Psoriatic arthritis is an inflammatory disease of the joints that is usually accompanied by psoriasis. Around 5 to 15 percent of those affected by psoriasis develop this form of arthritis, the underlying cause of which has not yet been clarified.
What is psoriatic arthritis?
Psoriatic arthritis is an inflammatory disease of the joints, which manifests itself primarily in the form of painful swelling in the joints of the hands and feet and the adjacent tendons. See whicheverhealth for POEMS Syndrome Meanings.
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 are affected differently on both sides of the body.
In addition, the so-called distal interphalangeal form of psoriatic arthritis mainly affects the end joints in fingers and toes, which often also show nail changes.
The underlying causes of psoriatic arthritis have not yet been conclusively clarified. A genetic predisposition (predisposition) is suspected, whereby certain triggering factors must also be present for the manifestation (outbreak) of the disease.
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. The factors mentioned can not only contribute to the manifestation of the disease, but also trigger new flare-ups.
It is certain that a dysregulation of the immune system (autoimmune processes) as a result of a bacterial infection can lead to endogenous structures such as the skin areas on joints being attacked. This triggers the inflammatory reactions characteristic of psoriatic arthritis, which can gradually spread to the underlying joints, their tendons, cartilage and bones.
Symptoms, Ailments & Signs
The disease psoriatic arthritis typically manifests itself in the symptoms of both psoriasis (psoriasis) and arthritis (joint inflammation). Redness, joint pain and swelling occur, mainly in the finger end joints. The thickenings on the fingers, which are colloquially referred to as sausage fingers, are characteristic.
Toes can also swell. Inflammation of the tendon attachments, such as the Achilles tendon, is also possible. Joint capsules and ligaments can also be affected. If this is the case, movement restrictions, deformations and pain occur. Finally, stiffening of the joints can set in, initially mainly in the morning after long periods of rest.
Other symptoms are reddened, painful and sharply demarcated areas of skin that are covered with scales and itch. They are called psoriasis foci or plaques. They are most common on the kneecaps, below the elbow, or on the scalp. They can also develop in the gluteal fold.
The nails of fingers and toes change ; they deform, sometimes yellow and crumble. There are 3 types of the disease. In the peripheral asymmetric type, which is common, symptoms appear asymmetrically on the fingers and toes. In the peripheral symmetrical type, large joints on both sides of the body are affected. Finally, the axial type presents with symptoms in the spine or sacroiliac joint.
Diagnosis & History
Psoriatic arthritis is diagnosed on the basis of the typical symptoms, in particular the painful swelling and skin changes in the affected joints. The diagnosis is backed up by blood analysis, which typically shows elevated inflammatory markers.
Skin samples and analyzes 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 that are characteristic of rheumatoid arthritis) can only be detected in isolated cases in psoriatic arthritis.
In the advanced stage of the disease, imaging methods such as X- ray (radiography), magnetic resonance imaging and sonography (ultrasound) allow statements to be made about existing changes in 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.
Due to psoriatic arthritis, those affected suffer in most cases from arthritis, which is also accompanied by psoriasis. Due to these complaints, the quality of life of the patient is significantly restricted and also further reduced. Likewise, psoriatic arthritis can lead to inferiority complexes or a significantly reduced self-esteem if those affected are ashamed of the symptoms and no longer feel comfortable with their skin.
There are also various changes in the bones and joints of the affected person. In some cases, psoriatic arthritis can also lead to restricted movement and difficulties in everyday life. Furthermore, the patients may also depend on the help of other people. Psoriatic arthritis is treated without complications. Medications are usually 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 need lifelong therapy. Some medications can also have side effects. However, the life expectancy of those affected is usually not reduced by psoriatic arthritis.
When should you go to the doctor?
A doctor should always be consulted for psoriatic arthritis. The symptoms of psoriatic arthritis can only be completely alleviated by medical treatment, since this disease does not heal itself and in most cases the symptoms worsen significantly.
Early diagnosis and treatment always have a positive effect on the further course of the disease. The doctor should be consulted if the person concerned suffers from severe pain in the joints. A doctor should be consulted, especially in the case of long-lasting pain that occurs for no particular reason and reduces the quality of life of the person affected. Redness in the joints often indicates 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 can also change. In the first place, psoriatic arthritis can be treated by a general practitioner or by an orthopedistbe recognized. Further treatment is usually carried out by a specialist.
Treatment & Therapy
Since it has not yet been possible to cure psoriatic arthritis, the therapeutic measures are aimed at alleviating or reducing the symptoms that are present. For this purpose, topical medication can be used for treatment, which is applied locally to the affected skin areas and joints.
Such a therapy is particularly useful in cases where only individual joints are affected by psoriatic arthritis. In addition, systemic drugs such as non-steroidal anti- inflammatory drugs or NSAIDs such as acetylsalicylic acid, ibuprofen or ibuprofen are used as pain and anti-inflammatory drugs. Phototherapy (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 also be maintained or their stiffening can be slowed down. If the disease is in an advanced stage, 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 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 only used in the presence of severe psoriatic arthritis because of the strong side effects.
Since the underlying cause of psoriatic arthritis is not known, it cannot be specifically prevented. By avoiding trigger 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.
Like psoriasis, psoriatic arthritis is not curable. So there is no classic aftercare. Instead, those affected should maintain a healthy lifestyle and avoid risk factors that could lead to renewed flare-ups as far as possible. Regular exercise adapted to individual needs can have a positive effect on the course of psoriatic arthritis.
Joint-gentle sports such as swimming and cycling are particularly recommended, but long walks in the fresh air are also beneficial for body and soul. In the course of aftercare, the doctor treating you can also prescribe physiotherapy so that the joints remain mobile. There may also be a referral to a nutritionist who can also reduce the risk of joint inflammation by following a healthy and balanced diet with a high proportion of fresh fruit and vegetables and whole grain products.
High-fat foods, ready meals 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 possible as foam attachments for cutlery and cap openers, with the help of which those affected can open bottles and glasses without effort. Last but not least, it is also advisable in symptom-free phases to have regular follow-up examinations with the treating doctor so that he can document the course of the disease.
You can do that yourself
Since this painful disease is often based on a dysregulation of the immune system, patients are strongly advised to lead a healthy lifestyle. This includes a regulated sleep-wake cycle as well as a diet rich in vital substances and roughage 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 medication to be taken for psoriatic arthritis, patients should take care of their liver and avoid alcohol and nicotine. At the same time, those affected should drink a lot so that the body can flush out toxins better. Patients should also exercise as much as they can. Anyone who can no longer walk or cycle should switch to water sports such as aqua jogging or water aerobics. The aim is to maintain the mobility of the individual joints. Massages, physiotherapy and/or heat or cold therapies have also proven to be helpful.
If the symptoms lead to a lower self-esteem because the patients literally do not feel comfortable in their own skin, then psychotherapeutic treatment is advisable. But contact and exchange with other patients also helps.
Suffering a relapse in a psychosis is not only very stressful for the person affected, but also for their social environment. However, this can be prevented with appropriate follow-up care. As part of the follow-up examinations, it is determined whether the patient is still well adjusted to the medication prescribed during treatment.
In addition, the attending physician conducts appropriate discussions with the patient about the mode of action and side effects of the antipsychotics. The problem with stopping the medication on your own is that there will be improvements in the state of health in the first period. After that, however, the same symptoms appear again during a relapse. This can be prevented by consistent aftercare.
During aftercare, psychological support is important in addition to family doctor and neurological therapy. Social contacts that were lost during the illness can be reestablished in this way. Cognitive abilities such as memory and the ability to concentrate are also regained and stabilized.
Therapy to reduce stress and avoid excessive demands are also advisable. The basis for successful aftercare is that the patient gets involved with the team of doctors and therapists. Psychosocial aftercare treatment is then also successful.
You can do that yourself
To improve the situation, a healthy lifestyle is important. This includes a very sparing intake of stimulants such as coffee, tobacco and sugar as well as abstaining from illegal and legal drugs. Eating and drinking healthy and getting enough and regular sleep are the better alternatives. The daily routine should be clearly regulated.
The social factor is also crucial. Discussing a crisis plan with close friends or relatives is just as important as regular contact with mentally stable people. These do not necessarily always have to come from the closest social network. You can find yourself doing numerous activities that are also good for you. These include sports, hiking and volunteering. Since stressful or otherwise stressful situations can arise again and again, relaxation should always be provided as compensation. This should not be postponed until later.
It may be advisable to join a self-help group in order to discuss a situation that is perceived as stressful with others or to receive new tips for dealing with a psychosis. These and similar contacts should be maintained permanently, as this is the only ideal way to respond to a later crisis situation.