Psoriatic Arthritis

What Is Psoriatic Arthritis?

Psoriatic Arthritis is a chronic inflammatory condition of the joints associated with psoriasis (a skin-related auto-immune disease).  It commonly affects the feet and ankles, and is characterized by swelling of the toes and feet, changes to the toe nails, and skin rashes on the feet.  The joints in the toes, feet and ankle may also become stiff and painful.

Like Rheumatoid Arthritis, it is an inflammatory disorder with an auto-immune component, meaning that it occurs when our immune system starts fighting healthy cells.  Because both conditions involve chronic inflammation in the joints, the symptoms and presentation are often similar.  

About 30% of people with psoriasis develop psoriatic arthritis. Usually people develop psoriasis before psoriatic arthritis, but sometimes the arthritic symptoms may present before the disease starts affecting the skin.

What Are The Signs Of Psoriatic Arthritis?

Some of the common symptoms of Psoriatic Arthritis in the feet are:

• Pain, swelling and stiffness in the joints of the feet and ankle.  This can be in both feet or isolated to one. 
• Sausage-like swelling in the toes (called dactylitis).  The rest of the foot may also swell.
• Heel pain: This occurs due to inflammation of the achilles’ tendon, which connects our heel bone to our calf muscles. 
• Pain on the sole of the foot, similar to plantar fasciitis.
• Discoloration, pitting (small depressions), thickening or detachment of the toenails from the nail bed (psoriatic onychodystrophy or “psoriatic nails”):  These symptoms occur more frequently in elderly psoriatic arthritis patients. 
• Extreme exhaustion lasting days or weeks that does not go away with adequate rest. 
• Redness or warmth in affected joints
• Red or purple raised scaly patches or lesions on the skin of the feet.  These lesions are characteristic of psoriasis and also present elsewhere on the body in psoriasis patients. 
• Symptoms may occur intermittently in “flare-ups”, which alternates with periods of inactivity (referred to as “remission”).

What Causes Psoriatic Arthritis?

Psoriatic Arthritis is secondary to, and often preceded by Psoriasis.  Both are auto-immune diseases where the body’s immune system becomes overactive and starts attacking healthy cells – in Psoriasis, the body attacks skin cells; in Psoriatic Arthritis it attacks the joints. The body’s immune system responds by producing inflammation in the affected areas, which then produces joint pain and stiffness, and can damage the surrounding muscle and tissue.  

The exact cause of psoriatic arthritis is unknown.  There is believed to be a strong genetic component that either causes or predisposes a person to developing Psoriasis and Psoriatic Arthritis.  There is also evidence that infection or trauma can be a contributing factor, because both of these trigger the body’s immune system. 

Psoriatic arthritis cannot be cured, but it can be effectively managed and treated.  Some of these treatment options include:

• Splinting or bracing:  A chiropodist can splint or brace the affected joints (i.e.: the toes or ankle), which immobilizes it and helps reduce pain and inflammation.
• Proper footwear and orthotics that relieve pressure on the affected areas and promote healthy biomechanics:  These will reduce the strain and burden on the affected joints, which in turn reduces frequency and intensity of disease flare-ups.
• Physical and Occupational Therapy:  This will strengthen the affected muscles and make movement easier.  Strong muscles alleviate strain on the joints, which can mitigate any damaging effects of the disease on the joints. Click here for strengthening and wellness tips specific to psoriatic arthritis, from Healthline.com.  You can also check out our stretching series for ways you can strengthen the muscles in your feet and ankles at home.
• Medication:  There are various medication options, mostly falling into two categories:
  • Anti-inflammatory medication:  As the name suggests, these medications reduce inflammation, which reduces stiffness and allows the joints to move easier.  Examples are: Aspirin, Ibuprofen and Naproxen.  Sometimes, corticosteroids are prescribed or injected.
  • Anti-Rheumatic medication:  These medications are designed to suppress the immune system and target the auto-immune response that causes the disease.

What Puts Me At Risk For Psoriatic Arthritis?

Risk factors for developing Psoriatic Arthritis are:

• Psoriasis
• Family History of skin or joint disease
• Human Immunodeficiency Virus (HIV) infection – the correlation between psoriatic arthritis and HIV still being researched. 

There is evidence that infection or trauma may contribute to the disease, but this is yet to be determined. 

How Can I Prevent Psoriatic Arthritis?

There is no known way to prevent psoriatic arthritis. In psoriasis patients, risk factors can be mitigated with overall healthy lifestyle habits, like regular exercise, strengthening the muscles in your feet and ankles, and a balanced diet.