Psoriatic arthritis is a chronic inflammatory disease that affects the joints and causes pain, swelling, stiffness. The disease affects people with psoriasis or who are familiar with this disease.
What is psoriatic arthritis?
Psoriatic arthritis consists of an inflammatory disease affecting the joints such as the hands, elbows, knees, ankles and feet. It is a chronic disease, therefore destined to last long and often throughout life. It is closely related to psoriasis , a skin disease that results from an immune system defect and affects patients with the intermittent appearance of red patches covered with white-silvery squamous plaques in numerous areas of the body, some of which are located so-called typical of psoriatic localization. The disease affects more frequently between 30 and 50 years without significant gender distinction and subjects with typical psoriasis lesionsthat family members of psoriatic patients. Sometimes, in a patient with psoriatic arthropathy, skin involvement can appear even after the onset of arthritis.
What are the causes of psoriatic arthritis?
The mechanism that causes the disease is not yet fully known, but the autoimmune origin is now clear , that is to say linked to a defect in the immune system which mistakenly attacks the body’s healthy cells causing inflammation. Genetic and environmental factors , together with some infections, are currently considered to be the main defendants for the disease.
What are the symptoms of psoriatic arthritis?
There are various forms of psoriatic arthropathy :
- Peripheral psoriatic arthritis is characterized by some prevalent symptoms such as pain, swelling and stiffness of the peripheral joints . These are often intermittent symptoms: as in the case of psoriasis, periods of remission alternate, in which the symptoms tend to disappear partially or totally, with others of recurrence. The extent of the symptoms is varied, they can be mild or severe and the location also differs: sometimes they occur symmetrically on both joints, merging with the symptoms of rheumatoid arthritis.
- The spondyloarthritis that mainly affects the spine;
- It is the purely enthesitic form that mainly affects the entheses, that is, the points where the tendons attach to the bone head;
- Often the enthesitic part accompanies peripheral arthritis.
But the disease can also affect the tissues of other organs such as the eyes, heart, lungs and kidneys.
Different symptoms occur depending on the area affected by inflammation :
- if it affects the hands and feet, the fingers take on the typical sausage shape (dactylitis) .
- in the feet it causes pain and inflammation of tendons and ligaments at the point where they are anchored to the bone. Achilles tendonitis and plantar fasciitis occur more frequently .
- spine . In this case it occurs with lower back pain or pain in the buttocks, due to inflammation of the area between the vertebrae (spondylitis) or sacroiliac joints ( sacroiliitis ) .
The disease is diagnosed through a comprehensive patient examination which includes observation and monitoring of symptoms, reconstruction of its history and some laboratory tests. There is no specific examination to diagnose psoriatic arthritis, but tests can be performed in able to exclude other forms of arthritis, such as gout and rheumatoid arthritis. An indicative factor for the diagnosis is the state of general inflammation of the patient which is established by examining the C-reactive protein (PCR) . It is a diagnostic marker that photographs the patient’s inflammatory state even in the presence of an infection and therefore further diagnostic investigations are needed to identify the disease.genetic test for the detection of the HLA-B27 gene that is present in 50% of patients with psoriatic arthritis affecting the spine.In the event that the disease affects large joints, such as the knee, the fluid can be examined in the joint, the synovial fluid, collected by arthrocentesis. The other tests to evaluate the joints involved are radiography , ultrasound and magnetic resonance imaging (MRI).
Psoriasis and psoriatic arthritis are chronic diseases that do not currently have a definitive cure, but numerous new generation therapies are being studiedthat promise a more effective contrast to these diseases. The therapies available for the treatment of psoriatic arthritis allow a good control of the disease and include traditional drugs DMARDs, such as methotrexate, leflunomide, sulfasalazine, etc. and “biotechnological” drugs that block TNF alpha, the central molecule in inflammation.
Psoriatic arthritis cannot be prevented, but with early diagnosis at the first signs of the disease or in the presence of family cases and timely therapy, damage can be stopped which in the long run can cause permanent disability to the patient.
For more information, see the clinical activity and the doctors of ‘ Rheumatology Clinic of Humanitas Mater Domini .