| 6. Psoriatic
arthritis
Definition
Psoriatic arthritis is an arthritis that is often associated with
psoriasis of the skin.
Alternative Names
Arthritis - psoriatic
Causes, incidence, and risk factors
Psoriasis is a common, chronic skin condition that causes red patches
on the body. About 1 in 20 individuals with psoriasis will develop
arthritis along with the skin condition. In the majority of cases,
psoriasis comes before the arthritis.
The disorder can be exhibited in a variety of ways. The arthritis
is generally mild and involves only a few joints. In a few people,
the disease is severe and usually affects the fingers and the spine.
When the spine is affected, the symptoms are very much like those
of ankylosing spondylitis.
The cause of psoriatic arthritis is not known, but genetic factors
may play a role. In general, people who have psoriasis have a higher
prevalence of arthritis than the general population.
Symptoms
- Nail abnormalities, or skin lesions of psoriasis
Joint swelling and joint pain (arthritis)
- Usually of the fingers and toes, but other joints can be affected
- Wrist pain, knee pain, hip pain, elbow pain, ankle pain
- Pain and swelling at the site of attachment of tendons to bone
- The Achilles tendon is often involved
Signs and tests
During a physical examination, the doctor will identify skin lesions,
tenderness, and swelling of joints. Joint X-rays may be performed.
Treatment
Treatment of psoriatic arthritis involves medication, patient education,
and physical and occupational therapy.
Nonsteroidal anti-inflammatory medications (NSAIDS) or salicylates
are used to reduce pain and inflammation of the joints. More severe
arthritis requires treatment with more powerful drugs called disease-modifying
antirheumatic drugs (DMARDS). Occasionally, particularly painful joints
may be injected with steroid medications.
Recently, new medications have been introduced. Inhibitors of the
inflammatory protein called tumor necrosis factor (TNF) are fast becoming
the treatment of choice. These include etanercept (Enbrel), infliximab
(Remicade), and adalimumab (Humira).
Rarely, surgery to repair or replace damaged joints will be performed.
Get rest and exercise. To increase mobility, physical therapy provides
exercise programs for specific joints. Heat and cold applications,
or hydrotherapy may also be used. Expectations
(prognosis)
The course of the disease is often mild and affects only a few joints.
In those with severe arthritis, treatment is usually very successful
in alleviating the pain.
Complications
Repeated episodes may occur. Calling your health care
provider
Call for an appointment with your health care provider if arthritis
symptoms develop along with psoriasis. Prevention
There is no proven prevention of psoriatic arthritis.
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