Psoriatic Arthritis Symptoms and Treatment Solutions | Psoratic Arthritis Pain Relief

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Psoriatic arthritis is a specific condition in which a person has both psoriasis and arthritis. Psoriasis is a skin condition characterized by red, scaly raised areas. It may occur in localized areas or all over the body. In some cases, arthritis may develop before the skin disease is apparent. A person with psoriasis generally has patches of raised red skin with scales. The affected skin looks different depending on the type of psoriasis the individual has. Arthritis is joint inflammation.

Psoriatic arthritis is an autoimmune disease, meaning that your cells and antibodies (part of your immune system) fight your own tissues. Rarely, a person can have psoriatic arthritis without having obvious psoriasis. Usually, the more severe the skin symptoms are, the greater the likelihood a person will have psoriatic arthritis.

Psoriatic Arthritis Causes

The cause of psoriatic arthritis is currently unknown. It may have a combination of genetic (family), environmental, and immune causes. About 40% of people with psoriasis or psoriatic arthritis have a close relative with the condition. Some cases of psoriasis may be linked to infections.

Variable Symptoms of Psoriatic Arthritis

There are typically 6 variants of psoriatic arthritis:

1. Swelling of both the joint and tendon so that the involved toe or finger resembles a sausage.
2. Involvement of the joints next to the finger nails - often those nails will contain tiny pits.
3. Similar appearance to rheumatoid arthritis (RA) - eg. symmetrical involvement of the hands, feet, knees or ankles.
4. Involvement of the spine - typically associated with the HLA-B27 gene.
5. A very destructive, deforming arthritis - rare.
6. Associated with the HIV infection - while uncommon, this typically occurs with a very severe form of psoriasis
   

Patterns of joint pain in psoriatic arthritis

Doctors have identified five types of psoriatic arthritis, and you may experience several of them over time. They include:

1. Pain in joints on one side of your body. The mildest form of psoriatic arthritis, called asymmetric psoriatic arthritis, usually affects joints on only one side of your body or different joints on each side — including those in your hip, knee, ankle or wrist. Fewer than five joints are generally involved, and they're often tender and red. When asymmetric arthritis occurs in your hands and feet, swelling and inflammation in the tendons can cause your fingers and toes to resemble small sausages (dactylitis).

2. Pain in joints on both sides of your body. Symmetric psoriatic arthritis usually affects five or more of the same joints on both sides of your body. More women than men have symmetric psoriatic arthritis, and psoriasis associated with this condition tends to be severe.



3. Pain in your finger joints. Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. This type of arthritis affects the small joints closest to the nails (distal joints) in the fingers and toes. The nails, too, often show classic signs of psoriasis, including thickening, pitting and discoloration.

4. Pain in your spine. This form of psoriatic arthritis, called spondylitis, can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints. Inflammation can also occur where ligaments and tendons attach to your spine. As the disease progresses, movement tends to become increasingly painful and difficult.

5. Destructive arthritis. A small percentage of people with psoriatic arthritis have arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in your hands, especially the fingers, leading to permanent deformity and disability.

Psoriatic Arthritis Treatments and Pain Relief

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability. Often, a multidisciplinary approach is used to treat both skin and joint symptoms.

Medications
Medications commonly used to treat psoriatic arthritis include:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs such as aspirin and ibuprofen (Advil, Motrin, others) may help control pain, swelling and morning stiffness, and they're usually the first treatment tried for psoriatic arthritis. Prescription NSAIDs provide higher potencies than do over-the-counter drugs. But all NSAIDs can irritate your stomach and intestine, and long-term use can lead to ulcers and gastrointestinal bleeding.

Other potential side effects include damage to your kidneys, fluid retention and heart failure. In addition, NSAIDs may worsen skin problems. Still, these medications may be a good option for people with minor joint pain and stiffness.

2. Corticosteroids. If you have mild psoriatic arthritis, your doctor might recommend corticosteroids to control infrequent joint pain flares. Corticosteroids can be taken orally, or they can be injected directly into aching joints. Corticosteroid injections provide almost immediate relief and improve range of motion — sometimes for months. But because injected steroids can cause damage, their use is usually limited.

3. Disease-modifying antirheumatic drugs (DMARDs). Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. But because DMARDs act slowly, you may not notice the effects for weeks or even months. For that reason, your doctor may prescribe a pain reliever, such as aspirin, in addition to a DMARD. Examples of DMARDs include sulfasalazine (Azulfidine) and methotrexate. The latter, particularly, has potentially serious side effects, including lung disease and liver problems. Taking folic acid with methotrexate can relieve certain side effects such as a sore mouth and an upset stomach.

4. Immunosuppressant medications. These medications act to suppress your immune system, which normally protects your body from harmful organisms, but which attacks healthy tissue in people with psoriatic arthritis. Commonly used immunosuppressants include azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) and leflunomide (Arava).

Immunosuppressants can have potentially dangerous side effects and usually are used in only the most severe cases of psoriatic arthritis. Because they suppress the immune system, all such drugs can lead to anemia and an increased risk of serious infection. And many of them can cause liver and kidney problems.

5. TNF-alpha inhibitors. Your doctor may recommend tumor necrosis factor-alpha (TNF-alpha) inhibitors if you have severe psoriatic arthritis. These drugs block the protein that causes inflammation in some types of arthritis. Drugs in this category include etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade). TNF-alpha inhibitors can improve signs and symptoms of psoriasis, as well. All carry a risk of serious side effects, however, including some that can be life-threatening. Be sure to discuss with your doctor whether the benefits you'll receive from these medications outweigh the risks. Keep in mind that these treatments, which must be injected, are very expensive, often costing thousands of dollars per treatment. If you and your doctor decide to use TNF inhibitors, check with your insurance company about coverage.

More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs (DMARDS) such as:

* Leflunomide
* Methotrexate
* Sulfasalazine

New medications that block an inflammatory protein called tumor necrosis factor (TNF) are becoming the treatment of choice. These include:
* Adalimumab (Humira)
* Etanercept (Enbrel)
* Infliximab (Remicade)

Occasionally, particularly painful joints may be injected with steroid medications.

In rare cases, surgery to repair or replace damaged joints is needed.

Your doctor may suggest a healthy mix of rest and exercise. Physical therapy may help increase movement of specific joints. You may also use heat and cold therapy.

Surgery

Although surgery is rarely performed for psoriatic arthritis, your doctor may recommend some form of joint operation when other treatments fail to relieve your symptoms. Surgeons use various procedures to ease pain and restore mobility. Because these operations pose some risks, be sure you thoroughly discuss your options with your doctor.

Source:
- emedicinehealth
- mayoclinic