Psoriatic Arthritis: symptoms, causes, and treatments

 

psoriatic arthritis in hands

This form of inflammatory arthritis is closely associated with psoriasis, a chronic, painful, red, itchy autoimmune disease of the skin.  This form of arthritis can appear as five distinct types: symmetric psoriatic arthritis; asymmetric psoriatic arthritis; distal interphalangeal predominant, or DIP; spondylitis; and arthritic mutilans.

The first, symmetrical psoriatic arthritis appears in the same joints on opposite sides of the body. It can be disabling, and most closely resembles rheumatoid arthritis in this respect.  The asymmetrical form appears randomly, a finger on the left hand, the right hip, the left knee. The DIP form of psoriatic arthritis largely affects the joints of the fingers and toes closest to the nail, and is easily confused with osteoarthritis.

Spondylitis, or spondylitic psoriatic arthritis, affects the spinal column, and can cause pain and stiffness anywhere from the neck to the sacroiliac the pelvic area.  Spondylitic psoriatic arthritis can also affect connective tissue, just like lupus, scleroderma and polymyositis, and causes arthritis in any joint whether hands, arms, hips, legs, or feet.

The most difficult and destructive form of psoriatic arthritis is arthritis mutilans, which as its name mutilans suggests can cause severe pain and deformity in the finger and toe joints closest to the nail. Surprisingly, this form also causes lower back and neck pain.

Striking men and women equally, psoriatic arthritis usually appears about age 30.  Researchers believe the cause is hereditary, since almost 40 percent of sufferers have a family history of skin or joint disease.  Triggers appear to include sunlight, any skin injury, strep infections, HIV, and drugs like lithium and beta-blockers. Stress, smoking, hormone changes (as during pregnancy), and alcohol use are also implicated.

In addition to avoiding these psoriatic arthritis triggers, doctors also treat patients with twice-daily moist heat or cold treatments, and NSAIDs. Newer remedies include anti-rheumatic drugs or biologics to prevent long-term joint damage. These medicines are marketed under the generic names ustekinumab, secukinumab, and apremilast, the latter sold commercially as Otezla.