Psoriatic arthritis

Diagnosis

Psoriatic arthritis cannot be diagnosed with a single test. In most cases, if the psoriasis appears together with arthritis symptoms, doctors will be able to confirm the diagnosis of psoriatic arthritis more easily. The diagnosis is usually made based on a patient’s medical history, physical exam, blood tests, and X-rays of the affected joints.

The physical examination usually involves checking the joints for inflammation or pain, examining the fingernails for pitting, flaking, and other irregularities, and checking for tender spots by pressing on the soles of the feet and around the heels.

In the early stages of the illness, X-rays are frequently ineffective in making a diagnosis. However, X-rays in the later stages may reveal alterations that are more typically seen in psoriatic arthritis. Several tests may be required to rule out other potential causes of joint discomfort, such as rheumatoid arthritis or gout.

• Imaging tests:
  • X-rays. Also known as radiograph, uses a safe amount of radiation to create images of the bones and soft tissues. It can assist in identifying joint abnormalities present in psoriatic arthritis but not in other arthritic diseases.
  • MRI. This test is often required only for special circumstances. An MRI can be utilized to look for tendons and ligaments abnormalities in the feet and lower back. It combines radio waves and a strong magnetic field to create very clear photographs of the body’s hard and soft tissues.
• Laboratory tests
  • Rheumatoid factor (RF). Positive biomarker tests like RF can assist with differentiating between rheumatoid arthritis and psoriatic arthritis. RF is an antibody found in the blood of people with rheumatoid arthritis but not in those with psoriatic arthritis. About 80% of people with rheumatoid arthritis test positive for rheumatoid factor.
  • Joint fluid test. Gout and psoriatic arthritis can coexist. The presence of uric acid crystals in the joint fluid could signify gout instead of psoriatic arthritis. During the procedure, a fluid sample from one of the problematic joints is extracted through a needle for laboratory analysis.

Treatment

Psoriatic arthritis is presently incurable. The treatment strategy usually depends on the severity of the symptoms when diagnosed. The primary goal is to manage the disease, aiming for remission and minimizing the risk of complications. Patients may need to undergo multiple therapies before discovering one that is successful for them.

The medication will focus on reducing inflammation in the affected joints to prevent joint pain and disability, as well as managing skin involvement. Prescription pharmaceuticals known as disease-modifying antirheumatic drugs (DMARDs) are one of the most widely used therapies.

Treatment may include any combination of the medications, surgery and other procedures.

• Medications: Medication options for psoriatic arthritis include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Mild inflammation may respond to NSAIDs in the early stages of the disease. It can help decrease pain and inflammation. Stomach irritation, cardiac problems, and liver and kidney damage are all possible side effects. Over-the-counter NSAIDs are ibuprofen and naproxen sodium and other stronger medications may require a prescription.
  • Conventional DMARDs: When NSAIDs are unsuccessful and patients have persistent and/or erosive condition, DMARDs are utilized. Unlike NSAIDs, it can reduce the disease progression by altering the immune system. It can prevent irreparable damage to joints and other tissues.

Methotrexate, sulfasalazine, and cyclosporine are examples of DMARDs that are useful in the treatment of psoriatic arthritis. Liver damage, bone marrow suppression, and lung inflammation and scarring are all possible side effects. DMARDs may be prescribed alone or in conjunction with other medications.

• • Biologic agents (biologic response modifiers): When NSAIDs or DMARDs are ineffective for disease control, biologic medicines should be considered. This family of DMARD targets different immune system pathways.

Commonly known biologic agents are adalimumab, certolizumab, etanercept, golimumab, among others. Although known to be extremely effective at slowing and preventing joint deterioration progression, these medications may raise the risk of infection.

• • Targeted synthetic DMARDs: If standard DMARDs and biologic medicines did not work, tofacitinib may be administered. Risk for pulmonary blood clots, severe cardiac events, and cancer is increased with higher doses of tofacitinib.
  • Newer oral medication: A medication, known as apremilast is prescribed for people with mild to moderate psoriatic arthritis who refuses or are unable to use DMARDs or biologic medicines. Diarrhea, nausea, and headaches are all possible adverse effects. Apremilast inhibits the action of an enzyme in the body that regulates inflammation inside the cells.
• Therapies: Various non-pharmacologic methods can be employed to aid with the joint discomfort. Massage treatment as well as physical and occupational treatments may help to relieve discomfort and make daily activities easier.

Range-of-motion and strengthening exercises performed as directed by a physical or occupational therapist may be beneficial when combined with low-impact aerobics. Regular, moderate exercise may help alleviate joint stiffness and pain associated with psoriatic arthritis.

• Surgical and other procedures
  • Steroid injections: This form of treatment in which a large dose of drug is delivered directly to the affected joint. Steroids works by decreasing inflammation.
  • Joint replacement surgery: In most instances, surgery is not necessary for psoriatic arthritis. However, if a joint has suffered severe injury, joint replacement surgery may be necessary. In certain cases, damaged joints can be replaced with artificial joints made of metal and plastic. The primary objective of surgery is to restore function, alleviate pain, enhance mobility, or improve the physical appearance of the affected area.