Arthritis means inflammation of a joint. Psoriatic arthritis is a form of arthritis that occurs in people who also suffer from psoriasis. In the UK, 2-3% of the population develop some form of psoriasis. 10-20% of people with psoriasis develop some form of psoriatic arthritis, with symptoms usually starting between the ages of 30 and 50 (although the condition can occur in teenagers too). In 80% of cases, the arthritis appears after the skin symptoms. In 20% of cases, the joint inflammation comes first. There is no link between the severity of the skin symptoms and the risk of developing arthritis. Over 40% of people with psoriatic arthritis have a family history of the condition.
As with any type of arthritis, the inflamed joints are tender, swollen and painful. Joints also become stiff after resting, especially after a night's sleep. Other symptoms include inflamed muscles and tendons, especially around the elbows, wrists and heels. Joints may lose their range of movement and become deformed or locked.
A joint forms where two bones come into close contact. Some joints are fixed (e.g. in the skull) whilst in others the bones can move more freely. The bone surfaces in a mobile joint are protected from wear and tear by slippery cartilage and a lubricating fluid (the synovial fluid - produced by the synovial membrane). Most joints are held together by bands of tissue called ligaments.
In psoriatic arthritis, the synovial membrane becomes thickened and inflamed. It releases more fluid than normal so that the joint becomes tender and swollen. As inflammation continues, it spreads to the cartilage underneath and may eventually erode the bone. As the tendons are lined and lubricated by synovial membrane, these also become inflamed.
Asymmetrical oligoarticular - involves one or more joints, especially the knees, fingers and toes that may show sausage-like swelling and redness.
Symmetrical rheumatoid-like -involves the small joint of the fingers or toes.
Distal interphalangeal (DIP) - involves the last small joint of the fingers or toes. Nail changes are common.
Arthritis Mutilans - a rare deforming condition of the joints.
Spondylitic - inflammation of the spine and sacroiliac joints.
Aspirin-like drugs (non-steroidal anti-inflammatory drugs) such as ibuprofen reduce the inflammation, but can sometimes make skin symptoms worse and can also cause indigestion or heartburn. They should not be used in those with asthma. Injections of a corticosteroid drug into, or around, a single or painful joint can relieve pain, increase mobility and reduce deformity. Oral corticosteroid drugs are best avoided. They can cause severe relapse of the psoriasis in some people when they are withdrawn. Disease modifying drugs switch off the immune reactions that are causing inflammation and pain. They do not have any immediate effect and may take from 6 weeks to 6 months to work. It is important to avoid pregnancy whilst taking these drugs (effective contraception must be used during treatment).
Psoriasis (also see section on Psoriasis)
Psoriasis is a long-term (chronic) scaling disease of the skin, caused by the over production of skin cells. The skin shows raised, red patches, which are often covered with dead cells to form fine silvery scales or thick white plaques. Pustules may form when white blood cells (polymorphs) move into the area. Psoriasis is a genetic disease and hence there may be a family history of the condition.
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