Do you have red, scaly patches on your skin? Do you sometimes see these more on your head, knees, and elbows? Do you also feel stiff and painful in your body, especially your fingers and knees, when you wake up in the morning? If you have both of these problems, you may have a condition called 'Psoriatic Arthritis'. Don't be scared when you hear this name. This is something that many people have. Today, we will talk about this in a simple way that you can understand.
What is this psoriatic arthritis?
Simply put, psoriatic arthritis is a type of arthritis. It is an inflammation of the joints. It usually occurs in people who have a skin condition called psoriasis. Sometimes, if someone in your family has psoriasis, they can also develop it.
Now let's explain this a little more.
- Arthritis: This is a common condition that affects our joints. It causes pain and swelling (inflammation) in and around the joints.
- Psoriasis: This is an inflammatory skin condition. In this condition, red patches of skin appear, covered with silvery scales. These scaly patches are called plaques. In addition, some people's fingernails and toenails may become thick, scaly, or have small pits.
Both of these conditions, arthritis and psoriasis, are classified as autoimmune diseases . Think of it this way: our body's defense system, the immune system, is like an army. Its job is to protect us by fighting off foreign invaders. But in this ``autoimmune'' condition, our own defense system mistakenly starts attacking our own healthy cells. In psoriatic arthritis, this attack occurs simultaneously on the skin and joints.
The symptoms of this disease are not constant. Sometimes the symptoms get worse, which we call 'flares' . Sometimes the symptoms go away. If you develop new skin spots, or if you experience pain, swelling, or stiffness in your joints, be sure to see your doctor and talk about it.
How common is this condition?
Less than 1% of the world's population has psoriatic arthritis. However, if you already have psoriasis, your risk of developing the condition is much higher. About 30 out of 100 people with psoriasis will develop psoriatic arthritis at some point in their lives.
What are the main types of this disease?
Psoriatic arthritis is not the same for everyone. Doctors divide it into five main types, depending on the joints affected and how symptoms develop. It's important for you to be aware of these.
| Type of disease | Simply put... |
|---|---|
| Distal interphalangeal predominant | This mainly affects the small joints near the tips of the fingers and toes. This is the most common type of psoriatic arthritis that affects the nails. Your nails may change color, peel, or develop small pits. |
| Symmetric polyarthritis | This affects five or more joints at the same time. The word 'symmetric' means "symmetrical". This means that the same joints are affected on both sides of the body . For example, both your knees and both elbows can be affected at the same time. This is also a common type. |
| Asymmetric oligoarticular | This affects two to four joints on both sides of the body, but it is not 'symmetrical', meaning it does not affect the same joints on both sides. For example, the right knee and the left elbow may be affected. This is also the other most common type. |
| Spondylitis | Our spine is made up of small bones called vertebrae. In this type of arthritis, the joints between the vertebrae become inflamed . This can cause back pain and stiffness. Sometimes, pain can also be felt in the hips and shoulders. |
| Arthritis mutilans | This is the most severe and rare type of psoriatic arthritis. It affects the hands and feet. The inflammation is so severe that the bones can melt. In medical terms, this is called ``osteolysis.'' But this is a very rare condition. This type is seen in less than 5% of people with psoriatic arthritis. |
What symptoms might you experience?
Psoriatic arthritis can affect any joint in the body. For some people, the symptoms are very mild. There may be only a few small patches of skin with some pain and stiffness in the joints. However, during flare-ups, the pain can be so severe that the joints cannot be used and large patches of skin may develop.
These are the symptoms that are commonly seen:
- Joint pain: Pain may occur in one or more joints.
- Stiffness in the joints: Difficulty in bending or stretching the joints, especially when you wake up in the morning.
- Joint swelling and redness: The affected joints may become swollen and red around the joint.
- Tendon and ligament pain: Pain or tenderness where our muscles attach to our bones (e.g., the Achilles tendon).
- Swelling of the fingers: The fingers or toes swell up like sausages. Doctors also call this `(dactylitis)`.
- Psoriasis rash: Red patches with silvery scales, especially on the scalp, knees, elbows, and lower back.
- Nail changes: Nail discoloration, pitting, thickening, or separation of the nail from the skin.
- Fatigue: This is not just tiredness. It is extreme tiredness that makes you unable to do anything, and it feels like this fatigue won't go away even if you sleep all day.
Why does this happen? Who is most at risk?
Experts still don't know exactly what causes psoriatic arthritis. However, some studies have found that people with the disease have similar changes in their genes (genetic mutations). However, it is not yet clear whether these genetic changes cause the disease or if these changes occur after the disease has developed.
Importantly, about 40% of people with psoriatic arthritis, or about 40 out of 100, have another family member with the disease, suggesting that it may be a hereditary condition.
So if anyone in your family has psoriasis or psoriatic arthritis, be sure to tell your doctor.
Although this disease can affect anyone, it is most common in people between the ages of 30 and 50. Most often, psoriasis (a skin disease) develops in young people, around the age of 15-25, and joint symptoms appear several years later, in midlife.
Can this condition cause other diseases?
Yes, people with psoriatic arthritis may be at slightly increased risk of developing other health problems. This is due to the chronic inflammation in the body.
Some of the most common complications that can occur are:
- High blood pressure (Hypertension)
- Increased blood cholesterol levels (Hyperlipemia)
- Obesity
- Diabetes
- Depression
- Anemia
- Muscle weakness
Joint pain can make it difficult to exercise. But not exercising can increase your body weight and put more stress on your joints. So, talk to your doctor about low-impact exercises that don't put too much pressure on your joints. Things like yoga, walking, or aqua therapy are good ways to keep your body healthy without putting too much stress on your joints.
How does a doctor find this?
A doctor diagnoses psoriatic arthritis through a physical exam and several other tests. The doctor will ask you about your symptoms and carefully examine your skin and joints.
You may also be referred to specialists:
- Rheumatologist: This is a doctor who specializes in joint diseases, autoimmune diseases, and inflammatory conditions.
- Dermatologist: This is a doctor who specializes in skin diseases.
There is no single test that can confirm psoriatic arthritis. Doctors will do tests to rule out other conditions that could be causing your symptoms.
Some tests you may be asked to do:
- Blood tests: Check for things like infections.
- Imaging tests: These can look for damage or inflammation in the joints.
- X-rays
- MRI scan
- CT scan
- Ultrasound scan
What are the treatments for this?
Your doctor will prescribe treatment to manage your symptoms. The type of treatment you need will depend on several factors:
- What joints are affected by the disease?
- How severe are the symptoms?
- How much do these symptoms interfere with your daily activities?
The most commonly used treatments are:
- Painkillers: Painkillers that reduce inflammation, such as ``NSAIDs'', can be purchased at a pharmacy.
- Cold or heat therapy: Reduce pain and stiffness.
- Corticosteroids: A powerful class of drugs that quickly reduce inflammation. These can be given as pills or as an injection directly into the joint.
- DMARDs (Disease-modifying antirheumatic drugs): These are a special type of medication that changes the course of the disease, that is, they control the activity of the immune system and stop damage to the joints.
- Physical therapy or occupational therapy: These can help you learn how to improve joint function and strength and make daily tasks easier.
Is surgery necessary?
Surgery for psoriatic arthritis is very rare. However, if the disease has severely damaged your joints or caused bone loss, you may need to have joint replacement surgery (arthroplasty). In that case, your doctor or surgeon will explain the surgery you need and what to expect.
Is this worse than rheumatoid arthritis?
Psoriatic arthritis and rheumatoid arthritis are two types of arthritis. Both are autoimmune diseases.
- Psoriatic arthritis is a type of joint inflammation associated with psoriasis (a skin and nail disease).
- Rheumatoid arthritis is a type of arthritis caused by the immune system attacking the tissues that line the joints in both sides of the body.
One disease is not "better" or "worse" than the other. Both are long-term (chronic) conditions. This means that you will have to manage your symptoms for a long time, perhaps your entire life. Your doctor will help you find the right treatment for you and help you minimize the impact of the disease on your daily life.
Take-Home Message
- Psoriatic arthritis is a condition that occurs when a skin disease (psoriasis) and a joint disease (arthritis) come together.
- This is an autoimmune disease, meaning our body's own defense system attacks our own cells.
- Joint pain, stiffness, swelling, peeling skin, and nail changes are the main symptoms.
- This disease cannot be completely cured, but there are very effective treatments to control symptoms and flare-ups.
- If you have psoriasis and are experiencing joint pain, don't ignore it. See your doctor right away. Starting treatment early can help prevent long-term damage to your joints.
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