One of the classic features of psoriatic arthritis (PSA) is joint pain, swelling, and stiffness. However, PSA is known for its diversity in presentation and in its response to treatment. Different patients can have very different symptoms with different disease progression. In addition to joint pain in psoriatic arthritis, PSA patients may experience inflammation at the attachment points of tendons and ligaments, fatigue, and changes in their nails.
joint pain in psoriatic arthritis
Psoriatic arthritis causes inflammation in the joints, which can cause swelling, pain, and stiffness. People with PSA may experience a loss of normal function in the affected joints, which can make it difficult to perform even the usual tasks of daily life, such as cooking, dressing, or shopping.
PSA can asymmetrically affect joints that occur on one side of the body rather than the other. For example, one knee may become inflamed while the other does not change. However, people with PSA may also experience symmetrical articular involvement that occurs on both sides of the body.
PSA often begins in the distal joints farthest from the core of the body, such as the interphalangeal joints in the fingers and toes. The disease can cause significant swelling of the fingers and toes, creating a sausage-like appearance called dactylitis.
oint swelling – Psoriatic arthritis causes inflammation in the joints. In some cases, patients develop dactylitis, swelling of the fingers or toes in a sausage form. Another common PSA feature is dactylitis (seen in about 35% of people with PSA), often referred to as “sausage finger”. It is a very painful and sometimes disabling problem that involves swelling of the entire toe or toe. We now know that dactylitis is caused by swelling and inflammation of all tissues within the toe, including joints, tendons, entheses, and bones.
- Joint stiffness – With PSA inflammation, the joints become stiff, especially in the morning or after a period of rest.
- Redness of the joint. Many people with PSA experience redness in the affected joints.
- Joint warmth – PSA inflammation can also create a feeling of warmth in the joint.
- Loss of Normal Function – Psoriatic arthritis can cause a noticeable loss of normal function, including daily tasks of care, shopping, and other activities.
Joint inflammation leads to pain
The immune responses – both normal and abnormal as seen from PSA – that cause inflammation are painful because excess blood flow and substances released by white blood cells and excess fluid irritate the nerves in the area, sending pain signals to the brain.
Joint pain in psoriatic arthritis, its structure can change and develop over time. Some patients go from asymmetric oligoarthritis to symmetric polyarthritis. With effective treatment, some patients with polyarticular disease may become oligoarticular.
Joint fluids (synovial pathology)
Synovial tissue sits between the joints connected by a fibrous capsule, the inner membrane of which secretes a lubricating fluid known as synovial fluid. These types of joints allow a wide range of motion and are found in the wrist, elbow, shoulder, knee, and hips.
When PSA affects synovial tissue, inflammation is due to an increase in immune cells, especially white blood cells (T cells, B cells, and some macrophages). While there are no specific diagnostic tests for PSA, there is one abnormality that can be definitively tested for detection in synovial fluid.
How is PSA diagnosed in joints?
Psoriatic arthritis is often diagnosed using imaging techniques, including x-rays, MRI (magnetic resonance imaging), and ultrasound. Ultrasound and MRI have been shown to be more sensitive than X-rays for detecting inflammatory changes in PSA patients. Ultrasound is useful for assessing structural changes and detecting abnormal blood flow. MRI allows visualization of soft tissue as well as bone changes.
How to treat psoriatic arthritis in the joints
The minor pain and stiffness of mild PSA can be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, corticosteroid injections can be used.
For moderate to severe illness, a treatment that targets joint disease in the PSA can reduce symptoms and prevent disease progression, including deformity and loss of function. Recommended treatments include disease-modifying antirheumatic drugs (known as DMARDs). The first stage of treatment is usually a DMARD such as methotrexate, leflunomide, or sulfasalazine. Other treatments include drugs that target tumor necrosis factor (TNF), a chemical that produces a wide range of inflammation in the PSA. Examples of TNF blockers include etanercept, adalimumab, infliximab, and golimumab. Other PDOs that have been shown to be effective in clinical trials include ustekinumab (stelara), brodalumab (pending FDA approval). The FDA has also approved inflectra,
Physical and occupational therapy can be critical treatment approaches, both to protect the involved joints and to maintain function. A physical therapy program usually includes various exercises and stretches, applied heat or cold, orthopedics, gait aids, and possible professional adjustments.
Surgical care can be indicated for severe illnesses. Arthroscopic synovial capsule surgery has been shown to be effective and joint replacement or reconstructive surgery may be required. What joint pain in psoriatic arthritis is, see above.