Psoriasis affects about one percent of the population in North America. Psoriatic arthritis is an inflammatory arthritis seen in 4 to 6 percent of patients with psoriasis.
The exact etiology of psoriatic arthritis is unclear. Genetic, immunologic and environmental elements are thought to play a role. Psoriasis and psoriatic arthritis have a familial clustering. The disease is much more likely to occur in first-degree relatives of affected individuals than in the general population or in spouses. Psoriatic arthritis is an inflammatory disease with articular and extra-articular features. The onset of arthritis is usually insidious, but it can occur acutely. There are five general patterns of psoriatic arthritis:
- Arthritis of the distal interphalangeal joints
- Destructive (mutilans) arthritis
- Symmetric polyarthritis indistinguishable from rheumatoid arthritis
- Asymmetric oligoarthritis
Frequently Asked Questions
Spondyloarthropathy develops in 20 to 40 percent of the patients, but rarely is detected at the onset of disease. It tends to affect men and older patients and begins later in the course of the disease.
Other clinical features of psoriatic arthritis include dactylitis (swelling of an entire digit), tenosynovitis (swelling of a tendon), and enthesitis (swelling of a tendon at its insertion into a bone).
The treatment of psoriatic arthritis is directed at controlling the inflammatory process. The skin and joint aspects of the disease need to be treated simultaneously. Initial treatment is with non-steroidal anti-inflammatory drugs. In individuals with moderate to severe disease disease modifying agents and biologic treatments are used to control disease progression and joint preservation.
Reactive arthritis refers to a form of peripheral arthritis often accompanied by one or more extra-articular manifestations that appears shortly after certain infections of the genitourinary or gastrointestinal tracts. The majority of affected individuals have inherited the HLA B27 gene. Cases have been observed following epidemics or sporadic outbreaks of diarrheal illnesses caused by Shigella, Salmonella, and Campylobacter microorganisms, as well as by venereally acquired genitourinary infections, usually Chlamydia trachomatis. Reactive arthritis typically begins acutely two to four weeks after venereal infections or bouts of gastroenteritis. Most venereally acquired cases of reactive arthritis occur in young men. Cases following foodborne enteric infections affect both genders equally. Whites are affected more commonly than African Americans or other racial groups that have a lower frequency of HLA-B27.
Joints involvement with pain and swelling typically appear last, following gastroenteritis, the bowel symptoms usually have resolved one to three weeks earlier. 50% of the patients can have low back pain and buttock pain. sacroiliitis develops in only 20% of patients.
Education is a key element in the care of a person with reactive arthritis. If the reactive arthritis has been preceded by a sexually transmitted disease, safer sex practices should be employed.
In general, people with reactive arthritis experience significant improvement in joint inflammation after administration of non-steroidal anti-inflammatory drugs (NSAIDS). If the arthritis is refractory to NSAIDS, second-line agents which are more potent can be used.
Giant cell arteritis (GCA):
Giant Cell arteritis or temporal arteritis, is a systemic inflammatory vasculitis of unknown etiology that occurs in older persons and can result in a wide variety of systemic, neurologic, and ophthalmologic complications.1GCA is the most common form of systemic vasculitis in adults with typically onset at the 60 or above. GCA usually affects the superficial temporal arteries—hence the term temporal arteritis. And has shown to involve medium- and large-sized vessels. Age and female sex are established risk factors for GCA, a genetic component seems likely, and infection may have a role.
Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hip girdles. Symptoms of polymyalgia rheumatica usually begin quickly and are worse in the morning. Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people under 50.
About 20 percent of people with polymyalgia rheumatica also have signs and symptoms of giant cell arteritis. About half of the people with giant cell arteritis may also have polymyalgia rheumatica.The exact cause of polymyalgia rheumatica is unknown. Genetics and environmental factors seem to play a role.
People who taper off the medication too quickly are more likely to have a relapse. Thirty to 60 percent of people with polymyalgia rheumatica will have at least one relapse when tapering off the corticosteroids. Close monitoring with your Rheumatologist is needed for proper care and taper off of Corticosteroids. Steroid Sparing agents like Methotrexate or DMARDS may be used if unable to taper of of steroids after one year.