Psoriatic Arthritis (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
In this Article
- Psoriatic arthritis facts
- What is psoriatic arthritis?
- What causes psoriatic arthritis?
- What are risk factors for developing psoriatic arthritis?
- What are the different types of psoriatic arthritis?
- What are psoriatic arthritis symptoms and signs?
- What types of doctors treat psoriatic arthritis?
- How does a health care professional diagnose psoriatic arthritis?
- What is the treatment for psoriatic arthritis?
- Disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis
- What are psoriatic arthritis complications?
- What is the prognosis of psoriatic arthritis?
- Is it possible to prevent psoriatic arthritis?
- Is there a psoriatic arthritis diet? Are there home remedies for psoriatic arthritis?
- What does the future hold for patients with psoriatic arthritis?
- Find a local Rheumatologist in your town
What are psoriatic arthritis symptoms and signs?
In most patients, the psoriasis precedes the arthritis by months to years. There can be tiny pitting nail changes of the finger and toenails. The type of psoriatic arthritis depends on the distribution of the joints affected. Accordingly, there are five types of psoriatic arthritis: symmetrical, asymmetric and few joints, spondylitis, distal interphalangeal joints, and arthritis mutilans.
The arthritis frequently involves the knees, ankles, and joints in the feet. Usually, only a few joints are inflamed at a time. The inflamed joints become painful, stiff, swollen, hot, tender, and red. There is usually loss of range of motion of the involved joints. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit (dactylitis), giving them a sausage-like appearance. Joint stiffness is a common symptom and is typically worse early in the morning. Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis. Psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum (sacroiliitis), causing other symptoms like pain and stiffness in the low back, buttocks, neck, and upper back. Occasionally, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive, though less common, form of arthritis called "mutilans" can cause rapid joint damage. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.
Patients with psoriatic arthritis can also develop inflammation of the tendons (tendinitis), tendon insertion points on bone (enthesitis, inflammation of the entheses), and around cartilage. Inflammation of the tendon behind the heel causes Achilles tendinitis, leading to pain with walking and climbing stairs. Inflammation of the chest wall and of the cartilage that links the ribs to the breastbone (sternum) can cause chest pain, as seen in costochondritis.
Aside from arthritis and spondylitis, psoriatic arthritis can cause symptoms like fatigue and inflammation in other organs, such as the eyes, lungs, and aorta. Inflammation in the colored portion of the eye (iris) causes iritis, a painful health condition that can be aggravated by bright light as the iris opens and closes the opening of the pupil. Corticosteroids injected directly into the eyes are sometimes necessary to decrease inflammation and prevent blindness. Inflammation in and around the lungs (pleuritis) causes chest pain, especially with deep breathing as the lungs expand against the inflamed areas, as well as shortness of breath. Inflammation of the aorta (aortitis) can cause leakage of the aortic valves, leading to heart failure and shortness of breath.
Acne and nail changes are symptoms commonly seen in psoriatic arthritis. Pitting and ridges are seen in fingernails and toenails of 80% of patients with psoriatic arthritis. Onycholysis, or separation of the nail bed, may also occur. Interestingly, these characteristic nail changes are observed in only a minority of psoriasis patients who do not have arthritis. Acne has been noted to occur in higher frequency in patients with psoriatic arthritis. In fact, a syndrome exists that features inflammation of the joint lining (synovitis), acne, pustules on the feet or palms, thickened and inflamed bone (hyperostosis), and bone inflammation (osteitis). This syndrome is, therefore, named by the eponym SAPHO syndrome.
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