What Is Psoriatic Arthritis?

                                                                                         

Psoriatic skin disease is a relatively common condition for which the treatments are somewhat unpleasant and not entirely effective. It is known that an arthritic syndrome is associated with this skin disorder but even then the diagnosis may be missed when patients with psoriasis present with joint signs. There are many effects from psoriatic arthritis on the joints and the arthritic damage can lead to disability and compromised quality of life. In the United Kingdom the prevalence of psoriasis itself is around 2%, with 14% of this number exhibiting some signs of involvement in their joints.

The symptoms of joint involvement can be present in about 15 percent of people before any of the skin changes become obvious and ultrasound of tendons in people with psoriasis have shown abnormalities without any joint symptoms. A lesser number of joints are typically affected in psoriatic in comparison to rheumatoid arthritis although they may be affected in a similar arrangement, with in some instances only one or two joints affected. The entheses, the areas where the ligaments and tendons are attached to the bones, are typically affected with pain and inflammation. The attachment of the Achilles tendon to the heel bone is a good example.

The number of entheses in the body is very great and this may be related to some patients' widespread symptoms of pain which are not joint related. In the fingers there can be swelling of individual joints either alone or along with other joint involvement, this being an unfavourable sign for disease prognosis overall. There may be spondylitis or back pain of inflammatory origin with the usual symptoms of gradual and steady onset, increased symptoms at night, stiffness in the mornings, symptoms are typically worse with resting and better with activity. Up to a third of patients with back involvement may have no trouble from it, with involvement of the nails and the end finger joints also common.

Diagnosing joint symptoms related to psoriasis can be difficult as the population ages and people complain routinely of more and more joint symptoms. The possibility of psoriatic arthritis should however always arise when a diagnostician is consulted by a person with psoriasis who complains of joint symptoms, with particular reference to back pain of possible inflammatory origin and involved distal finger joints. Typical blood tests which are raised in the presence of inflammation in the body are the ESR (erythrocyte sedimentation rate) and the CRP (C-reactive protein). If the joint picture is suspicious but no psoriasis is easily apparent it may be important to examine the patient carefully for hidden affected areas.

Typically 30% of people diagnosed with this condition will suffer with non-progressive disease in a few affected joints. This presentation is usually effectively treated with steroid injections into the joints as required and by symptomatic management. Identifying this group initially is important to exclude those with worse disease who are likely to show increased inflammatory blood markers, to be male, to have a larger number of affected joints and to have used steroids previously. If showing these negative factors they are more likely to develop damaging disease to the joints with increased disability and a reduction in their quality of life.

Psoriatic arthritis sufferers have benefited less from research and development that those who have other major arthritic conditions but over the last ten years there has been a large increase in investigations concerning this disease. Development of the recent biological treatment agents has stimulated new treatment methods. Despite this there is still a lack of evidence for treatments and when to apply them.

Treatment of psoriatic arthritis has suffered from a lack of good research evidence compared to other major arthritic diseases but the last decade has shown a great increase in work on this condition. The new biological agents used for therapy have pushed forwards research and the possibilities for treatment. However, treatment choices are still not clear and evidence for them lacking.

About the author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapist in hartlepool. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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