Health
Problems
Psoriatic Arthritis
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What
is Psoriatic Arthritis?
Psoriatic arthritis is an inflammatory arthritis associated with
psoriasis, a chronic skin and nail disease. There are five types of this
disease:
- Arthritis involving primarily the small
joints of fingers or toes
- Asymmetrical arthritis, which involves
joints of the extremities
- Symmetrical polyarthritis, which resembles
rheumatoid arthritis
- Arthritis mutilans, which is rare but very
deforming and destructive
- Arthritis of the sacroiliac joints and
spine (psoriatic spondylitis)
The exact prevalence of each of these forms
of arthritis is difficult to establish. Patterns may themselves change
with time in individual patients, and some patients may show overlapping
features or more than one type. Sometimes arthritis is associated with
inflammation of the eyes, or inflammation at the bony sites of attachment
of ligaments and tendons, causing local pain, for example at the heels.
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Known Causes
The exact cause is unknown, but an interplay of immune, genetic, and
environmental factors are suspected. Up to 40% of patients with psoriatic
arthritis may have a history of psoriasis or arthritis in family members.
Both psoriasis and psoriatic arthritis flare up in the presence of
immunodeficiency due to HIV infection (AIDS).
Health Impact
- Psoriatic arthritis affects at least 10%
of the 3 million people with psoriasis in the United States.
- It affects men and women equally and
usually begins between 30-50 years of age, but can begin in childhood.
- Psoriatic arthritis may precede the
onset or the diagnosis of psoriasis in up to 15% of patients.
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Diagnosis
Skin and nail changes characteristic of psoriasis must be demonstrated
before a diagnosis can be made with certainty. Elevated erythrocyte
sedimentation rate (ESR), mild anemia, and elevated levels of blood uric
acid can be seen in some patients. Gout must be excluded.
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Conventional
treatments
Initial treatment of psoriatic arthritis consists of the use of
nonsteroidal anti-inflammatory drugs (NSAIDs), but methotrexate may be
needed for arthritis that doesn’t respond. An antimalarial drug,
hydroxychloroquine, may be effective, but some patients experience a flare
of their psoriasis. Sulfasalazine has been found to be very beneficial for
some psoriatic arthritis patients. Azathioprine may be used in severe
cases of the disease.
Corticosteroid injections directly into the
joints can be useful. Cyclosporin has been used recently with some good
results, but because of kidney side effects, it should be reserved for
patients with progressive disease unresponsive to other measures. Proper
exercise is very important. Surgery can be helpful in patients who develop
joint destruction.
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