If left untreated, PsA will get increasingly worse and the affected joints could be permanently damaged or deformed. A study has found that patients who do not receive treatment within the first two years of a flare-up will have more severe problems.
A flare-up is a period of time when the person's symptoms get worse. Flare-ups are also known as relapses. It is difficult to know when a flare-up will occur, but they can be treated with medication when they do.
Causes and triggers
The main cause of PsA is psoriasis itself. As stated earlier, up to 30 percent of people with psoriasis also develop PsA. Heredity may also be a factor, as 40 percent of people with PsA also have a family member who has psoriasis or arthritis.
PsA usually occurs in people already diagnosed with psoriasis, although it is unclear why some develop it and others do not.
Risk factors for PsA include the following:
- severe psoriasis
- scalp, genital, and inverse psoriasis
- nail disease
- injuries to the skin
It is not clear why some people who have psoriasis also develop PsA and others don't.
Several things can trigger flare-ups of PsA, with the most common being:
- Stress: This can make an existing condition worse. People should try to reduce stress as much as possible.
- Injury to the skin: This is known as the Koebner phenomenon. Vaccinations, sunburn, and scratches can all be triggers.
- Medication: Known medications that can be a trigger include lithium, antimalarials, Inderal, quinidine, and indomethacin.
PsA can also result from an infection that activates the immune system. Both psoriasis and PsA are caused by an overactive immune system, which stops working properly and starts fighting the body's own tissue with an inflammatory response, instead of fighting infection.
The duration of a flare-up of PsA can vary greatly and, as with psoriasis itself, the symptoms can range from mild to severe.
The most important thing is identifying the flare-up and then deciding an effective treatment.
Three types of flares have been identified:
- symptom increase flare
- short-lived flare
- persistent increase flare
Short-lived flares are often caused by lifestyle factors, such as stress, over exertion, or poor diet. Persistent increase flares will often need to be treated with prescribed medication.
Symptoms and complications
PsA can affect any joint in the body, but often it will be in the hands, feet, elbows, knees, spine, and neck.
Common symptoms of PsA include swollen fingers and toes, as well as stiffness and throbbing in the joints.
Symptoms can vary greatly from case to case. They can be mild and develop slowly, or they can be quick and severe.
Here are some common symptoms:
- stiffness, pain, and throbbing in joints
- tenderness, pain, and swelling in tendons
- swollen fingers and toes
- reduced movement
- stiffness and tiredness after sleep
- nail changes or abnormalities
- redness and pain in the eyes
Around 80 percent of people who suffer with PsA will do so after they have had psoriasis.
While PsA and psoriasis are closely linked, the severity of each case is not. Someone who has severe psoriasis will not necessarily have severe PsA, and vice versa.
When to see a doctor
Anyone who has aches and pains in their joints and thinks they might have PsA should see a doctor as soon as they can. Early treatment is vital for limiting permanent joint damage.
There is no specific test for PsA, but a doctor will be able to work out if it is present through a physical examination, blood tests, MRI scans, or X-rays. They will also look at the person's medical history, particularly concerning psoriasis.
Primary care doctors and dermatologists may make the initial diagnosis. A person should then be referred to a specialist doctor, know as a rheumatologist, for further assessment.
Treatment and management
A healthful lifestyle, including regular exercise and quitting smoking, may improve the condition of the skin.
There are ways to try and reduce psoriasis and PsA, including taking good care of the skin and keeping it from becoming dry.
Some ways to do this include:
- losing weight if necessary
- not smoking
- only drinking alcohol in moderation
The normal amount of rest from sleep should be enough, but in cases of extreme fatigue then prolonged rest is needed.
There are several ways that PsA can be treated. People with the condition should consult with their doctor to determine the best course of action.
There are some well-known NSAIDs available over the counter, such as ibuprofen, while dozens more can be prescribed.
Side effects can include:
People with PsA should always consult with a doctor before taking any kind of NSAIDs.
These mimic the hormone cortisol, which is created in the adrenalin glands and acts as a natural anti-inflammatory. They can be taken by mouth or injected directly into the affected joint.
NSAIDs and some corticosteroids can be taken by mouth and act to reduce inflammation.
There can be serious side effects if taken for 2 weeks or longer, such as:
- weight gain
- bone thinning
- stomach ulcers
- reduced ability to fight infections
- high blood pressure
Disease-modifying antirheumatic drugs, known as DMARDs, suppress chemicals in the body that cause inflammation. DMARDs can help people to try and limit joint damage, reduce pain, and slow progression of the disease.
Other side effects can include increased risk of infection, hair loss, fatigue, and liver damage.
These are a subset of DMARDs that help reduce inflammation. There are several types given for PsA: anti-tumor necrosis factor-alpha (TNF-alpha) drugs and ustekinumab, as well as other types of inhibitors such as apremilast and ixekizumab, are also used.
The main side effects are:
- increased risk of infection
- allergic reaction
- reactivating hepatitis B
Less common side effects include blurred vision, numbness, swelling of hands and ankles, shortness of breath, heart failure, and rashes on face and arms.
There is anecdotal evidence of natural remedies also helping, but results vary and a person should always speak to a doctor before taking them.
The main natural remedies thought to help are:
- Fish oil: Contains omega-3 fatty acids, which the body converts into anti-inflammatory chemicals.
- Curcumin: Found in the spice turmeric, it has been found to have anti-inflammatory properties.
- Probiotics: Found in yogurt and some milks.
- Vitamin D: Can help skin health.
Often, PsA is mild and will affect only a few joints. Pain and joint damage can be significantly reduced by early treatment.
However, severe PsA that goes untreated can lead to hand, feet, and spine deformity, as well as reduced physical ability, health-related quality of life, and joint destruction.
There is a direct link between how quickly PsA is diagnosed and treated and the severity of the problems that come with it. People should always consult a doctor at the earliest possible opportunity if they have any concerns.
Written by Tom Seymour