Psoriatic arthritis (PSA) is a chronic inflammatory joint disease associated with psoriasis, a chronic inflammatory skin condition that causes painful, red, scaly patches. PSA usually develops after psoriasis, however, a small percentage of patients develop arthritis before psoriasis. PSA can cause progressive joint damage over time. PSA-induced joint damage is irreversible and begins before the disease becomes clinically apparent. However, not all patients progress to joint damage. Early, aggressive treatment is critical for those patients whose disease may progress to prevent permanent joint damage. In this article, we’ll look at the complications of psoriatic arthritis.
Complications of psoriatic arthritis
In addition to joint damage, PSA inflammation is thought to place patients at increased risk for other diseases associated with the inflammatory condition, including:
Cardiovascular disease, which includes coronary artery disease, congestive heart failure, and vascular disease, can lead to death from heart attack or stroke. Several studies have shown an increased risk among PSA patients for cardiovascular disease.
Eye disease. Several patients with autoimmune diseases affecting the eye have been observed in patients with PSA, including uveitis, keratitis, blepharitis, conjunctivitis, episcleritis, and scleritis. The most common ophthalmic disease in PSA patients is uveitis.
Loss of hearing. A recent study found that a larger percentage of people with PSA have hearing loss. Psoriatic arthritis can damage the inner ear or auditory nerve, which can lead to hearing loss as well as balance problems. How to live with psoriatic arthritis ?
The most severe form of PSA is mutating arthritis, which affects about 5% of people with psoriatic arthritis. It is characterized by digital shortening of the fingers or toes associated with severe bone destruction. In mutating arthritis, the bones in the fingers or toes deteriorate and begin to protrude into each other, sometimes referred to as “pencil-in-cup” deformity because the degradation resembles a pencil-in-cup on radiographic images. It can also be called the “opera glass finger”. Mutilating arthritis is often associated with polyarticular disease, that is, the effect of many joints throughout the body, as well as symmetrical distribution (on both sides of the body), inflammation between the spine and pelvis (sacroiliitis), and long duration of the disease. It causes severe deformity and loss of function for the patient.
Impact on quality of life
Skin disease with psoriasis reduces quality of life and affects function and daily activities. Psoriatic arthritis increases the burden of disease and further reduces the quality of life, causing more work-related problems, more fatigue, more disease-related health and hospital visits.
The job can be especially challenging for people with psoriatic arthritis. PSA is associated with a loss of productivity, especially in patients with a greater severity of the disease. PSA is also associated with long-term disability and lack of employment. Joint pain and stiffness caused by PSA can cause physical limitations as well as emotional distress and discomfort – complications of psoriatic arthritis. Physical or occupational therapy can be beneficial for patients with PSA and can provide access to assistive devices for self-care, training in modification, and possible occupational adaptation.
Susceptibility to joint damage
Much research has focused on identifying the characteristics of those patients whose disease is likely to progress to irreversible and disabling joint damage. Aggressive treatment can potentially prevent joint disease, but aggressive treatment has a high cost and potential side effects. Since only a small percentage of PSA patients will progress to severe joint disease, the researchers sought to find a measurable function that could differentiate patients at risk.
No biomarker (a medical sign that can be measured to indicate or predict a disease) has been found to be a reliable predictor, but there are studies suggesting a possible link of progressive joint disease from psoriatic arthritis to the following:
- Calgranulin, a protein secreted by some white blood cells and mediators of the PSA inflammatory process.
- Markers of angiogenesis, the process of building blood vessels expressed in PSA.
- Molecules that regulate bone turnover.
More research is needed to definitively identify biomarkers and develop diagnostic tests.