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Psoriatic arthritis is a form of arthritis associated with psoriasis, a chronic skin and nail disease characterized by red, scaly rashes and thick, pitted fingernails. The disease is similar to rheumatoid arthritis in symptoms, characterized by joint inflammation. However, psoriatic arthritis tends to affect fewer joints than rheumatoid arthritis and does not produce the typical rheumatoid arthritis antibodies. The arthritis associated with psoriatic arthritis comes in five forms:
Arthritis that affects the small joints in the fingers and/or toes
Asymmetrical arthritis of the joints in the extremities
Symmetrical polyarthritis, a type of arthritis similar to rheumatoid arthritis
Arthritis mutilans, a rare type of arthritis that destroys and deforms joints
Psoriatic spondylitis, arthritis of the sacroiliac sac (in the lower back) and the spine
Although the cause of psoriatic arthritis is unknown, factors such as immunity, genetics, and the environment may play a role.
The following are the most common symptoms of psoriatic arthritis. The skin condition, psoriasis, may actually precede or follow psoriatic arthritis. However, each individual may experience symptoms differently. Symptoms may include:
Inflamed, swollen, and painful joints, usually in the fingers and toes
Deformed joints from chronic inflammation
The symptoms of psoriatic arthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
When psoriasis has been diagnosed, a diagnosis of psoriatic arthritis may be easily confirmed. However, when psoriatic arthritis symptoms precede other symptoms of psoriasis, diagnosis is more difficult. Although psoriatic arthritis sometimes causes an increased erythrocyte sedimentation rate (ESR), mild anemia, and elevated blood uric acid levels, these symptoms are also associated with other rheumatic diseases, including gout. ESR is a measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation.
Specific treatment for psoriatic arthritis will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, and therapies
Expectation for the course of the disease
Your opinion or preference
Treatment usually involves treating both the skin condition and the joint inflammation. Some medications used to treat rheumatoid arthritis are also used to treat psoriatic arthritis, including:
Nonsteroidal anti-inflammatory medications to relieve symptoms
Vitamins and minerals, such as calcium and vitamin D, to slow bone deformation
Immunosuppressive medications, such as methotrexate to suppress inflammation if NSAIDs are not effective
Biologic medications, such as the drugs Enbrel (etanercept) and Humira (adalimumab)
Other treatment may include:
Corticosteroids for inflammation
Ultraviolet light treatment (UVB or PUVA)
Heat and cold
Physical therapy to improve and maintain muscle and joint function
Occupational therapy to improve ability to perform activities of daily living
Dermatology management of psoriasis skin rash, if present
Surgery to repair or replace a damaged joint; if warranted, this usually occurs years after the initial diagnosis
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