Psoriatic Arthritis (PsA)

As seen in The Consultant Connection, January 2017 Issue
Irene Sours, RN, WCC, Nurse Consultant
Psoriatic arthritis is an inflammatory arthritis seen in association with skin psoriasis.  Skin psoriasis is a scaly red skin lesion that occurs on the skin (elbows, knees, and scalp).  Psoriatic arthritis can affect any joint in the body, and it may affect just one joint or multiple joints. Psoriasis and psoriatic arthritis are both autoimmune conditions.
A person who has a history of psoriasis who begins to experiencing pain, stiffness, or swelling in and around their joints could possibly be experiencing psoriatic arthritis, or PsA.
How are PsA and psoriasis related?
  • PsA effects up to 30% of psoriasis patients
  • 80% of PsA patients develop the symptoms of psoriasis first
  • On average, symptoms of PsA does not appear until 10 years after symptoms of psoriasis
PsA can cause pain and stiffness in joints on just one side (asymmetric arthritis) or both sides of the body (symmetric arthritis). While PsA can affect any joint in the body, swelling and pain in the fingers and toes is typical. The lower back, wrists, knees, or ankles may also be affected.
Symptoms may include the following:
  • Swollen fingers and toes
  • Back pain (lower back, upper back, and neck)
  • Tender, painful, throbbing, or swollen joints
  • Tender, painful, or swelling around tendons
  • Reduced range of motion
  • Morning stiffness
  • General fatigue
  • Changes to nails (pitting or separation from the nail bed)
Treatment options include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Disease modifying anti-rheumatic drugs
  • Local steroid injections for certain joints
Patients with psoriasis and psoriatic arthritis are at an elevated risk of developing other chronic and serious health conditions.
  • Increased risk for certain types of cancer, such as lymphoma and nonmelanoma skin cancer.  Patients with psoriasis and psoriatic arthritis should incorporate regular cancer screening.
  • Cardiovascular disease has been linked to patients with severe psoriasis, and they are more likely to have a major cardiac event and 43% more likely to have stroke.
  • Crohn’s and inflammatory bowel disease
  • Depression
  • Diabetes
  • Metabolic syndrome
  • Obesity
  • Osteoporosis
Psoriatic arthritis is a very complex disease with serous comorbidities.  As specialists in musculoskeletal disorders, rheumatologists are more likely to make a proper diagnosis and evaluate treatment options to prevent further joint damage.  Disease progression will vary differently with every person.

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