DEAR DR. GOTT:
Your recent article about the difference between osteoarthritis and rheumatoid arthritis was great. It was simply written so that the general public can understand.
I am writing to you now because I hope that you can explain psoriatic arthritis. This is a very painful, sometimes disabling, type of arthritis. Little is known about it, despite the fact that it affects a great number of people.
Patients with psoriatic arthritis also have psoriasis so they are doubly affected. They have to put up with the constant skin lesions on top of the painful arthritis. It is treated with the same biological medications as RA. I am a sufferer and am tired of trying to explain the difference so I hope you will be able to help get the word out in your column.
DEAR READER:
Psoriatic arthritis is fairly easy to figure out based on the name: arthritis which is related to and develops in those with the skin disorder psoriasis. This is not to say that every psoriasis sufferer will develop psoriatic arthritis. For those who do develop it, the skin manifestations often develop first followed by the symptoms of arthritis. However, for a few, the arthritis develops first.
Primary symptoms include joint pain and/or swelling, stiffness and joints that are warm to the touch. There are five different types known. Some patients may even experience more than one type.
Asymmetric psoriatic arthritis is pain in the joints on one side of the body or pain in more than one joint on both sides (for example, the right hip, left elbow, etc.). It is the mildest form, usually involving five or fewer joints.
Symmetric psoriatic arthritis is pain on both sides of the body. It often affects more than five joints and is more common in women than in men. The psoriasis associated with this type is often severe.
Distal interphalangeal (DIP) joint predominate psoriatic arthritis primarily affects the small joints of the fingers and toes that are nearest the nails. It is rare and is more common in men. It is most often associated with psoriasis of the nails.
Spondylitis is a form of psoriatic arthritis that affects the spine.
The final type is arthritis mutilans, better known as destructive arthritis. It occurs only in a small percentage of those with psoriatic arthritis. Over time it can destroy the small bones of the hands, usually the fingers, leading to permanent damage and disability.
Risk factors include already having psoriasis, a family history of psoriatic arthritis, and being between the ages of 30 and 50.
There is no cure, but fortunately, there are several treatment options available. As the first writer correctly stated, many of the treatments used for rheumatoid arthritis are also used for psoriatic arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are a common first step. These medications reduce swelling and may help control pain and stiffness. Over-the-counter varieties include ibuprofen and aspirin. Your doctor may prescribe stronger NSAIDs if OTCs are unsuccessful.
Corticosteroids such as prednisone or methotrexate may be used. Because of the relatively high risk of side effects these medications are generally used at the lowest possible dose for short periods of time, such as during flare-ups.
Disease-modifying anti-rheumatic drugs (DMARDs) are used to limit the amount of damage done to joints. Because they are slow acting, they are usually prescribed in conjunction with NSAIDs.
Immunosuppressant medications literally suppress the immune system to limit the amount of joint damage. Because both arthritis and psoriasis are autoimmune (caused by the bodies inability to differentiate between self and invader), they can provide excellent results. However, because of potentially serious side effects, they are often only prescribed to those with severe or disabling symptoms.
TNF-alpha inhibitors may be considered in those with severe disease. These drugs block the protein that causes inflammation.
Rarely surgery may be necessary to repair or replace joints that have been severely damaged.
Regardless of which type you have, it is important to exercise regularly to keep joints limber. If overweight, losing weight can also reduce the pressure on affected joints and may delay the use of stronger medications.
Anyone who is interested in learning more about psoriatic arthritis, its causes, symptoms and treatments should go online. There are several excellent sites available.
For those individuals with symptoms, I recommend you see your primary care physician or a rheumatologist as soon as possible for a proper diagnosis. Early treatment can reduce the severity and potential damage done to the joints.
To give you related information, I am sending you copies of my Health Report “Dermatitis, Psoriasis and Eczema” and “Understanding Osteoarthritis”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).
About Dr. Gott