Though the two conditions may seem unrelated, arthritis and psoriasis are both inflammatory disorders and sometimes present together. When a person has both conditions, it is known as psoriatic arthritis. Psoriatic arthritis affects millions of people and varies from mild to severe.
Psoriasis and Arthritis
It is estimated that between 10 and 30 percent of all people with psoriasis also have arthritis. When both conditions occur in the same patient, the conditions are considered to be related, as they are both caused by an inflammatory immune response. Arthritis associated with psoriasis is known as psoriatic arthritis. This is not a specific type of arthritis, but rather any type of arthritis that happens in a psoriasis sufferer.
Symptoms of Psoriatic Arthritis
Most sufferers experience psoriasis symptoms before arthritis symptoms set in; a person may begin to display psoriasis symptoms and then develop arthritis a few years later. The opposite scenario, with the arthritis beginning first, is not uncommon, however. Most people with psoriatic arthritis first show symptoms around the age of 30 to 50. Other people begin to experience it as teens or pre-teens, and in these cases it is common for the arthritis to manifest first. There are different types of psoriasis, such as plaque, guttate, pustular and nail psoriasis. The most common form is plaque psoriasis and this is the type most often associated with psoriatic arthritis. It appears as a slightly raised red area of skin covered in a silvery film or flakes of dead skin. It ranges in severity from very mild, invlolving just one or two spots at a time, to severe cases that cover much of the body. The severity of psoriasis is not necessarily indicative of the severity of the accompanying arthritis; it is possible to have mild psoriasis and rather severe arthritis and vice-versa. In many cases, psoriasis comes and goes in outbreaks. The pain of the arthritis tends to be worse during an outbreak. The pain of arthritis is a burning, sharp ache in the bones and can be quite debilitating. During a flare-up, sufferers may experience side effects such as stiffness in the affected joints, slight fever and mild to severe fatigue. Psoriatic arthritis can affect any joint in the body, depending on what type it is.
Types of Psoriatic Arthritis
There are five categories of psoriatic arthritis. Asymmetric arthritis tends to be the mildest form, usually affecting three or fewer joints on just one side of the body. Distal interphalangeal predominant arthritis (DIP) affects mainly the joints closest to the tips of the fingers and toes. Symmetric arthritis affects about half of all psoriatic arthritis sufferers and can be quite severe. It affects multiple joints on both sides of the body. Spondylitis is arthritis of the spine, and can affect any or all of the vertebrae from the sacroiliac joint to the neck. Over time, it can lead to fusing of the affected vertebrae and can impair range of movement and lung capacity. Arthritis mutilans is perhaps the most disabling type of arthritis; it destroys the small bones in the hand, resulting in significant disability and deformation.
Diagnosis
A diagnosis of psoriatic arthritis is made when psoriasis and arthritis are present together, but the psoriasis and arthritis are themselves diagnosed separately. Psoriasis can usually be diagnosed simply by sight, though occasionally a biopsy or scraping may be taken for testing, in order to rule out other possible conditions. Arthritis is usually diagnosed by X-ray, which will show areas of inflammation or deterioration. Other diagnostic tools for arthritis include sedimentation rate tests and rheumatoid factor tests. A joint fluid test is sometimes performed to rule out gout. People with the HLA-B27 gene are more likely to develop psoriatic arthritis and so a doctor will often perform a blood test to look for this gene in order to finalize a diagnosis of psoriatic arthritis.
Risk Factors
The main risk factor for psoriatic arthritis is pre-existing psoriasis. At least 10 percent of psoriasis sufferers also develop psoriatic arthritis. Family history is also a factor; many psoriatic arthritis sufferers have a genetic predisposition to it, though this is not always the case. Men and women are almost equally affected by psoriatic arthritis, but the types of arthritis affect the sexes differently; men are more likely to suffer from spondylitis and DIP, while more women suffer from symmetric arthritis.
Medical and Drug Treatment
There is no cure for psoriasis or psoriatic arthritis, but there are ways to manage the pain and slow the progression of arthritis and reduce the incidence and severity of psoriasis outbreaks. Many people with mild to moderate psoriatic arthritis find non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin and ibuprofen, very helpful in managing the pain and inflammation. NSAIDS are relatively mild and are available over the counter. Brand names include Aleve, Advil and Motrin. For more severe cases, prescription drugs may be necessary. Some of these include corticosteroids, TNF-alpha inhibitors and immunosuppressants. Immunosuppressants also help with psoriasis, because psoriasis, like arthritis, is an autoimmune disease. All these prescription drugs can have serious side effects, but they may nevertheless be a good choice for those who suffer from severe cases. Surgery is rarely done for psoriatic arthritis, but may be deemed necessary in extreme cases to reconstruct deformed digits or separate fused vertebrae.
Lifestyle Tips and Supplements
In addition to medications, or even in mild cases, instead of medications, there are some lifestyle tips that will benefit psoriatic arthritis sufferers. Regular, low-impact exercise is vital, as it keeps joints loose and can help alleviate pain. Walking, yoga and swimming are considered especially helpful. It is also important to maintain a healthy weight, so that arthritic joints don't have to support more weight than necessary. Cold and hot packs may help relieve painful joints, as well. Those with spondylitis need to focus on proper posture; though it may be uncomfortable to stand up straight, it is necessary in order to keep the vertebrae loose and to help prevent vertebral fusion in a stooped posture. As for psoriasis itself, many sufferers find relief from itching and flaking by taking salty baths and liberally applying lotion. Exposure to sunlight also helps break down plaques, though care must be taken in order to avoid sunburn. Salicylic acid soaps and coal-tar shampoo may help alleviate or even prevent outbreaks for some people. Some supplements may also help those with psoriasis and arthritis; glucosamine and condroitin may help keep joints from deteriorating by promoting healthy cartilage and many people find that a daily dose of fish oil helps with both the inflammation of arthritis and the severity of psoriasis.
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