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PSORIATIC ARTHRITIS

Welcome to Wellspring Health and Wellness’s guide to psoriatic arthritis.

Psoriasis is commonly known as a skin disease due to its persistent rash, but it can also cause psoriatic arthritis, a joint disease that affects about seven percent of people with psoriasis. Psoriatic arthritis can occur at any age but most commonly between ages 30 and 50. Typically, a patient has psoriasis for several years before developing arthritis, which often progresses slowly. However, patients must manage both the outbreaks of itchy, scaly skin and the pain and stiffness of arthritis.

This guide will help you understand:

  • How psoriatic arthritis develops
  • How doctors diagnose the condition
  • What can be done about the problem?
  • Wellspring Health and Wellness’s approach to rehabilitation

Where Does Psoriatic Arthritis Develop?

Psoriatic arthritis can affect any joint and often mimics the symptoms of rheumatoid arthritis (RA) or degenerative arthritis of the spine. X-rays can help distinguish psoriatic arthritis by showing unique bone destruction patterns and swelling in the tissues around the joints.

Patients with psoriatic arthritis fall into three categories:

  1. Asymmetric Arthritis: Only a few joints are involved, and it does not affect the same joints on both sides of the body (e.g., one wrist and one foot).
  2. Symmetric Polyarthritis: Arthritis occurs in several corresponding joints on both sides of the body (e.g., both elbows, both knees, and both hands), similar to RA.
  3. Axial Disease: This includes arthritis of the spine, sacroiliac joint, hip, and shoulder joints. Patients may move between categories over time, but the overall treatment remains similar.

Why Do I Have This Problem?

The exact cause of psoriatic arthritis is unknown, but heredity plays a major role. People related to someone with psoriatic arthritis are 50 times more likely to develop the disease. Injuries and infections, such as strep infections in children, can also trigger the condition. Some researchers believe it may be an immune response to bacteria from skin lesions.

What Does Psoriatic Arthritis Feel Like?

All patients with psoriatic arthritis have psoriasis. Some have a few rash areas, while others have extensive psoriasis. The skin lesions are reddish and itchy, and silvery scales appear on the elbows, knees, scalp, ears, and abdomen. In psoriatic arthritis, psoriasis often affects fingernails or toenails, causing pits, ridges, discoloration, or nail separation.

Symptoms of psoriatic arthritis include joint swelling and pain, similar to other types of arthritis, but with unique features:

  • Affected joints near fingernails and toenails (distal interphalangeal or DIP joints)
  • “Sausage-like” appearance of fingers and toes
  • Inflammation of bones (dactylitis)
  • Inflammation of tendons and ligaments where they attach to bones (enthesitis), especially in the heels
  • Stiffening and freezing of joints (bony ankylosis) in hands and feet
  • Inflammation where the spine meets the pelvis (sacroiliitis), visible on X-rays
  • Inflammation of vertebrae (spondylitis)
  • Eye inflammation

About five percent of patients develop arthritis mutilans, a severe and destructive form affecting the small joints of hands and feet, leading to deformity. Rare symptoms include heart valve issues, lung tissue formation, and metabolic disorders affecting tissues.

How Do Health Care Professionals Identify the Condition?

Diagnosing psoriatic arthritis involves a detailed medical history, including a family history of psoriasis. Tests are conducted to rule out other forms of arthritis, as psoriatic arthritis symptoms can resemble other joint diseases. Blood studies help rule out RA, and efforts are underway to identify biomarkers for psoriatic arthritis.

Diagnostic tools include:

  • X-rays: To rule out other diseases and identify psoriatic arthritis characteristics
  • Ultrasonography: Noninvasive and radiation-free, it provides detailed images of bones, joints, and soft tissues, including early signs of inflammation.
  • MRIs: Useful for detecting bone marrow edema, tenosynovitis, and early joint erosion. Whole-body MRIs can identify inflammation undetected by clinical examination.

What Can Be Done for the Condition?

Managing psoriatic arthritis involves treating both skin lesions and joint pain. Various lotions and creams are available for psoriasis-affected skin. PUVA therapy, which combines psoralen with ultraviolet A (UVA) light, can be helpful for skin lesions and joint pain.

Treatment for arthritis symptoms depends on the affected joints and disease severity. Common treatments include:

  • NSAIDs: Nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen
  • DMARDs: Disease-modifying antirheumatic drugs, like methotrexate, which control symptoms and slow disease progression
  • Anti-TNF Agents: Medications like infliximab, which target tumor necrosis factor (TNF) to reduce inflammation

In severe cases, a combination of drugs may be necessary. Cortisone injections can relieve joint pain, and surgery may be required for unmanageable pain or loss of joint function. Physiotherapy is also crucial for maximizing joint strength and mobility.

Treatment at Wellspring Health and Wellness

Physiotherapy at Wellspring Health and Wellness can assist in managing psoriatic arthritis alongside prescribed medications. While physiotherapy cannot cure the disease, it can help manage pain and prevent joint decline. The focus is on the effects of psoriatic arthritis on joints rather than the skin lesions.

During your first visit, the physiotherapist will take a detailed history, including when the arthritis started, which joints are affected, pain levels, and activities that irritate or relieve pain. They will also inquire about skin lesions, family history, current treatments, medications, and your work and recreational activities.

If the arthritis affects lower extremity joints, the physiotherapist will observe your gait and assess posture and alignment. They will advise on proper posture and walking techniques and may suggest using a walking aid if necessary.

The physiotherapist will measure the range of motion and muscle strength around affected joints. They will prescribe range of motion exercises, stretches for tight muscles, and strengthening exercises for weak muscles. Water therapy exercises may be recommended as they are easier on the joints.

Cardiovascular exercise is vital for managing psoriatic arthritis, improving overall physical and mental well-being, and aiding weight reduction. Exercises like stationary cycling, using a stepper machine, elliptical, or walking can be beneficial.

In some cases, electrotherapy, such as TENS, may be used to decrease joint pain. Hands-on techniques like massage and mobilizations may be employed to improve joint range of motion. Heat therapy can also be soothing and may be recommended for home use.

Though psoriatic arthritis is a lifelong condition, many treatment options can help manage it. Working with your doctor, physiotherapist, and other healthcare professionals, you can find a management program that works for you.

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