What is psoriatic arthritis?
Psoriatic Arthritis is a type of inflammatory arthritis that commonly affects people with psoriasis. It is a chronic autoimmune disease that causes joint inflammation and subsequent pain, stiffness, and swelling. The immune system attacks itself, the body’s joints, skin, and organs.
Psoriasis is an autoimmune disease in which the body rapidly multiplies skin cells. The skin cells build-up and form itchy, scaly plaques on the knees, elbow, trunk, and scalp.
Psoriatic arthritis affects 3 in 10 people who have psoriasis. For many people it develops 10 years after psoriasis appears. It can, however, affect people who don’t have psoriasis.
Psoriatic arthritis affects men and women equally. It usually develops after 30 but may begin in childhood. Children who develop psoriatic arthritis are at risk of developing uveitis (inflammation of the middle layer of the eye).
The exact cause behind psoriatic arthritis is not fully understood however, we understand it stems from an exaggerated immune system response. The biggest risk factor for developing psoriatic arthritis is genetics. In fact, it was found that, in people who had psoriatic arthritis, 40% had a family member with psoriasis or arthritis. It is also believed that environmental triggers such as an infection, stress, trauma or a virus may play a role in the pathogenesis of psoriatic arthritis.
Psoriatic arthritis symptoms, severity and number of joints affected, vary person to person. Symptoms can come and go, with triggers catalysing a flare up. Psoriatic arthritis affects mainly the large joints of the lower limb, the small joints of the fingers and toes, the spine and sacroiliac joints of the pelvis. Psoriatic arthritis also affects the eyes, tendons, gastrointestinal tract and nails.
Research has shown that prolonged persistent inflammation from psoriatic arthritis causes joint damage so early intervention is integral in reducing disability. Unfortunately, there is no cure for psoriatic arthritis however, there are treatments available to slow disease progression, lessen pain, protect joint integrity, and preserve joint mobility.
It is important to work with a rheumatologist (a doctor who specialises in the treatment of arthritis) to find the right treatment plan for you.
What are the different types of psoriatic arthritis?
There are different types of psoriatic arthritis which all vary depending on which joints of the body are affected. The importance of sub-classifying psoriatic arthritis means that diagnostic conclusions can be drawn faster, and individualised treatment can be started earlier. The different types of psoriatic arthritis include:
- Asymmetric arthritis
- Symmetrical polyarthritis
- Distal interphalangeal arthritis
- Spondylitis
- Arthritis Mutilans
Asymmetric arthritis
Asymmetric arthritis occurs in 35% of people with the psoriatic arthritis. The joints affected by asymmetric arthritis occur on one side of the body. Asymmetric psoriatic arthritis affects no more than 5 joints. Asymmetric arthritis often precedes symmetrical polyarthritis.
Symmetrical polyarthritis
Symmetrical polyarthritis is similar to rheumatoid arthritis, as affected joints are mirrored on both sides of the body (e.g. left and right elbow). Symmetrical polyarthritis affects 5 or more joints on both sides of the body and is more disabling than asymmetric arthritis. This is the most common type of psoriatic arthritis and is present in 50% of people with psoriatic arthritis.
Distal interphalangeal arthritis
Distal interphalangeal arthritis affects the small joints of the fingers and/or toes. We know that psoriatic arthritis doesn’t just affect the joints, it also affects other organs like the skin and nails. In distal interphalangeal arthritis, nail symptoms of spotting, pitting, or separating from the nail bed are prevalent. Less than 20% of people with psoriatic arthritis have this type of arthritis in isolation, it often occurs with other sub types of psoriatic arthritis.
Spondylitis
Spondylitis is a type of psoriatic arthritis that affects the joints of the spine. The cervical spine (neck), lumbar supine (lower back) and sacroiliac joints (pelvic joints) are the most affected. If left untreated the joints can fuse together cause great stiffness and pain. This sub type occurs in 20% of people with psoriatic arthritis.
Arthritis mutilans
The rarest and most severe form of psoriatic arthritis is arthritis mutilans. It affects less than 5% of people with psoriatic arthritis. In this sub type, bone is reabsorbed, and joints are dissolved by the body. Joints become stiff and immobile as they fuse together (ankyloses). This results in the shortening of the fingers, and the skin folds in on itself. This unique appearance is described as an “opera glass hand” or “telescope finger.”
What are the symptoms of psoriatic arthritis?
Psoriatic arthritis can present differently person to person. Below are the most common symptoms of psoriatic arthritis:
- Joint pain, swelling and stiffness.
- Morning stiffness and fatigue.
- Tenderness and swelling over tendons.
- Nail changes such as pitting, thickening or separation from the nail bed.
- Pain and redness of the eyes.
- Swelling in the peripheries (fingers and toes).
Treatments for psoriatic arthritis
Treatments for psoriatic arthritis vary depending on sub type and severity. Psoriatic arthritis can be managed conservatively with medications, lifestyle changes, exercise, topical treatments, physiotherapy and assistive devices, or non-conservatively through surgery.
Natural remedies for psoriatic arthritis
Let’s start by addressing natural remedies and therapies for psoriatic arthritis treatment. When psoriatic arthritis isn’t majorly disabling or worsening, implementing lifestyle changes can make a difference in your symptoms. Natural remedies to psoriatic arthritis include:
- Exercise Regularly! Exercise is vital for strong muscles, a well calibrated nervous system and joint mobility! Exercise has proven to be key in managing symptoms of fatigue and joint pain. If you haven’t exercised for a while due to pain, your joints will probably feel stiff and sore initially. This, however, improves as you get stronger, so persevere!
- Implement a Healthy Diet! Having a diet that is well balanced, nutritious, and healthy is so important for meeting the essential daily vitamin levels your body needs to function. A healthy diet is also responsible for weight management. Obesity has even thought to be a trigger for psoriatic arthritis due to its link to systemic low-grade inflammation. Being a healthy weight reduces strain and load through painful joints.
- Protect your Skin! This may include using Abundant Natural Health’s Ocean Soothe range to reduce the itchy, painful plaques if you have psoriasis. When skin psoriasis is poorly managed, we are more susceptible to infections which can trigger a psoriatic arthritis flare. Also, make sure you protect your skin from sunburn by wearing an SPF sunscreen or long sleeve clothing.
- Physiotherapy is integral in optimising your muscle and joint function, but also provides manual therapy for pain and swelling management.
- Use assistive devices! These take the pain out of daily activities like putting shoes on, or opening jars.
- Hot and cold therapy reduces joint pain and swelling.
- Develop stress management strategies to prevent and reduce flare ups. Stress triggers an inflammatory response by the body which can, again, trigger a psoriatic arthritis flare.
- Vitamin supplementation to improve skin and joint health. These include vitamins like magnesium and vitamin D. Magnesium not only helps reduce joint pain and restore skin health but enables the body to absorb vitamin D more effectively.
- Reconsider your alcohol and smoking habits. Not only are they inflammatory stressors, they also negatively interact with other psoriatic arthritis medications.
Topical treatments and creams
When deciding on topical ointments and creams for psoriatic arthritis treatment, you need to decide what symptoms you are looking to treat. The reason we say this is because people can have psoriatic arthritis without having psoriasis. If you have psoriatic arthritis and skin psoriasis, it is integral that you manage both. Good news is, for some cases, both can be managed with topical treatments.
For joint pain and swelling we recommend any topical ointment high in magnesium.
Magnesium's pain relief effect is due to being able to block a particular pain receptor known as NMDA. These receptors are located in the skin and the spinal cord and are responsible for communicating the sensation of pain to the brain. That’s why topical magnesium is so good for reducing pain, because the receptors responsible for pain communication are in the skin. It also bypasses the gastrointestinal tract (no laxative effect) and is fast acting!
Our top pick? Abundant Natural Health’s MAG I.C. pain relief gel.
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This topical magnesium gel has the highest purity magnesium on the market and is organic certified! It’s formulation with purpose bred cucumbers allow the magnesium to be absorbed through the skin quickly!
As for topical creams to manage psoriasis, look no further than Abundant Natural Health’s Ocean Soothe Range. A full body solution for psoriatic skin! Ocean Soothe contains NaCl (salt), Magnesium and citric acid to reduce the itch, pain, and inflammation of psoriatic plaques. The citric acid in ocean soothe exfoliates the dead skin cells on the dermis to open sweat glands and hair follicles. This allows the magnesium and sodium chloride to penetrate the skin layers below, giving direct, instant, long lasting relief of itch and pain.
Our top pick? Ocean Soothe Gel and Lotion
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Medications for psoriatic arthritis
There are many medications for treatment of psoriatic arthritis. However, psoriatic arthritis is a complex disease, so seeking professional advice from a rheumatologist is integral finding individualised, effective psoriatic arthritis treatment. The following medications are currently prescribed to manage psoriatic arthritis.
- Nonsteroidal anti- inflammatory drugs (NSAIDs). NSAIDs are effective pain relievers. They are the first line medications in managing pain, however, can be ineffective in more severe disease. Some common examples are ibuprofen and naproxen.
- Anti-rheumatic drugs (DMARDs) are prescribed to slow the progression of psoriatic arthritis and preserve joints and soft tissue. When taking DMARD you will need to undertake regular blood, blood pressure and urine tests to monitor the efficacy of the drug, but also any side effects. Common examples are sulfasalazine and methotrexate.
- Corticosteroid injections help reduce joint inflammation caused by psoriatic arthritis. These injections wear off after a few months. Prolonged steroid use is, however, associated with poor ligament and tendon health.
- Biological therapies reduce inflammation by targeting key parts of the immune system. Biological therapies commonly prescribed are Humira (adalimumab) and Enbrel (etanercept).
- In very severe cases of psoriatic arthritis surgery is required to improve joint function and reduce pain.
When to see a doctor for your psoriatic arthritis
If you have read this and are thinking, I think I have psoriatic arthritis… go and see a doctor as soon as possible. We know that psoriatic arthritis can cause permanent, disabling joint damage if not treated early. In addition to stopping joint damage, treating psoriatic arthritis will reduce your systemic inflammation and reduce your risk of developing other inflammatory diseases.
Living with psoriatic arthritis
Psoriatic arthritis is not an isolated physical disease. Our social and mental paradigms are usually negatively impacted as well. Gaining adequate treatment for the physical symptoms of psoriatic arthritis helps reduce daily discomfort but seeking help from a mental health professional or psoriatic arthritis support group is also important in managing the disease holistically. The two groups we recommend are the National Psoriasis Foundation (NPF) and Overcoming Psoriasis community group on facebook. The NPF has resources, community groups and social support for people living with the disease. Overcoming Psoriasis focuses on sharing personal experiences of living with the disease- from diagnosis, to symptoms, to treatments, no stone is left unturned.