What is it?
Psoriatic arthritis is a disorder that causes pain and inflammation in the joints. It occurs in people with psoriasis, which is a chronic (long-term) skin disease that is characterized by the presence of a dry, scaly, itchy skin rash. This rash is more common on the elbows, knees and scalp. Psoriasis can cause changes in the nails of the fingers and toes as small depressions that resemble dots on the surface of the nails, called fovea.
What is the cause?
The cause of the disease is still unknown. It is believed that genetic factors (hereditary), a malfunction of the body's immune system that causes inflammation in the joints and the environment, play a role in the development of the disease. Some researchers believe that certain bacteria, such as streptococci, may be related to psoriatic arthritis and cause chronic stimulation of the immune system. This stimulation of the immune system can result in arthritis in those who have a genetic "susceptibility" to psoriatic arthritis. In the inflammatory types of arthritis, such as psoriatic arthritis, the body's defense system mistakenly attacks the lining of the joints, causing pain and inflammation.
What are the symptoms?
The common symptoms of psoriatic arthritis are:
The course of psoriatic arthritis varies. Most people are able to lead a normal life. However, some have chronic joint pain and can not use the joints affected by arthritis. The constant presence of heat and swelling in the membrane that covers the joint, called synovium, can cause damage and deformity in the joint.
How is it diagnosed?
To know if you have psoriatic arthritis, your doctor will ask about your symptoms and perform a physical examination. The latter can detect abnormalities in the joints such as pain, inflammation, pain during joint movement, or inability to move joints in their entirety. In addition, your doctor will look for evidence of psoriasis on the skin or changes in the nails. Also, they will do some of the following tests:
The goal of psoriatic arthritis treatment is to reduce joint pain and inflammation, control skin psoriasis, and delay or prevent joint damage. The most common treatments, including skin care, drugs and exercise, are described below.
The following information does not cover all possible uses, precautions, side effects or drug interactions for the treatment of psoriatic arthritis. You should not replace the advice and guidance of your rheumatologist. If you have questions about these or other treatments, consult your rheumatologist or pharmacist.
Using special makeup can help hide skin problems and make you feel better.
Inquire with your dermatologist about special cosmetics or inquire at the sideboards of any department store. Cosmetics employees can teach you how to apply their products.
TREATMENTS WITH LIGHT
Light treatments, such as those presented below, should only be followed under the recommendation of a dermatologist. Do not apply them if you are taking methotrexate.
The benefits of medications used to treat psoriatic arthritis include helping to relieve joint pain and inflammation, as well as slowing joint damage. However, what works for you may not work for someone with psoriatic arthritis. Take your medicines as directed by your doctor and pharmacist. Be sure to tell your doctor about all prescription and over-the-counter medications and / or dietary supplements or herbalists that you are taking. Taking certain medicines together can cause an adverse reaction.
Your dermatologist or rheumatologist may prescribe topical creams or ointments to control psoriasis, such as:
NON-STEROID ANTI-INFLAMMATORY MEDICINES (NSAIDs) Nonsteroidal
anti-inflammatory drugs or NSAIDs can help reduce pain and inflammation of the joints. You may have to take NSAIDs for a few days, weeks, or maybe much longer, depending on your situation. Over-the-counter or over-the-counter NSAID medications include aspirin, ibuprofen, and naproxen. Some of them are only issued with a prescription. Over-the-counter medications are often available at lower-than-prescribed doses and can control pain, but at these lower doses they may not control inflammation. Check with your doctor if it is advisable to take over-the-counter medications in addition to those prescribed.
NSAIDs work by inhibiting the production of substances called prostaglandins at the site of inflammation. These drugs carry the risk of creating stomach problems, a fall in kidney function, and heart attacks or strokes. Talk to your doctor to understand the risks. One type of NSAID called COX-2 selective inhibitor, celecoxib ( Celebrex ), was designed to be softer to the stomach, but may pose an increased risk of heart attack and stroke. Check with your doctor about the possible risks and to decide which drugs are right for you.
Etretinate is a medicine similar to vitamin A that is used to treat psoriasis. It is usually prescribed when other medicines have failed. Etretinate is not recommended in children because it can interfere with bone growth. It can cause congenital defects, so contraceptive measures should be taken in women of childbearing age to prevent pregnancy and continue for two more years after their use has been suspended.
The corticosteroids are synthetic forms of cortisol, a hormone produced by the body. Your doctor may prescribe corticosteroid pills or creams or inject the medicine directly into the inflamed muscles or joints. Oral corticosteroids, such as prednisone, may be necessary to control extensive joint inflammation at low doses. The prolonged use of oral corticosteroids is not highly recommended in psoriatic arthritis due to its adverse effects: hypertension, osteoporosis, Cushing syndrome (weight gain, roundness and facial redness "moon face", thinning of the skin, muscle weakness and fragile bones), cataracts, predisposition to infections, sudden mood swings, increased appetite and risk to develop stomach ulcers
ANTIRREUMATIC DRUGS MODIFIERS OF THE DISEASE (DMARD)
The disease-modifying anti-rheumatic drugs or DMARDs are usually more potent than NSAIDs and may slow the progression of chronic forms of inflammatory arthritis, such as psoriatic arthritis. They work best when used before extensive damage has occurred. Your doctor should watch you carefully while you are under DMARD.
Methotrexate ( Rheumatrex, Trexall) has been used for cancer management for many years, but when used for the treatment of arthritis it is done in much smaller doses, with fewer side effects. Methotrexate helps relieve the pain, stiffness and inflammation of many types of arthritis, including psoriatic arthritis and improve skin symptoms. The medication is administered orally as a liquid, pill or by injection. Adverse effects are nausea, vomiting, mouth sores, diarrhea, low white blood cell counts, liver function abnormalities, and pneumonia. Taking folic acid can reduce some of the side effects. You should avoid getting pregnant, because the drug can cause harm to the fetus or miscarriages, so women of childbearing age should have an effective method of contraception. You should not drink alcohol if you are taking methotrexate.
Some clinical studies suggest that the action of leflunomide ( Arava ) is comparable to methotrexate in terms of improving the symptoms of psoriatic arthritis. The possible side effects are nausea, diarrhea, rashes, liver toxicity, hypertension, hair loss and headaches (headaches). It is known that leflunomide causes birth defects. Both men and women must take effective contraceptive measures while they are under the medication and continue them for three months after they have stopped using it.
Clinical studies have revealed that sulfasalazine ( Azulfidine, Azulfidine EN-Tabs ) can relieve joint pain and swelling in people with psoriatic arthritis. However, those who are allergic to drugs that contain sulfa drugs can not take such medication. Side effects may include gastrointestinal problems, loss of appetite, skin rashes, increased sensitivity to sunlight, dizziness, headaches, liver abnormalities, a low lobule count and sperm counts as well.
Cyclosporine ( Neoral ) is used for the treatment of skin and joint problems in psoriatic arthritis. Blood pressure should be carefully monitored and blood tests performed to check liver and kidney function. The side effects are nausea, vomiting, diarrhea, inflammation of the gums (gingivitis), hypertension, itching, excessive hair growth ((hirsutism) and abnormalities in liver and kidney function.Cyclosporin can also cause congenital defects if taken during pregnancy, so women of childbearing age should use effective contraception during treatment with this drug.
Azathioprine ( Imuran ) also suppresses the action of the immune system and can relieve joint pain, stiffness and swelling of psoriatic arthritis. Adverse effects of the medication include irritation of the stomach, inflammation of the pancreas, rash, and a low count of blood cells. Regular blood tests are required. Azathioprine can cause congenital defects if taken during pregnancy, so women of childbearing age should use an effective method of contraception while taking the medication.
Hydroxychloroquine ( Plaquenil ) is prescribed for the treatment of mild psoriatic arthritis in its early stages. There is a possibility that vision problems may develop with the use of this medication. Consequently, you should have an eye exam every 6 or 12 months while you are taking this medicine. Other side effects are stomach irritation, diarrhea, headache, skin rashes and whitening of skin or hair.
MODIFIERS OF THE BIOLOGICAL RESPONSE
Biological response modifiers (MRB), also called biological , are a category of DMARDs that prevent the immune system from causing psoriatic inflammation or arthritis. Some biologics are given intravenously while others are given as an injection.
Anti-TNF agents (which block a chemical signal of inflammation) etanercept ( Enbrel ), adalimumab ( Humira ) and infliximab ( Remicade ) are approved by the FDA to reduce the symptoms of active psoriasis and psoriatic arthritis in adult patients . Golimumab (Simponi) is approved to treat adults with psoriatic arthritis. Ustekinumab ( Stelara ), which inhibits an inflammatory compound called interleukin and alefacept ( Amevive ), against T lymphocytes involved in inflammation, also serve the treatment of moderate to severe psoriasis.
Consult your doctor if you develop symptoms of infection (fever, sore throat, chills, cough), being treated with any biological agent. You should also be tested for tuberculosis before you start taking this type of medication and not receive any attenuated (live) virus vaccine during the course of treatment. With certain drugs of this kind, there is a risk of an allergic reaction. It is generally advised to avoid pregnancy when you are under treatment with MRB.
Physical activity is an important part of your treatment. It can limit the pain and inflammation of the arthritis that makes the joints rigid. The activity can also improve flexibility, strengthen muscles, improve sleep, strengthen the heart, help lose weight and improve physical appearance. It is essential to exerciseas soon as it is diagnosed to maintain complete mobility of the joints.
The aquatic exercise like swimming can be a good choice because it puts less stress on joints that exercise is practiced on the ground. Work with your doctor, physiotherapist or rehabilitation specialist to develop an exercise program according to your needs.
Generally, a normal amount of rest and sleep is enough to reduce joint fatigue and inflammation. In some people, however, psoriatic arthritis can cause extreme fatigue. If this happens, you may need to rest more than usual and learn to keep up with your activities so that you can use your energy wisely throughout the day. It is important to rest the individual joints of the forces of tension. If the feet, ankles or knees are compromised, it may be necessary to decrease the activities that involve carrying weight during acute episodes.
Heat and cold
treatments Heat and cold treatments such as getting into a bathtub or hot tub or placing an ice pack on the painful joint can temporarily relieve pain and reduce swelling in the joints. Ask your doctor or physiotherapist about the most appropriate treatments for you. If the joints are hot and swollen, cold should be used. If you feel pain, but without heat or inflammation, then you can apply cold or heat indistinctly.
Splints or splints
splints help you to rest your joints. They can be useful if you have joint inflammation or problems with the alignment or stability of them. Using splints helps reduce pain, swelling and stiffness in them. Your doctor, physiotherapist or occupational therapist can assist you in determining what is the best splint for you and when you should wear it.
Most people with psoriatic arthritis may never require surgery to replace the joints. However, if your joints are seriously damaged by the disease or when other treatments do not diminish the pain, your doctor may recommend surgery, in which the joints damaged by psoriatic arthritis are replaced with artificial joints. The benefits include less pain and improvement in joint function.
Who is at risk?
Psoriatic arthritis occurs in people with psoriasis, a chronic (long-term) skin disease. Not everyone who has psoriasis has psoriatic arthritis. From 10 to 30% of people with psoriasis develop psoriatic arthritis.
The condition affects both men and women. It usually develops between 30 and 55 years of age.