Psoriatic Arthritis
Psoriatic arthritis is a form of arthritic joint disease associated with the chronic skin scaling and fingernail changes seen in psoriasis. A form of inflammatory arthritis, psoriatic arthritis, otherwise known as arthropathic psoriasis, is a condition that causes swelling and pain in the joints.
Around 20% of people suffering from the chronic skin condition, known as psoriasis, are affected by this disease. Most patients affected by psoriasis have the tissue type HLA-B27, the disease causing their skin to form scaly rashes, usually on the elbows, knees, and scalp.
Psoriatic arthritis is characterized by pain and swelling in and around the joints, including the elbows, wrists, fingers, knees, toes, ankles, and shoulders. Sometimes, it may even cause pain in the spine as well the joints in the lower back, called sacroiliac joints. In addition to affecting the joints themselves – the region where bones meet, psoriatic arthritis could also cause damage to the surrounding tissues, such as the tendons and ligaments.
In some cases, psoriatic arthritis cause swelling of the whole digit in a condition colloquially termed as “sausage” finger or toe. It may also cause skin inflammation, particularly on the elbows, knees, and scalp, which leads to development of “scales” – dead skin tissue.
Causes Of Psoriatic Arthritis
The causes of psoriatic arthritis are unknown. A combination of genetic and immune as well as environmental factors are likely involved. In patients with psoriatic arthritis who have arthritis of the spine, a gene marker named HLA-B27 is frequently, but not always, found.
Blood testing is now available to test for the HLA-B27 gene. Many other genes have also been found to be more common in patients with psoriatic arthritis. Certain changes in the immune system may also be significant in the development psoriatic arthritis.
Researchers are investigating the significance of infectious agents and other environmental factors in the causes of psoriatic arthritis.
Symptoms Of Psoriatic Arthritis
In most patients, the psoriasis precedes the arthritis by months to years. The arthritis often involves the ankles, knees, and joints in the feet. Generally, only a few joints are inflamed at a time. The inflamed joints become painful, swollen, hot, and red.
Sometimes, joint inflammation in the fingers or toes can cause swelling of the complete digit, giving them the appearance of a "sausage." Stiffness of the joints is common, and is typically worse early in the morning.
Less commonly, psoriatic arthritis may involve many body joints in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis. Psoriatic arthritis can also cause inflammation of the spine and the sacrum, causing pain and stiffness in the low back, buttocks, neck and upper back.
In about 50% of those with spondylitis, the genetic marker HLA-B27 can be found. In rare instances, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive form of arthritis, called "mutilans," can cause rapid damage to the joints. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.
Psoriatic arthritis patients can also develop inflammation of the tendons and around cartilage. Inflammation of the tendon behind the heel causes Achilles tendinitis, resulting in pain with walking and climbing stairs. Inflammation the of chest wall and of the cartilage that links the ribs to the breastbone can cause chest pain, as seen in costochondritis.
Psoriatic Arthritis Forms
There are five different forms of psoriatic arthritis:
- Asymmetric Arthritis which makes up about 70% of all cases of psoriatic arthritis, and often affects one or few joints, like knee, hip or fingers. Although more often mild, sometimes it can be debilitating. Inflamed joints may be red and hands and feet maybe swollen.
- Symmetric Athritis is the second most common forms of psoriatic arthritis, and often causes symptoms in the same joints on both sides of the body. The symptoms are the same as rheumatoid arthritis and can also cause permanent damage.
- Distal interphalangeal predominant (DIP) affects the joints close to the fingernails and toenails, and the nails are often affected too, but is a less common form of psoriatic arthritis.
- Spondylitis is a form of psoriatic arthritis that makes movement painful especially in the neck and back. The spinal column can also become inflamed.
- Arthritis Mutilans this form of psoriatic arthrits is seldom but is often destructive. It can result in permanent deformity, often affecting the hands and feet and sometimes the back and neck.
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