Historically, psoriatic arthritis (PsA) has received inadequate attention from the medical community. Researchers believed the condition was a relatively mild form of arthritis, and as a result, it frequently went undiagnosed and untreated. Only recently has it become the subject of greater understanding.
Today, psoriatic arthritis is recognized as a chronic condition with profound, deleterious effects that are considered equal to those of other destructive immune system diseases, such as rheumatoid arthritis. A recent survey conducted by the National Psoriasis Foundation found that about one million Americans suffer from the disease, a number that is roughly double of what was previously thought.
Quality of Life Affected
Psoriatic arthritis occurs when a malfunctioning immune system causes inflammation that leads to painful swelling of the joints, hands and feet. Often, it strikes in the prime of adulthood, between the ages of 30 and 50, and it can have a serious impact on the overall quality of life. This was proven in a 2002 survey conducted by the National Psoriasis Foundation. Nearly 85 percent of the 27,000 people surveyed said that psoriatic arthritis has a moderate to significant impact on their daily activities. Three quarters of the people surveyed said they lose sleep or sleep poorly as a result of the disease, while 69 percent said the disease interferes with their educational, vocational and/or social activities.
Serious Consequences at Stake
Identifying psoriatic arthritis as soon as possible is important, because the resulting joint damage, or "joint progression," often takes place in the early stages of the disease. However, the complications caused by the erosion and destruction of the joints, specifically, painful movement leading to a limited ability to function, may not appear until a much later date.
Unfortunately, the disease can be difficult to diagnose. Few tests exist to recognize its presence, and X-rays usually do not reveal the initial signs. Instead, doctors must rely on their clinical observations and learn to recognize the distinct characteristics of psoriatic arthritis in order to make an early diagnosis. Left untreated, the disease has the potential to cripple and disable.
In about 20 percent of people, psoriatic arthritis is deforming and destructive. The damage is caused by the persistent inflammation of the synovium, the thin membrane or connective tissue that lines the cavity of a joint and produces synovial fluid. It also results in enthesitis, an inflammation occurring at the point of attachment of the tendons, ligaments and connective tissue to a bone.
In some instances, the condition also leads to inflammation in bodily tissues, such as the tendons and cartilage, and in the eyes, heart, lungs and kidneys. On rare occasions, complications, such as joint dislocations of the neck and leaking of the heart valves, have been known to occur.
Health
Fortunately, there are signs that doctors can look for that are considered early indicators of the more severe forms of the disease. These signs include an onset of symptoms at a young age and the involvement of many joints, including the spine. Being female and having a family history of the disease are also considered risk factors that may influence the degree of severity of psoriatic arthritis.
The Five Types of Psoriatic Arthritis
Researchers still don't know what causes the disease or what occurs to initiate the development of the destructive rather than the mild form of psoriatic arthritis. However, they do know there are five types of this disease, which can be identified by the types of joints that are involved. The five types are:
- Symmetric arthritis is considered to be similar to rheumatoid arthritis but is a milder form of the disease and results in less deformity.
- Asymmetric arthritis is often characterized by hands and feet that may have enlarged and swollen digits that are reminiscent of sausages. The joint pain associated with this type of psoriatic arthritis is usually responsive to medical therapy. Asymmetric arthritis is generally a milder form of the disease, although some people may develop a more disabling type.
- Distal interphalangeal predominant is considered the classic version of the disease, even though it occurs in only about 5 percent of the people who have psoriatic arthritis. Sometimes it can be confused with osteoarthritis, but nail changes are usually prominent, which make it easy to differentiate.
- Spondylitis involves inflammation of the spinal column. Some of the common symptoms include stiffness of the neck, lower back and spinal vertebrae. All of the symptoms can make motion painful and difficult.
- Arthritis mutilans is the most severe, deforming and destructive version of psoriatic arthritis. It affects fewer than 5 percent of people who have the disease.
Prognosis Can Be Positive
For most people, psoriatic arthritis is a minor annoyance that requires medication when symptoms flare. Patients with this degree of psoriatic arthritis do reasonably well and lead productive lives.
The key to their success is appropriate therapy and regular monitoring by a rheumatologist. Effective medications that relieve the pain and inflammation caused by the disease are available to ensure that the majority of people with psoriatic arthritis have good control of their pain, improved function and limited joint damage.
The future for the treatment of psoriatic arthritis is encouraging. Researchers have made many advances in treatments that will help advance the management of the disease. Genetic markers have been discovered, which can help physicians identify individuals with more severe arthritis. Those markers are also proving useful in helping doctors recommend the best treatments.
At the same time, newer treatments have demonstrated their ability to target the actual mechanisms that cause inflammation and joint damage. And research is underway on even more advanced therapies that may one day prove useful in reducing, and possibly even preventing, progressive joint involvement and damage.
