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PSORIATIC ARTHRITIS: WHAT IS IT?
Psoriatic Arthritis is different from Rheumatoid arthritis.
Other symptoms include morning stiffness and fatigue. Some persons will also develop inflammatory eye diseases, including conjunctivitis. Nail changes may also occur.
Psoriatic arthritis differs
Secondly, psoriatic arthritis is more likely to appear asymmetrically (affect one joint). Rheumatoid arthritis is more likely to appear symmetrically (affecting a pair of joints). The simultaneous presence of psoriasis and nail malformation are also markers of psoriatic arthritis. Nail malformation is rare in rheumatoid arthritis. Nodules under the skin do not appear in psoriatic arthritis as they do in rheumatoid arthritis. The rheumatoid factor is usually absent in the blood of psoriatic patients.
Acute psoriatic arthritis can also stimulate a type of gout. Gout is a form of arthritis or inflammation about a joint. The inflammation is caused by excess uric acid in the blood. Attacks occur suddenly and are accompanied by great pain. The big toe is a frequent site. Hyperuricemia (excess uric acid in the blood) occurs in 10-20% of patients with psoriatic arthritis, but classical gout is uncommon. Acute gouty arthritis is usually self-limiting and lasts, untreated, a couple of weeks.
There has also been reports of a possible association between HLA antigens, found on the surface of white blood cells, and psoriatic arthritis. These antigens may predispose a person to developing psoriatic arthritis. Data from family surveys suggest a possible genetic predisposition to psoriasis and psoriatic arthritis. What role these markers play is still subject to speculation and further study.
There are three general types of psoriatic arthritis.
Commonly observed among the latter are the "sausage" digits of the hands and feet. The term describes the appearance of the enlarged affected digit. The joints are usually warm, tender and red. It has been estimated that 55-70% of patients with psoriatic arthritis may have this form of arthritis.
Asymmetric arthritis is associated with psoriatic nail changes of the finger. This form is generally mild and the patient faces a mild to moderately progressive disease course. Persons may experience intermittent joint pain which is usually responsive to medical therapy.
The course of psoriatic arthritis
As there is no cure, therapy is aimed at controlling the symptoms of the disease. Various treatments are applied to relieve the pain, reduce inflammation, prevent damage to joints, prevent deformities and to keep joints mobile and functioning properly. It is not believed that therapy can stop the basic disease process.
The course of psoriatic arthritis is unpredictable. In a recent study, the majority of patients experienced remissions that lasted from several months to 15 years. These remissions were characterised by the absence of joint pain, improved function, and freedom from general symptoms of the disease. Remissions rarely occurred spontaneously. They were usually a result of therapy. The investigators concluded that the prognosis of psoriatic arthritis requires an evaluation of many factors, including sex, age of onset of the arthritis, distribution of the arthritis, and the individual's genetic predisposition.
There are several different treatments for psoriatic arthritis. Mild psoriatic arthritis is treated like other forms of arthritis with aspirin, anti-arthritis, anti-arthritis drugs such as indomethacin, and related non-steroidal, anti-inflammatory drugs. When only a few joints are involved, an excellent response can be obtained by the local injection of steroids by a rheumatologist into the affected joints without requiring oral medications. Symptomatic care involving heat, warm water soaks, exercise programs can also be used with appropriate medical consultation.
Extensive or severe psoriatic arthritis can be treated successfully with methotrexate. Methotrexate can be effective for those patients with severe psoriatic arthritis who do not respond to the standard anti-arthritis medications or those patients who do not tolerate standard anti-arthritis medications and can only tolerate methotrexate.
Injections of gold salts may also be used on occasion for those patients with severe and destructive psoriatic arthritis. Traditionally, gold therapy has been believed to be of limited usefulness in treating psoriatic arthritis, but some investigators have reported success with this therapy.
Anti-malarial drugs are not generally recommended for the treatment of psoriatic arthritis because of the risk of exfoliative dermatitis (chronic inflammation of the skin commonly involving the whole surface with scaling or flaking). However, one study has reported that 72% of the psoriatic arthritis patients who used an anti-malarial drug in combination with aspirin experienced improvement in their arthritis with no skin eruptions.
Choosing a treatment
It is thought by some investigators that improvement of the psoriasis-involved skin is associated with improvement of the arthritis. There is no scientific evidence that there is a correlation, but investigators report that with some individuals, joint disease remits when the psoriasis clears. They, therefore, recommend that the skin be treated along with the arthritis.
The psoriatic skin lesions in patients who develop arthritis are identical to those
seen in patients who do not manifest joint disease. Skin disease usually precedes the
development of joint symptoms. Nail changes are found more frequently in patients with
psoriatic arthritis than in patients without.
Dr Gerrald Weinstein of University of California, Irvine, suggests that patients
with symptoms of psoriatic arthritis should first see the dermatologist who is treating
the psoriasis. Appropriate initial therapy might be started by the dermatologist. If
significant arthritis develops, a rheumatologist should be consulted.
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about Psoriasis, please call (03) 9530 4454 or write to the address below.
MEMBERSHIP of the Psoriasis Association of Victoria Inc., entitles the member to :
Psoriasis Association of Victoria