How it manifests itself
The picture is varied, which makes early diagnosis difficult. Multiple joints may be affected asymmetrically, or the joints of the hands, including the distal joints closest to the nail, are affected, which is not typical for rheumatoid arthritis. Dactylitis is very characteristic - inflammation of the entire finger, which becomes like a sausage. Enthesitis often causes concern: pain in the heel at the insertion of the Achilles tendon or plantar fascia, pain in the elbow and pelvis. Some patients have spinal involvement with nighttime back pain and morning stiffness. Nails almost naturally suffer: pinpoint impressions, thickening, and detachment from the bed appear.
- Asymmetrical damage to multiple joints
- Involvement of the joints of the toenails
- Dactylitis - sausage finger
- Enthesitis, heel pain
- Back pain and stiffness in the morning
- Nail changes: thimble-shaped impressions, peeling
- Fatigue
Causes and risk factors
It is based on a dysfunction of the immune system in genetically predisposed people. The risk is higher if close relatives have psoriasis, as well as if the nails and scalp are affected, and if there are extensive skin manifestations. Obesity, smoking, physical injury and severe stress can contribute to the development. It is important that arthritis can develop with very modest skin manifestations - sometimes the only focus is hidden in a fold of skin, behind the ear, in the navel or on the scalp, and the patient does not even know about psoriasis.
- Skin psoriasis, especially involving nails
- Hereditary predisposition
- Obesity
- Smoking
- Joint injuries
- Severe stress
- Hidden foci of psoriasis without obvious complaints
How is it different from other arthritis?
It is distinguished from rheumatoid arthritis by asymmetry, involvement of the joints near the nail, dactylitis, nail damage and negative rheumatoid factor. For arthrosis - the presence of signs of inflammation, prolonged morning stiffness and improvement after movement. For gout, there is a gradual onset and no severe attacks with normal levels of uric acid, although in patients with psoriasis it can be elevated. The difference from reactive arthritis is its chronic course and its connection with a skin disease, and not with a previous infection.
- Asymmetrical lesion, unlike rheumatoid arthritis
- Involvement of joints near the nail
- Dactylitis and enthesitis
- Nail changes
- Rheumatoid factor is usually negative
- Association with cutaneous psoriasis
Diagnostics
The diagnosis is clinical: there is no specific analysis. The doctor examines the joints, nails and entire skin, including hidden areas, and evaluates the entheses and mobility of the spine. Laboratory tests determine indicators of inflammation, which can be normal even with an active process, and rheumatoid factor - its negative result supports the diagnosis. Ultrasound helps to detect inflammation of the synovium and entheses at an early stage, x-rays of the hands and feet show characteristic changes, and MRI is used for damage to the spine. Because the disease is associated with increased cardiovascular risk, blood pressure, lipids, and glucose are also assessed.
- Examination of joints, skin and nails
- Complete blood count with ESR and C-reactive protein
- Rheumatoid factor for differential diagnosis
- Ultrasound of joints and entheses
- X-ray of hands and feet
- MRI for spinal lesions
- Assessment of blood pressure, lipids and glucose
Treatment
The goal of modern treatment is to achieve remission or low disease activity and prevent joint destruction. In mild cases, they begin with non-steroidal anti-inflammatory drugs and, if necessary, local administration of a glucocorticosteroid. If the process is active, the rheumatologist prescribes basic therapy, and if it is insufficiently effective, genetically engineered biological drugs that specifically block the key components of inflammation. Treatment is selected in conjunction with a dermatologist to simultaneously control the skin and joints. Weight loss, smoking cessation and regular physical activity are of great importance: they significantly improve the response to therapy.
- Nonsteroidal anti-inflammatory drugs
- Local injections of glucocorticosteroids
- Basic therapy under the supervision of a rheumatologist
- Genetically engineered biological drugs with active disease
- Joint management with a dermatologist
- Losing weight and quitting smoking
- Regular physical therapy
- Control of cardiovascular risk factors