Psoriatic arthritis, a problem that cannot be ignored

What is psoriatic arthritis?

Psoriatic arthritis is a form of chronic inflammation of the joints characterized by redness, swelling, and pain in the affected joints.

Psoriatic arthritis primarily affects the joints of the patient's fingers and toes, lumbar spine and spine, wrists and knees, and in some cases can cause irreversible damage to the joints if left untreated.

Between 10% and 30% of people with psoriasis will develop arthritis, most likely between the ages of 30 and 50, but it can occur at any time. There is no way to know who will develop psoriatic arthritis because there are no blood markers to predict it. However, people with more severe psoriasis and more nail involvement are more likely to develop arthritis.

Importance of early diagnosis

Sometimes, joint involvement precedes skin lesions by months or years, and may not even be noticed by doctors or patients. If a person with psoriasis experiences joint pain or swelling, they should consult a doctor and ask about this possibility. Early diagnosis of psoriatic arthritis is essential to avoid the complications or sequelae listed above.

How is psoriatic arthritis diagnosed?

If you experience joint soreness and pain, see your doctor promptly. There is no definitive blood test standard for psoriatic arthritis. The diagnosis is made primarily by the doctor's clinical observation and a process of eliminating differential diagnoses. Your doctor will need your medical history, especially your history of psoriasis, and may order tests such as blood tests, MRI, high-frequency ultrasound, or X-rays.

How to differentiate it from rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease characterized by erosive arthritis, and the pathological basis is synovitis. The early symptoms are morning stiffness, swelling, and pain in the joints. Finally, joint deformities and loss of normal joint function may occur. Rheumatoid arthritis usually affects joints symmetrically on both sides of the body, and may cause lumps under the skin that are not present in psoriatic arthritis. Rheumatoid factor is usually positive.

How to differentiate it from gout?

Gout is a common and complex arthritis that can occur in all age groups, with a higher incidence in men than in women. Gout patients often experience sudden joint pain at night, with acute onset, pain, edema, redness, swelling and inflammation in the joints, which gradually subside until they disappear, lasting for a few days or weeks. If you have experienced extremely painful attacks on your joints (especially your big toe), you may need to test your serum uric acid level to diagnose gout.

How to differentiate it from ankylosing spondylitis?

Ankylosing spondylitis is a chronic inflammatory disease. The main lesions are the sacroiliac joints, spine and peripheral joints, accompanied by varying degrees of eye, lung, intestinal, and cardiovascular lesions. In severe cases, spinal deformities may occur. This disease does not have obvious clinical symptoms in the early stages. Some people may show fatigue, weight loss, long-term or intermittent low fever, anorexia, etc., but due to the mild condition, it is often not taken seriously. In the middle and late stages of ankylosing spondylitis, pain and deformation of the cervical and lumbar spine often occur, which is difficult to cure.

How do I know which type of psoriatic arthritis I have?

Like psoriasis, psoriatic arthritis can range from mild to severe. Your doctor will consider how many joints are affected before determining a treatment plan. However, even a few joints that are inflamed can have a profound effect on pain, function, and factors that influence treatment decisions.

Milder psoriatic arthritis is sometimes called oligoarthritis, and it may affect fewer joints in the body.

Severe psoriatic arthritis is often called polyarthritis, which affects four or more joints.

Psoriatic arthritis can also affect the joints of your arms and legs, including your elbows, wrists, hands, and feet. Treatments for psoriatic arthritis range from oral medications that reduce inflammation and swelling (methotrexate, leflunomide, cyclosporine, and others) to injectable medications (corticosteroids or adalimumab, among others) that target specific parts of the immune system to fight psoriatic arthritis symptoms and slow joint damage.

Definition of severe psoriatic arthritis

The presence of one or more of the following: poor prognostic indicators such as erosive lesions, dactylitis, elevated inflammatory markers due to psoriatic arthritis, such as C-reactive protein and erythrocyte sedimentation rate, long-term damage that affects function (such as joint deformities), highly active disease leading to severe impairment of quality of life, and rapidly progressive psoriatic arthritis.

What to do if you have psoriatic arthritis?

Psoriatic arthritis is a chronic, progressive disease that can lead to permanent joint damage if treatment is delayed. Like psoriasis, psoriatic arthritis is associated with other comorbidities. The good news is that treating your disease can reduce your risk of developing certain comorbidities, such as cardiovascular disease.

Interleukin-17A inhibitors have achieved good results in the treatment of psoriatic arthritis (PsA), psoriasis (PsO) and ankylosing spondylitis (AS).

(Yang Meng, Nanning Second People's Hospital)