Understanding the Different Types of Psoriatic Arthritis
Psoriatic arthritis is a chronic inflammatory type of arthritis that affects the joints and skin. Psoriatic arthritis is often accompanied by psoriasis, which is a skin condition that is characterized by red, irritated patches of skin that commonly appear white and scaly. Often, individuals who have psoriasis also have fingernail and toenail changes, including pitting, ridging, crumbling, and nail separation from the nailbed.
Approximately a quarter of individuals with psoriasis develop an associated inflammation of their joints. In this article, we will explore the five types of psoriatic arthritis.
5 Types of Psoriatic Arthritis
There are 5 types of psoriatic arthritis, including:
1. Symmetrical Psoriatic Arthritis
This is the most common type of psoriatic arthritis, affecting about half of all individuals with psoriatic arthritis. It affects the same joints on both sides of the body (i.e. both knees, both feet, etc.).
Symptoms range from mild to severe and include morning stiffness, skin rashes, and difficulty moving the joints.
This type of psoriatic arthritis is often mistaken for rheumatoid arthritis because both of these conditions affect both sides of the body. A classic differentiating symptom is that psoriatic arthritis often affects the fingers and toes leading to “sausage digits.”
2. Asymmetrical Psoriatic Arthritis
It affects about a third of all individuals with psoriatic arthritis. This type is often mild and affects different joints on each side of the body. Symptoms include red, scaly skin rashes, morning stiffness, and difficulty moving the joints.
3. Distal Interphalangeal Predominant (DIP)
This type affects the tips of the fingers and toes. Symptoms include pain, stiffness, and swelling. Additionally, it may change the look of the nails leading to pitting, discolored spots, and lifting of the nail away from the nailbed.
This involves inflammation of the vertebral joints in the spine. The hallmark symptom is constant back pain, although the neck may also be stiff and uncomfortable. Other symptoms include shoulder stiffness, weakness of the arms and/or legs, headaches, and bowel and/or bladder issues.
This type can affect the connective tissues of the body and be associated with arthritis in the hips, legs, feet, and/or arms.
5. Arthritis Mutilans
Arthritis mutilans is the most severe and rarest form, affecting less than 5% of individuals with psoriatic arthritis.
It involves damage to the small joints and tissues in the feet and hands. The damage may be so severe that it leads to bone loss and may shorten the fingers and toes. In some cases, the neck and back may also be affected.
Other symptoms include pain and stiffness in the hands and feet, decreased range of motion, nail changes, and/or finger and toe disfiguration.
It’s also possible to have more than on type of psoriatic arthritis, and the pattern of your symptoms may change over time.
Cause of Psoriatic Arthritis
Psoriatic arthritis is classified as an autoimmune disease, meaning that the immune system mistakenly attacks the healthy tissues of the body leading to inflammation and pain.
The exact cause of psoriatic arthritis remains unknown. However, researchers believe that a combination of genetics, the environment, and immune system malfunction are involved in the development of the condition.
Diagnosis of Psoriatic Arthritis
Unfortunately, there is no definitive test for the diagnosis of psoriatic arthritis.
Typically, it is diagnosed by reviewing your personal and family history of psoriasis and/or psoriatic arthritis in combination with a physical examination of the joints.
In some cases, x-rays may be ordered to determine if there is bone damage. Additionally, blood tests may be ordered to evaluate:
- Sedimentation rate (inflammation)
- Rheumatoid factor (to exclude rheumatoid arthritis)
- HLA-B27 (a genetic marker present in more than 50% of psoriatic arthritis individuals with inflammation of the spine)
- Joint fluid testing (to exclude infectious arthritis)
Treatment of Psoriatic Arthritis
The goal of treatment is to decrease inflammation and pain, and to prevent joint damage and disability. Depending on the severity and location of symptoms, one or a combination of these medications may be used:
- Non-steroidal anti-inflammatory drugs (NSAIDS)
- Disease-modifying anti-rheumatic drugs (DMARDs)
- TNF-alpha inhibitors
- Topical medication
- Joint replacement may be recommended if the joints are severely damaged
There are additional lifestyle changes that may help to control symptoms and improve quality of life for individuals suffering with psoriatic arthritis, including:
- Protecting the joints when performing every day activities.
- Protecting the skin by keeping it moisturized.
- Washing clothes with unscented and gentle detergent to minimize the risk of skin irritation.
- Wearing loose, natural fiber clothing to minimize skin irritation.
- Massage therapy to ease muscle tension.
- Exercising, including stretching to increase joint range of motion, and low impact activities such as swimming, biking, and/or walking to keep the joints moving.
- Applying moist heat to the affected area for 20 minutes at a time to decrease stiffness and relax muscles.
- Icing the affected area for 10 minutes at a time to decrease inflammation and pain.
- Mediation, yoga, and/or deep breathing techniques to help manage stress.
- Eating a healthy diet that includes lots of fruits and vegetables, and that is low in fats, salt and sugar.
- Losing weight to ease the stress on the joints of the body.
- Quitting smoking and limiting alcohol consumption.
While there is no cure currently available for psoriatic arthritis, there are a variety of medications and lifestyle changes that can be made to help manage symptoms and slow or prevent the progression of the disease, and help to improve the quality of life for individuals with psoriatic arthritis.