Psoriatic arthritis - inflammatory joint disease in psoriasis
Psoriatic arthritis is an inflammatory joint disease caused by psoriasis. Find out all about the symptoms, causes, diagnosis and modern treatment strategies here.
Things worth knowing about "Psoriatic arthritis"
Psoriatic arthritis is an inflammatory joint disease caused by psoriasis. Find out all about the symptoms, causes, diagnosis and modern treatment strategies here.
Psoriatic arthritis (PsA) is a chronic inflammatory joint disease that occurs in conjunction with psoriasis. It belongs to the group of spondyloarthritides and occurs in around 20-30% of people with psoriasis. PsA not only affects the skin, but also joints, tendons, spine and internal organs. If left untreated, it can lead to permanent joint damage.
Symptoms
The symptoms are varied and similar to those of other inflammatory joint diseases:
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Joint pain and swelling, often asymmetrical
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Morning stiffness (longer than 30 minutes)
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Tendonitis (enthesitis), e.g. Achilles tendon or plantar fascia
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Swelling of entire fingers or toes (dactylitis) - so-called ""sausage fingers""
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Nail changes (spotted or crumbling nails)
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Skin symptoms of psoriasis: Scaly, inflamed patches of skin, usually on the elbows, knees or scalp
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In some cases: Eye inflammation (uveitis) or intestinal involvement
PsA usually progresses in phases, but can also be chronic and progressive.
Causes and risk factors
The exact cause is not fully understood. Psoriatic arthritis is caused by an interplay of genetic, immunological and environmental factors.
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Genetic predisposition (e.g. HLA-B27)
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Immune system dysregulation, in particular overactive T-cell responses
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Trigger factors: Infections, skin injuries, stress, smoking, obesity
Diagnosis
The diagnosis is based on:
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Anamnesis and clinical examination
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Imaging (X-ray, MRI, ultrasound) to visualise joint changes
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Lab values: Inflammatory markers (CRP, ESR), exclusion of other autoimmune diseases (e.g. rheumatoid factor negative)
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CASPAR criteria for classification
Therapy
The treatment aims to inhibit inflammation, relieve pain and protect the joints.
Medication therapy:
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NSAR (e.g. ibuprofen, diclofenac) for mild cases
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Basic therapeutics (DMARDs): e.g. methotrexate, leflunomide
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Biologics: TNF inhibitors (e.g. etanercept, adalimumab), IL-17 or IL-23 inhibitors
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JAK inhibitors in case of insufficient response to other therapies
Non-drug measures:
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Physiotherapy and occupational therapy to maintain joint function
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Weight reduction, exercise, stress management
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Change in diet (e.g. low-inflammatory, Mediterranean diet)
Prognosis and progression
With early diagnosis and targeted therapy, good disease control is possible. If left untreated, there is a risk of permanent joint damage and functional impairment.
Literature references:
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Ritchlin, C. T. et al. (2017). ""Psoriatic Arthritis-From Pathogenesis to Therapy."" New England Journal of Medicine.
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German Society for Rheumatology (DGRh) (2022). ""S2k guideline psoriatic arthritis.""
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Robert Koch Institute (2023). ""Chronic inflammatory diseases - psoriasis and PsA.""
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