Psoriatic arthritis can develop at any age, however on average it tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 50, but it can also affect children. Men and women are equally affected by this condition. In about one in seven cases the arthritis symptoms may occur before any skin involvement.
As well as causing joint inflammation, psoriatic arthritis can cause tendinitis and a sausage-like swelling of the digits known as dactylitis. Radiology will give the appearance of "fluffy, new" bone.
There are five main types of psoriatic arthritis:
The underlying process in psoriatic arthritis is inflammation, therefore treatments are directed at reducing and controlling inflammation. NSAIDs such as diclofenac and naproxen are usually the first line medication.
If acceptable control is not achieved using NSAIDs or joint injections then second line treatments with immunosuppressants such as methotrexate or leflunomide are added to the treatment regimen. An advantage of immunosuppressive treatment is that it also treats the psoriasis in addition to the arthropathy.
Recently, a new class of therapeutics developed using recombinant DNA technology called Tumor necrosis factor-alpha inhibitors have come available, for example, infliximab, etanercept, and adalimumab. These are becoming increasingly commonly used but are usually reserved for the most severe cases. As more is learned regarding the long-term safety of these biologic agents there is a trend toward earlier use to prevent irreversible joint destruction.
MRI bone oedema scores are higher in the arthritis mutilans form of psoriatic arthritis and correlate with high radiographic scores for joint damage.(Research article)(magnetic resonance imaging)(Clinical report)
Jan 06, 2009; Authors: Yu M Tan [1,2]; Mikkel Østergaard ; Anthony Doyle ; Nicola Dalbeth ; Maria Lobo ; Quentin Reeves ;...