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Psoriatic Arthritis
Author: Richard H. Camer
Definition
of Psoriatic Arthritis
Psoriatic arthritis is a form of arthritic joint disease associated
with the chronic skin scaling and fingernail changes seen in psoriasis.
Description
of Psoriatic Arthritis
Physicians recognize a number of different forms of psoriatic arthritis.
In some patients, the arthritic symptoms will affect the small joints
at the ends of the fingers and toes. In others, symptoms will affect
joints on one side of the body but not on the other. In addition,
there are patients whose larger joints on both sides of the body
simultaneously become affected, as in rheumatoid arthritis. Some
people with psoriatic arthritis experience arthritis symptoms in
the back and spine; in rare cases, called psoriatic arthritis mutilans,
the disease destroys the joints and bones, leaving patients with
gnarled and club-like hands and feet. In many patients, symptoms
of psoriasis precede the arthritis symptoms; a clue to possible
joint disease is pitting and other changes in the fingernails.
Most
people develop psoriatic arthritis between ages 35-45, but it has
been observed earlier in adults and children. Both the skin and
joint symptoms will come and go; there is no clear relationship
between the severity of the psoriasis symptoms and arthritis pain
at any given time. It is unclear how common psoriatic arthritis
is. Recent surveys suggest that between 1 in 5 people and 1 in 2
people with psoriasis may also have some arthritis symptoms.
Causes
& symptoms of Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. As in psoriasis, genetic
factors appear to be involved. People with psoriatic arthritis are
more likely than others to have close relatives with the disease,
but they are just as likely to have relatives with psoriasis but
no joint disease. Researchers believe genes increasing the susceptibility
to developing psoriasis may be located on chromosome 6p and chromosome
17, but the specific genetic abnormality has not been identified.
Like psoriasis and other forms of arthritis, psoriatic arthritis
also appears to be an autoimmune disorder, triggered by an attack
of the body's own immune system on itself.
Symptoms
of psoriatic arthritis include dry, scaly, silver patches of skin
combined with joint pain and destructive changes in the feet, hands,
knees, and spine. Tendon pain and nail deformities are other hallmarks
of psoriatic arthritis.
Diagnosis
of Psoriatic Arthritis
Skin and nail changes characteristic of psoriasis with accompanying
arthritic symptoms are the hallmarks of psoriatic arthritis. A blood
test for rheumatoid factor, antibodies that suggest the presence
of rheumatoid arthritis, is negative in nearly all patients with
psoriatic arthritis. X rays may show characteristic damage to the
larger joints on either side of the body as well as fusion of the
joints at the ends of the fingers and toes.
Treatment
of Psoriatic Arthritis
Treatment for psoriatic arthritis is meant to control the skin lesions
of psoriasis and the joint inflammation of arthritis. Nonsteroidal
anti-inflammatory drugs, gold salts, and sulfasalazine are standard
arthritis treatments, but have no effect on psoriasis. Antimalaria
drugs and systemic corticosteroids should be avoided because they
can cause dermatitis or exacerbate psoriasis when they are discontinued.
Several
treatments are useful for both the skin lesions and the joint inflammation
of psoriatic arthritis. Etretinate, a vitamin A derivative; methotrexate,
a potent suppresser of the immune system; and ultraviolet light
therapy have all been successfully used to treat psoriatic arthritis.
Alternative
treatments for Psoriatic Arthritis
Food allergies/intolerances are believed to play a role in most
autoimmune disorders, including psoriatic arthritis. Identification
and elimination of food allergens from the diet can be helpful.
Constitutional homeopathy can work deeply and effectively with this
condition, if the proper prescription is given. Acupuncture, Chinese
herbal medicine, and western herbal medicine can all be useful in
managing the symptoms of psoriatic arthritis. Nutritional supplements
can contribute added support to the healing process. Alternative
treatments recommended for psoriasis and rheumatoid arthritis may
also be helpful in treating psoriatic arthritis.
Prognosis
for Psoriatic Arthritis
The prognosis for most patients with psoriatic arthritis is good.
For many the joint and other arthritis symptoms are much milder
than those experienced in rheumatoid arthritis. One in five people
with psoriatic arthritis, however, face potentially crippling joint
disease. In some cases, the course of the arthritis can be far more
mutilating than in rheumatoid arthritis.
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