The intervals of attack of the disease alternate with periods of remission. The signs and symptoms include the following.

Joint inflammation

Based on the type of joint involved, psoriatic arthritis can be categorized into:

• Symmetric
• Asymmetric
• Spondylitis (spinal involvement), causing difficulty in bending forwards
• Distal interphalangeal joints
• Arthritis mutilans

Typical sign and symptoms of psoriatic arthritis related to the joints include the following.

• Joints become painful and swollen
• Range of movement is decreased due to joint stiffness
• Difficulty in walking and other movements
• Tendinitis (inflammation of tendons)
• Dactylitis, inflammation and swelling of fingers with a “sausage-like” appearance
• Synovitis

A large number of findings are also seen in the other organs and systems of the body. These include the following.

• Dermatological abnormalities: Acne, deformities of the nails (such as Beau lines, leukonychia,pitting, ridging and cracking) along with scaly patches on the skin (psoriasis) are commonly seen.
• Eye abnormalities: Iritis (inflammation of iris) and uveitis are the commonly seen abnormalities of the eye.
• Lung involvement: Lung involvement occurs in the form of chest pain and pleuritis.
• Involvement of bone and cartilages: This includes costochondritis and osteitis. Respiratory difficulties are also seen when ribs and sternum get involved.
• Cardiovascular involvement: Cardiovascular involvement consists of aortitis and heart failure.

• Fever

  The yellow fever vaccines on the market are contraindicated for immunocompromised and elderly patients. A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. [ncbi.nlm.nih.gov]

  [ 713.6 ] Staphylococcus 711.0 Streptococcus 711.0 syphilis (see also Syphilis) 094.0 [ 711.4 ] syringomyelia 336.0 [ 713.5 ] thalassemia (see also Thalassemia) 282.40 [ 713.2 ] tuberculosis (see also Tuberculosis, arthritis) 015.9 [ 711.4 ] typhoid fever [icd9data.com]

• Reiter Syndrome

  ’s syndrome As with ankylosing spondylitis and Reiter’s syndrome, bone proliferation is a major feature. [learningradiology.com]

  syndrome ) tends to involve feet > hands [radiopaedia.org]

  The other disorders are juvenile ankylosing spondylitis, inflammatory bowel disease, and Reiter's syndrome. [stanfordchildrens.org]

  Sausage digit and spontaneous joint fusion are common in PA and Reiter syndrome but not in RA. [emedicine.com]

• Swelling of the Finger

  Painful, sausage-like swelling of the fingers and/or toes. Thickness and reddening of the skin with flaky, silver white patches called scales. Pitting of the nails or separation from the nail bed. Tiredness. Pink eye or other eye infections. [niams.nih.gov]

  The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. [en.wikipedia.org]

  Joint swelling occurs with psoriatic as well as other types of arthritis. But PsA commonly causes a unique type of swelling in your fingers or toes. [healthline.com]

• Family History of Arthritis

  Approximately 40 percent of affected individuals may have a family history of arthritis or psoriasis. [rarediseases.org]

  Usually, psoriasis occurs before arthritis, sometimes as much as 20 years before arthritis. Tell your doctor if you have a family history of psoriasis because this can be an important clue as to the type of arthritis. [emedicinehealth.com]

• Toe Pain

  Other symptoms of psoriatic arthritis include: swollen fingers and toes pain in the buttocks, lower back, or neck caused by inflammation in the spine (spondylitis) fatigue pain and/or swelling in the back of your heel caused by inflammation of the Achilles [arthritis.org.nz]

• Skin Rash

  Key points about psoriatic arthritis Psoriatic arthritis is a form of arthritis with a skin rash. Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. [cedars-sinai.edu]

  Experts estimate that approximately 30 percent of people with psoriasis (a skin condition characterized by itchy, scaly rashes and crumbling nails) also develop a form of inflammatory arthritis called psoriatic arthritis. [arthritis.org]

  Psoriatic arthritis is a rare form of arthritis or joint inflammation that affects both skin and joints. Psoriasis is an ongoing (chronic) condition that causes a red, scaly, itchy rash. [urmc.rochester.edu]

• Pitting Nails

  Psoriatic arthritis occurs in about 30% of people with psoriasis (a skin condition causing flare-ups of red, scaly rashes and thickened, pitted nails). [msdmanuals.com]

  Psoriasis is a skin condition causing flare-ups of red, scaly rashes and thickened, pitted nails. [merckmanuals.com]

• Koebner Phenomenon

  Some patients with psoriasis experience an event known as a Koebner phenomenon, where new lesions develop at sites of previous cutaneous trauma. [medpagetoday.com]

  Trauma to a joint sometimes triggers psoriatic arthritis and is considered the articular equivalent of the Koebner phenomenon (appearance of a psoriatic plaque in the area of trauma to the skin). C. [clinicaladvisor.com]

• Anterior Uveitis

  uveitis in the patient or a family history or one of these conditions in a parent or first-degree relative; and the presence of systemic arthritis in the patient. [orpha.net]

  Ocular involvement may be seen with conjunctivitis (20-30% of cases) and anterior uveitis (5% or so). Sacroiliitis and HLA-B27 positivity are commonly associated with ocular disease. [patient.info]

  uveitis in 7%; in patients with uveitis, 43% have sacroiliitis Patterns of arthritic involvement The patterns of psoriatic arthritis involvement are as follows: Asymmetrical oligoarticular arthritis Symmetrical polyarthritis Distal interphalangeal arthropathy [emedicine.medscape.com]

• Arthritis

  An asymmetrical arthritis pattern is shown below. Asymmetrical arthritis pattern of psoriatic arthritis (fixed flexion deformity). [emedicine.medscape.com]

  This type of arthritis is solely prevalent in psoriatic arthritis and does not occur in any other form such as rheumatoid arthritis or osteoarthritis. [psoriasis.qualitycarebyleo.com]

  How is psoriatic arthritis diagnosed? There is no test which clearly diagnoses early psoriatic arthritis. When you first develop symptoms of arthritis it can be difficult for a doctor definitely to confirm that you have psoriatic arthritis. [patient.info]

  Use this form to apply for continuing Pharmaceutical Benefits Scheme (PBS) subsidised treatment with biological agents for psoriatic arthritis. [humanservices.gov.au]

• Back Pain

  Do you wake up at night because of low back pain?; 4. Have you had pain in your heels?; 5. Has a doctor ever diagnosed you with psoriatic arthritis?) with a dichotomous response, demonstrated high sensitivity and specificity for predicting PsA. [ncbi.nlm.nih.gov]

  Some people also experience neck or lower back pain. Causes The exact cause of developing psoriatic arthritis is not known. [combinedrheumatology.com.au]

  You may have one or more of the following: Joints at the tips of your fingers and toes become inflamed (swollen, red, and warm) Back pain Pain in your hips and knees Joints that are inflamed for a long time may become deformed Psoriasis causes a rash. [merckmanuals.com]

• Asymmetrical Arthritis

  X-ray findings that are characteristic of psoriatic arthritis include: Changes affecting the joints at the end of the fingers ( distal interphalangeal joints) Asymmetrical joint involvement (particularly asymmetrical arthritis of the sacroiliac joints [dermnetnz.org]

  These include: asymmetric arthritis – usually affects one side of the body, or different joints on each side symmetrical polyarthritis – often affects several joints on both sides of the body distal interphalangeal arthritis – affects the joints closest [healthdirect.gov.au]

  The arthritis associated with psoriatic arthritis comes in five forms: Arthritis that affects the small joints in the fingers and/or toes Asymmetrical arthritis of the joints in the extremities Symmetrical polyarthritis, a type of arthritis similar to [stanfordchildrens.org]

  Asymmetric Arthritis Can occur in any joint, but not necessarily the same joints on both sides of the body. Fingers and toes can become enlarged and "sausage-like." [psoriasis.com]

• Joint Swelling

  A Diagnosing psoriatic arthritis is usually done by ruling out other causes for joint problems. Doctors will do a physical examination to check for joint swelling and tenderness around the affected area. [sharecare.com]

  During a physical exam, the health care provider will look for: Joint swelling Skin patches (psoriasis) and pitting in the nails Tenderness Inflammation in the eyes Joint x-rays may be done. [nlm.nih.gov]

  Medications Some medications can help relieve joint pain and swelling and can help slow down the joint damage. [orthop.washington.edu]

  Joint swelling occurs with psoriatic as well as other types of arthritis. But PsA commonly causes a unique type of swelling in your fingers or toes. [healthline.com]

• Enthesopathy

  […] bone “Ivory phalanx” Most frequent in terminal phalanges of toes, especially first Ankylosis is common Especially in PIP and DIP joints of hands and feet Feature common to seronegative spondyloarthropathies Whiskering at sites of tendinous insertion (enthesopathy [learningradiology.com]

  […] pattern at presentation may not be useful for classification. 13 The typical features of psoriatic arthritis are 19, 20 : Clinical Laboratory Radiographic Psoriasis of skin or nails Peripheral arthritis Distal interphalangeal involvement Dactylitis Enthesopathy [discoverpsa.com]

  Enthesopathies may be readily detected on bone scans and show hyperactive foci. [emedicine.com]

  Enthesopathy (inflammation at tendinous insertion into bone—eg, Achilles tendinitis, patellar tendinitis, elbow epicondyles, spinous processes of the vertebrae) can develop and cause pain. Back pain may be present. [msdmanuals.com]

Diagnosis is made on the basis of:

• Family history
• Clinical findings
  
  • Mild anemia
  • Inflammation

• Blood tests
  
  • Erythrocyte sedimentation rate (ESR)
  • Rheumatoid factor levels
  • HLA-B27 genetic marker
  • Anti–cyclic citrullinated peptide (anti-CCP)

• Arthrocentesis 
• Skin biopsy of psoriatic lesions
• Imaging techniques
  
  • X-rays (bone defects)
  • Magnetic resonance imaging
  • Computerized tomography imaging
  • Ultrasounds

• HLA-B27

  While a number of genes are linked to PsA, the highest predictive value is noted with HLA-B27. [spondylitis.org]

  The provider may test for a gene called HLA-B27. People with involvement of the back are more likely to have HLA-B27. Your provider may give nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. [nlm.nih.gov]

  […] factor-α, and other inflammatory markers recruit T-cells into the skin and joints osteoclasts are exposed to inflammatory molecules in the psoriatic joint, triggering osteoclast activation and causing osteolysis Associated conditions skin psoriasis other HLA-B27 [step2.medbullets.com]

  Up to 60% are HLA-B27 positive 2. The hallmark of PsA is the combination of erosive change with bone proliferation, in a predominantly distal distribution (e.g. interphalangeal more than metacarpophalangeal joints). [radiopaedia.org]

Complete cure of psoriatic arthritis is not possible. However, treatment of symptoms can help the patients to live with this disease.

Conservative treatment is done through:

• Exercise
• Physiotherapy

Medical treatment of the disease is done with:

• Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or indomethacin

• Disease-modifying anti rheumatic drugs
  
  • Methotrexate [1]
  • Sulfasalazine [2] [3]
  • TNF-blockers (adalimumab, etanercept, infliximab) [4][5]
  • Cyclosporine [6]
  • Leflunomide [7] [8]

• Corticosteroids like prednisone [9]
• Immunosuppressants
• Analgesics
• Anti-malarial drugs (chloroquine) [10]

Treatment of secondary disorders like hypertension should also be done.

Surgical options include:

• Joint replacement (Total hip joint replacement, knee joint replacement surgery)
• Arthroscopic synovectomy
• Arthrodesis
• Arthroplasty

The disease may be mild causing occasional attacks and flares or severe causing acute joint damage. Early treatment can help avoid gross joint deformities. With early diagnosis, preventive measures and treatment, the prognosis of the disease is usually excellent with long life expectancy. Newer medications are proving to be more effective, resulting in an even better prognosis.

Most of the cases of psoriatic arthritis are idiopathic with unknown etiology. Known causes that can trigger the disease include the following.

• Genetic defects: HLA-B27 is a genetic marker for the disease.
• Reduced immune defenses : Helper T cell count is usually low.
• Autoimmune mechanism
• Environmental factors
• Infections (post-streptococcal)
• Family history of psoriasis or psoriatic arthritis

5-30% of the patients with psoriasis develop psoriatic arthritis. The disease usually develops during the fourth and fifth decade of life, being most common at the age of 30 to 50. Males and females are equally affected. A familial predisposition to psoriatic arthritis exists.

The disease is more prevalent amongst the Caucasians as compared to people of African or Asian origin. The condition is not infectious.

The exact underlying mechanism of psoriatic arthritis is unknown. However, autoantibodies against the body’s own tissues are thought to be the underlying mechanism of psoriatic arthritis. The normal joint cells are destroyed. Overproduction of skin cells also occurs.

Response to anti-TNF α therapy suggests the involvement of activated T cells and tumor necrosis factor alpha (TNF-α) in the pathophysiology of the disease. Major histocompatibility complex (MHC) and non-MHC loci may also be involved.

• Vitamin D supplementation can help prevent psoriatic arthritis.
• Physical activity helps maintain the muscle movements and range. Moderate stretching and endurance exercises are especially helpful.
• Physical activity also helps combat the disorders that develop secondary to immobility caused by arthritis. These include hypertension, hypercholesterolemia, diabetes and obesity. Even simple walking constitutes a good exercise.
• Weight reduction can help reduce undue strain on the joints and can prevent the aggravation of developing arthritis.
• Dietary changes like fish oil can help prevent psoriatic arthritis. Fresh fruits and vegetables should also be incorporated in diet.
• Keeping the inflamed joints warm with hot water bottle and warm clothing can help reduce the pain and stiffness. Keeping them cold with cold ice packing can help reduce swelling. The cold packs should not be applied directly.
• Splinting can help rest the involved joints but complete immobilization should be avoided.

Psoriatic arthritis is a chronic, inflammatory disorder that affects the joints and is closely related to psoriasis (a skin disorder). Tissues other than joints can also be involved. In about 80% of the cases, arthritis follows psoriasis but in approximately 15% of the cases, it precedes psoriasis. Multiorgan inflammation can develop leading to wide spread signs and symptoms of the disease.

The disease is usually managed with non-steroidal antiinflammatory drugs (NSAIDs) and disease modifying anti-rheumatic drugs (DMARDs). If the disease is diagnosed early, gross deformities of the joints can be prevented and the patients have a very good prognosis.

Psoriatic arthritis is a disease of joints that is closely related to a skin disorder, called psoriasis. The disease develops mainly due to gene abnormalities as well as defect in body’s immune mechanisms. The simplest way to prevent psoriatic arthritis is to maintain the physical activity. Vitamin D supplements and incorporation of calcium containing foods in diet (milk etc.) can also prevent the development of this disease.

The disease manifests as pain and swelling in the joints leading to restriction of movements. The patient may experience difficulty in walking. Development of raised skin patches is also a common finding of this disease. As the disease progresses, eyes, lungs, bones and even heart can become involved. The disease is treated by the use of pain killers along with other agents. If the disease is diagnosed and treated early, there is good long term quality of life.

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