psoriatic arthritis
   HOME

TheInfoList



OR:

Psoriatic arthritis (PsA) is a long-term
inflammatory arthritis Inflammatory arthritis is a group of diseases which includes: rheumatoid arthritis, psoriatic arthropathy, inflammatory bowel disease, adult-onset Still's disease, scleroderma, juvenile idiopathic arthritis, and systemic lupus erythematosus (SLE). ...
that may occur in some people affected by the autoimmune disease
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
. The classic features of psoriatic arthritis include dactylitis (sausage-like swelling of the fingers), skin lesions, and nail lesions. Lesions of the nails may include small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin lesions consistent with
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
(e.g., red, scaly, and itchy plaques) frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy.
Genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinians, Augustinian ...
are thought to be strongly involved in the development of psoriatic arthritis.
Obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
and certain forms of psoriasis are thought to increase the risk. Psoriatic arthritis affects up to 30% of people with psoriasis. It occurs in both children and adults. Some people with PsA never get psoriasis. The condition is less common in people of Asian or African descent. It affects men and women equally.


Signs and symptoms

The signs and symptoms of psoriatic arthritis are very variable from one individual to the next. Symptoms usually appear after age 30.


Peripheral joints

The majority of patients with PsA experience peripheral joint involvement. Pain, swelling, or stiffness in one or more joints is commonly present in psoriatic arthritis. Psoriatic arthritis is inflammatory, and affected joints are generally red or warm to the touch. Asymmetrical oligoarthritis, defined as inflammation affecting two to four joints during the first six months of disease, is present in 70% of cases. However, in 15% of cases, the arthritis is symmetrical. The joints of the hand that are involved in psoriasis are the proximal interphalangeal, the distal interphalangeal, the metacarpophalangeal joint, and the wrist. Involvement of the distal interphalangeal joints is a characteristic feature in many cases. Sausage-like swelling in the fingers or toes, known as dactylitis, occurs in about 40% of PsA cases. PsA may cause shoulder pain, most commonly felt in the front of the shoulder or the upper part of the arm. It is usually felt when moving the arm and may only be noticed in certain movements. In addition, many people find it painful when lying on the sore side in bed at night.


Axial skeleton (spine)

Approximately 25–70% of PsA patients have inflammation of the axial skeleton. There are also post inflammatory changes. Axial pain can occur in the area of the sacrum (the lower back, above the tailbone), as a result of sacroiliitis or spondylitis, which is present in 40% of cases. The inflammatory pain in the axial skeleton is worse in the early hours of the day. The pain is not relieved by resting, but rather by movement. The pain may be located in only part of the spine or sacroiliac joints, and may radiate to the legs down to the level of the back of the knee. It may be on both sides or only one side. There may also be stiffness and reduction of mobility in the spine. There are no symptoms in 20% of people with axial involvement. Over time, the spine may undergo ankylosis.


Nails

Nail psoriasis (also termed psoriatic onychopathy) occurs in 80 to 90% of PsA cases. When PsA affects the finger joints, usually the distal interphalageal joint is involved, which is the joint closest to the nail. The changes in the nails may only be very minimal, such as minor pits of the nail surface. The nails may be discolored (e.g., "oil spots"). There may be subungual (under the nail)
hyperkeratosis Hyperkeratosis is thickening of the stratum corneum (the outermost layer of the epidermis, or skin), often associated with the presence of an abnormal quantity of keratin,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins & Cotran Pathol ...
. The nail may separate from the nail bed, which is termed onycholysis.


Psoriasis (skin)

Psoriasis classically presents with scaly skin lesions, which are most commonly seen over extensor surfaces such as the scalp, natal cleft, and umbilicus. Plaque-like psoriasis (''psoriasis vulgaris'') is the most frequent type of psoriasis in persons with PsA, but other types of psoriasis skin lesions are possible. 20-30% of people with psoriasis develop PsA.


Enthesitis

Enthesitis is inflammation of an enthesis (the site where a tendon or ligament attaches to a bone). In PsA, enthesitis most often occurs at the attachment of the calcaneal tendon (Achilles tendon). It may also occur at the epicondyles of the elbow, plantar fascia, tendon of the
quadriceps The quadriceps femoris muscle (, also called the quadriceps extensor, quadriceps or quads) is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the sole extensor muscle of the knee, forming a large ...
muscle, patella (knee bone), iliac crest (part of the hip), rotator cuff attachment, or supraspinatus attachment. Enthesitis is sometimes considered as a hallmark sign of PsA. Sometimes it may appear before any other sign of PsA or be the only sign of the disease. The same person may have multiple sites with enthesitis. Overall, enthesitis occurs in 42% of people with PsA. However, this figure varies significantly from 6% to 72% in reports. Enthesitis in PsA is associated with more active disease and the coexistence of fibromyalgia. Enthesitis, if present, may cause pain over a wider area around the joint. Pain can also occur in and around the feet and ankles, especially if there is enthesitis in the Achilles tendon or plantar fasciitis in the sole of the foot.


Fatigue

Severe
fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...
is present in approximately 30% of patients with PsA. It is sometimes described as extreme exhaustion that does not go away with adequate rest. The fatigue may be caused directly by the disease itself, or be a secondary effect of other factors. Poor sleep quality is common among people with psoriatic arthritis.


Psychological

PsA is associated with
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
and depression. People with the condition may have reduced participation in social activity and become socially isolated.


Pattern of disease activity

Psoriatic arthritis may remain mild or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission. In severe forms, psoriatic arthritis may progress to arthritis mutilans which on X-ray gives a "pencil-in-cup" appearance.


Complications

Rare complications are uveitis in one or both eyes, slightly higher risk of heart conditions, and increased risk of
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...
and of non-alcoholic fatty liver disease (NAFLD). Other potential comorbidities which may occur together with PsA include
hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
(high blood pressure),
obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
,
diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
, metabolic syndrome,
cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
, fibromyalgia,
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk. It is the most common reason f ...
, and infections. While people with psoriasis have a slightly increased risk of
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
(especially lymphoma and keratinocyte cancer), there is very limited evidence available about any possible link between PsA and cancer. From available evidence, there does not appear to be any increased risk of cancer, apart perhaps from breast cancer.


Causes

Psoriatic arthritis is an inheritable polygenic disease, with many genes known or theorized to contribute to its clinical presentation (or lack thereof). When someone with the genes for psoriatic arthritis comes into contact with certain substances, these substances may induce an autoimmune reaction, causing the
immune system The immune system is a network of biological systems that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to bacteria, as well as Tumor immunology, cancer cells, Parasitic worm, parasitic ...
to target normal tissues in the body. The exact strength, location, and clinical effects of this reaction depend on which genes are involved for each individual. The substance that triggers the reaction is typically not known. Genomic analysis has identified several genes involved in some patients, notably genes related to class I MHC including HLA-B*08, HLA-B*27, HLA-B*38, and HLA-B*39. Other genes relating to the immune system and central tolerance may also be involved, such as interleukin receptor genes. Thematically, these genes are often those that identify human tissues as normal and healthy, or the genes in immune cells designed to recognize those identifiers. In the case of psoriatic arthritis, the genes targeting immune cells are overexpressed, which leads to an increase in the recruitment of phagocytic neutrophils present in psoriatic skin lesions, hereby increasing inflammation and phagocytosis of healthy cells. If the genes are functioning abnormally, then the immune system has a higher risk of attacking normal tissues. Bone cells such as osteoclasts are theorized to be involved in patients with psoriatic arthritis, in contrast to most people with psoriasis whose bone cells are not significantly involved in the disease.


HLA-B27

Approximately 40–50% of individuals with psoriatic arthritis have the HLA-B27
genotype The genotype of an organism is its complete set of genetic material. Genotype can also be used to refer to the alleles or variants an individual carries in a particular gene or genetic location. The number of alleles an individual can have in a ...
. Whilst the incidence of psoriatic arthritis is significantly higher among people positive for HLA-B27 (compared to the overall population), the vast majority of people with HLA-B27 will not have psoriatic arthritis. For instance in the US HLA-B27 incidence is 6-8%, whilst psoriatic arthritis incidence has been estimated at 0.06–0.25%.


Risk factors

Health and environmental factors known to be associated with psoriatic arthritis include: * Current, or history of, severe psoriasis * Disease of the finger/toenails *
Obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
* Tissue trauma, or deep lesions associated with sites of trauma * Smoking. * Alcohol.


Diagnosis

There is no definitive test to diagnose psoriatic arthritis. Several classification criteria have been proposed, but they have wide variability. A rheumatologist (a physician specializing in autoimmune diseases) may use physical examinations, health history, blood tests, and X-rays to accurately diagnose psoriatic arthritis. Factors that contribute to a diagnosis of psoriatic arthritis include the following: * Psoriasis in the patient, or a family history of psoriasis or psoriatic arthritis. * A negative test result for rheumatoid factor, a blood factor associated with rheumatoid arthritis. * Arthritis symptoms in the distal interphalangeal articulations of hand (the joints closest to the tips of the fingers). This is not typical of rheumatoid arthritis. * Ridging or pitting of fingernails or toenails ( onycholysis), which is associated with psoriasis and psoriatic arthritis. * Radiologic images demonstrating degenerative joint damage. Other symptoms that are more typical of psoriatic arthritis than other forms of arthritis include enthesitis (inflammation in the
Achilles tendon The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcane ...
(at the back of the heel) or the plantar fascia (bottom of the feet)), and dactylitis (sausage-like swelling of the fingers or toes). Enthesitis also occurs in axial spondyloarthritis.


Imaging

File:Psoriatic arthritis digit ar1934-2.gif, T2-weighted MRI ( sagittal) of
index finger The index finger (also referred to as forefinger, first finger, second finger, pointer finger, trigger finger, digitus secundus, digitus II, and many other terms) is the second digit of a human hand. It is located between the thumb and the m ...
in PsA (mutilans form) showing probable erosion (increased signal) at base of the middle phalanx (long thin arrow), synovitis at the proximal interphalangeal joint (long thick arrow), soft tissue edema (short thick arrow), and diffuse bone edema (short thin arrows) of the proximal phalanx. File:Psoriatic arthritis dactylitis ar1934-4.gif, T1 weighted axial MRIs of the fingers in PsA. (a) Pre- and (b) post-contrast showing dactylitis due to
flexor In anatomy, flexor is a muscle that contracts to perform flexion (from the Latin verb ''flectere'', to bend), a movement that decreases the angle between the bones converging at a joint. For example, one's elbow joint flexes when one brin ...
tenosynovitis at the second finger with enhancement and thickening of the tendon sheath (large arrow), and synovitis at proximal interphalangeal joint (small arrow). File:Psoriatic arthritis spine ar1934-6.gif, (a) T1-weighted and (b) STIR MRI of
lumbar In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm (anatomy), diaphragm and the sacrum. Naming and location The lumbar region is sometimes referred to as the lowe ...
and lower
thoracic The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main ...
spine in PsA showing active inflammation at several levels (arrows),
anterior Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...
spondylitis at L1/L2, and an inflammatory Andersson lesion at the upper vertebral endplate of L3. File:Sacroiliitis MRI ar1934-5.gif, T1-weighted semi-coronal MRI of sacroiliac joints (a) before and (b) after contrast showing active sacroiliitis (arrow). File:Psoriatic arthritis fingers ar1934-1.gif, Coronal T1-weighted MRI of fingers in PsA. (a) Pre- and (b) post-contrast showing active synovitis at proximal and distal interphalangeal joints (large arrows), joint space narrowing, bone proliferation at proximal interphalangeal joint, erosions at distal interphalangeal joint (white circle), enthesitis medial to proximal interphalangeal joints. File:Psoriatic arthritis ankle ar1934-3.gif, (a) STIR Sagittal MRI of ankle showing enthesitis at
Achilles tendon The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcane ...
insertion (thick arrow), synovitis of ankle joint (long thin arrow), and bone marrow edema at tendon insertion (short thin arrow). T1 weighted images, before (b) and after (c) contrast show enthesitis (large arrow) and bone erosion at tendon insertion (short thin arrows).


Differential diagnosis

Several conditions can mimic the clinical presentation of psoriatic arthritis including
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
,
osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...
, reactive arthritis, gouty arthritis, systemic lupus erythematosus, and
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine ...
-associated arthritis. In contrast to psoriatic arthritis, rheumatoid arthritis tends to affect the proximal joints (e.g., the metacarpophalangeal joints), involves a greater number of joints than psoriatic arthritis, and affects them symmetrically. Involvement of the spinal joints is more suggestive of psoriatic arthritis than rheumatoid arthritis. Rheumatoid factor (RF) and cyclic citrullinated peptide autoantibodies are typically found in the blood of people with RA, but not, as a rule, in those with PsA. Comorbidities may help differential diagnosis. Osteoarthritis shares certain clinical features with psoriatic arthritis such as its tendency to affect multiple distal joints in an asymmetric pattern. Unlike psoriatic arthritis, osteoarthritis does not typically involve inflammation of the sacroiliac joint. Psoriatic arthritis sometimes affects only one joint and is sometimes confused for gout or pseudogout when this happens.


Classification

PsA itself may be classified both as a type of arthropathy (a condition affecting the joints) and as a type of spondyloarthritis / spondyloarthropathy (inflammation of the joints in the spine). There are five main types of psoriatic arthritis: * Oligoarticular: This type affects around 70% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves fewer than 3 joints. * Polyarticular: This type accounts for around 25% of cases, and affects five or more joints on both sides of the body simultaneously. This type is most similar to
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
and is disabling in around 50% of all cases. * Arthritis mutilans (): Affects less than 5% of patients and is a severe, deforming, and destructive arthritis. This condition can progress over months or years causing severe joint damage. Arthritis mutilans has also been called chronic absorptive arthritis and may be seen in
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...
. * Spondyloarthritis (): This type is characterized by stiffness of the neck or the sacroiliac joint of the spine, but can also affect the hands and feet, in a similar fashion to symmetric arthritis. * Distal interphalangeal predominant (): This type of psoriatic arthritis is found in about 5% of patients and is characterized by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail damage is often marked.


Management

Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended. The underlying process in psoriatic arthritis is
inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
; therefore, treatments are directed at reducing and controlling
inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
. The first-line initial treatment for most patients is a TNF inhibitor-type biological disease-modifying anti-rheumatic drug (DMARD). The goal of treatment is to achieve minimal or low disease activity. The criteria for minimal disease activity is meeting five of these seven criteria and low disease activity/remission is achieved when all seven criteria are fulfilled: (1) tender joint count ≤1, (2) tender entheseal joints ≤1, (3) swollen joint count ≤1, (4) PASI ≤1 or BSA ≤3%, (5) patient pain VAS ≤15, (6) patient global disease activity VAS ≤20, (7) HAQ ≤0.5.


Biological DMARDs

Biologics (also called biological response modifiers) are a class of therapeutics developed using
recombinant DNA Recombinant DNA (rDNA) molecules are DNA molecules formed by laboratory methods of genetic recombination (such as molecular cloning) that bring together genetic material from multiple sources, creating sequences that would not otherwise be fo ...
technology. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDs that affect the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion. Biologics prescribed for psoriatic arthritis are TNF-α inhibitors, including
infliximab Infliximab, a chimeric monoclonal antibody, sold under the brand name Remicade among others, is a medication used to treat a number of autoimmune diseases. This includes Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing ...
, etanercept, golimumab, certolizumab pegol and adalimumab, as well as the IL-12/ IL-23 inhibitor
ustekinumab Ustekinumab, sold under the brand name Stelara among others, is a monoclonal antibody medication used for the treatment of Crohn's disease, ulcerative colitis, Psoriasis, plaque psoriasis and psoriatic arthritis, targeting both IL-12 and IL-23. ...
, the IL-17A inhibitor secukinumab, and the IL-23 inhibitor risankizumab. Biologics may increase the risk of minor and serious infections. More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer. People with psoriasis who are treated with biologics do not have a higher risk of cancer.


Nonsteroidal anti-inflammatory drugs

Typically the medications first prescribed for psoriatic arthritis are NSAIDs such as
ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes dysmenorrhea, painful menstrual periods, migraines, and rheumatoid arthritis. It can be taken oral administration, ...
and naproxen, followed by more potent NSAIDs like diclofenac, indomethacin, and etodolac. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding. Coxibs ( COX-2 inhibitors) e.g. celecoxib or etoricoxib, are associated with a statistically significant 50 to 66% relative risk reduction in gastrointestinal ulcers and bleeding complications compared to traditional NSAIDs, but carry an increased rate of cardiovascular events such as
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...
(MI) or heart attack, and
stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
. Both COX-2 inhibitors and other non-selective NSAIDs have potential adverse effects that include damage to the kidneys.


Conventional synthetic disease-modifying antirheumatic drugs

Oral small molecules such as methotrexate, leflunomide, cyclosporin, azathioprine, and sulfasalazine are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps slow down or halt the progression of the disease, and therefore limit the amount of joint damage that occurs. Most DMARDs act slowly and may take weeks or even months to take full effect. According to a recent Cochrane review, low dose oral methotrexate was slightly more effective than placebos. Immunosuppressant drugs can also reduce psoriasis skin symptoms but can lead to liver and kidney problems and an increased risk of serious infection.


Phosphodiesterase-4 inhibitors

A first-in-class treatment option for the management of psoriatic arthritis is apremilast, a small molecule phosphodiesterase-4 inhibitor approved for use by the FDA in 2014. By inhibiting PDE4, an enzyme that breaks down cyclic adenosine monophosphate, cAMP levels rise, resulting in the down-regulation of various pro-inflammatory factors including TNF-α, interleukin 17 and interleukin 23, as well as the up-regulation of anti-inflammatory factor interleukin 10. It is given in tablet form and taken by mouth. Side effects include headaches, back pain, nausea, diarrhea, fatigue, nasopharyngitis, and upper respiratory tract infections, as well as depression and weight loss. It was patented in 2014 and manufactured by
Celgene Celgene Corporation, headquartered in Summit, New Jersey, was a pharmaceutical company that produced cancer and immunology drugs. Its primary products were Revlimid (lenalidomide), which is used in the treatment of multiple myeloma (63% of 2018 r ...
. There is no current generic equivalent available on the market.


JAK inhibitors

The JAK1 inhibitors tofacitinib (Xeljanz) and upadacitinib (Rinvoq) are approved for the use in active psoriatic arthritis. The TYK2 inhibitor deucravacitinib (Sotyktu), which has been approved for plaque psoriasis, is currently undergoing a Phase II clinical trial to evaluate the efficacy and safety on psoriatic arthritis. The Takeda TYK2 inhibitor TAK-279 recently demonstrated a 20% improvement in signs and symptoms of disease at week 12 as compared to placebo in a Phase II clinical trial. Takeda has also initiated a Phase III, Multicenter, Randomized, trial to evaluate the efficacy and safety of TAK-279 in subjects with Moderate-to-Severe Plaque Psoriasis.


Other treatments

A review found tentative evidence of benefit of low level laser therapy and concluded that it could be considered for relief of pain and stiffness associated RA. Photochemotherapy with methoxsalen and long-wave ultraviolet light ( PUVA therapy) are used for severe skin lesions. Doctors may use joint injections with
corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...
s in cases where one joint is severely affected. In psoriatic arthritis patients with severe joint damage orthopedic surgery may be implemented to correct joint destruction, usually with the use of a
joint replacement Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pai ...
. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.


Management of fatigue

Changes in lifestyle may help manage fatigue.


Prognosis

The condition can be disabling, severely decreasing physical health. People with PsA may have reduced ability to work. Psychological health may also be decreased as a result of chronic pain, anxiety, depression, and reduced self esteem. As a result, quality of life may also be significantly reduced. Some of the possible comorbidities (conditions which may occur together with PsA) may reduce life span.


Epidemiology

A 2024 systematic review reported the global
prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of adults with PsA as 0.112% (112 per 100 000 adults). Reported prevalence ranges from 0.1 to 1% of the general population. The reason for the wide variation is possibly related to different genetics, environmental factors such as lifestyle and diet, and the methods used in the research (e.g., definition and method of detection). The disease is more common in some populations. In Europe, the prevalence is 0.188% (188 per 100,000), 0.048% (48 per 100,000) in Asia, 0.133% (133 per 100,000) in North America, and 0.017% (17 per 100,000) in South America. Other studies found an overall prevalence rate of 0.1-0.2%, and an incidence rate of 0.006% annually. Males and females are affected in equal proportion. The peak incidence (number of new cases) happens between the ages of 30 and 60. 70% of people who develop psoriatic arthritis first show signs of
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
on the skin, 15% develop skin psoriasis and arthritis at the same time, and 15% develop skin psoriasis following the onset of psoriatic arthritis. Some people with PsA never get psoriasis. Psoriatic arthritis can develop in people who have any level severity of psoriatic skin disease, ranging from mild to very severe. Studies have found that obesity is a significant risk factor and predictor of disease outcome. Other risk factors associated with an increased risk of developing psoriatic arthritis include severe psoriasis, nail psoriasis, scalp psoriasis, inverse psoriasis, and having a first-degree relative with psoriatic arthritis. Psoriatic arthritis tends to appear about 10 years after the first signs of
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
. For the majority of people, this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults. More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterized by nail pitting, separation of the nail from the underlying nail bed, ridging and cracking, or more extremely, loss of the nail itself ( onycholysis). Men and women are equally affected by this condition. Like psoriasis, psoriatic arthritis is more common among Caucasians than African or Asian people.


Prevention

Some progress has been made in preventing patients with psoriasis from developing psoriatic arthritis. However, once psoriatic arthritis is established, the inflammatory burden of psoriatic disease might not be susceptible to modulation in many patients.


References


External links


Psoriatic Arthritis
at Patient.info
Guidelines of care for the management of psoriasis and psoriatic arthritis
€” National Guideline Clearinghouse
US National Institute of Arthritis and Musculoskeletal and Skin Diseases
{{Authority control Arthritis Autoimmune diseases Psoriasis Rheumatology