PSORIATIC ARTHRITIS

by Serj Elabuzhskiy ***

There are six types of psoriatic arthritis.

Symmetrical psoriatic arthritis
Asymmetrical polyarthritis
Distal interphalangeal predominant (DIP)
Spondylitis
Arthritis mutilans
Juvenile psoriatic arthritis

SYMPTOMS

The disease causes an inflammation of the joints in various parts of the body, ranging from large joints like the hip joint to smaller ones like those of the toes. The spine may also be affected. Symptoms are specific to the site affected, and cause pain and disability e.g. back pain, neck pain, swelling of fingers and ankles. Skin and nail changes may also occur. In addition, the skin symptoms of psoriasis like red plaques are also present on the body. in psoriatic arthritis, eye symptoms are also present, shown by reddening and watering from the eyes.

DIAGNOSIS

The diagnosis depends on the history and the physical examination. The presence of the lesions of psoriasis along with inflammation of joints is indicative of psoriatic arthritis. Nail changes with arthritis is also diagnostic of psoriatic arthritis, differentiating it from osteoarthritis and rheumatoid arthritis. Sometimes diagnostic tests like X-rays, CT scans and MRI may be required.

TREATMENT

There is no known cure for the disease. Treatment mainly aims at reducing the pain and disability associated with the disease.

Treatment at home

Treatment at home includes home remedies like placing cold packs on the inflamed joints to reduce the inflammation, or soaking the affected limb in warm water. Splints have also been found to be useful for resting the joints, reducing the joint pain and swelling. A regular exercise also keeps the joint from getting stiff.

Medical treatment

Topical agents

in most of the patients, topical treatment is enough to treat the disease. the main treatment options are corticosteroids, Vitamin D3 derivatives, coal tar, retinoids and anthralin. It is recommended to switch them alternatively to prevent the development of side effects.

PUVA

Ultraviolet light combined with Psoralen is used for the treatment in combination with topical treatment have shown very good results.

Systemic medication

In psoriatic arthritis, the main management of the pain associated with the swollen joints. For the pain, drugs known as Non Steroidal Anti inflammatory Drugs (NSAIDs) are very effective e.g. ibuprofen. They also reduce the inflammation and swelling of the joints.

Other drugs known as Disease Modifying Anti Rheumatic Drugs (DMARDs) are prescribed to slow down the disease process itself e.g. methotrexate, cyclosporine, etanercept.

Injections of steroids into the joints may be used for relief of extreme inflammation of the joints.

Surgery

According to studies, 7% of the patients need surgery for the relief of extreme symptoms. Sometimes joint replacement is also required.