Saanichton, BC

Dr. Miguel A. Lipka

Psoriatic Arthritis

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Psoriatic arthritis is an inflammatory arthritis associated with psoriasis, a chronic skin and nail disease that causes a scaly, itchy skin rash as well as pitting, or indentations, on the finger and toe nails. Psoriatic arthritis causes pain and swelling in joints, especially in the fingers and toes. People with psoriatic arthritis may experience either the skin or joint symptoms first, or both symptoms may occur simultaneously.

Psoriatic arthritis affects at least 10 percent of the three million people with psoriasis across North America. It affects men and women equally and usually begins between 30 to 50 years of age, but also can occur in childhood.

The exact cause of psoriatic arthritis is unknown, but the condition, like other forms of arthritis, may be an autoimmune disorder, where the immune system mistakes healthy cells and tissue for foreign invaders and wrongly attacks them. Genetic and environmental factors also may play a role in the development of the disease.

The joint pain associated with psoriatic arthritis often causes stiffness, especially in the morning. About a third of people with psoriatic arthritis also experience neck or back pain and stiffness.

Although the severity and range of symptoms of psoriatic arthritis can vary in each person, common symptoms include:

  • Stiffness, pain, swelling and tenderness of the joints and surrounding soft tissue
  • Reduced range of motion
  • Morning stiffness and tiredness
  • Nail changes, including small indentations in the nail, called pitting, or lifting of the nail, which occurs in 80 percent of people with psoriatic arthritis
  • Redness and pain of the eye

Consult a physician if you experience any of these symptoms.

The underlying process in psoriatic arthritis is inflammation, therefore treatments are directed at reducing and controlling inflammation. NSAIDs such as diclofenac and naproxen are usually the first line medication. Other treatment options for this disease include joint injections with corticosteroids - this is only practical if a few joints are affected.

If acceptable control is not achieved using NSAIDs or joint injections then immunosuppressants such as methotrexate or leflunomide are added to the treatment regimen. An advantage of immunosuppressive treatment is that it also treats the psoriasis in addition to the arthropathy.

The most severe cases are treated with therapeutics developed using recombinant DNA technology called tumor necrosis factor-alpha inhibitors. As more is learned regarding the long-term safety of these biologic agents there is a trend toward earlier use to prevent irreversible joint destruction.

Orthopedic surgery (joint replacement) may be implemented to correct joint destruction in psoriatic arthritis patients with severe joint damage. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.