Psoriatic Arthritis is an illness with many faces. It occurs in about 15% of patients with psoriasis, a chronic inflammatory skin disease affecting 2% of the United States population. The joint illness can manifest in a variety of ways and with varying degrees of severity, just like the skin condition.
PsA (pronounced "sor-ee-á-tick" arthritis) is typically grouped with reactive arthritis and ankylosing spondylitis (AS) as spondyloarthropathies (see related sections). These types of arthritis typically affect soft tissue structures including ligaments and bursa as well as the spine, especially the sacroiliac region.
While the cause of arthritis in some psoriasis sufferers is unknown, some doctors think that bacteria on the skin are to blame for the inflammation of the joints. Even so, there is no clear correlation between the intensity of arthritis and the severity of psoriasis in a given patient. For instance, it is typical to observe severe, incapacitating arthritis in an individual who has minor psoriasis.
Moreover, some individuals (about 15% of all patients) develop arthritis before the onset of noticeable psoriasis.
Five subgroups of PsA patients have been identified: oligoarthritis, polyarthritis, joint participation limited to the fingertips, primarily spinal involvement, and arthritis mutilans, a debilitating condition.
In Psoriasis Arthritis, oligoarthritis represents the most typical pattern. Knees, ankles, fingers, and toes are commonly affected joints in these patients. When arthritis occurs in finger or toe joints, swelling of the entire digit is common, resulting in a “sausage” appearance. As opposed to rheumatoid arthritis (RA), joint involvement in PsA patients tends to be asymmetric, involving different joints on each side of the body.
With the exception of the fact that often just one sacroiliac joint is inflammatory rather than both joints as is characteristic in AS patients, polyarthritis patients are frequently difficult to identify from RA. Those with predominantly spinal involvement also resemble AS. Some people just experience edema at the fingertip knuckles. Additionally, psoriasis involvement in the fingernails or toenails is very common in these people. Finally, arthritis mutilans has the ability to cause joint damage and deformity very quickly. Thankfully, this PsA variant is the least prevalent.
Psoriatic arthritis doctors near me (In Phoenix, AZ, USA) typically concentrate on the joint disease, but in many individuals, the psoriatic skin condition is so bad that it overshadows the arthritis. Similar to the arthritis it causes, psoriasis can take many distinct forms. Psoriasis typically manifests as scaly or silvery plaques with red bases that most frequently affect the scalp, knees, and elbows. Another kind known as "guttate psoriasis" exhibits the same scaly look but with thinner plaques that are shaped like "teardrops." A "pitted" appearance or damage at the base of the nails may be seen in some people whose condition primarily affects their nails. "Erythroderma," the most serious condition of psoriasis, is characterized by red, inflammatory skin that covers the entire body. Infections could arise from this type of psoriasis as a consequence of skin germs getting into the bloodstream.
Psoriatic arthritis doctors near me. can accurately diagnose PsA primarily by taking a history of the complaints and examining the skin and joints. For this type of arthritis, there are no valid laboratory testing available. Moreover, many of the markers of inflammation that are usually seen in RA and other forms of arthritis may be entirely normal in a patient with active PsA. Findings such as joint swelling or evidence of spinal inflammation that fit into any of the above subsets of PsA, along with typical features of psoriasis, are the most important pieces of information that lead to a correct diagnosis.
X-rays may offer further evidence for PsA as well as demonstrating the severity of joint damage. Early in the phase of the illness, many people may have normal x-ray results, but in some, the degree of joint destruction may be fairly severe. The combination of erosions around joints and bony enlargement around these erosions is fairly unique to PsA. Near sites of inflammation, there also may be a “shaggy” appearance to the surface of the bone that also suggests PsA. In patients with spinal symptoms, sacroiliac joints, found near the junction of the pelvis and sacrum in the lower back, may appear inflamed or damaged on x-ray. As opposed to AS, however, PsA tends to involve only one, not both, sacroiliac joints.
Depending on how active the arthritis is, patients with PsA (Psoriatic Arthritis) have access to a wide range of psoriasis therapy options. Reducing symptoms may be sufficient in patients with milder disease, but certain medications can halt disease progression in individuals with more advanced joint involvement or those at risk of permanent damage. While many of these therapies also help treat underlying psoriasis, the focus here is on managing joint symptoms with effective PsA treatment strategies.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce joint pain and stiffness. These medications, including ibuprofen and naproxen, may be adequate for patients with mild PsA. Some individuals may respond better to indomethacin, although stomach-related side effects can limit its use. Traditional NSAIDs carry risks like stomach irritation, ulcers, and internal bleeding. However, newer NSAIDs like celecoxib (Celebrex) and valdecoxib (Bextra) offer fewer gastrointestinal complications. Patients with kidney issues must use NSAIDs cautiously, as they can impair kidney function.
Corticosteroids,such as prednisone, are useful for short-term relief from joint inflammation. However, long-term steroid use can lead to unwanted side effects, and withdrawal may trigger a psoriasis flare. Corticosteroids are often best administered via injection into inflamed joints or soft tissues for temporary relief.
Sulfasalazine (SSZ) is a slower-acting medication often combined with NSAIDs. While SSZ does not treat the skin component of psoriasis, it can reduce joint swelling in PsA. It typically begins to work within 2 to 3 months. Common side effects include nausea and allergic reactions, with rare but more serious effects detectable through blood test.
Methotrexate (MTX), is a cornerstone of both psoriasis therapy and PsA treatment. Taken weekly in doses of 7.5 to 20 mg (or more), MTX helps manage both skin and joint symptoms by suppressing the immune system and controlling inflammation. It carries potential side effects like liver toxicity, lowered blood counts, and increased risk of infections, so regular monitoring is necessary. Despite risks, the benefits often outweigh the concerns in patients with significant disease.
Other disease-modifying antirheumatic drugs (DMARDs) include azathioprine (Imuran), cyclosporine (Neoral), leflunomide (Arava), mycophenolate mofetil (Cellcept), and hydroxychloroquine (Plaquenil). Though fewer studies support their use in PsA compared to MTX or SSZ, they remain valuable options for patients who do not respond to first-line treatments.
Tumor necrosis factor (TNF) The most exciting and advanced psoriatic arthritis treatment options involve Tumor Necrosis Factor (TNF) inhibitors. These biologic medications block TNF, a protein responsible for inflammation in PsA and other types of arthritis. Etanercept (Enbrel) is FDA-approved for both PsA and psoriasis. Other TNF inhibitors, such as infliximab (Remicade) and adalimumab (Humira), have also proven safe and highly effective. These medications can halt or significantly slow joint damage.
While effective, TNF inhibitors may cause side effects such as infections or injection/infusion site reactions. They should not be used by individuals with multiple sclerosis or severe heart failure, and patients should be screened for tuberculosis before starting treatment.
To choose the most suitable PsA treatment, it's essential to evaluate the severity of both joint and skin symptoms. Today, we have more targeted psoriasis therapy options than ever before to improve quality of life and prevent long-term damage.
Finding the right psoriatic arthritis treatment injections tailored to your condition is vital, especially with so many modern therapies available. If you're looking for psoriasis treatment in Scottsdale or specialists in PsA, working with an experienced rheumatologist can ensure the best care.
For individuals searching online for "best doctors for psoriatic arthritis" or "psoriatic arthritis treatment near me", our dedicated team in Scottsdale, AZ is here to guide you through your treatment journey with compassion and clinical expertise.
