The Different Types Of Arthritis – Psoriatic arthritis (PsA) is a complex and often debilitating form of inflammatory arthritis that affects each patient differently. PsA is known to cause inflammation, stiffness, redness, pain, and damage to the skin, nails, joints, and more. Although it has a similar perception to rheumatoid arthritis, but with skin involvement from psoriasis, psoriatic arthritis is actually a completely different disease with unique risk factors, symptom sets, and options. in treatment.
Most PsA patients already have psoriasis when they are diagnosed with PsA; it usually develops within five to 12 years after psoriasis is diagnosed. However, about 10% to 15% of people develop symptoms of joint pain before psoriasis plaques appear, explains Daphne Gladman, MD, FRCPC, professor of medicine at the University of Toronto, senior scientist at the Kremlin Research Institute. , and deputy director of the Center for Prognostic Research in Rheumatic Diseases
The Different Types Of Arthritis
When it comes to psoriatic arthritis, no two patients are alike. Some people with PsA may have only peripheral joint disease (where the arms, hands, and knees are affected by joint symptoms), while others may have only the spine. However, other people can have both, says Brett Smith, DO, a rheumatologist at Blount Memorial Hospital in Alcoa, Tennessee.
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“Sometimes it can be difficult to fully put the puzzle together and provide a formal diagnosis,” said Dr. Smith, “but when a diagnosis is made, many of these symptoms or disorders respond to similar treatments.”
The most effective way to manage your psoriatic arthritis is to work with your rheumatologist to find the right combination of medications—and understanding the types and domains of psoriatic arthritis can help you do that.
There are five main types of psoriatic arthritis, categorized by joint type. People may have one type at first, only to develop another type later.
Also known as asymmetric psoriatic arthritis, this type of PsA usually affects fewer than five small or large joints in your body. It’s called “asymmetric” because joint symptoms like pain and redness don’t occur on both sides of your body. For example, you may have pain in your right knee but not in your left knee. About 35 percent of people with psoriatic arthritis have asymmetric oligoarthritis.
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As the name suggests, “symmetrical” polyarthritis affects five or more joints on both sides of your body (such as the right and left elbow), similar to the symptoms of rheumatoid arthritis. This is the most common type of PsA, occurring in about half of people with the disease.
This type of PsA affects the joints at the ends of your fingers and toes (distal interphalangeal joints) and can cause nail changes such as scarring, pitting, or separation from the nail bed. Less than 20 percent of people with PsA have only distal arthritis; it often occurs with other types of psoriatic arthritis.
Severe forms of psoriatic arthritis can deform and damage the joints in your fingers, hands, wrists, and feet. Arthritis mutilans prevent your bone cells from breaking down and repairing themselves, which can cause opera glasses (“opera glass hand”) or telescoping (“telescopic fingers”). Other symptoms of arthritis include stretchy, shiny, and itchy skin on the fingers; stiffness and immobility of joints as a result of fusion of bones (ankylosis); and destruction of joints and bone tissue in the feet and hands. Thanks to increasing advances in the treatment of psoriatic arthritis, psoriatic arthritis is rare, occurring in less than 5 percent of people with PsA.
Psoriatic arthritis is considered a type of spondyloarthritis, which is an umbrella term for different types of arthritis that share some common characteristics. (Ankylosing spondylitis and axial spondyloarthritis are also types of spondyloarthritis, for example.) With spondyloarthritis, people experience inflammation in the joints of the spine, which causes pain and stiffness in the neck, back, and sacroiliac (hip) joints. joint on each side of your spine). If left untreated, the vertebrae in your spine can fuse together. Your arms, legs, feet, hands, and hips can also be affected. Psoriatic arthritis with axial involvement is a unique condition that differs from having spondylitis and psoriasis at the same time, a new study finds.
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However, while these five types of psoriatic arthritis describe different presentations of the disease—and you can read about them when researching PsA online—many rheumatologists no longer use them to -classify patients with PsA. “We’re starting to think more about people,” says Rebecca Haberman, MD, a rheumatologist in New York Langone. “It’s not just your joints or your skin—psoriatic arthritis can affect any and all parts of the body.”
To better diagnose and treat patients, experts have identified six different domains (or manifestations) that people with PsA have:
Not everyone with psoriatic arthritis experiences all six domains. Each person may experience a combination of their domains that vary in severity. “Unfortunately, at this point, we can’t tell you who will develop in other domains or who won’t,” said Dr. Haberman. It is the combination and severity of these domains that influence rheumatologists’ opinion on PsA treatment recommendations.
Peripheral arthritis tends to move from one joint to another, affecting the large joints of the arms and hands (elbows, wrists) and legs (knees, ankles). People with peripheral arthritis are more likely to develop bunions and enthesitis (inflammation of the point where bones or ligaments join bones). Dr. warned. Haberman that “even though there may be inflammation, you can still have serious joint damage, so you don’t want to ignore your symptoms.”
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Also known as spondylitis or spondyloarthropathy, axial arthritis causes pain and stiffness in the joints of the spine and sacroiliac (lower back) joints. Estimates of the presence of axial disease in PsA vary widely, from 12 to 70 percent. “Patients with axial pain are more likely to have worse disease, including worse skin disease, but researchers don’t know why,” said Dr. Haberman.
Inflammation of the enthesis, where the bone or ligament joins the bone, affects about half of people with psoriatic arthritis. Although there are many places where enthesis can occur, people with PsA often experience it in the Achilles tendon (heel) or plantar fascia (bottom of the feet), as well as the epicondyle (elbow).
“Why the heels/feet are more common is unknown, but one theory is that enthesitis is caused by microtrauma and these areas may be more vulnerable,” said Dr. Haberman.
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Dactylitis is a painful, red, and hot inflammation of the entire digit – a finger or toe – not just a single digit within a finger or toe. It is often called “sausage finger” because it can cause the appearance of sausage fingers. For many patients, dactylitis is the first symptom of PsA. “A patient presenting with dactylitis should be carefully evaluated for skin and nail disease,” says Dr. Gladman. “Sometimes the lesions are hidden on the scalp or around the anal area and are not clearly appreciated by the patient.”
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Although some studies show that people with PsA tend to have more severe skin disease than people with psoriasis, you can have PsA with very little psoriasis. In other cases, where you have psoriasis on your body, it can be a sign of risk of developing psoriatic arthritis. “Studies have shown that people with psoriasis involving their skin and nails may be at a higher risk of developing PsA,” says Dr. Gladman. Skin psoriasis with PsA is different from psoriasis alone; these include signs and symptoms at joints, axes, and enthesis.
About 90 percent of people with psoriatic arthritis have nail problems, including nail thinning, flaking, lunulae (red spots on the white arch above the cuticle), and petechiae (blood spots on under the nail). It can include both toenails and toenails, and it can be in one or all 20 nails, says Dr. Haberman.
Although there are clinical treatment guidelines from the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF) for the best management of this condition, your personal treatment plan will depend on how PsA affects you. your body and the severity of your symptoms.
In general, rheumatologists recommend a “treat-to-target” approach (treating patients as needed to achieve remission or low disease activity), which often includes prescribing tumor necrosis factor inhibitors (anti -TNF medication) or small doses. molecular medicine (OSM).
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Beyond these guidelines, some drugs work better for some domains than others. For example, conventional antirheumatic drugs (DMARDs) such as methotrexate (Trexal) and leflunomide (Arava) have been shown to work for the peripheral arthritis of PsA, but not for axial disease. These drugs are less effective, however, for enthesitis and dactylitis, says Dr. Gladman.
Haberman added that newer biologics called IL-17 inhibitors, such as secukinumab (Cosentyx) and ixekizumab (Taltz), may work better with fewer patients.