Condition: Psoriatic Arthritis (PsA)
Brief Overview: Psoriatic arthritis is a chronic autoimmune inflammatory arthritis associated with psoriasis. It primarily affects the joints and the areas where tendons and ligaments attach to bone, leading to pain, swelling, and stiffness. PsA can also cause systemic symptoms and may lead to joint damage if untreated.
Prevalence: Approximately 30% of individuals with psoriasis develop psoriatic arthritis, with a prevalence of around 1-2% in the general population.
Etiology: Psoriatic arthritis is an autoimmune condition involving genetic, environmental, and immunologic factors. Dysregulated immune responses target the synovium, skin, and entheses (connective tissue that attaches tendons or ligaments to bone).
Risk Factors:
• Existing psoriasis
• Family history of PsA or psoriasis
• Age (commonly presents between ages 30-50)
• Obesity
• Environmental triggers (e.g., infections, trauma)
Commonly Associated Conditions:
• Psoriasis (especially with nail involvement)
• Uveitis
• Inflammatory bowel disease (IBD)
• Metabolic syndrome
• Depression and anxiety
Common Medications:
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Disease-modifying antirheumatic drugs (DMARDs)
• Biologic agents (e.g., TNF inhibitors, IL-17 inhibitors)
• Corticosteroids
• Topical treatments for psoriasis
Common Labs, Imaging, and Tests:
• Blood tests: CRP, ESR (markers of inflammation)
• Rheumatoid factor (to rule out rheumatoid arthritis)
• HLA-B27 (genetic marker associated with spondylitis)
• X-rays (to detect joint damage)
• MRI or ultrasound for soft tissue involvement
Common Symptoms:
• Joint pain, swelling, and stiffness, often asymmetrical
• Morning stiffness lasting over 30 minutes
• Nail changes (e.g., pitting, onycholysis)
• Enthesitis (pain at tendon or ligament insertions)
• Dactylitis ("sausage digits")
• Fatigue
Common Treatments:
• NSAIDs for pain and inflammation
• DMARDs (e.g., methotrexate) for joint and skin symptoms
• Biologic therapies to target immune dysregulation
• Physical therapy and exercise
• Topical and phototherapy for skin involvement
Physical Findings:
• Swollen and tender joints
• Enthesitis at common sites (e.g., Achilles tendon, plantar fascia)
• Dactylitis (swelling of entire digits)
• Skin and nail changes associated with psoriasis
Potential Complications and Contraindications:
• Permanent joint damage and deformity
• Increased cardiovascular risk
• Potential contraindications for certain biologics in cases of active infections or malignancies
General Health and Lifestyle Guidance:
• Maintain a healthy weight to reduce stress on joints
• Engage in regular low-impact exercise (e.g., swimming, yoga)
• Avoid smoking and manage stress
• Protect skin from trauma to minimize psoriasis flare-ups
Suggested Questions to Ask Patients:
• Do you have any current patches of psoriasis or has your skin worsened lately?
• Are your joint symptoms accompanied by nail changes or fatigue?
• Have you experienced pain or swelling in your fingers or toes?
• Are there activities that worsen your joint symptoms?
Suggested Talking Points:
• Explain the connection between psoriasis and joint inflammation.
• Highlight the importance of early treatment to prevent joint damage.
• Discuss options for controlling symptoms and improving quality of life. These may include daily bone broth intake for collagen which benefits both skin and joints, avoiding sugar which can cause inflammation in joints, eating a whole foods diet with a focus on protein and vegetable intake, eating wild-caught salmon two times a week for omega 3 intake, and adding turmeric and ginger to dishes for their anti-inflammatory properties.
• Reassure patients that effective therapies can manage both skin and joint symptoms.