We Treat Psoriatic Arthritis

Normal joints are cushioned by cartilage that allows the bones to glide past one another for a smooth range of motion. Arthritis occurs when any number of underlying conditions causes this cartilage to break down. The uneven cartilage restricts motion and causes pain and swelling as the bones and cartilage are repeatedly subjected to wear and tear. The inflammation of the joint compounds the problem by loosening the surrounding ligaments and pulling the joints out of alignment.

Psoriatic arthritis is a byproduct of psoriasis, an autoimmune skin condition that causes patches of dry, scaly, red skin that can affect skin anywhere on the body. It is estimated that up to 30% of adults with psoriasis may develop psoriatic arthritis. When the immune system begins to attack the cartilage between joints, the resulting PsA can be debilitating and can reduce productivity and quality of life.

Signs and Symptoms

Beyond the classic pain and inflammation of arthritis, PsA can cause:

• Redness
• Swelling
• Stiffness
• Warm sensations
• Decreased range of motion

Unlike other causes of arthritis, PsA can cause swelling of the entire finger with more severe swelling around the middle joint. The fingernails may also be affected by a condition known as nail dystrophy or nail psoriasis. This can cause discoloration, bleeding under the nail, red or white spotting, pitting, depressions, or crumbling. In most cases, PsA is restricted to the fingers and does not affect the hands or wrists.

Diagnosing

Most people with PsA will know they have the psoriatic type of arthritis because they will also exhibit signs of psoriasis in general, which causes scaly, red patches of skin that can be painful or itchy. When a patient with diagnosed psoriasis begins to exhibit joint problems in the fingers and hands, PsA is a good bet. X-rays can confirm the loss of cartilage between the joints and help measure and track the development of bone deformation or excessive swelling. A skin biopsy may be performed to confirm the diagnosis of PsA.

Treatment

While psoriatic arthritis is not curable, it is a manageable condition. Medications may be prescribed to reduce swelling and pain. Hand therapy through a specially trained occupational therapist can be especially useful in regaining and retaining a full range of motion using gentle hand exercises, splinting techniques, lifestyle changes, and other tools. The goal of hand therapy is to allow the patient to return to a normal, productive life.

Surgery may be a last resort option for some cases of PsA. An experienced hand surgeon can determine which type of surgery, if any, can best improve a patient's condition.