Psoriatic Arthritis
As the name implies Psoriatic Arthritis is an inflammatory joint disease occurring in patients with psoriasis. Psoriatic Arthritis is part of a larger group of conditions, the seronegative spondyloarthropathies, which have common clinical features and are distinct from rheumatoid arthritis. The term ‘seronegative’ denotes the absence of rheumatoid factor in the blood.
There are five subgroups of spondyloarthropathy:
Psoriatic arthritis
Ankylosing spondylitis
Reactive arthritis (Reiter’s disease)
Enteropathic arthritis
Undifferentiated arthritis
The rash of psoriasis affects about 3% of the general population and around 10% of these will develop arthritis.
Although the cause is unknown, advances have helped define the genetics and molecules causing inflammation in Psoriatic Arthritis.
Clinical features
Clinically patients complain of joint pain and deformity which may lead to significant disability. Generally the rash precedes the arthritis by some years although occasionally the skin changes may develop after the onset of arthritis. Five main categories of psoriatic arthritis have been described: one or a small number of joints affected, arthritis similar to rheumatoid arthritis, finger joint inflammation with nail involvement, severe destructive arthritis and arthritis predominantly involving the spine. Lower limb large joints are most frequently affected. Skin lesions may be scarce and a search for these should include the scalp, lower back, feet, genitalia and tongue.
- Subtypes of psoriatic arthritis:
- Mono or oligoarthritis (usually lower limb large joints)
- Symmetrical polyarthritis (similar to RA)
- DIP joint inflammation with nail involvement
- Arthritis mutilans (the most severe form)
- Spondylitis (with radiological sacro-iliitis in 20%)
Initial management
Management is directed at the relief of pain, halting the destructive process and maintaining joint function. The focus involves pharmacological and non-pharmacological measures.
Patient education and support
Patient education is essential to help people to understand the disease, the drugs used to treat it, how to look after their joints and strategies for overcoming and living with the problems caused by the arthritis. . Several support groups exist for patients with Psoriatic Arthritis.
Physiotherapy
Physiotherapy can be helpful in educating about joint protection and improving joint mobility.
Medical management
The first type of drug used in people with psoriatic arthritis is usually NSAIDs.
Sulphasalazine and methotrexate have traditionally been used for Psoriatic Arthritis and a newer agent Leflunomide has also been found to be effective.
Intermittent intra-articular corticosteroids are beneficial for symptom relief. Occasionally oral steroids are used although side effects limit their use. Psoriatic skin disease may flare upon weaning corticosteroids.
The newer biologic agents (anti-TNFalpha therapies such as infliximab, etanercept and adalimumab) have been shown to lead to excellent symptomatic relief.
The prognosis for patients with Psoriatic Arthritis has improved recently with early identification of disease and commencement of effective safe medical therapies.
Click on the picture to link to the ARC booklet which will tell you much more about psoriatic arthritis.
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