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Spotlight on psoriatic arthritis

There are over 100 different types of arthritis affecting approximately 4 million Canadians. Psoriatic arthritis is linked to the skin disease, psoriasis, which causes a scaly-type rash usually occurring on the elbows, knees, and scalp. Psoriasis is considered a significant risk factor for developing psoriatic arthritis - up as up to 30% of people diagnosed with psoriasis go on to develop psoriatic arthritis.

Psoriatic arthritis is a form of inflammatory arthritis which causes swelling and pain in and around joints, as well as a scaly rash on the skin. Joints most commonly affected are the fingers, wrists, toes, knees, shoulders, elbows, and ankles.

In addition to joints and skin, psoriatic arthritis affects the tendons and ligaments around the joints. This causes swelling, not just of joints, but of surrounding tissue as well. Psoriatic arthritis can also affect the spine - a form of the disease called psoriatic spondylitis.

Psoriatic arthritis affects men and women in equal numbers, and like many forms of inflammatory arthritis, it tends to strike people in the prime of their lives; most commonly, people are diagnosed between the ages of 20 and 50.

Diagnosis of psoriatic arthritis

If you suffer from psoriasis, it is important to remember that you are at an increased risk for developing psoriatic arthritis; speak with your doctor immediately if you develop any of the warning symptoms of psoriatic arthritis.

Psoriatic arthritis has several "hallmark" symptoms, which are often present at the onset of disease. These include:
  • Pain and swelling in the joints, tendons, and ligaments fingers and toes, causing the appearance of "sausage fingers"
  • Fingernails becoming detached from the nail bed or developing small pin hole sized dents (called "pitting") on the surface
  • Reduced range of motion
  • Morning stiffness, lasting more than one hour

Often, doctors are able to tentatively diagnose psoriatic arthritis if a patient has several red, swollen fingers or toes along with a case of psoriasis. If symptoms include finger- or toenails lifting or "pitting", a more solid diagnosis can be made. It is important to remember, though, that the symptoms of psoriatic arthritis often mimic other forms of arthritis, including gout and rheumatoid arthritis. For this reason, doctors often confirm a diagnosis of psoriatic arthritis by running blood tests to rule out other forms of arthritis.

While there is no known cause of psoriatic arthritis, research has proved that heredity plays a role; children with parents who have psoriatic arthritis are up to three times more likely to develop it. For this reason, be sure to tell your doctor about any family history of psoriasis or psoriatic arthritis if you suspect you may have the disease.

Treatment of psoriatic arthritis

If your doctor believes you may have psoriatic arthritis, you will usually be referred to a rheumatologist—a specialist in the treatment of arthritis. Rheumatologists have many years of extra training on top of their regular medical schooling, and are experts at diagnosing and treating all forms of arthritis, including psoriatic arthritis.

Once your rheumatologist has diagnosed psoriatic arthritis, there are effective treatments available to help you manage the symptoms, maintain joint health, and minimize joint damage. While there is no known cure for psoriatic arthritis, treatments are available, and your rheumatologist is the best person to discuss these with and formulate a treatment plan to address all aspects of psoriatic arthritis.

There are five major groups of medications which are used to treat psoriatic arthritis. These are:
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example Advil® or Motrin IB®), naproxen (or Naprosyn®), diclofenac (or Voltaren® and Arthrotec®)
  • COX-2 inhibitors, such as celecoxib (Celebrex®) or lumiracoxib (Prexige®)
  • Corticosteroids, such as prednisone
  • Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide (Arava®), hydroxychloroquine and azathioprine
  • Biologic response modifiers (or "biologics"), including adalimumab (Humira®), etanercept (Enbrel®), and infliximab (Remicade ®), all of which have been approved in Canada and the United States for use in treating psoriatic arthritis.

These medications can work alone or, most often, in combination to reduce the pain and other symptoms associated with psoriatic arthritis. As well, a medication called alefacept (Amevive®) is available for treatment of the skin symptoms associated with the disease.

To treat and protect your skin, you can use a humidifier in your home to prevent dryness. As well, unscented lotions and creams can protect and sooth your skin. Avoid any strong perfumes or dyes in skin lotion, as these can aggravate psoriasis. If the psoriasis is not well controlled by simple measures, consultation with a skin specialist (or "dermatologist") is needed. In some people, better control of the skin disease can result in better control of the arthritis aspect, too.

As with any form of arthritis, maintaining a healthy lifestyle is also a critical part of any psoriatic arthritis treatment plan. Poor diet, lack of exercise, and high levels of stress may make disease activity worse, so healthy eating, appropriate levels of aerobic and strengthening exercise, and relaxation are highly recommended.