Arthritis, by definition, is characterized by the breakdown of the cartilage within the joints. If you are suffering from any type of arthritis, this is the general cause of the pain and stiffness in your joints. With over 100 types of arthritis, the top three most common types are osteoarthritis, rheumatoid arthritis, and psoriatic arthritis. In this article, we will discuss the third most common type of arthritis: psoriatic arthritis.
Psoriatic arthritis is a form of arthritis affecting individuals who also suffer from psoriasis. Psoriasis is a chronic skin condition affecting 2% of the population. The classic symptoms of psoriasis are red, patchy skin with silvery scaling. Psoriatic arthritis is characterized by skin inflammation (psoriasis) combined with joint inflammation. Up to 30% of people who have psoriasis will develop psoriatic arthritis according to the National Psoriasis Foundation. In most cases, psoriasis develops first and then psoriatic arthritis develops in later years. However, in approximately 15% of the cases, arthritis develops prior to psoriasis, making diagnosis of psoriatic arthritis very difficult.
The onset of psoriatic arthritis in most individuals occurs in their 40s and 50s and men and women are about equally affected by the condition. While psoriatic arthritis affects individuals worldwide, the prevalence of the condition is greater in North America and Europe.
How is psoriatic arthritis differentiated from rheumatoid arthritis and osteoarthritis? Osteoarthritis is characterized by inflammation of the joints, breakdown of joint cartilage, and bone rubbing on bone, causing pain and limited mobility. Rheumatoid Arthritis (RA) is a more severe form of arthritis in that your joints and your organs are ultimately attacked by your autoimmune system. Psoriatic arthritis is also a chronic autoimmune disorder. While many of the arthritic symptoms of psoriatic arthritis appear in the joints, symptoms of the condition can also appear in other parts of the body, including the eyes, heart, lungs, and kidneys. Most often, psoriatic arthritis presents itself within the hands, feet, and spine. This type of arthritis shares many of its symptoms with other arthritic conditions, including ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn’s disease and ulcerative colitis.
While psoriatic arthritis can have very similar symptoms to other types of arthritis, the main differentiation is the presence of psoriasis in conjunction with joint inflammation. Five types of psoriatic arthritis exist, the difference being the distribution of affected joints on the body. The five types of psoriatic arthritis include: symmetric polyarthritis (joint inflammation occurring on both sides of the body equally), asymmetric olioarticular (involving different joints on both sides of the body), spondylitis (affecting the spine), distal interphalangeal (affecting the fingers and toes), and arthritis mutilans (severe arthritis causing deformity in the hands and feet). Below, we go over the most common symptoms of psoriatic arthritis.
Painful joint swelling
This is the most classic symptom of psoriatic arthritis, or arthritis in general. Because arthritis is characterized by the breakdown of the cartilage within the joints, the joints become inflamed and pain results because of the inflammation and because of the cartilage deterioration causing bones to rub against bones. Inflamed joints become painful, swollen, stiff, tender, red, and hot. Psoriatic arthritis typically affects the ankles, fingers, toes, knees, and lower back.
Sausage-like fingers or toes
Many people who suffer from psoriatic arthritis experience extreme swelling of the fingers or toes, making them “sausage-like.” The medical term for this condition is called dactylitis – and is indicative of swelling across the entire length of the fingers and toes. This symptom is often a differentiating factor of a diagnosis of psoriatic arthritis over rheumatoid arthritis. Rheumatoid arthritis sufferers usually only experience severe swelling in a single joint.
Lower back pain is very common among psoriatic arthritis sufferers and is caused by a secondary condition called spondylitis. Psoriatic spondylitis presents itself in approximately 20% of individuals with psoriatic arthritis. Spondylitis causes joint inflammation in two areas of the back: the lower back (between the pelvis and the spine) and between the vertebrae. It is the resultant joint inflammation from spondylitis that causes the back pain that many psoriatic arthritis patients endure.
Pain in your feet
While joint pain is very present in osteoarthritis, rheumatoid arthritis, and psoriatic arthritis, individuals with psoriatic arthritis often experience inflammation and pain in the tendons, especially in the feet. Because psoriatic arthritis can impact the tendons in your feet, two common conditions can result: plantar fasciitis and Achilles tendonitis. Plantar fasciitis is characterized by an inflamed tendon that connects your heel to your toes, causing pain in the bottom of the foot. Achilles tendonitis presents itself as pain in the heel due to inflammation in the tendon that connects your calf muscles to your heel.
It’s common among all types of arthritis sufferers to have stiffness when first waking up in the morning or stiffness after periods of rest. This stiffness makes it hard to move and ‘get-going.’ However, once you start moving, the stiffness eases. The stiffness can be so bad, especially with morning stiffness, that you find it difficult to move your joints, on both sides of the body.
Tendon or ligament pain
While we previously discussed inflammation of the tendons or ligaments in the foot (resulting in Achilles tendonitis or plantar fasciitis), psoriatic arthritis can also cause inflammation on other tendons and ligaments in the body. Enthesitis, described as pain that occurs where tendons or ligaments attach to the bone, is most prevalent in the foot and in the elbow (i.e., tennis elbow).
Skin rashes or nail changes
One of the most distinguishing symptoms of psoriatic arthritis is the presence of psoriasis (itchy, scaly, red skin patches) and changes in the nail bed. While psoriasis is a precursor to psoriatic arthritis, the presence of psoriasis and nail changes (e.g., fingernails lifting from the nail bed; infected looking nails) can help confirm a diagnosis of psoriatic arthritis.
Common in both rheumatoid arthritis and psoriatic arthritis, general feelings of fatigue are a prevalent symptom. The fatigue is mostly caused by the pain of the inflamed joints and mobility problems; however, certain medications that individuals with arthritis are taking also cause fatigue. Because fatigue can also limit energy levels and mobility, it can cause secondary complications, such as obesity and mood changes. Around 29% of individuals with psoriatic arthritis have severe fatigue. The Journal of Rheumatology published research citing a link between psoriatic arthritis sufferers and fibromyalgia, which causes severe levels of fatigue.
Your range of motion may diminish greatly if you have psoriatic arthritis. Arthritis in general (all types) causes mobility issues due to the pain and inflammation you experience. If you have reduced range of motion, exercise can help loosen up stiff joints. Choose exercises that focus on your range of motion to get the most benefit.
Many individuals with psoriatic arthritis also experience inflammation of the eyes and around the eyes. This leads to eye redness and eye swelling. This symptom of psoriatic arthritis can also cause secondary conditions, including uveitis (disturbed vision) and conjunctivitis (commonly known as pink eye).
Many individuals who have psoriatic arthritis are also anemic. Anemia is characterized by decreased functionality and volume of fully functioning red blood cells. The symptoms of anemia include fatigue, shortness of breath, paleness, and headaches. Because anemia is psoriatic arthritis patients is often mild, iron supplements can readily help.
While there are five types of psoriatic arthritis, as mentioned previously, the most prevalent types (4 of the 5) cause asymmetrical pain. This is in contrast to rheumatoid arthritis, where pain and inflammation affects joints symmetrically. Psoriatic arthritis tends to affect larger joints (knees, ankles, legs, and fingertips) – and it tends to affect them asymmetrically (that is affecting one knee, but not the other).
Fingernail and toenail pitting
Fingernail and toenail pitting is a classic symptom of psoriatic arthritis and it tends to affect men more than women. It most often occurs with the distal interphalangeal type of psoriatic arthritis. Pitting of the nails presents itself as small indentations or depressions form in the nail. In some cases, the nail falls off completely. Fingernail and toenail pitting occurs in approximately 5% of individuals with psoriatic arthritis.
Flexion deformity, sometimes caused by psoriatic arthritis, is when the fingers are pulled out of their natural alignment. This symptom is very characteristic of individuals who have psoriatic mutilans, the most severe type of psoriatic arthritis. If finger deformities are left untreated, telescoping fingers can occur, where the bones in the finger are reabsorbed into the body.
Cardiac symptoms can occur as a secondary symptom of psoriatic arthritis. According to the National Psoriasis Foundation, individuals with psoriatic arthritis are at a 58% greater risk for severe cardiac problems (e.g., heart attacks) and a 43% greater risk for stroke.
Another secondary symptom of psoriatic arthritis is mood changes and depression. Reduced mobility and increased pain can be debilitating and cause feelings of hopelessness. Of note, the severity of the conditions of psoriatic arthritis are not necessarily the causes of the depression; rather, how the condition is treated and controlled. Left untreated, individuals with psoriatic arthritis who are left in great pain with limited mobility and other complications are more likely to develop resultant depression.
Crohn’s Disease or Irritable Bowel Syndrome
According to a published study in the Annals of the Rheumatic Diseases, individuals who have psoriatic arthritis are more likely to have irritable bowels and be diagnosed with bowel troubles, such as Crohn’s Disease, a type of Irritable Bowel Syndrome. The reason for this is because the genetic mutations between Crohn’s and psoriatic arthritis are very similar.
Weight gain or changes in appetite or thirst
Another side effect of psoriatic arthritis is weight gain and increased thirst. Limited mobility can cause weight gain. However, individuals with psoriatic arthritis are at an increased risk of developing Type 2 diabetes and metabolic syndrome, which both lead to increased thirst. If you notice your appetite and thirst levels changing, get checked out by your doctor.
Symptoms of psoriatic arthritis tend to wax and wane – showing increased and decreased levels of activity or “flares.” Many individuals with psoriatic arthritis have very frequent flares of the condition, while some individuals experience less frequent flares. These types of flares are often seen in individuals who have rheumatoid arthritis.
If you feel you or a loved one is suffering from psoriatic arthritis, you should get checked out by your doctor sooner than later. You may experience one or several of the above mentioned symptoms. Only your doctor can make a full diagnosis of psoriatic arthritis, by conducting a physical exam, medical history, and creating a plan for treatment.
If left untreated, psoriatic arthritis can cause complications, in addition to the symptoms listed above. With more severe cases of psoriatic arthritis, you may be left with joint deformities, lack of mobility, and secondary conditions that put your health at risk.
Even though there is no cure for psoriatic arthritis, with aggressive treatment and monitoring of your condition, you can live a normal life, virtually pain-free.