Psoriatic arthritis, which affects roughly 2.25 million people in the US, is a specific form of arthritis; about 30 percent of the patients with the autoimmune disease psoriasis will develop it. It can affect any part of the body, and it is most common in patients who are between 30 and 50 years old.
Symptoms
Psoriatic arthritis can range from mild to severe. Its symptoms include the following:
- Stiffness, pain, swelling, tenderness, or throbbing in at least one joint
- Swollen toes and fingers that can look like sausages
- Pain, swelling, and tenderness over tendons
- Reduced range of motion
- Stiffness in the morning
- Fatigue
- Changes in the nails, like becoming pitted or pulling away from the nail beds
- Reddened and painful eyes
- Painful or itchy red patches on the skin or a silvery, scaly accumulation of dead skin cells
Complications
A small percentage of patients can develop complications such as the following:
- Arthritis mutilans – a severe form of psoriatic arthritis that gradually destroys the hand and finger bones
- Eye problems like uveitis or conjunctivitis
- Shortness of breath
- Osteoporosis
- Metabolic syndrome
- Gastrointestinal problems including bloating and diarrhea
- Increased risk of cardiovascular disease
Treatment
There is currently no cure for psoriatic arthritis, but there are a variety of treatments that help control the symptoms. Doctors will recommend treatments based on the type of psoriatic arthritis a patient has, its location, its severity, and the patient’s reaction to earlier treatments.
Keep reading to learn about these treatments…
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
If the patient has a mild case of psoriatic arthritis with no joint damage, the doctor will usually start by recommending an NSAID. They include over-the-counter medications like ibuprofen and aspirin as well as various prescription medications.
The doctor will periodically administer tests to determine how well the patient is responding.
Why NSAIDS May Help
NSAIDS can relieve inflammation, pain, and stiffness in the joints. They can also help improve a patient’s range of motion.
2. Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
If the NSAID doesn’t work, the doctor may recommend a DMARD. There are two types: biologic and non-biologic. Methotrexate is the most commonly used non-biologic DMARD; other non-biologic DMARDs include Imuran and Acthar.
Why DMARDs May Help
DMARDs work by quieting an over-active immune system, so they reduce inflammation. They can slow the disease’s progression and thus prevent joint damage. At least some DMARDs can relieve the skin problems caused by psoriasis.
3. Biologics
Biologics or biologic DMARDs work at a molecular level by blocking a protein that is produced by the immune system and worsens the symptoms. The doctor will administer the biologic through injection or an IV.
Why Biologics May Help
Biologics are used to treat people with moderate to severe psoriatic arthritis. Like DMARDs, they slow the progression of the disease and reduce the chances of joint damage.
4. Weight Loss
The doctor will recommend weight loss if the patient is overweight or obese. Doctors typically recommend at least 150 minutes of moderate-to-vigorous exercise every week.
Why Weight Loss May Help
Losing weight can increase the patient’s responsiveness to medication. Strength-training builds up muscles that can then support the joints, while low-impact exercises like swimming or walking can reduce stiffness and pain in the joints.
Patients with psoriasis or psoriatic arthritis are more susceptible to type II diabetes and heart disease; weight loss can reduce that risk. A healthy diet with lots of fresh vegetables and fruits will reduce fatigue and inflammation.
5. Corticosteroids
Corticosteroids can be applied to the skin, taken orally, or administered through injection or IV. Some types can be used as eye drops to treat complications like uveitis. They have a chemical similarity to cortisol and work quickly.
Why Corticosteroids May Help
Corticosteroids can make the immune system less active and thus reduce inflammation. Some of them can also treat the skin problems seen in psoriasis. In addition, corticosteroids can help nails affected by psoriatic arthritis.
6. Change in Drinking and Smoking Habits
The doctor will advise smokers to quit. They will also advise patients who drink alcohol to limit their intake.
Why Change in Drinking and Smoking Habits May Help
Smoking is as bad for patients with psoriatic arthritis as it is for anybody else.
Drinking alcohol can cause problems such as weight gain and can also reduce a medication’s effectiveness or increase the risk of side effects. In some cases, it may not be safe for the patient to drink at all while undergoing treatment.
7. Physical Therapy
Once the inflammation is under control, the rheumatologist will often send the patient to physical therapy. The physical therapist may suggest different exercises or bodily manipulation like massage.
Why Physical Therapy May Help
Physical therapy can improve a patient’s range of motion. It also helps strengthen the muscles and joints, so the patient retains their ability to function independently. The physical therapist can also teach the patient to use assistive devices like braces, shoe inserts, or walkers to make their life easier and less painful.
8. Cold and Hot Therapies
Cold and hot therapies can be administered by the doctor or physical therapist or used by the patient at home.
Examples of hot therapies include:
- warm showers or baths
- hot water bottles
- heating pads
- paraffin baths
Cold therapies can include bags of ice or cold packs filled with gel.
Why Hot and Cold Therapies May Help
Cold therapies make blood vessels constrict and thus reduce swelling. They also relieve pain during flare-ups and reduce inflammation and soreness. Hot therapies reduce joint stiffness and muscle tension.
9. Mind and Body Therapies
Mind and body therapies include treatments like aromatherapy and meditation. Aromatherapy involves using essential oils in a bath, massage, or a diffuser. Tea tree, rose, lavender, and chamomile are among the more beneficial essential oils for patients with psoriatic arthritis.
Why Mind and Body Therapies May Help
Mind and body therapies help relieve stress, which can trigger or exacerbate the symptoms of psoriatic arthritis. Some mind and body therapies can also ease pain.
10. Acupuncture
Acupuncture is a form of traditional Chinese medicine that dates back thousands of years. The practitioner will insert thin and sterilized needles into the patient’s skin at certain parts of the body.
Why Acupuncture May Help
Acupuncture stimulates the production and release of nature pain-killers like serotonin, endorphins, and adenosine throughout the body. It thus relieves pain without causing any of the side effects triggered by some medications. Acupuncture can also prevent flare-ups by relieving stress and anxiety.
11. Skin Treatments
Psoriasis affects the skin as well as the joints. The doctor will thus prescribe skin treatments that can include light therapy and various topical creams, ointments, gels, and lotions.
UV light, when combined with a drug called psoralen, can help people with severe skin rashes or lesions.
Why Skin Treatments May Help
Topical skin treatments relieve pain and itching. Light therapy reduces inflammation. Some forms of light therapy can also help nails affected by psoriatic arthritis.
12. Massage
Massage is often recommended during the early stages of psoriatic arthritis. There are many different types of massage, and they all involve manually manipulating the soft tissues of the body.
Examples of massage used to treat psoriatic arthritis include:
- sports massage
- acupressure
- reflexology
- shiatsu
Why Massage May Help
The different types of massage can relieve pain, stress, and tight muscles. It can also stimulate the circulatory system and reduce inflammation.
13. Joint Surgery
Joint surgery is a last resort that most patients won’t need. If the patient has severely damaged joints, though, the doctor may remove the joint lining, fuse two joints together, or even replace a diseased joint with a prosthetic made of metal, plastic, or ceramic.
Joint surgery is most commonly done on the knee, hand, or hip.
Why Joint Surgery May Help
The different types of joint surgery can all reduce pain. While joint fusion can limit the joint’s mobility, the other two procedures will improve mobility.
What’s Next?
What’s most important for people with this condition to know?…
Final Thoughts
Anybody who believes that they have psoriatic arthritis should schedule an appointment with their doctor as soon as possible. Untreated psoriatic arthritis can lead to permanent joint damage and a variety of complications.
On the other hand, if a patient gets treated early, they can stave off the worst effects and even slow down the progression of the disease. In addition, if the patient gets treated early, they will probably need less extreme and invasive treatments than will somebody who delays their treatment.
