The bout of psoriasis subsides and you heave a sigh of relief. Then you start having swollen, inflamed, painful joints, apart from feeling exhausted. Wondering what is wrong? An extension of your psoriasis, psoriatic arthritis can affect your joints, causing pain, swelling, and stiffness.
Psoriasis is a chronic skin condition that leads to cosmetically disturbing silvery white layers of tissue peeling off the skin. The itching, bleeding, and scars are life altering and often take a toll on lifestyle and social life, sometimes even hampering work. Psoriasis is a condition that never completely abates, see-sawing between no visible symptoms and severe symptoms over the course of weeks to years. Since the underlying cause of psoriasis is your auto-immunity, it affects not just the skin, but may also attack joints, eyes, and kidneys in the long run. Auto-immunity simply means the body’s inability to differentiate between its own safe healthy cells and harmful foreign cells. Our defense system starts destroying our own cells, thus leading to inflammation. Based on the tissue or organ this destruction begins in, a person has psoriasis, joint rheumatism, thyroid disorders, etc.
Psoriatic arthritis is another outcome of this very autoimmune disorder, causing inflammation that triggers joint pain, swelling, and stiffness. Individuals susceptible to psoriatic arthritis usually carry genes of psoriasis. Around 10% people globally carry genes of psoriasis, with 2–3% of these suffering from psoriatic arthritis.1 And about 30% of people suffering from psoriasis can develop psoriatic arthritis later in life. In fact, it is vital to rule out psoriatic arthritis in people with psoriasis or a family history of psoriasis alongside joint complaints.2 In some cases, however, there may be no skin symptoms and people may directly present with psoriatic arthritis.
Certain factors are responsible for triggering or activating these genes, leading to a manifestation of the disease. Stress; a skin injury like a cut or sunburn; drugs containing lithium, antimalarials, and beta-blockers are some factors that can precipitate psoriatic arthritis.3
Signs To Watch Out For
The signs and symptoms of psoriatic arthritis are very similar to that of rheumatoid arthritis as both the conditions are auto-immune in nature and can produce painful joints that are swollen and warm to touch. Here are a few things that distinguish psoriatic arthritis from rheumatoid arthritis.
- Sausage-like swelling of fingers and toes: Clinically known as dactylitis, this swelling is seen along the entire length of finger or toes. This is one of the important features that distinguishes psoriatic arthritis from rheumatoid arthritis, where usually only a single joint of the finger is involved.4
- Tendon or ligament pain: Psoriatic arthritis can also trigger enthesitis, an inflammation at the sites of muscle or tendon attachment to the bone.5 This is commonly seen at the heel (Achilles tendinitis) or the bottom of the foot (plantar fasciitis), but it may even occur in the elbow (tennis elbow).
- Skin rash and nail changes: As psoriatic arthritis is generally found in people with psoriasis, red skin with thick, silvery white flakes is a common sight. Skin disease is present in the majority of patients. Psoriasis can even be detected in hidden areas like behind the ears, at the top of the natal cleft, and around the umbilicus.6 Nail also get affected, in the form of small pits, infection of the nail bed, onycholysis (separation of the nail from the nailbed), and crumbling of nails.7
These symptoms are seen specifically in cases of psoriatic arthritis.
- Fatigue: People with psoriatic arthritis tend to experience severe fatigue. This can also worsen the pain associated with the condition.8
- Pain in the lower back: Often, the spine is involved in cases of psoriatic arthritis and causes pain in the lower back because of spondylitis. There is also a decreased range of movement of the back because of sacroiliac joint inflammation. This makes actions like stooping extremely painful.9
- Eye problems: According to the National Psoriasis Foundation, about 7% of people with psoriatic arthritis suffer from eye problems due to inflammation.10 Patients often complain of redness, irritation, and disturbed vision (uveitis) or redness and pain in tissues surrounding the eyes (conjunctivitis or “pink eye”) due to inflammation of the internal structures of the eye. Psoriatic arthritis also increases the probability of cataracts and glaucoma, both of which can cause blurry vision and, in the case of glaucoma, lead to permanent vision loss.11
- Digestion problems: Abdominal pain, cramping, blood in stool, and diarrhea are common and may indicate an inflammatory bowel disease (IBD). One study reports that people with psoriasis or psoriatic arthritis are at a high risk of developing Crohn’s disease, owing to similar mutations in the genes of people with both psoriatic arthritis and Crohn’s disease.12
- Non-steroidal anti-inflammatory drugs: In mild cases, the physician begins with NSAIDs like aspirin, ibuprofen, and naproxen to prevent the body from producing chemicals that cause inflammation.
- Disease-modifying anti-rheumatic drugs: If the disease is severe or does not respond to NSAIDs, you may be prescribed a disease-modifying antirheumatic drug (DMARD) that will stop pain, swelling, and damage to joints and tissues.
- If the DMARDs do not work, then a biologic is prescribed. This is a new type of DMARD which blocks the protein that causes inflammation.
- Enzyme inhibitor: These drugs work by blocking a specific enzyme called PDE-4; it slows down the reactions that cause inflammation and also improves the flexibility of the joints.
- Steroids: Corticosteroids are the “magic bullet” drugs used for reducing pain and swelling. These can be injected or taken orally.
Managing Psoriatic Arthritis
The National Psoriasis Foundation points out that many people with psoriasis and psoriatic arthritis turn to alternative therapy for relief from symptoms and pain management. Herbal remedies such as aloe vera and apple cider vinegar can relieve redness, itching, and scaling. Ointments with capsaicin may help reduce the pain. Turmeric and Oregon grape are also being studied for their protective properties against flareups.
Massages can improve circulation and function of the joints. While clinical studies don’t yet vouch for acupressure or acupuncture, many people find these beneficial. Regular yoga and exercises, especially range-of-motion exercises that help move joints to their full extent, can reduce stiffness and improve your flexibility.13
References [ + ]
|1.||↑||Hébert HL, Ali FR, Bowes J, et al. Genetic susceptibility to psoriasis and psoriatic arthritis: implications for therapy. Br J Dermatol. 2012 Mar;166(3):474-82.|
|2.||↑||D’Angelo S, Palazzi C, et al. Improvements in diagnostic tools for early detection of psoriatic arthritis. Expert Rev Clin Immunol. 2016 Jun 10:1-7.|
|3.||↑||Tidman MJ. Improving outcomes in patients with psoriasis. Practitioner. 2013 Jan;257(1757):27-30.|
|4, 6.||↑||Conaghan PG, Coates LC. Improving recognition of psoriatic arthritis. Practitioner. 2009 Dec;253(1724):15-8, 2-3.|
|5.||↑||Behrens F, Thaçi D, et al. Psoriatic arthritis : Overview of drug therapy options and administration characteristics. Z Rheumatol. 2016 Jun;75(5):471-88.|
|7.||↑||Lai TL, Pang HT, et al. Psoriatic nail involvement and its relationship with distal interphalangeal joint disease. Clin Rheumatol. 2016 Jun 1.|
|8.||↑||Gudu T, Etcheto A, de Wit M, et al. Fatigue in psoriatic arthritis – a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine. 2016 Jul;83(4):439-43.|
|9.||↑||Sudoł-Szopińska I, Matuszewska G, et al. Diagnostic imaging of psoriatic arthritis. Part I: etiopathogenesis, classifications and radiographic features. J Ultrason. 2016 Mar;16(64):65-77.|
|10.||↑||Uveitis: A Threat to Eyesight, National Psoriasis Foundation.|
|11.||↑||Lima FB, Abalem MF, et al. Prevalence of eye disease in Brazilian patients with psoriatic arthritis. Clinics (Sao Paulo). 2012;67(3):249-53.|
|12.||↑||Li, Wen-Qing, Jia-Li Han, Andrew T. Chan, and Abrar A. Qureshi. “Psoriasis, psoriatic arthritis and increased risk of incident Crohn’s disease in US women.” Annals of the rheumatic diseases (2012): annrheumdis-2012.|
|13.||↑||Complementary and Alternative Therapies, National Psoriasis Foundation.|