Psoriatic Arthritis

What is Psoriatic Arthritis?

   Psoriatic arthritis is a specific type of arthritis. It causes inflammation in
and around the joints, usually the wrists, knees, ankles, lower back and neck.
    Psoriatic arthritis is a specific type of arthritis that has been diagnosed in
approximately 23 percent of the people who have psoriasis, according to the
Psoriasis Foundation’s 2001 Benchmark Survey.
    It commonly affects the ends of the fingers and toes. It can also affect the
spine. The disease can be difficult to diagnose, particularly in its milder forms
and earlier stages. Early diagnosis, however, is important for preventing long-term
damage to joints and tissue.
   Most people with psoriatic arthritis also have psoriasis. Rarely, a person
can have psoriatic arthritis without having psoriasis. Several other related
diseases are similar to psoriatic arthritis and share some overlapping features.
These diseases include Ankylosing Spondylitis, Reiter’s syndrome, and
arthritis related to inflammatory bowel diseases.

What are the symptoms?

• Stiffness, pain, swelling and tenderness of the joints and surrounding
  soft tissue
• Reduced range of motion
• Morning stiffness and tiredness
• Nail changes, including pitting (small indentations in the nail) or lifting
  of the nail—found in 80 percent of people with psoriatic arthritis
• Redness and pain of the eye, similar to conjunctivitis

How does it develop?

Psoriatic arthritis can develop at any time. On average, it appears about
10 years after the first signs of psoriasis. For most people it appears between
the ages of 30 and 50. It affects men and women equally. In about one of
seven people with psoriatic arthritis, arthritis symptoms occur before any
skin lesions.
   Like rheumatoid arthritis, psoriatic arthritis is thought to be caused by a
malfunctioning immune system. Psoriatic arthritis is usually milder than
rheumatoid arthritis, but some patients with psoriatic arthritis have as severe
a disease as patients with rheumatoid arthritis.
   Psoriatic arthritis can start slowly with mild symptoms, or it can develop
quickly.  It is very important to have as early and accurate a diagnosis as
possible. Left untreated, psoriatic arthritis can be a progressively disabling
disease. In fact, half of those with psoriatic arthritis already have bone loss by
the time the disease is diagnosed.

How is it diagnosed?

There is no definitive test for psoriatic arthritis, but the following steps are
usually involved:
• Person with psoriatic arthritis talks to physician
• Physician may refer person to rheumatologist, who specializes in arthritis
• Diagnosis is done by process of elimination using medical history, physical
  examination, blood tests to rule out other diseases and X-rays of the
  affected joints

Treatment

   Many of the same treatment approaches to treat rheumatoid arthritis are
also used for psoriatic arthritis.
   Non-steroidal anti-inflammatory medicines such as Ibuprofen or Naprosyn
are often an initial step in treatment. Newer medicines in this group include
Celebrex, Voixx and Bextra. Steroid anti-inflammatory medicines such as
Prednisone or shots of cortisone are at times helpful. Disease modifying
medicines such as Methotrexate may help both the skin and joints in patients
with psoriatic arthritis.
   The new biological medications such as Enbrel and Remicade are emerging
as very helpful in some patients with psoriatic arthritis.
   The appropriate treatment for each patient with psoriatic arthritis would
be determined by their physician or their rheumatologist. Often this disease
can be well-controlled with today’s modern medications.
   We have extensive experience with psoriatic arthritis and related diseases.

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