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Psoriatic Arthritis - Symptoms And Treatment

Psoriatic (sore-EE-AA-tick) arthritis causes pain and swelling in some joints and scaly skin patches on some areas of the body. Psoriatic arthritis is a rheumatoid like joint disease associated with psoriasis of skin and nails.

Antimalarials may be used with caution because they can provoke exfoliative dermatitis. Centers that specialize in pain management can help to treat Psoriatic Arthritis. In addition to the inflamed, scaly skin that's typical of psoriasis, people with psoriatic arthritis have swollen, painful joints - especially in their fingers and toes - and pitted, discolored nails. They may also develop inflammatory eye conditions such as conjunctivitis.

Psoriatic arthritis affects men and women of all races and usually occurs between the ages of 20 and 50, but can occur at any age.

Causes of Psoriatic Arthritis

Evidence suggests that predisposition to psoriatic arthritis is hereditary; 20% to 50% of patients are HLA-B27-positive. However, onset may be precipitated by streptococcal infection or trauma.

Signs and symptoms of Psoriatic Arthritis

Psoriatic lesions usually precede the arthritic component, but once the full syndrome is established, joint and skin lesions may recur simultaneously.

Arthritis may involve one joint or several joints asymmetrically or symmetrically. Spinal involvement occurs in some patients. Peripheral joint involvement is most common in the distal interphalangeal joints of the hands, which have a characteristic sausage-like appearance. Nail changes include pitting, transverse ridges, onycholysis, keratosis, yellowing, and destruction. The patient may experience general malaise, fever, and eye involvement.

Diagnosis of Psoriatic Arthritis

Inflammatory arthritis in a patient with psoriatic skin lesions suggests psoriatic arthritis. X-rays confirm joint involvement and show:

• marginal erosion at interphalangeal joints with areas of thin, "fluffy" new bone formation
• ''whittling'' of the distal end of the terminal phalanges
• "pencil-in-cup" deformity of the distal interphalangeal joints.
• relative absence of osteoporosis
• sacroiliitis
• atypical spondylitis with syndesmophyte formation, resulting in hyperostosis and paravertebral ossification, which may lead to vertebral fusion.

Blood studies indicate negative rheumatoid factor and elevated erythrocyte sedimentation rate and uric acid levels.

Treatment of Psoriatic Arthritis

In mild psoriatic arthritis, treatment is supportive and consists of immobilization through joint rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other non­steroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids

may help control skin lesions. Gold salts, cyclosporin, sulfasalazines, and - most commonly - methotrexate therapy are effective in treating both the particular and cutaneous effects of psoriatic arthritis. Antimalarials may be used with caution because they can provoke exfoliative dermatitis.

Expectations (prognosis)

The course of the disease is often mild and affects only a few joints. In those with severe arthritis, treatment is usually very successful in alleviating the pain.

Prevention

There is no proven prevention of psoriatic arthritis. However some special considerations steps can be taken:-

• Explain the disease and its treatment to the patient and his family.
• Reassure the patient that psoriatic plaques aren't contagious. Avoid showing revulsion at the sight of psoriatic patches - doing so will only reinforce the patient's fear of rejection.
• Encourage exercise, particularly swimming, to maintain strength and range of motion.
• Teach the patient how to apply skin care products and medications correctly; explain possible adverse effects.
• Stress the importance-of adequate rest and protection of affected joints.
• Encourage regular, moderate exposure to the sun.
• Refer the patient to the Arthritis Foundation for self-help and support groups.