Psoriatic arthritis (PA) is a serious illness that, without timely and quality therapy, can lead to disability. 
At the moment, medicine has not found ways to completely cure this pathology, however, it is quite possible to achieve stable remission. Treatment of psoriatic arthritis should be carried out under the constant supervision of a rheumatologist. Treating Psoriatic Arthritis

What is psoriatic arthritis

Psoriatic arthritis is a chronic and progressive joint disease. The disease can occur earlier than psoriasis, develop with it at the same time or appear after several years of its presence.




The clinical course is divided into:

  • The degree of activity of articular psoriasis: Asymmetric psoriatic arthritis. Due to the development of this pathology, several joints are affected (up to three joints are most often affected). Due to the active pathological activity, the large and small bone element suffers. It is worth noting that in this case, the paired joints do not suffer.
  • Symmetric psoriatic arthritis. In this case, a characteristic manifestation of the pathology is the defeat of paired joints, after which the disease actively progresses and leads to human disability.
  • Distal interphalangeal psoriatic arthropathy. Most often, this disease affects the joints of the small vessels of the fingers, which are located near the nails.
  • Spondylitis. In this case, the area of ​​the disease is the spine or several of its departments.
  • Deforming arthritis.  This form of the disease is considered the most severe, since it completely destroys the joints, as a result of which a person becomes disabled and incapable of independent life.
  • Psoriatic polyarthritis. With this form, there is swelling and inflammation of more than five joints. Tendons, ligaments, and other parts of the body may be affected.
  • Psoriatic sacroiliitis. This pathology often proceeds imperceptibly for a person and does not cause any discomfort, characterized by an asymmetric lesion. Sacroiliitis is diagnosed in 50-60% of psoriasis.
  1. Active. In this case, the progression is minimal, maximum, or moderate.
  2. Inactive. The disease is in remission.
Arthritis is diagnosed in 8-10% of patients with scaly lichen.

Is it possible to overcome the disease

In the treatment of psoriatic arthritis, a lot of patience is required, it must be approached in stages. It should be understood that it is impossible to completely get rid of this pathology, however, with timely therapy, there is a rather high probability of achieving stable remission.

Which doctor to contact

In the pathological process of joint disease, it is necessary to consult a rheumatologist, and if the patient already has diagnosed psoriasis, then a dermatologist.

When internal organs and the central nervous system are involved in the process, the patient will be additionally examined by a neurologist, cardiologist, urologist, ophthalmologist, and other relevant specialists.

How to treat Psoriatic Arthritis fingers and toes

In most cases, the disease proceeds systemically, and many joints will be involved in the process of pathological activity. In this case, drug treatment is indispensable. To minimize the occurrence of side effects, medications must be taken as prescribed by the doctor.

In the treatment of PA of the fingers and toes use:

  • Drugs based on glucosamine and chondroitin sulfate. It will take a rather long time to take them. The minimum duration of therapy is 90 days. The duration of treatment is explained by the slow restoration of the cartilage of the joints of the fingers.
  • NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed only when the disease is in the acute phase (Ibuprofen, Ibuklin, Diclofenac, Ketonal).
  • The systemic administration of antibiotics is prescribed in case of arthritis with a bacterial nature.
  • Preparations for the expansion of blood vessels are used to increase the intake of food from the blood. Used such funds for intramuscular and intravenous administration: Theonikol, Trental, Actovegin.
  • Non-steroidal ointments, such as Voltaren, Fastum gel and others. The advantage in using these funds is that they do not have a negative effect on the digestive tract.
  • Vitamin complex is necessary for the optimal nutrition of the joints.

Basic and supportive medication for psoriatic arthritis

The use of various drugs for the treatment of psoriatic arthritis is a leading technique, it involves the use of various groups of active substances:

  • Basic funds. These include sulfasalazine, methotrexate, chrysanol, tauredon. Such drugs are prescribed in case of rheumatoid-like, mutating, as well as polyarticular forms of psoriatic arthritis.
  • Treatment with immunosuppressive agents. These include cyclosporine, sulfasalazine, methotrexate, azathioprine.

In basic therapy, drugs are used according to the following schemes:


  • Sulfasalazine. Therapy begins with taking 500 milligrams (one tablet) of the drug per day. The dose is increasing every week, after a month it should be 1000 milligrams two to three times a day. The course of treatment is at least six months.
  • Methotrexate. The drug is prescribed for admission in a dosage of 2.5-5 milligrams three to four times a day with a weekly course and breaks of three days.
  • Metipred. The drug is taken in an amount of 5 to 50 milligrams every other day. When arthritis proceeds in a mild form, the minimum dosage is prescribed. If you need to take a large amount of funds, it can be divided into several times.
  • Arcoxia. The drug is prescribed in a dosage of 60 milligrams per day. In case of insufficient therapeutic effect, the amount increases to 90 milligrams.
  • Aspirin. The drug is taken in a dosage of 300 to 1000 milligrams once no more than 4-8 hours. The maximum dosage per day should not exceed four grams.
  • Ibuklin. The drug is taken one tablet two to three times a day before or after meals two hours later. The maximum dosage is 4 tablets.
  • Fluorocort. A thin layer of ointment (no more than 5 grams at a time) should be applied to the affected areas of the skin two to three times a day. You can also use the product under occlusive dressing (no more than 10 grams per day).
  • Lefno. In the active phase of PA, the maintenance dosage is 20 milligrams once a day.
  • Plaquenil. The drug is recommended to be taken in the minimum dosage that can have a therapeutic effect. The dose is calculated not by actual weight, but by the average and should not exceed 6.5 milligrams per kilogram per day.
The use of drugs, the action of which is aimed at regulating the immune activity, in some cases leads to a significant decrease in immunity, which causes the inability to resist any viral infections.

Nonsteroidal anti-inflammatory drugs

Such funds are used to significantly reduce the inflammatory processes manifested by the disease, reduce swelling, as well as in case of pain during movement. The most popular drugs in the form of tablets and ointments are:

  • Ibuprofen.
  • Diclofenac.
  • Ketoprofen.
  • Fastum gel.
  • Apizartron.

Corticosteroids and glucocorticoids

These hormones can eliminate all the main symptoms of psoriatic arthritis in a short time. With their systemic use, there is a high probability of the development of negative reactions.  These funds can be entered into the joint cavity or taken in the form of tablets.

From this group, such agents are often prescribed:

  • Prednisone.
  • Triamcinolone.
  • Methylprednisolone.
  • Dexamethasone.

Monoclonal antibodies

Monoclonal antibodies affect only active molecules, which are one of the main causes of psoriatic inflammation.

Due to this process, immunity is not suppressed, which allows the body to protect itself from various infections.

From this group apply:

  • Adalimumab.
  • Efalizumab.
  • Ustekinumab.
  • Infliximab.

Antidepressants

The use of antidepressants and sedatives helps to restore mental state, normalize sleep, helps to cope with depression and stress.

Of the drugs that are classified as sedatives, are shown:

  • Glycine.
  • Novo-Passit.
  • Tincture of motherwort.
  • Valerian extract.

Type of antidepressant selected individually.

Biological products

Biologics are drugs that can relieve inflammatory processes at the cellular level. Usually prescribed for their use as an injection.

Two types of biological products that are prescribed for the treatment of PA:

  1. Tumor Necrosis Factor Inhibitors alpha. These drugs can block the production of protein by the immune system, which is the cause of inflammation. The drugs of this type include Certolizumab, Adalimumab, Infliximab, Etanercept, Golimumab.
  2. The second type includes a drug called Ustekinumab. It is able to block two anti-inflammatory proteins (interleukin-12 and interleukin-23).

Despite the fact that these biological products are very effective in combating the disease, they have many disadvantages, one of which is suppressing the immune system, which significantly increases the risk of developing infectious diseases.


What methods of physiotherapy well help in the fight against PA

The most popular methods of physiotherapy for psoriatic arthritis include:

  • Ultra-high-frequency therapy.
  • Electrophoresis and phonophoresis.
  • Massage treatments.
  • Manual therapy.
  • Paraffin treatment.
  • Magnetic therapy.
  • UFO ( ultraviolet radiation ).

The essence of physiotherapy and beneficial physical activity

The necessary exercises for people with psoriatic arthritis are complex activities that are aimed at maintaining muscle mass. Patients need to do light gymnastics every day. The duration of the training should be no more than twenty minutes, from one to three times during the day.

To tone the hip area, you should perform swings with your legs, while trying to make the deviation angle as large as possible. You can also add light swaying during the exercise to this exercise.

For the development of the knees, the following exercise is suitable: put your hands on the joints and bring them together-raise them several times. Squats are also suitable.

Exercise therapy of the shoulder joint is carried out using the exercise “mill”, while the hands should be relaxed. Perform until a feeling of heaviness in the palm of your hand appears.

To develop brushes, you must perform the following exercises:

  • Quickly squeeze-unclench your fingers for 30 seconds.
  • Rotate the brush relative to the wrist.
  • Stretch your arms forward, straighten your fingers, bend the brush in different directions (up, left, down, right).
To tone the feet, they should be bent and unbent, stretch the tips of the fingers. You can also twist them in different directions, trample on the inside and outside of the foot.

The principles of diet and food products that help achieve sustainable remission

Compliance with the prescribed diet is part of the therapeutic process, this allows for stable remission.

Experts recommend daily use of such foods for psoriatic arthritis:

  • Quail and chicken eggs.
  • Dairy products.
  • Dietary meat (chicken, turkey).
  • Vegetables, fruits, berries, and greens.

You should also know which foods should not be consumed:

  • Rich soups.
  • Salty dishes.
  • Sorrel.
  • Legumes
  • Fat meat.
  • Various sauces.
  • Spicy seasonings.
  • Canned food.

Folk remedies that help stop the progression of the disease

All diseases have their own treatment methods developed by the people. But they are recommended to be combined with other methods of therapy.

The most popular recipes for psoriatic arthritis:

  • Lingonberry decoction. Dried plant leaves in a volume of two teaspoons pour 200 milliliters of boiling water. Cool and drink in small sips.
  • Infusion of parsley. The roots and leaves of greenery must be scrolled in a meat grinder, then pour boiling water and leave for 12 hours. After expiration, strain the mixture and add lemon juice. Take 70 milliliters three times a day.
  • Herbal infusion. Take in equal amounts the leaves of St. John’s wort, coltsfoot, and dandelion. Mix everything and pour a liter of boiling water. Insist a day, then strain and take 50 milliliters per day.
  • Compress of carrots. Grate a fresh vegetable, add five drops of oil and the same amount of turpentine to it. Stir everything and put on the affected area in the form of a compress.

The use of surgical treatment for joint deformities

Surgery is resorted to as a last resort and only if the medication is ineffective when the pain from inflammation does not disappear.

Types of surgical interventions:

  • Synovectomy This operation is performed to remove damaged tissue and also helps to restore joint activity.
  • Arthroplasty surgery.  It is prescribed exclusively for severe joint damage.
  • Joint replacement. This type of operation is necessary to replace severely damaged joints with artificial dentures.
With the help of surgery, it becomes possible to correct articular deformation and remove bone growths.

The most effective methods of relieving exacerbation in arthropathy

In the case of inefficiency of the treatment regimen with classical drugs, the use of corticosteroids and antimalarial drugs is prescribed.

For the effective treatment of arthritis, they often resort to the use of such physiotherapeutic procedures: massage, acupuncture, ultrasound, electrophoresis, quantization.

Clinical recommendations for patients

Therapy of psoriatic arthritis is carried out constantly, throughout life. When choosing patient management tactics, specialists prefer the strategy: “Treatment to achieve the goal”, which is characterized by constant and objective monitoring of the patient’s condition while taking an active immunosuppressive complex. The strategy has proven effective in episodes of diagnosing early forms of the disease (up to 3 years), and immediately started therapy. It is recommended to monitor the condition every 3-6 months, and the decision on treatment correction is made depending on the achieved remission or low activity of psoriatic arthritis.



Forecast

How to behave this disease is difficult to say, because its development in most cases is unpredictable. Psoriatic arthritis can occur both benignly and behave more aggressively and in a short period of time lead to the destruction of the joint. For a more accurate prognosis of the disease, it is necessary to take into account the frequency of its exacerbations and their severity, the duration of the use of medications and at what stage the therapy began.

It is known that about 30% of people with psoriatic arthritis have a mild form of this pathology, which remains stable for a fairly long period of time. The rest need longer treatment and an active fight against the symptoms of the disease.

Medicine has stepped forward far enough and now even the presence of a severe form of psoriatic arthritis does not lead to disability due to the use of new drugs.

Avoiding Psoriatic Arthritis: Prevention

Psoriatic arthritis is most often hereditary, that is, people whose relatives have suffered from this disease are at risk. The exact causes of this pathology in humans have not been determined, so there is no primary prevention. It is known that the following factors influence the likelihood of developing psoriatic arthritis: the presence of mental disorders, insufficiently strong immune defense, metabolic disturbances.

To stop the progression and prevention of psoriatic arthritis, it is recommended:

  • Monitor your posture.
  • Completely abandon bad habits.
  • Periodically engage in physical therapy.
  • Maintain optimal body weight.
  • Timely contact a rheumatologist.
  • Conduct regular laboratory tests.
  • Refrain from hard physical work.

Psoriatic arthritis is a serious disease that affects the joints. Without proper treatment, pathology can lead to disabilityUnfortunately, arthritis cannot be cured forever, but modern methods of therapy can achieve long-term remission. First of all, drugs of various groups are used, physiotherapy and lifestyle correction are added to them.

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