Psoriatic arthritis is a chronic inflammatory disease which is accompanied by psoriatic skin changes and joint pain. At the same time, the skin and/or nails are affected, and sometimes the eyes, too. The skin changes usually appear before joint involvement. In most cases, the joints in the hands and feet or the spine are affected.
Psoriatic arthritis often progresses gradually with painful swelling of the joints, redness and restrictions of mobility. In contrast to rheumatoid arthritis, the joints are mostly affected unevenly. In severe courses of the disease, destruction of the joints and vertebrae can occur, in particular in the joints of the fingers and toes.
In psoriatic arthritis, patients only experience little pain in the inflamed joints over a long period of time. This means that significant structural changes with lasting damage to the joints can progress unnoticed.
The skin and nail changes of psoriatic arthritis including treatment options are described in the section on psoriasis vulgaris.
Psoriatic arthritis develops in 5-30% of psoriasis patients. The disease can develop at any age, but more frequently between the ages of 20 and 40.
Psoriatic arthritis is caused by a malfunction of the immune system. The immune system is in charge of recognising dangerous pathogens, foreign and hazardous substances and destroying them in a targeted way.
The body’s own substances and surrounding tissue are usually recognised and tolerated by the cells of the immune system. However, if the intercellular communication malfunctions the immune system directs its destructive activity also towards the body’s own tissue.
Psoriatic arthritis is not a hereditary illness. However, certain genes are known that carry a disposition for psoriatic arthritis. If certain physical or environmental factors are added to a genetic disposition in the body, psoriasis or psoriatic arthritis can develop.
Currently, not all possible factors have been identified but it is considered certain that stress, physical or psychological traumas and streptococcal infections can trigger or aggravate psoriasis or psoriatic arthritis.
Patients are encouraged to find individual strategies to avoid and handle stress situations.
Psoriatic arthritis patients do not have to follow a special diet. Some patients have reported that some foods or stimulants such as alcohol and nicotine can aggravate or even trigger a flare-up of the disease. A balanced diet that is not too high in calories is recommended.
Psoriatic arthritis is often difficult to diagnose in the early stages of the disease. Frequently, only single joints are inflamed and the typical pattern of finger and toe joint involvement is not yet present in many patients. Between the different flare-ups of the disease there are symptom-free intervals which also makes a diagnosis more difficult. The only option is to wait and closely monitor further progression of the disease.
It often takes a fair amount of time until there is a certain diagnosis of psoriatic arthritis. Rheumatologists are the right doctors to consult. They can assess the inflamed joints correctly.
Different diagnostic procedures are available
- Laboratory testing of blood
- Depending on the diagnosis, physicians will determine the treatment tailored to the individual patient.
Inflammation of the joints, bones and tendons caused by the disease must be reduced and any pain must be relieved.
It is important to halt the progressive destruction of body structures to preserve the original stability and function of the joints and prevent permanent changes.
The following therapy options are available:
- Medicinal products
- Joint replacement
Initially, physicians will prescribe fast-acting medicinal products, so-called nonsteroidal anti-inflammatory drugs in a suitable dose, to help with the pain and inflammatory reactions of the joints. During acute flare-ups of the disease, anti-inflammatory cortisone-containing medicinal products are indicated in addition; these are taken as tablets. If single joints are severely inflamed, physicians will also use a syringe to inject cortisone directly into the joint capsule. The next step in drug-based therapy is a long-term treatment with disease modifying antirheumatic drugs.
If drug-based therapy does not result in satisfactory improvement of the joints, surgical intervention and joint replacement should be considered. In order to preserve mobility targeted physiotherapeutic exercises are an important addition.
An increasing therapeutic significance is found in non-drug based measures such as an exchange of experiences in self-help groups or participating in patient training courses.