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Dr Jason’s presentation on Psoriatic arthritis (PsA)
Healthy living is the greatest gift a person can ever ask for; however that’s not the case when you are struck by illness or attacked by a pathogen of some kind, often we are helpless for what we beget from our parents who make us who we are. Genetic predisposition is one of the greatest challenges we face today and I am here to address the very cause and concern of one such condition called Psoriatic arthritis.
So how different is arthritis from psoriatic arthritis and how different is psoriatic arthritis from its other forms?
Psoriasis follows arthritis, sometimes it may take years. When arthritis symptoms occur with psoriasis, it is called psoriatic arthritis (PsA). In Psoriasis the joints on the end of the fingers get affected with visible signs of inflammation and pain, other places include the wrists, knees and ankles can also become involved. This is usually accompanied by visible symptoms on fingernails and toes, small pits as seen in later stages of OA are also seen in the nails accompanied by nearly complete obliteration and crumbling a characteristic in reactive arthritis or fungal infections, some people also develop psoriasis in spinal cord causing Spondylitis. It is a characteristic feature of Psoriatic arthritis to present within itself variations that mimic other forms of arthritis.
One form of Psoriatic arthritis is “psoriatic arthritis mutilans”, which forms 5% of arthritis. It’s the most lethal form that causes widespread destruction of the joints a term sometimes referred to as “telescoping fingers.”
As mentioned earlier, the causes apart from hereditary are yet to be ascertained. Genes play a major role in development of PsA but the risk genes are yet to be confirmed, recently a paper which was involved in PsA studies had the following to say
“Genome-wide association studies have been highly successful in identifying genetic susceptibility factors for psoriasis. Most of the psoriasis loci tested so far are also associated with PsA. For example, associations of HLA-Cw*06 and the IL12B and IL23R genes are well-established with both conditions”
So it’s safe to conclude that we may have inched closer towards full blown treatment towards PsA
- PsA if mild may involve only a few joints, particularly those at the end of the fingers or toes.
- PsA if severe may affect many joints, including spine.
- If the spine is affected, the symptoms are stiffness, burning, and pain mostly in the regions involving the lower spine and sacrum and development of s Spondylitis
- Skin and nail changes of psoriasis, the skin deteriorates at the same time as the arthritis
Other symptoms include
- Tenderness, pain and swelling over tendons
- Swollen fingers and toes
- Stiffness, pain, throbbing, swelling and tenderness in one or more joints
- Limited range of motion
- Morning stiffness and tiredness
- Nail changes— For Eg the nail separates from the nail bed and/or becomes pitted and mimics fungus infections
- Redness and pain of the eye, such as conjunctivitis
Psoriatic arthritis cannot be determined directly rather has to be arrived through selective deletion of other conditions showing similar symptoms.
Pedigree analysis: - The family chart plays crucial and linkage pattern of genes involved in Psoriatic arthritis studied across generations
Other forms of tests: - Include blood tests, MRIs and X-rays of the joints and spinal cord Medical history, physical examination, blood tests,
- MRIs and X-rays of the joints that have symptoms may be used to diagnose psoriatic arthritis. Presence of psoriasis on the skin and nail changes supports a diagnosis of psoriatic arthritis. A person can also have PsA and Osteoarthritis or PsA and rheumatoid arthritis but chances of them occurring is very rare
- X-rays initially may not reveal signs of PsA making diagnosis more difficult. In the later stages however X-rays may show changes that are characteristic of psoriatic arthritis such as “pencil in cup” where bone gets whittled to a sharp point, peripheral joint changes and in the spine support the diagnosis of psoriatic arthritis.
The treatment of PsA depends upon which symptoms are the most severe and can change over time. Two primary types of physicians will be involved in treatment: A dermatologist and a rheumatologist trained to treat the arthritic symptoms of the disease.
A common regimen for treating psoriatic arthritis includes medication and exercise.
A number of medications can be used to help treat the symptoms of PsA:
1) NSAIDs (non-steroidal anti-inflammatory drugs) to reduce the inflammation, joint pain and stiffness.
2) DMARDs (disease-modifying anti-rheumatic drugs) are sometimes prescribed in more severe cases. These include methotrexate and sulfasalazine.
3) All four of the TNF-a inhibitor medications approved by the FDA for ankylosing spondylitis are also approved for treating psoriatic arthritis: Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), and Simponi (golimumab).
- Exercise & Other Management Tools
Exercise is essential. Exercise helps keep the muscles strong around a joint. Not using a sore joint will cause the muscles to become weak, thus resulting in more pain. Other management tools include physical therapy, heat for stiffness, and ice for swelling, physical therapy and surgery for those with severe joint damage.