Psoriatic arthritis can develop in individuals who have psoriasis, affecting various joints, especially the knees. Psoriasis is a skin condition that causes skin cells to build up and form patches of itchy, dry skin known as plaques. Psoriatic arthritis is a long-term inflammatory disease that can cause inflammation, stiffness, and pain. Symptoms can progressively worsen over time without treatment. Early diagnosis is vital to minimize damage to the joints and slow the condition’s progress with treatment.

Psoriatic Arthritis

Psoriatic arthritis symptoms like stiffness and swelling can present differently from person to person. For example, some individuals with psoriatic knee arthritis will experience stiffness or pain in one knee, while others experience symptoms in both knees. Psoriatic arthritis in the knee can also cause swelling in the surrounding:

• Ligaments
• Tendons
• Synovial membranes
• Symptoms can also present in the:
• Elbows
• Feet
• Hands

Symptoms

Symptoms usually begin between the ages of 30 and 50. Common symptoms include:

• Stiffness after resting or sleeping.
• Swelling.
• Inflammation in the knee and surrounding area.
• Warm or hot skin on the knee from the inflammation.
• Pain in and around the joints, tendons, or ligaments.
• Joint sticking, difficulty moving, or reduced range of motion.

Other symptoms include:

• Back pain
• Fatigue
• Pain and redness in the eyes
• Swollen fingers or toes
• Difficulty walking from pain in the feet or Achilles tendon.
• Nail pitting or separation.

The severity of psoriasis does not determine psoriatic arthritis symptoms. Symptoms can go through a pattern of relapses and remissions. Individuals can have a sudden attack where symptoms get worse over a short time. After the flare-up, symptoms can improve as the condition goes into remission. Symptoms may not present for a long time until another flare-up. For example, an individual may have severe psoriasis but only mild psoriatic arthritis.

Causes

Psoriatic arthritis develops when the body’s immune system mistakenly attacks healthy cells and tissues. The faulty immune response causes the body to quickly generate new skin cells that stack on top of each other forming plaques. When the condition affects the joints, it leads to inflammation. While there is no apparent cause for psoriatic arthritis, researchers have found connections to genetics and the environment, as well as, individuals with close relatives that have psoriatic arthritis could be more likely to develop the condition. Other factors that could influence the development include:

• Severe psoriasis
• Traumatic injury/s
• Obesity
• Nail disease
• Smoking

The condition can happen at any age, but according to the National Psoriasis Foundation, most individuals first notice symptoms about ten years after their psoriasis begins. However, only 30% of individuals with psoriasis develop psoriatic arthritis.

Diagnosis

Doctors use imaging tools to diagnose psoriatic arthritis in the knee. They will use:

• MRI
• X-rays
• Ultrasound
• To help them check for irregularities or signs of inflammation in the joint and surrounding tissues.
• Additional tests are used to rule out other common forms of arthritis like rheumatoid and osteoarthritis.
• Blood tests check for inflammation and specific antibodies.
• In some cases, a small amount of fluid from the joint is taken to help eliminate the possibility of other underlying conditions like an infection.

Treatment

There is currently no cure for psoriatic arthritis, but treatments are being developed and show promise for long-term management. Current treatments focus on managing symptoms and improving the quality of life for the individual.

Biologics

Biologic medications like tumor necrosis factor or TNF inhibitors are recommended as the first-line therapy for most individuals with a new diagnosis of psoriatic arthritis. These meds help block TNF, which plays a crucial role in inflammation. They have shown to be effective at reducing the severity of symptoms and the frequency of flare-ups. Biologics can cause unwanted side effects, especially in individuals that experience frequent infections and need routine monitoring.

Small Molecule Medications

Individuals that cannot use biologic medications may be recommended a new class of medication called oral small molecules or OSMs. Examples include apremilast – Otezla and tofacitinib – Xeljanz.

Disease-modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs – DMARDs are a long-term option. They are used to slow the progression of psoriatic arthritis, and examples include methotrexate and cyclosporine. DMARDs work best when an individual begins taking them as early as they can take time to work. However, individuals are encouraged to continue taking them, even if symptoms do not improve right away.

Easing Inflammation

A doctor may prescribe nonsteroidal anti-inflammatory drugs – NSAIDs and corticosteroid injections when knee symptoms flare-up. These are short-term treatments that provide immediate relief, as long-term use can lead to side effects. Individuals can find relief with combined self-care that includes:

• Taking over-the-counter NSAIDs like ibuprofen/Advil or naproxen/Aleve.
• Applying ice and heat packs.
• Gentle exercise to promote a full range of motion.
• Gentle stretching or yoga can help relax tight muscles.
• Chiropractic.
• Acupuncture.
• Therapeutic Massage.
• Anti-inflammatory diet.
• Electrical stimulation.

Chiropractic treatment can help to:

• Relieve soreness.
• Prevent muscle spasms.
• Realign joints.
• Improve mobility.

However, chiropractic is not the primary treatment for arthritis but is intended to be used in combination to relieve pain, loosen and stretch the muscles and balance the body.

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InBody

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Strength, Balance, and Improved Body Composition

Functional fitness is the ability to move comfortably every day. The benefits of physical activity also contribute to improved body composition. Working to reach a certain level of functional fitness can help the aging process that has been shown to reduce metabolic rate. Inactivity is why individuals lose Lean Body Mass as they age, leading to increased body fat. Lean Body Mass contributes to the body’s overall Basal Metabolic Rate or BMR, also known as metabolism. This is the number of calories the body needs to support essential functions. Everyone is encouraged to engage in strength training or resistance exercises, but specifically older adults. This can help regain muscle loss which can lead to an increase in lean body mass. The increase in Lean Body Mass increases BMR, which helps prevent fat gain.

References

Chang, K. L., et al. (2015). Chronic pain management: Nonpharmacological therapies for chronic pain [Abstract]. www.ncbi.nlm.nih.gov/pubmed/25970869

Chiropractic care for arthritis. (n.d.). arthritis.org/health-wellness/treatment/complementary-therapies/physical-therapies/chiropractic-care-for-arthritis

Chiropractic: In-depth. (2019). nccih.nih.gov/health/chiropractic-in-depth

How to achieve remission in psoriatic arthritis. (n.d.). arthritis.org/diseases/more-about/how-to-achieve-remission-in-psoriatic-arthritis

Living with psoriatic arthritis. (n.d.). psoriasis.org/living-with-psoriatic-arthritis/

Sankowski, A. J., et al. (2013). Psoriatic arthritis. www.ncbi.nlm.nih.gov/pmc/articles/PMC3596149/