Psoriatic arthritis

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What is it about ?

Psoriatic arthritis is a form ofjoint inflammation

(arthritis) which affects people with psoriasis, a chronic skin condition. It is possible to have psoriatic arthritis without skin symptoms.

Hereditary factors play a role in the disease.

Joint inflammation

A joint inflammation or arthritis is an inflammatory reaction of a joint. A joint is where two bones come together and can change position relative to each other. The ends of these bones are covered on the surface with a layer of cartilage. The entire joint is in a sort of sleeve, the joint capsule. The internal face of this envelope is covered with a mucous membrane which produces a lubricant, the synovial fluid.

Often, inflammation results in more fluid being present in the joint. The joint then has trouble functioning normally.

Where and how often?
  • Psoriatic arthritis mostly affects people between the ages of 30 and 50.
  • Out of 100 people with psoriasis of the skin, 5 to 7 have psoriatic arthritis.
  • 40 of every 100 people with severe skin psoriasis have psoriatic arthritis.
  • Psoriatic arthritis of small joints is as common in men as it is in women.
  • The disease associated with inflammation of the joints of the back and pelvis (ankylosing spondylitis or Bechterew’s disease) is more common in men.

How to recognize it?

Psoriasis

the psoriasis most often presents as red, hard, thick patches (plaque psoriasis). They are often covered with small dry, white skin (scales). The plaques are found in the elbows, knees, legs, lower back and scalp.

Psoriatic arthritis

Psoriatic arthritis can come in many different forms, it can also change over time.

In most people, psoriatic arthritis affects several joints in the arms and legs. It often affects the last joints of the fingers (distal interphalangeal joints). It does not affect the right and left sides of your body the same way (asymmetric involvement).

Affected joints may be painful, stiff, and swollen. The stiffness can last for more than 30 minutes. You feel it mostly in the morning or after a period of rest.

The tendons and ligaments around the affected joints may be tender. The place where the tendon attaches to the bone is tender (enthesitis). The Achilles tendon is most often affected.

In addition to the joints of the arms and legs, psoriatic arthritis can also affect the joints of the spine, shoulders and pelvis. When the pelvic joint (sacroiliac joint) is affected, you may feel pain in the lower back, which radiates to the buttock, groin, and thigh.

How is the diagnosis made?

The doctor can make the diagnosis when the psoriasis and joint inflammation are present at the same time. It is not always obvious. This is because joint inflammation may appear first, well before psoriasis. Psoriatic arthritis cannot be diagnosed on the basis of a blood test.

If the doctor thinks of psoriatic arthritis, he will refer you to a specialist (rheumatologist).

What can you do ?

Do you have symptoms that sound like psoriatic arthritis? So see your GP.

If you have psoriatic arthritis, it is helpful to take the following tips:

  • stop smoking;
  • keep moving, for example by walking, cycling, swimming or yoga;
  • take your medications well.

What can your doctor do?

Medications

During attacks, your doctor will prescribe a anti-inflammatory, such as ibuprofen or naproxen.

Do you have only one large joint affected? You may be relieved by an injection of cortisone into the joint (infiltration).

Background treatment

Do you have repeated attacks or a chronic form of psoriatic arthritis? It is best to take a background treatment.

Disease modifying drugs (also called “Disease modifying drugs” or DMARDs) are drugs that stop the inflammatory process in your joints. They prevent joint damage from continuing to be damaged. They are not pain relievers.

Your doctor will regularly check the effect of treatment with:

  • a blood test;
  • an examination of the joint;
  • a global clinical examination.

This will see if

  • psoriatic arthritis is under control;
  • the drug does not cause side effects, such as:
    • gastrointestinal problems,
    • liver problems,
    • anemia,
    • decrease in the number of white blood cells (leukopenia) leading to a higher risk of infection.

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