Other Conditions

Overview
Types
Symptoms
Treatment options
Support and links

Overview
Symptoms
Treatment options
Support and links

Understanding psoriatic arthritis

Overview

Psoriatic arthritis is a chronic, immune-mediated inflammatory disease characterized by both joint inflammation and the skin lesions associated with psoriasis. This inflammatory condition affects an estimated one million adults.

Though the exact cause of psoriatic arthritis is unknown, it is believed to be an immune-mediated inflammatory disease with a genetic link. Moreover, environmental factors may play a role in the development of the disease.

Types

There are five types of psoriatic arthritis:

Symmetric arthritis, the most common type, usually affects the same joints on both sides of the body
Asymmetric arthritis usually involves only one to three joints, such as the knee, ankle, wrist, or finger
Distal Interphalangeal Predominant (DIP) arthritis occurs in only about five percent of people with psoriatic arthritis. It primarily involves joints closest to the nail in the fingers and toes
Spondylitis involves inflammation of the spinal column. The common symptoms are inflammation with stiffness of the neck, lower back, or spinal vertebrae
Arthritis mutilans is a severe, deforming form of arthritis that affects fewer than 5 percent of people with psoriatic arthritis. It predominantly affects the small joints of the hands and feet, though it can be associated with neck or lower back pain

Symptoms

Psoriatic arthritis can present in a number of ways. Approximately 95 percent of people with the condition have swelling in joints outside the spine, and more than 80 percent experience changes in their nails, such as indentations or lifting. Other symptoms may include:

Stiffness, pain, swelling, and tenderness of the joints and surrounding tissues
Reduced range of motion
Silvery layers of skin that flake off leaving red, inflamed skin underneath
Swelling of the digits in the hands or feet, known as dactylitis
Inflammation of a tendon or site where a ligament attaches to bone, known as enthesitis

Treatment options

For people with psoriatic arthritis, there are different options for treating symptoms. Some treatments are for joint symptoms and others for just skin symptoms. The goal of therapy for people with psoriatic arthritis is to effectively manage both joint and skin symptoms for the long term in order to help maintain quality of life.

The proper medication regimen is important in controlling your psoriatic arthritis. It is important that you help your doctor determine the best combination for you. However, keep in mind that nearly all medications have side effects. Be sure to check the patient information provided with your prescription and talk to your doctor about the kinds of side effects certain medications may have, and whether they are safe for you to use.

For people whose joint symptoms have become severe and debilitating, surgery is considered a last resort in treating psoriatic arthritis.

Topical treatment: Ointments and creams for joint and skin symptoms

Analgesic creams applied topically to affected joints can temporarily help reduce pain. Most are available over the counter. These topical pain relievers may contain substances such as menthol that produce a tingling sensation, which serves as a distraction from the pain. Creams that contain salicylates, the same pain-fighting ingredients found in aspirin, are absorbed through the skin and may help reduce inflammation in joints, as well as treat pain. If you are allergic to aspirin or are taking an anticoagulant blood thinner, check with your doctor before using topical medications that contain salicylates. Topical treatments should not be used in combination with a heating pad or bandage, and they should never be applied to broken or irritated skin.

Topical treatments, such as anthralin, corticosteroids, retinoids, and vitamin D, are all used to treat itchy, scaly skin due to psoriasis. They are available as creams, sprays, gels, and medicated tapes. Corticosteroids are commonly prescribed medications because they work quickly to reduce skin inflammation.

Exercise and pain management techniques

Exercise can help keep joints flexible and is beneficial to overall health, including weight management. Maintaining a healthy weight is important since excess weight on the joints can worsen pain and decrease mobility. You should talk with your doctor or physical therapist about tailoring an exercise routine that is right for you.

If you are exercising and feel pain or discomfort at any time, stop immediately. You and your doctor may need to make a few more adjustments to your routine to avoid pain or undue stress on your joints and bones.

Many people use pain management therapies to treat arthritis symptoms. These therapies do not, however, treat skin symptoms associated with psoriatic arthritis. Treatments such as massage, whirlpools, and cold or hot compresses can help alleviate joint pain, swelling, and stiffness, but they do not protect against bone loss or joint damage. They are designed to provide temporary relief and do not offer sustained pain relief.

Pain medication and Disease-modifying antirheumatic drugs (DMARDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used pain medications. These drugs include over-the-counter remedies, such as aspirin and ibuprofen, as well as prescribed medications. NSAIDs are effective at treating mild joint inflammation associated with psoriatic arthritis. They do not treat skin symptoms.

DMARDs are drugs that can help control symptoms of psoriatic arthritis. These drugs are prescribed by a doctor and include methotrexate and cyclosporine. DMARDs can help control both joint and skin symptoms.

Biologics

These drugs are the latest treatment options available to people with psoriatic arthritis. These therapies selectively target parts of the immune system that lead to inflammation as well as joint and tissue damage in psoriatic arthritis.

Support and links

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National Psoriasis Foundation

www.psoriasis.org/home

The National Psoriasis Foundation is a patient-driven nonprofit advocacy organization that serves patients with psoriasis and psoriatic arthritis. The site offers information on symptoms and treatment, as well as access to educational materials, discussion forums, and news on research and treatment advances.

Psoriasis Cure Now

www.psoriasis-cure-now.org

Psoriasis Cure Now focuses on finding a cure for psoriasis by encouraging people with psoriasis and psoriatic arthritis to speak out and demand their fair share of federal medical research resources. The site advocates an increase in the amount of federal funds directed toward research on psoriasis and psoriatic arthritis, as well as the urgency for patients to have access to the full range of safe and effective treatments for psoriasis and psoriatic arthritis.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

www.niams.nih.gov

Part of the National Institutes of Health network of information, NIAMS offers general information on psoriatic arthritis and other inflammatory diseases. NIAMS offers information packets on psoriatic arthritis, which can be requested online.

Mayo Clinic on Psoriatic Arthritis

www.mayoclinic.com/health/psoriatic-arthritis/DS00476

The Mayo Clinic site provides a user-friendly overview of psoriatic arthritis, including symptoms, risk factors, treatment, lifestyle issues, and advice on how to talk to your doctor about your condition.

American College of Rheumatology (ACR)

www.rheumatology.org

ACR is a professional organization serving patients and healthcare professionals. The site includes information about inflammatory conditions, including psoriatic arthritis, and provides access to information about symptoms, diagnosis, treatment, and research.

American Academy of Dermatology (AAD)

www.aad.org/default.htm

The AAD is the largest and most representative of all dermatologic associations and consists of over 14,000 healthcare professionals around the world. The site includes information about research and patient care, as well as medical, surgical, and cosmetic treatment of the skin, hair, and nails.

Understanding ankylosing spondylitis

Overview

Ankylosing spondylitis (AS) is a chronic, inflammatory disease that primarily affects joints of the spine, causing severe back pain. It may also cause other various symptoms throughout the body, including stiffness and fatigue. Some AS patients may experience inflammation and discomfort in the shoulders, hips, ankles, and jaw.

In some advanced cases, inflammation can cause bone formation on the spine, resulting in a stooped-over posture that significantly limits mobility. The symptoms of AS and the disease's effect on the body can be disabling, making it difficult for patients to work and even accomplish simple everyday activities.

Ankylosing means stiff or rigid; spondyl refers to the spine; and itis means inflammation
AS affects at least 500,000 people in the United States
AS typically affects young people between the ages of 17 and 35
AS affects nearly three times as many men as women

Although there is no known cause of AS, genetics are thought to play a significant role. Studies show that 90 percent of people who have AS also have a gene that produces a genetic marker called HLA-B27.

Symptoms

AS may be characterized by:

Back/spinal pain
Stiffness
Weight loss and fatigue
Joint swelling in the hips, elbows, knees, and ankles

Treatment options

For some patients, doctors may include deep breathing, stretching, and strengthening exercises to reduce the stiffness and pain associated with AS. Exercise can also help reduce bending and stooping by making muscles stronger and improving posture. It is important to keep in mind what is within your limits. Even moderate exercise is beneficial. You should talk to your doctor about what exercises might provide the most benefit to you with the least amount of strain.

The proper medication regimen is also important in controlling your AS. It is important that you help your doctor determine the best combination for you. However, keep in mind that nearly all medications have side effects. Be sure to check the patient information provided with your prescription and talk to your doctor about the kinds of side effects certain medications may have, and whether they are safe for you to use.

Traditional ankylosing spondylitis treatments include:

Biologics

Shown to be highly effective in treating spinal arthritis associated with AS, these drugs selectively target parts of the immune system that lead to inflammation in AS.

Corticosteroids

These drugs, such as prednisone, reduce inflammation and symptoms.

Disease-Modifying Antirheumatic Drugs (DMARDs)

These drugs, such as sulfasalazine, reduce inflammation in AS. When prescribed for treating ankylosing spondylitis, these drugs are given in much smaller doses than for treating rheumatoid arthritis.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are the most commonly used class of medication for treating the pain and stiffness associated with AS. One example is ibuprofen, a generic NSAID that is found in over-the-counter pain relievers. They commonly come in tablet form and are taken orally.

Support and links

For more information about ankylosing spondylitis, please visit the Spondylitis Association of America at www.spondylitis.org.