What is it?
Psoriatic Arthritis (PsA) is a chronic inflammatory condition that varies in symptom severity, progression and response to treatment. As a result, about 50% of cases are unrecognised and patients left unable to access early treatment to prevent joint damage and manage symptoms.
Signs & Symptoms
PsA is a type of arthritis that commonly occurs in people with psoriasis, a skin condition characterised by red, scaly patches. The symptoms differ from person to person but can include:
- Joint Pain and Swelling: Often affects the fingers, toes, knees, or lower back, and is usually asymmetrical (affecting one side more than the other).
- Morning Stiffness: A common feature, lasting longer than 30 minutes and improving with activity.
- Dactylitis: Swelling of an entire finger or toe, giving it a “sausage-like” appearance.
- Skin and Nail Changes: Psoriasis plaques (red patches with silvery scales) and nail involvement such as pitting, thickening, or separation of the nail from the nail bed.
- Fatigue: A result of chronic inflammation and its impact on energy levels.
- Enthesitis: Inflammation at tendon and ligament attachment points, often occurring in the Achilles tendon or the bottom of the foot.
- Reduced Range of Motion: Stiff joints may limit movement and daily function.
Causes and Contributing Factors
While the exact cause of psoriatic arthritis is not fully understood, several factors are thought to contribute:
- Genetics: A family history of psoriasis or psoriatic arthritis increases the risk, suggesting a genetic predisposition.
- Immune System Dysfunction: Psoriatic arthritis is an autoimmune condition where the immune system mistakenly attacks healthy tissue, causing inflammation.
- Environmental Triggers: Factors such as infections, stress, or physical trauma may trigger the onset of symptoms in susceptible individuals.
- Psoriasis: Up to 30% of people with psoriasis develop psoriatic arthritis.
- Lifestyle Factors: Obesity and smoking are associated with a higher risk and more severe disease progression.
Grading
Psoriatic arthritis can be graded based on the severity of symptoms and the pattern of joint involvement:
- Mild: Occasional joint pain and swelling with minimal functional impairment.
- Moderate: More frequent symptoms, including dactylitis and enthesitis, with moderate limitations in daily activities.
- Severe: Extensive joint damage, deformity, and significant impairment in mobility and quality of life.
- Patterns of Joint Involvement:
- Oligoarticular: Involvement of 1-4 joints, often asymmetrical.
- Polyarticular: Involvement of 5 or more joints, similar to rheumatoid arthritis.
- Axial: Predominantly affects the spine and sacroiliac joints.
- Distal: Mainly affects the joints near the fingertips or toes.
- Arthritis Mutilans: A rare, severe form causing significant joint deformity.
Prognosis
The prognosis of psoriatic arthritis depends on the severity of the disease and the effectiveness of treatment. With early diagnosis and appropriate management, many people can maintain good quality of life and avoid permanent joint damage. However, untreated or poorly managed psoriatic arthritis can lead to progressive joint destruction, disability, and complications such as cardiovascular disease due to chronic inflammation.
Treatment
Managing psoriatic arthritis requires a multidisciplinary approach, with treatment tailored to the individual’s symptoms and disease severity. Physiotherapy plays a crucial role in maintaining joint health and function.
1. Physiotherapy and Rehabilitation
- Exercise Therapy: Regular, gentle exercises improve joint mobility, reduce stiffness, and strengthen muscles supporting the joints. Activities such as swimming and yoga are particularly beneficial.
- Range-of-Motion Exercises: Prevent or reduce stiffness and improve flexibility.
- Strengthening Exercises: Enhance the muscles around affected joints, improving stability and function.
- Hydrotherapy: Warm water exercises can ease pain and improve mobility.
- Postural Training: For axial involvement, physiotherapists help correct posture to alleviate spinal discomfort.
- Assistive Devices: Orthotics, braces, or walking aids may be recommended to reduce joint stress and improve mobility.
2. Medications
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Provide relief from pain and inflammation.
- Disease-Modifying Antirheumatic Drugs (DMARDs): Such as methotrexate or sulfasalazine, help slow disease progression.
- Biologic Therapies: Target specific immune pathways (e.g., TNF inhibitors, IL-17 inhibitors) to control severe inflammation.
- Corticosteroids: Used for short-term relief of severe symptoms.
3. Lifestyle Modifications
- Weight Management: Reduces stress on joints and improves medication efficacy.
- Smoking Cessation: Reduces the risk of severe disease and cardiovascular complications.
- Dietary Changes: A diet rich in anti-inflammatory foods (e.g., fish, nuts, leafy greens) may help reduce symptoms.
4. Surgical Options
- In advanced cases with severe joint damage, surgical interventions like joint replacement may be necessary.
5. Psychological Support
- Chronic pain and visible symptoms can affect mental health. Counselling or support groups can help manage emotional and psychological challenges.
This information is provided for education purposes only. Always consult your physiotherapist or other health professional.