Psoriatic Arthritis is a chronic inflammatory disease that affects the joints and other tissues of the sufferer. This inflammation can lead to joint destruction and complications that are debilitating. Research, however, has led to several treatment options that allow the patient to live comfortable lives.
The first step is the correct diagnosis. There are over 100 different kinds of arthritis. Arthritis is a generic term that encompasses illnesses and diseases that affect the joints. Inflammation in the joint can be caused from dietary allergies, gout, lupus, and other diseases not commonly thought to be grouped with arthritis.
Psoriatic arthritis is a system rheumatic disease that can affect the eyes, lungs, heart, kidneys, spine and skin. The causes are not currently known. Researchers believe that there is a combination of environmental, immune and genetic factors which lead to the development of psoriatic arthritis.
Patients who have the arthritic changes in their spine have a 50% chance of also carrying a genetic marker. Immune involvement is thought to begin when a patient T-cells (cells that fight infection) are too low. This happens in the case of AIDS or other immune deficient diseases where the patient is unable to fight off infection. Researchers continue to evaluate the role that the environment plays on the development of psoriasis - the precursor to psoriatic arthritis.
Patients who have developed psoriatic arthritis also have psoriasis. In fact, the diagnosis of the arthritis is dependent upon the presence of psoriasis. When patients develop the arthritis first (15% of the cases) a correct diagnosis is often delayed.
Diagnosis is made on clinical findings since there are no conclusive lab tests available. Physicians will often attempt to exclude other forms of arthritis to determine a correct diagnosis - often called a diagnosis of exclusion. In some cases there are genetic markers present. Blood tests will rule out Rheumatoid Arthritis and X-ray may show cartilage damage.
Symptoms of arthritis are often present after the development of psoriasis (85% of the cases). The patients will have inflammation in the knees, ankles, and joints of the felt. The joints are stiff, and worse in the morning. The affected joints are painful, swollen hot and red but they are not commonly symmetrical as they are in Rheumatoid Arthritis.
Arthritic changes can happen in the spine and sacrum. Patients can develop tendonitis, more often at the Achilles tendon, causing difficulty in walking. Inflammation of the eye (iritis) can result in blindness. Treatment for iritis includes corticosteroid injections to decrease the inflammation and prevent the damage to the patient's sight. Some patients develop an acute case of acne in the middle years. Pitting and ridging of the nail beds are common in 80% of the patients.
Treatment of the arthritic changes and pain, not the inflammation of other tissues, includes the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and exercise. Treatment is often symptomatic and when the symptoms go away the physican can make the decision to decrease or stop the treatment until another flare.
If the disease progresses the physican may consider Disease Modifying Anti-Rheumatic Drugs (DMARDs) such as methotrexate, corticosteroids and anti-malarial medications. The physician and patient must weigh the joint changes of the disease against the side effects of the medication. Some of the medications that are used have significant side effects but they also help the patient to live more comfortably.
As a last resort patients and physicians may consider complete joint replacement to stop the course of the disease and lessen the pain for the patient. At this point patients have usually lost the ability to walk for any significant distance and are often confined to a wheelchair when they leave their homes.
Psoriatic Arthritis, although devastating to the joints and soft tissue of the body, can be controlled with the correct medication. For this reason a rapid and correct diagnosis is important to a patient's comfort.
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