By Thomas Geppert, MD
Psoriatic arthritis is a type of arthritis that causes joint pain and inflammation. It affects about 10% of people with psoriasis.
Psoriasis is a chronic skin disorder that causes patches of thick, inflamed red skin that are often covered with scales. The extent of skin involvement varies tremendously from patients who have the disease in the scalp to those who have it over their body.
Most people who develop psoriatic arthritis have symptoms of skin psoriasis first, followed by arthritis symptoms. However, in some cases, arthritis symptoms are noticed before psoriasis appears or are diagnosed at the same time.
The exact cause of psoriatic arthritis is unknown. However, it is believed that the disease develops due to a combination of genetic, immunologic and environmental factors.
Signs and symptoms
Patients with psoriatic arthritis dervelop pain and tenderness in the peripheral joints or in the spine. Patients frequently complain of morning stiffness and have nail abnormalities such as separation of the nail from the nail bed or pitting of the nails.
Compared to people with other types of inflammatory arthritis, people with psoriatic arthritis tend to experience less joint tenderness and may have more difficulty with stiffness and immobility than pain.
In some cases, patients also experience eye problems. Inflammation of the eye typically results in eye pain and redness and is referred to as uveitis or iritis.
A psoriatic arthritis diagnosis is based first on the presence of inflammatory arthritis. This is documented during the physical exam and evidenced by inflamed joints on laboratory tests. Once inflammatory arthritis has been diagnosed, the specific type of inflammatory arthritis is determined by the pattern of joint involvement, the presence of psoriatic skin disease or the presence of a strong family history of psoriasis, and the presence or absence of serologic markers for other inflammatory diseases.
Treatment involves a variety of medications. Some medications help with the pain while others directly inhibit the inflammation and stop both the joint pain and the joint damage. Nonsteroidal anti-inflammatory drugs (NSAIDs) control the mild inflammation. They improve joint pain, swelling and stiffness, but do not affect the natural history of the disease.
Nonsteroidal anti-inflammatory drugs have a number of side effects including bleeding ulcers and rare kidney damage. More recent studies have suggested they may also increase the risk of coronary artery disease. People with certain medical problems and those taking various medications are at increased risk of harmful effects to NSAID. It is recommended you consult a rheumatology specialist if there is concern about psoriatic arthritis. They are trained to understand all ramification of the disease.
Thomas Geppert, MD was clinical professor in the Department of Internal Medicine at the University of Texas Southwestern Medical School for 15 years and is currently in private practice at Rheumatology Associates in Dallas. He is board certified in internal medicine with subspecialty certification in rheumatology.