It often starts with dry, scaly, and inflamed skin covered by silvery scales - a condition known as psoriasis. Next, it attacks joints in the hands, feet, knees, hips, shoulders, lower back, and ankles, which become painfully swollen, red, and stiff. For some, it even leads to severe joint destruction and disability.
Psoriatic arthritis is a little known, incurable disease that affects nearly one million people in America, mostly between the ages of 30 and 50 years old. Nobody knows for sure what causes it, although dermatologists believe it´s genetic and may be related to an overreaction by the body´s immune system. Diagnosis and treatment of the condition can be difficult to pinpoint, because psoriatic arthritis can look like other types of arthritis.
However, following years of research, dermatologists today have a better understanding of the condition and are developing treatments and therapies that offer new hope to patients with this lifelong disease.
"The physical and emotional discomfort felt by those with psoriasis and psoriatic arthritis can often be overwhelming," said dermatologist and rheumatologist Alice Gottlieb, MD, PhD, W.H. Conzen chair in Clinical Pharmacology, professor of medicine, and director of the Clinical Research Center at the University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School in New Brunswick, New Jersey "That´s why it´s encouraging to see innovative treatments and therapies that are improving the quality of life for these patients."
Diagnosing Psoriatic Arthritis
For psoriatic arthritis patients, diagnosis typically begins with a trip to the dermatologist. The doctor reviews a patient´s medical history and examines the patient´s skin, joints and fingernails. The dermatologist may also perform blood tests and take x-rays of the joints.
Because psoriatic arthritis can be confused with other types of arthritis, diagnosis may not be immediate. As a result, a dermatologist may send a patient to a rheumatologist to confirm the diagnosis.
Treating Psoriatic Arthritis
No single psoriatic arthritis treatment works for everyone. Instead, the goal is to find the treatment that works best for each patient with the fewest side effects. Dermatologists will often recommend a treatment or a combination of treatments based on the type and severity of psoriatic arthritis.
"Treatment of psoriatic arthritis can be challenging because each patient can respond differently to medications," said Dr. Gottlieb. "As such, finding the optimal treatment for each patient may take time."
Treatments can include:
- Non-steroidal Anti-Inflammatory Drugs (NSAIDs) can help alleviate pain, swelling, and stiffness in the joints. While some NSAIDs require a prescription, others can be purchased over the counter. These include aspirin, ibuprofen, and naproxen sodium.
- Disease Modifying Anti-Rheumatic Drugs (DMARDs) are an option when the pain and swelling from psoriatic arthritis are more severe or there is any sign of joint immobility. These can be used to control signs and symptoms of this condition. Only available by prescription, these medications have the potential for serious side effects and should only be taken following consultation with a dermatologist.
- Biologics are prescription therapies approved for treating various types of psoriatic arthritis and psoriasis. They have been shown to not only control symptoms but to slow progression of joint damage. These treatments, which can be used with other medications, target a specific part of the immune system to block the effects of arthritis. Observed side effects have been mild. However, long-term side effects are still not known but may include increased risk of malignancy and serious infections due to the ability of the biologics to alter the immune system. These potential side effects are not unique to biologics and have been demonstrated following use of some of the older DMARDs.
Non-medicinal treatments also can help psoriatic arthritis patient manage pain.
- Exercise can help patients keep up their strength, improve mobility of their joints and to keep control of their weight. Obesity puts further strain on impaired and inflamed joints.
- Physical, occupational, and massage therapy involve physical treatment of the joints, muscles, ligaments, and tendons by a licensed therapist to reduce pain and improve joint function. Splints can be used during physical or occupational therapy to hold joints in place and reduce pain and swelling. In addition, temperature therapy also can be used which includes soaking in a hot bath or placing an ice pack on painful joints to help reduce pain and swelling.
- Surgery can help psoriatic arthritis patients with badly damaged joints, lessening pain and improving movement. However, this option is not necessary for most people with psoriatic arthritis.
"Through a combination of the latest advances in medical treatment, combined with other therapeutic options, psoriatic arthritis patients are beginning to experience remarkable improvements in their condition," said Dr. Gottlieb. "Ongoing research should improve current treatments and lead to new discoveries to fight this debilitating disease."
For more information about psoriasis, visit the Academy´s patient education Web site PsoriasisNet, located at http://www.skincarephysicians.com/.
This public education program is made possible by unrestricted educational grants from Abbott Immunology, Amgen Wyeth, Biogen Idec, Centocor, Genentech, Hill Dermaceuticals, Inc., Boehringer Ingelheim and Daavlin.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
