joints). There is redness, joint pain and swelling, mainly in the finger end joints. Characteristic are the thickenings on the fingers, which are then colloquially called sausage fingers. The toes can also swell. In addition, inflammation of the tendon attachments is possible, such as at the Achilles tendon. Joint capsules and ligaments can also be affected. If this is the case, movement restrictions, deformities and pain occur. Eventually, stiffening of the joints may occur, initially mainly in the morning after prolonged periods of rest. Other symptoms manifest themselves in reddened, painful and sharply defined areas of skin that are covered with a layer of scales and itch. They are called psoriasis foci or plaques. They most commonly occur on the kneecaps, below the elbow, or on the scalp. They can also develop in the buttock crease. The nails of fingers and toes change; they deform, sometimes turn yellow and crumble. There are 3 types of the disease. In the common peripheral asymmetric type, symptoms appear asymmetrically on fingers and toes. In the peripheral symmetric type, large joints on both halves of the body are affected. Finally, the axial type presents with symptoms in the spine or sacroiliac joint.
Diagnosis and course
Psoriatic arthritis is diagnosed on the basis of the typical symptoms, especially painful swelling and skin changes at the affected joints. The diagnosis is confirmed by blood analyses, which typically detect elevated inflammatory markers. Skin samples and analyses of the synovial fluid provide additional information about the clinical picture. In contrast to rheumatoid arthritis, the so-called rheumatoid factor (detection of specific antibodies characteristic of rheumatoid arthritis) is only detectable in isolated cases of psoriatic arthritis.In the advanced stage of the disease, imaging procedures such as X-rays (radiography), magnetic resonance imaging and sonography (ultrasound) provide information about changes in the bones and joints. The course of psoriatic arthritis can vary greatly from person to person. For example, psoriatic arthritis can have a chronic or episodic, relapsing course.
Complications
Due to psoriatic arthritis, in most cases, affected individuals suffer from arthritis that is also accompanied by psoriasis. Due to these complaints, the patient’s quality of life is significantly reduced and continues to be reduced as well. Likewise, psoriatic arthritis can lead to inferiority complexes or significantly reduced self-esteem as sufferers feel ashamed of the discomfort and uncomfortable with the skin. Likewise, various changes occur in the bones and joints of the affected person. In some cases, psoriatic arthritis can thus also lead to movement restrictions and difficulties in everyday life. Furthermore, patients may also be dependent on the help of other people. The treatment of psoriatic arthritis is carried out without complications. As a rule, medications are used that can significantly alleviate and reduce the symptoms. However, it cannot be universally predicted whether the course of the disease will be completely positive. Patients may then be dependent on lifelong therapy. Side effects may also occur with some medications. However, the life expectancy of the affected person is usually not reduced by psoriatic arthritis.
When should you see a doctor?
A doctor should always be consulted for psoriatic arthritis. Only medical treatment can completely relieve the symptoms of psoriatic arthritis, since this disease does not heal itself and in most cases also significantly worsens the symptoms. Early diagnosis and treatment always have a positive effect on the further course of the disease. The doctor should be consulted if the affected person suffers from severe pain in the joints. Especially in case of long-lasting pain, which occurs without any particular reason and reduces the quality of life of the affected person, a doctor should be consulted. Redness in the joints is also often an indication of psoriatic arthritis and should be treated. Furthermore, restrictions in movement and stiff joints can also indicate the disease. The nails on the toes and fingers may also change. In the first instance, psoriatic arthritis can be diagnosed by a general practitioner or by an orthopedist. Further treatment is usually by a specialist.
Treatment and therapy
Since the cure of psoriatic arthritis is not yet possible, therapeutic measures are aimed at alleviating or reducing the symptoms present in each case. For this purpose, topical medications that are applied locally to the affected skin areas and joints can be used for treatment. This type of therapy is particularly suitable in cases where only individual joints are affected by psoriatic arthritis. In addition, systemically acting drugs such as non-steroidal anti-inflammatory drugs or NSAIDs such as acetylsalicylic acid, ibuprofen or ibuprofen are used as pain and inflammation inhibitors. Photo therapy (light therapy) or bath therapy with salt water can also have a positive effect on the skin areas affected by psoriasis and alleviate the symptoms. With the help of physiotherapeutic measures (physiotherapy, massages, heat and cold therapy) the mobility of the affected joints can be additionally maintained or their stiffening can be slowed down. In the presence of an advanced stage of the disease, a so-called basic therapy with long-term drugs such as methotrexate or sulfasalazine is indicated, during which the liver values of the affected person should be checked regularly. Ciclosporin is used in some cases as an immunosuppressant to suppress the autoimmune reactions of the body’s own defense system. In addition, so-called biologics or biologics (infliximab, etanercept, adalimumab) inhibit the tumor necrosis factor (TNF-alpha), which is held responsible for the inflammatory processes.Cortisone, on the other hand, is used only in the presence of severe psoriatic arthritis because of its severe side effects.
Prevention
Because the underlying cause of psoriatic arthritis is unknown, it cannot be specifically prevented. By avoiding triggering factors such as psychological stress and by early and consistent treatment of infectious diseases or hormonal changes, the manifestation of psoriatic arthritis can be prevented if necessary.
Follow-up
Like psoriasis, psoriatic arthritis is not curable. So there is no classic aftercare. Instead, sufferers should maintain a healthy lifestyle and avoid risk factors that could lead to recurrences of the disease as much as possible. Regular exercise adapted to individual needs can have a positive effect on the course of psoriatic arthritis. Sports that are easy on the joints, such as swimming and cycling, are particularly recommended, but extended walks in the fresh air are also beneficial for body and soul. In the course of follow-up care, the attending physician may also prescribe physiotherapy to keep the joints mobile. A referral to a nutritionist may also be made, who can recommend a healthy, balanced diet with a high proportion of fresh fruit and vegetables and whole grain products to reduce the risk of joint inflammation. High-fat foods, convenience foods and sweets, on the other hand, should rarely or not at all be on the menu. Furthermore, aids can make everyday life easier for those affected, which is why they should also be considered an important part of aftercare for psoriatic arthritis. Gripping aids are just as much a possibility as foam attachments for cutlery and cap openers, with the help of which sufferers can open bottles and jars without exerting force. Last but not least, even in symptom-free phases, it is advisable to attend regular follow-up examinations with the attending physician so that he or she can document the course of the disease.
What you can do yourself
Since this painful disease is often based on a dysregulation of the immune system, patients are strongly advised to adopt a healthy lifestyle. This includes a regulated sleep-wake rhythm as well as a diet rich in vital substances and fiber with little fat and sugar. Existing excess weight should be reduced, especially if the knee joints, toes or Achilles tendons are affected. Less weight relieves the joints, joint capsules and ligaments. Because of the medications to be taken with psoriatic arthritis, patients should take care of their liver and avoid alcohol and nicotine. At the same time, sufferers should drink plenty of fluids to help the body flush out toxins. Patients should also exercise within their means. Those who can no longer go for a walk or cycle should turn to water sports such as aqua jogging or water gymnastics. The aim is to maintain the mobility of the individual joints. Massages, physiotherapy and/or heat or cold therapies have also proven helpful. If the complaints lead to a lower self-esteem because the patients literally do not feel comfortable in their skin, then psychotherapeutic treatment is advisable. However, contact and exchange with other patients also help. Various self-help organizations provide these contacts as well as further information about the disease, for example the Psoriasis Association (www.psoriasis-bund.de), the Schuppenflechte-Info (www.schuppenflechte-info.de) and the Rheuma League (www.rheuma-liga.de).
