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August 2010
Psoriatic Arthritis
Dr.Sumit Kumar Bose
Psoriatic arthritis is an autoimmune inflammatory disorder, meaning that the cells and antibodies of the immune system are misdirected against one's own tissues. This disorder affects the skin, joints as well the tendons, ligaments, and the tissue called fascia which encloses muscles.

Skin psoriasis (a skin disease, with patches of redness and silvery scales, which show pin point bleeding when these scales are removed on scratching) is usually the starting point of this disease, though this can also occur without it. The joints of some patients with skin psoriasis could become inflammatory with arthritis. But though inflammatory and appearing like a rheumatoid disease, the usual blood tests for rheumatoid arthritis turn out negative - and hence this type is called seronegative arthritis. In this condition, resorption of bones and the consequent collapse of soft tissue, technically called arthritis mutilans, may also occur.

Be in the Know
  • The causes are unknown but genetic, environmental, immunological and vascular factors contribute to one’s predisposition to have this disease.
  • Though commonly occurring between 40 to 60 years of age, psoriatic arthritis may also erupt at any age, in a variety of clinical forms.
  • Men and women are equally affected with female predominance in rheumatoid form and male predominance in spondylitic form.
  • Skin psoriasis could be genetic in transferring – and the inheritors of these would have musculoskeletal problems.
  • Skin lesions precede arthritis in 60 to 80 percent patients.
  • Joint stiffness, while not specific, can be a prominent symptom.
  • Presence of nail psoriasis with severe skin involvement and a family history of arthritis – a deadly combination - increases the risk of arthritis
  • Psoriatic arthritis usually follows a course with flares and remission, but may also be severe enough to cause deforming arthritis.
In the absence of skin lesions, diagnosis can be difficult.
  • Your doctor will examine your joints to see if your fingers have become sausage shaped (dactylitis), reflecting inflammation of the insertion points of tendon into bone, tendonitis and spondylitis.
  • It is easy to overlook skin lesions in the belly button, the fold of the buttock and back of ears, so a careful examination of these areas is part of the protocol.
  • Different types of nail changes may be the only solitary finding in psoriatic arthritis.
  • Total body redness, scaling, patches and lesions are characteristic of psoriatic arthritis.
Disease Management
The symptoms can be eased with non-steroidal anti-inflammatory drugs, disease modifying antirheumatic drugs, and newer biological therapies. Even severe disease can now be successfully treated with medicine which works with the immune system. Do consult your doctor if you notice an inflammation of your finger joints with changes in the nails and skin.

Dr. Sumit Kumar Bose is Senior Consultant, Dermatology at Indraprastha Apollo hospital

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