Psoriatic Arthritis: is there a cure?

Psoriatic arthritis is a type of arthritic inflammation that occurs in about 15 percent of patients who have a skin rash called psoriasis. This particular arthritis can affect any joint in the body, and symptoms vary from person to person. Research has shown that persistent inflammation from psoriatic arthritis can lead to joint damage. Fortunately, available treatments are effective for most people.

Symptoms of Psoriatic Arthritis

Psoriatic arthritis symptoms may vary. For some, the onset of symptoms may be gradual and subtle; for others, it may be sudden and dramatic. Generally, the signs and symptoms of psoriatic arthritis include some or all of the following:

• Discomfort, stiffness, pain, throbbing, swelling, or tenderness in one or more joints.
• Reduced range of motion in joints.
• Morning stiffness and fatigue.
• Silver or gray scaly spots on the scalp, elbows, knees, or the lower spine.
• Inflammation or stiffness in the lower back, wrists, knees, or ankles, or swelling in the small joints in the fingers and toes closest to the nail, giving these joints a sausage-like appearance (dactylitis).
• Pitting (small depressions) of the nails.
• Detachment of fingernails or toenails.
• Tenderness, pain, or swelling where tendons and ligaments attach to the bone (enthesitis).
• Inflammation of the eye.

What are risk factors for developing Psoriatic Arthritis?

The major risk factor for developing psoriatic arthritis is having a family member with psoriasis. This relationship has been recognized as so significant that it is used as a helpful part of the history for the doctor to diagnose psoriatic arthritis. It might be that stressful life situations could affect the immune system, allowing for the expression and/or exacerbation of psoriatic arthritis. However, precisely how these emotional issues are related to psoriatic arthritis has not been established.

What causes Psoriatic Arthritis?

What causes psoriatic arthritis is not known exactly. Of those with psoriatic arthritis, 40 percent have a family member with psoriasis or arthritis, suggesting heredity may play a role.

Psoriatic arthritis can also result from an infection that activates the immune system. While psoriasis itself is not infectious, it might be triggered by a streptococcal throat infection.

Treating Psoriatic Arthritis

Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further joint damage. Doctors will recommend treatments based on the type of psoriatic arthritis, its severity and your reaction to treatment.

Treatment varies depending on the level of pain. Those with very mild arthritis may require treatment only when their joints are painful and may stop therapy when they feel better.

Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin or Advil) or naproxen (Aleve) are used as initial treatment.

If the arthritis does not respond, disease modifying anti-rheumatic drugs may be prescribed. These include sulfasalazine (Azulfidine), methotrexate (Rheumatrex), cyclosporine (Neoral, Sandimmune) and leflunomide (Arava). Sometimes combinations of these drugs may be used together. The anti-malarial drug hydroxychloroquine (Plaquenil) can help, but it usually is avoided as it can cause a flare of psoriasis. Azathioprine (Imuran) may help those with severe forms of psoriatic arthritis.

The more recently available anti-tumor necrosis factor agents such as adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade) are also available and can help the arthritis as well as the skin psoriasis.

For swollen joints, corticosteroid injections can be useful. Surgery can be helpful to repair or replace badly damaged joints.