Signs and Symptoms of Psoriatic Arthritis

Paying Attention to Symptoms Leads to Proper Treatment

Man's swelling knee
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Psoriatic arthritis is an inflammatory type of arthritis associated with the chronic skin condition psoriasis. It usually develops when people are between 30 and 50 years old, but it can begin in childhood. Men and women seem to be equally affected by psoriatic arthritis. There is an increased risk of developing the condition if someone has parents or siblings with the disease. It is important to recognize the signs and symptoms of psoriatic arthritis so a doctor can perform a physical examination and recommend proper treatment.

Psoriatic arthritis symptoms occur in variable patterns and with variable intensity. The symptoms may even change in the same person over a period of time. Psoriatic arthritis symptoms can occur at any time, flare up, and then disappear. Thought at one time to be mild and non-progressive, some psoriatic arthritis patients have persistent inflammation which requires proper treatment to prevent joint damage and disability.

Psoriatic arthritis is a seronegative spondyloarthropathy, meaning it is negative for rheumatoid factor and classified as a spondyloarthropathy (i.e. conditions which are characterized by inflammation of the spine). Lab tests for psoriatic arthritis mimic rheumatoid arthritis but rheumatoid factor is usually negative and genetic marker HLA-B27 is frequently positive.

Common Psoriatic Arthritis Symptoms

Common, general symptoms associated with psoriatic arthritis include:

  • Pain and swelling in one or more joints, often the wrists, knees, ankles, and joints at end of fingers and toes
  • Swelling of fingers and toes causing them to appear sausage-like
  • Low back pain or buttocks pain
  • Silvery or grayish scaly spots often on scalp, elbows, knees, lower end of backbone
  • Pitting of fingernails or toenails
  • Fatigue
  • Morning stiffness of joints
  • Tendinitis
  • Conjunctivitis

Five Types of Psoriatic Arthritis

The five types or patterns of psoriatic arthritis may evolve from one to another and they may overlap:

Asymmetric psoriatic arthritis

Most psoriatic arthritis is first noticed in this stage. Asymmetric psoriatic arthritis involves a few joints of the extremities randomly (e.g., left elbow and right knee). It affects about 30 to 50 percent of psoriatic arthritis patients.

Symmetric psoriatic arthritis

Many times, the asymmetric form eventually evolves into symmetric psoriatic arthritis, which is characterized by pain and swelling in joints on both sides of the body. The fingers and toes are often affected. This type is the most common form of psoriatic arthritis, affecting 30 to 50 percent of psoriatic arthritis patients.

Distal interphalangeal predominant psoriatic arthritis

This form mostly involves joints closest to the nails of the fingers and toes. Changes in the nails, including pitting, splitting, degeneration and other nail mainfestations are common. Other joints may also be affected. This type of psoriatic arthritis accounts for 25 percent of cases.

Arthritis mutilans

Arthritis mutilans is a rare (5 percent of all cases), painful, and destructive type of psoriatic arthritis.

It is characterized by a condition called enthesitis (inflammation where tendons and ligaments attach to bone) and also is characterized by resorption of phalangeal bones.

Psoriatic spondylitis or axial arthritis

This form is characterized by sacroiliitis (inflammation of the pelvic area where the sacrum joins the ilium bone) and spondylitis (inflammation of one or more vertebrae) occurring separately or together. It affects between 30 and 35 percent of psoriatic arthritis patients.

According to the American College of Rheumatology, about 15 percent of psoriasis patients develop psoriatic arthritis. Arthritis may develop before psoriasis in some patients.

Tips:

  • Respect symptoms and seek the advice of a rheumatologist.
  • Keep a diary or journal to document changes in symptoms so you can accurately report significant matters to your doctor.
  • Be compliant with your treatment plan.
  • Your quality of life can still be good with proper disease management.

Sources:

Psoriatic Arthritis. American College of Rheumatology. Accessed 03/10/16.

Psoriatic Arthritis. Johns Hopkins Arthritis Center. Accessed 03/10/16.

Kelley's Textbook of Rheumatology. Elsevier. Ninth Edition. Chapter 77. Psoriatic Arthritis.

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