WHAT IS PSORIATIC ARTHRITIS?

Psoriasis is a common skin disease that affects about 2% of the population. In some instances the skin disease may be accompanied by joint disease, this is termed PSORIATIC ARTHRITIS, however other common types of arthritis e.g. osteoarthritis and rheumatoid arthritis may occur in patients with psoriasis. You will need to consult your doctor who will be able to tell you what sort of arthritis you have from the history, examination, X-rays and blood tests.

WHAT IT IS

Psoriatic arthritis is inflammation of the lining of the joints causing swelling, pain and stiffness. Often, it affects only a few large joints, however it may also affect the neck, lower back as well as the small joints at the ends of the hands. Nails may develop pits and thickening with discoloration.

CAUSE

Psoriasis and psoriatic arthritis are due to a combination of genetic and environmental trigger factors such as infection, trauma and stress. It tends to run in families, so that if you are affected, there is a small chance that your children may develop it.

OUTLOOK

People with psoriatic arthritis usually do very well, depending on the number of joints involved. Some patients have a more severe form of the condition.

TREATMENT Depends on the extent and severity of the skin and joint disease.

Skin: Tar-based ointments are commonly used. Steroid creams are also helpful, however they should be used sparingly as thinning of the skin and sometimes flaring of the skin disease may occur. Ultraviolet light (PUVA) is sometimes used. Unfortunately, there is no useful therapy available for the nail changes. For joint pain, swelling and stiffness, most patients will respond to a combination of non-steroidal anti-inflammatory drugs (NSAIDS) and pain-killers (analgesics) that need to be taken regularly. One needs to be aware of possible side-effects such as heartburn and stomach ulcers, therefore the medication should be taken after a meal to reduce the chances of developing these problems. If you have severe arthritis, your doctor may advise you to start treatment with a 'disease modifying drug', which is a slow acting drug that prevents the actual joint damage and destruction from occurring, examples are sulphasalazine and methotrexate. These treatments require careful monitoring and blood checks need to be done regularly to ensure that they are not affecting the blood cells or the liver. Methotrexate has the added advantage of treating the skin disease as well as the joint disease. Sometimes, a steroid injection may be given into a swollen and painful joint.

EXERCISE

Exercise is very important to maintain the mobility of your joints, especially the joints in the hands. If your hands are stiff and painful in the morning, exercise them in warm water. If the knees are affected, you must practice thigh muscle strengthening exercises. Your physiotherapist will help you plan a programme of home exercises to strengthen your muscles, this is important since they provide strength and protection for your joints and the exercises also help to maintain the mobility of the joints. If you have stiffness of the neck and back, stretching exercises are important to maintain the mobility of these joints. Hydrotherapy and swimming are also useful in achieving this.

REST

Resting your joints when they are swollen and painful is important since it helps to reduce the inflammation. One can wear resting splints at night to keep your hands in a good position. A working splint worn during the day often helps your hand to function better. An occupational therapist will be able to advise you further about joint protection and assistive devices.

TO AVOID

Do not carry heavy objects as the weight may stress your joints. Contact sports and heavy physical activity is also discouraged. Wear comfortable footwear to avoid unnecessary pressure on the joints of your feet.

DIET

There is no special diet for psoriatic arthritis. A healthy balanced diet is important for any longstanding condition.

SURGERY

May be necessary when the joint is very painful or damaged. The results of surgery are as good as for other types of arthritis, however there is a slightly higher risk of joint infection occurring in patients with psoriasis who undergo joint surgery. Sometimes simple operations are carried out to release tendons or nerves that have become squashed by surrounding inflamed tissues. If joints are badly damaged, joint replacement surgery may be necessary. You should discuss the operation fully with your doctor, so that you understand what will be done and what exercises you will need to per form afterwards. The results of surgery are often rewarding.

PREGNANCY

If you are planning to fall pregnant make sure that you inform your doctor beforehand. You will be advised as to which drugs are safe to continue with during pregnancy and which ones to avoid.