Psoriatic Arthritis Treatment in Delhi, India

Psoriatic arthritis is a type of inflammatory arthritis that affects some people with psoriasis, a chronic skin condition characterised by red patches of skin covered with silvery scales. Psoriatic arthritis can cause joint pain, stiffness, and swelling, and it usually affects the joints closest to the nails, such as the fingers and toes, as well as larger joints like the knees, ankles, and spine.

The exact cause of psoriatic arthritis is not known, but it is believed to be related to both genetic and environmental factors. People with a family history of psoriasis or psoriatic arthritis are at higher risk, suggesting a genetic predisposition. However, not everyone with a genetic predisposition develops the condition, indicating that environmental factors, such as infections or injuries, may also play a role in triggering the disease.

Here are the factors that may increase the risk of developing psoriatic arthritis:

• Family history: Having a family member with psoriasis or psoriatic arthritis increases the risk.
• Psoriasis: About 10-30% of people with psoriasis will develop psoriatic arthritis.
• Age: Psoriatic arthritis can occur at any age, but it most commonly develops between the ages of 30 and 50.
• Gender: Both men and women can develop psoriatic arthritis, but studies suggest that men may be more likely to develop severe forms of the disease.
• Obesity: Being overweight or obese increases the risk of developing psoriatic arthritis, as excess weight can put extra stress on the joints.

The symptoms of psoriatic arthritis can vary from person to person, but they typically include:

• Joint pain and stiffness, especially in the morning or after periods of inactivity
• Swelling and tenderness in the joints
• Redness and warmth around the affected joints
• Reduced range of motion
• Nail changes, such as pitting, ridges, or discoloration
• Fatigue
• Eye inflammation (uveitis)
• Lower back pain and stiffness, which can be a sign of inflammation in the spine (spondylitis)

Diagnosing psoriatic arthritis typically involves a combination of medical history, physical examination, imaging tests, and laboratory tests. Here's an overview

• Medical history: The healthcare provider will ask about symptoms, including joint pain, stiffness, swelling, and skin changes characteristic of psoriasis. They will also inquire about family history of psoriasis or psoriatic arthritis.
• Physical examination: The healthcare provider will examine the joints for signs of inflammation, such as swelling, tenderness, and restricted range of motion. They may also examine the skin for psoriasis plaques and check for nail changes associated with psoriatic arthritis.
• Imaging tests: X-rays, ultrasound, and magnetic resonance imaging (MRI) scans may be used to assess joint damage, inflammation, and changes in the bones and soft tissues. These imaging tests can help confirm the diagnosis and evaluate the severity of the disease.
• Laboratory tests: While there is no specific blood test to diagnose psoriatic arthritis, certain laboratory tests may be ordered to rule out other conditions and assess inflammation levels. These may include blood tests to measure markers of inflammation (such as C-reactive protein and erythrocyte sedimentation rate) and to check for antibodies associated with other types of arthritis, such as rheumatoid arthritis.

Overall, a comprehensive evaluation combining medical history, physical examination, imaging tests, and laboratory tests is essential for accurately diagnosing psoriatic arthritis and distinguishing it from other types of arthritis or inflammatory conditions.

Treatment for psoriatic arthritis aims to relieve symptoms, control inflammation, prevent joint damage, and improve quality of life. The treatment plan may vary depending on the severity of symptoms, the extent of joint involvement, and other individual factors. Here are the main components of treatment:

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications help reduce pain and inflammation in the joints.

• Disease-modifying antirheumatic drugs (DMARDs): DMARDs such as methotrexate, sulfasalazine, and leflunomide are often prescribed to slow disease progression and prevent joint damage.

• Biologic agents: Biologic drugs, including tumour necrosis factor (TNF) inhibitors, interleukin inhibitors, and other targeted therapies, can effectively control inflammation in people with moderate to severe psoriatic arthritis.
• Corticosteroids: Injections of corticosteroids may be used to reduce inflammation and relieve pain in affected joints, particularly when other medications are not sufficient.

Physical therapy

A physical therapist can design an exercise program to improve joint flexibility, strength, and function, as well as provide techniques for pain management and joint protection.

Lifestyle modifications

Adopting healthy habits such as maintaining a balanced diet, exercising regularly, managing stress, quitting smoking, and avoiding excessive alcohol consumption can help improve overall health and reduce inflammation.

Surgery and other options

In some cases, surgery may be recommended to repair or replace severely damaged joints, although this is typically considered only when other treatments have been ineffective. Similarly, the use of steroid injections can help alleviate infection and other symptoms. 

Joint protection

Using assistive devices, such as splints or braces, and making modifications to daily activities and work tasks can help reduce strain on affected joints and prevent further damage.

Psoriatic arthritis can lead to several complications, especially if it is not effectively managed. Some of the potential complications include:

• Joint damage: Persistent inflammation in the joints can lead to irreversible damage, including joint deformities and destruction of cartilage and bone.
• Disability: Severe joint damage and deformities can significantly impair mobility and function, leading to disability.
• Enthesitis: Inflammation at the sites where tendons and ligaments attach to bones (entheses) can cause pain and stiffness, particularly in areas like the heels, bottom of the feet, and elbows.
• Eye problems: Psoriatic arthritis can cause inflammation in the eyes (uveitis), leading to eye pain, redness, and blurred vision if left untreated.
• Cardiovascular disease: People with psoriatic arthritis have an increased risk of developing cardiovascular diseases such as heart attack and stroke, possibly due to chronic inflammation and other risk factors such as obesity and smoking.
• Metabolic syndrome: Psoriatic arthritis is associated with an increased risk of metabolic syndrome, a cluster of conditions including obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels, which collectively increase the risk of heart disease, stroke, and type 2 diabetes.
• Osteoporosis: Chronic inflammation and the use of certain medications to treat psoriatic arthritis can increase the risk of osteoporosis, a condition characterised by weakened bones and an increased risk of fractures.

While there is no guaranteed way to prevent psoriatic arthritis, there are steps that individuals with psoriasis or a family history of the condition can take to reduce their risk or minimise its impact:

• Manage psoriasis: Since psoriatic arthritis often develops in people with psoriasis, effectively managing psoriasis may help reduce the risk of developing psoriatic arthritis. This includes following a treatment plan prescribed by a dermatologist to control psoriasis symptoms.
• Maintain a healthy lifestyle: Adopting healthy habits such as regular exercise, maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, and whole grains, and avoiding smoking can help reduce inflammation and improve overall health, which may help mitigate the risk of developing psoriatic arthritis or its complications.
• Early detection and treatment: Being aware of the symptoms of psoriatic arthritis and seeking medical evaluation promptly if any symptoms develop can lead to early diagnosis and treatment, which may help prevent or minimise joint damage and complications associated with the disease.
• Regular monitoring: People with psoriasis should undergo regular monitoring by their healthcare provider, who can assess their risk of developing psoriatic arthritis and provide appropriate interventions as needed.

While these strategies may help reduce the risk of psoriatic arthritis or its complications, it's important to note that not all cases can be prevented, as the disease is influenced by both genetic and environmental factors. Therefore, maintaining open communication with a healthcare provider and following their recommendations is crucial for managing psoriasis and reducing the risk of complications associated with psoriatic arthritis.

How does psoriatic arthritis affect daily life?

Psoriatic arthritis can significantly impact daily life by causing joint pain, stiffness, and swelling, making it difficult to perform tasks such as walking, standing, or even simple movements like grasping objects. Additionally, fatigue and reduced mobility can further affect one's ability to carry out daily activities.

Can psoriatic arthritis lead to disability?

In some cases, psoriatic arthritis can lead to disability, especially if it is not effectively managed. Severe joint damage and deformities can occur over time, impairing mobility and functionality. However, with early diagnosis, proper treatment, and lifestyle modifications, the risk of disability can be reduced.

What lifestyle changes can help manage psoriatic arthritis?

Lifestyle changes such as maintaining a healthy weight, engaging in regular exercise, practising stress management techniques, and following a balanced diet rich in anti-inflammatory foods can help manage psoriatic arthritis symptoms and improve overall well-being.

Are there specific exercises beneficial for psoriatic arthritis?

Low-impact exercises such as swimming, cycling, and yoga can be particularly beneficial for individuals with psoriatic arthritis. These exercises help improve joint flexibility, strengthen muscles, and reduce pain without putting excessive strain on the joints.

How does weather affect psoriatic arthritis symptoms?

Some people with psoriatic arthritis report that changes in weather, particularly cold and damp conditions, can exacerbate their symptoms, leading to increased joint pain and stiffness. However, the impact of weather on symptoms can vary from person to person.

Is there a connection between diet and psoriatic arthritis flare-ups?

While research on the link between diet and psoriatic arthritis flare-ups is ongoing, some individuals find that certain foods, such as processed foods, sugary snacks, and red meat, may trigger inflammation and worsen symptoms. Adopting an anti-inflammatory diet rich in fruits, vegetables, whole grains, and lean proteins may help alleviate symptoms for some people.

Can psoriatic arthritis affect mental health?

Yes, psoriatic arthritis can affect mental health by causing stress, anxiety, depression, and feelings of frustration or helplessness due to chronic pain, fatigue, and physical limitations. Seeking support from healthcare professionals, support groups, or mental health counsellors can be beneficial in managing these psychological aspects of the condition.

What should I know about managing psoriatic arthritis during pregnancy?

Managing psoriatic arthritis during pregnancy requires careful consideration, as some medications used to treat the condition may pose risks to the developing foetus. It's essential for individuals with psoriatic arthritis who are pregnant or planning to become pregnant to work closely with their healthcare providers to develop a treatment plan that balances symptom management with the safety of the pregnancy.

Are there alternative therapies or complementary treatments for psoriatic arthritis?

Yes, some alternative therapies and complementary treatments, such as acupuncture, massage therapy, dietary supplements (e.g., omega-3 fatty acids, turmeric), and herbal remedies, may provide relief from psoriatic arthritis symptoms for some individuals. However, it's essential to discuss these options with a healthcare professional before incorporating them into your treatment plan.

Can psoriatic arthritis be mistaken for other conditions?

Psoriatic arthritis can sometimes be mistaken for other types of arthritis, such as rheumatoid arthritis or osteoarthritis, due to similarities in symptoms like joint pain and stiffness. However, psoriatic arthritis typically presents with unique features such as skin lesions characteristic of psoriasis, nail changes, and involvement of specific joints like the fingers and toes, which can help differentiate it from other forms of arthritis. A thorough evaluation by a healthcare provider, including a physical examination, medical history review, and appropriate diagnostic tests, is crucial for an accurate diagnosis.

Reviewed By Dr. Lakshay Goel, Consultant - Robotic Joint Replacements & Orthopaedics on 12 July 2024.