Psoriatic arthritis is a common form of arthritis that occurs in association with psoriasis. Joint pain can occur years after the first skin problems develop. In fact, 85% of people with psoriatic arthritis develop skin lesions first, though some people experience joint pain first. But the real problem is most people don’t associate their joint pain and stiffness with their skin lesions. The signs and symptoms rheumatologists look for in determining whether you have psoriatic arthritis include:
• Joint pain and stiffness
• Swelling of the fingers and toes
• Red, flaky, scaly skin
• Changes in the appearance of your nails, like indentations and thickening
As many as 30% of people with psoriasis develop psoriatic arthritis.
While the exact cause of psoriatic arthritis is still unknown, the condition has been linked to an excess of tumor necrosis factor, or TNF, produced in the body. This excess TNF can attack healthy joint tissue, making it swell while causing damage and deformity. Typically, a patient may experience skin symptoms. The skin may become cracked, scaly, peeling and red. Then the joints may become swollen and inflamed and cartilage can begin to deteriorate. As psoriatic arthritis gets worse, inflammation and swelling may become more severe, cartilage can deteriorate and bone can begin to erode. At advanced stages, psoriatic arthritis can bring debilitating pain, inflammation and swelling. The bone and cartilage are destroyed. We know that about 40% of people with psoriatic arthritis can have some type of joint deformity or joint damage that’s visible in X-rays. But the good news is that early recognition, diagnosis and treatment of psoriatic arthritis can help relieve pain and inflammation that can cause disabilities.
And overall, early treatment can mean less stiffness and swelling, improved skin symptoms and a chance to improve your outlook, confidence, relationships and ability to do the things you enjoy. There are three main benefits to treating psoriatic arthritis: improving the effects on your skin, relieving joint symptoms like pain and swelling—and helping to keep joint damage from getting worse. These have a direct impact on your health-related quality of life and ability to function, as well as your comfort in social situations. There are a variety of medications out there. NSAIDs and COX-2 inhibitors, like ibuprofen and Celebrex, may temporarily ease the joint pain, but do nothing to treat the joint damage of psoriatic arthritis. Most people with psoriatic arthritis may need topical creams, in addition to traditional DMARDs, or disease-modifying anti-rheumatic drugs, such as methotrexate. DMARDs and TNF (tumor necrosis factor) blockers can relieve both joint and skin symptoms, and can help keep the joint damage of psoriatic arthritis from getting worse. TNF Blockers are a class of medications that have been developed that can effectively treat psoriatic arthritis.
TNF Blockers block the action of TNF-alpha, a protein that can attack body tissue such as the membrane that lines and cushions joints and cause inflammation. They have shown substantial benefits in treating psoriatic arthritis. These treatment options are effective in treating both skin and joint symptoms. When choosing a TNF Blocker, you should know that all TNF Blockers need to be injected or infused.
Etanercept (Enbrel) is usually taken every week and comes in a pre-filled syringe or pen. You can do the injection in a few minutes at home. Adalimumab (Humira) is usually taken every other week and can be injected with a pre-filled syringe or ready-to-use pen. You can do the injection in a few minutes at home.
Infliximab (Remicade) is an IV, or intravenous infusion, that is given every eight weeks by a healthcare professional in an office or a clinic and it takes a few hours. In addition to these medications, topical agents can sometimes help with the skin disease. Great strides, though, with anti-TNF therapy have made it possible for patients with psoriatic arthritis to enjoy a normal life.
The bottom line is that most people with psoriatic arthritis can enjoy a painless and normal life if diagnosed early and treated appropriately.
