What is Psoriatic Arthritis?
Psoriatic arthritis causes painful inflammation in and around your joints. It usually affects people who already have psoriasis, a skin condition that causes a red, scaly rash, especially on your elbows, knees, back, buttocks and scalp.
However, some people develop the arthritic symptoms before the psoriasis, while others will never develop the skin condition.
Your joint hurts for two reasons:
- Your nerve endings are irritated by the chemicals produced by the inflammation.
- The capsule is stretched by the swelling in your joint.
When the inflammation goes down, the capsule remains stretched and can’t hold your joint in its proper position. This can make your joint unstable and painful.
What are the Symptoms of Psoriatic Arthritis?
Symptoms of psoriatic arthritis can include:
- pain and stiffness in and around your joints
- swollen fingers or toes (dactylitis), caused by inflammation both in joints and tendons
- buttock pain, a stiff back or a stiff neck (spondylitis)
- pain and swelling in your heels
- pain in other areas where tendons attach to bone (enthesitis), such as your knee, hip and chest
- pitting, discoloration and thickening of your nails
- fatigue, which can be caused by the activity of the disease or the emotional effects of living with a long-term condition.
What Causes Psoriatic Arthritis
We don’t yet know exactly what triggers the inflammation, although a particular combination of genes and infection makes some people more likely to develop psoriasis and psoriatic arthritis. No specific infection has yet been found.Sometimes the arthritis can follow an accident or injury, particularly if it affects a single joint. People who are overweight are more susceptible to both psoriasis and the arthritis associated with this.
How is Psoriatic Arthritis Diagnosed?
Due to the variety of symptoms experienced by patients, diagnosing Psoriatic Arthritis can be complex. Doctors will confirm the diagnosis based on your symptoms, a physical examination and the results of x-rays, scans and blood tests. You may also be referred to a specialist (Rheumatologist) to confirm the diagnosis and receive treatment.
Blood tests in this case are used to measure inflammation. You may have one of these tests:
- Erythrocyte Sedimentation Rate (ESR)
- C-reactive protein (CRP).
Both of these may show a high value when inflammation is present. These tests may be repeated from time to time to help monitor your arthritis.
Psoriatic Arthritis Treatment
Your Doctor or Rheumatologist will use a combination of skin treatments and medication to treat your condition. The medications prescribed will depend on the severity of your symptoms.
Treatments for your Skin
Your skin will usually be treated with a variety of ointments. These may vary from tar-based ointments, dithranol based ointment, steroid-based creams,vitamin D-like ointments and vitamin A-like (retinoid) gels such as tazarotene
If the creams and ointments don’t help your psoriasis, your doctor may suggest light therapy or retinoid tablets.
Many of the DMARDs used for psoriatic arthritis will also help your skin condition. Similarly, some of the treatments for your skin may help your arthritis.
Medication and Drugs
The three main groups of drugs used to treat the pain and inflammation caused by Psoriatic Arthritis are:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- disease-modifying anti-rheumatic drugs (DMARDs)
Your doctor or rheumatologist specialist is the best person to discuss these drugs with and will manage the use of these medications carefully.
Physical Therapies for Psoriatic Arthritis
Looking after your joints and managing your symptoms is very important in the treatment of Psoriatic Arthritis. Your physiotherapist can suggest a number of different treatments that may help ease your symptoms and reduce the impact Psoriatic Arthritis can have on your life.
The following treatments have been shown to help patients with Psoriatic Arthritis.
- Therapeutic Exercise
- Heat/Cold Therapy
- Pain Management
- Splinting advice
- Fatigue management
- Manual techniques
Surgery is occasionally needed for Psoriatic Arthritis. These may include injections, tendon surgery or in the extreme cases joint replacement. Outcomes for these procedures are successful.
What Can You Do For Yourself?
Understand Your Condition and How it Affects You
“Knowledge is power”. Educating yourself on the condition will help you manage your inflammation better and empower you when you talk to others (Rheumatologist, GP, family etc) about your condition.
Understanding how your behaviour and activities influence your symptoms can help you reduce the pain and suffering caused by Psoriatic Arthritis. Speaking to a health professional can help you identify aspects of your life that may be aggravating your Psoriatic Arthritis and help address them.
Keep Moving with Respect to Pain and Swelling
- Exercise helps to lessen your pain in the long run by maintaining muscle strength and optimising joint health.
- Inflammation can lead to muscle weakness and stiffness in your joints. Exercise is important to prevent this and to keep your joints working properly.
- Well-designed activity programs can increase your range of movement, reduce fatigue and help you feel better overall. Appropriate low-impact aerobic activities like hydrotherapy, cycling, Tai chi, pilates and walking can help improve your general health and manage your symptoms.
- A strength-training program called progressive resistance training (PRT) has been proven to improve physical function in people with Rheumatoid conditions.
- Your physiotherapist is an expert in the assessment and prescription of Psoriatic Arthritis exercises. Please ask them what is best for you.
- Managing stress and anxiety with muscle relaxation techniques, distraction, guided imagery and other techniques can help improve your general health and control painful symptoms.
- Activities such as Tai Chi, Pilates and Yoga are a great way to relax and de-stress while conditioning the muscles and joints in the body.
Aids and Equipment
Supports such as walking aids and specialised cooking utensils reduce joint strain and can help you to manage pain and fatigue. Your therapist can give you advice on aids.
Heat and Ice Therapy
- Heat - heat works to reduce muscle tension and stimulate blood circulation. You may find that applying something warm prior to getting up in the morning, or during the day helps reduce discomfort and stiffness in your joint.
- Ice - Ice helps to reduce inflammation in muscles and joints by constricting blood vessels and preventing fluids from leaking into surrounding tissues. You should try icing your joints after any significant activity or at the end of the day.
- Being aware of how your daily habits and activities influence on your symptoms is very important. Learning about activity pacing through diaries and activity management strategies can help you achieve what you want to, but with less pain or discomfort.
- Poor sleep pattern, your sleeping environment and sleeping position can have a significant impact on your pain and symptoms. Most people are unaware of the factors that can influence sleep health and so address these factors can help you manage your symptoms.
Treat Your Muscles
- A quality remedial massage may be just the relief your muscles need. Treat yourself to a good rub down with someone you trust. The benefits vary from person to person but may include decreased pain and muscle stiffness associated with your arthritis, increased circulation, and an improvement in your sleep and immune functions. Mentally, massage can also decrease stress and depression. Besides all it that, massage just feels good!
For more advice, please ask your Physiotherapist, Doctor or Rheumatologist.
If you have any concerns or have some specific questions regarding your condition, please ask your physiotherapist.