What Are The Two Kinds Of Arthritis – Psoriatic arthritis (PsA) is a complex and often frustrating type of inflammatory arthritis that affects each patient differently. PsA is known to cause swelling, stiffness, redness, pain, and damage to the skin, nails, joints, etc. Although it appears similar to rheumatoid arthritis but with skin involvement due to psoriasis, psoriatic arthritis is actually a completely separate disease with its own risk factors, set of symptoms, and unique treatment options.

The majority of patients with PsA already have psoriasis when they are diagnosed with PsA; It usually develops within five to 12 years after a psoriasis diagnosis. However, about 10 to 15 percent of people experience symptoms of joint pain before psoriasis skin plaques appear, says Dafna D. Gladman, MD, FRCPC, professor of medicine at the University of Toronto, senior scientist at Krembil Research Institute and deputy. director of the Center for Prognostic Studies of Rheumatic Diseases.

What Are The Two Kinds Of Arthritis

When it comes to psoriatic arthritis, no two patients are alike. Some people with PsA may have only peripheral joint disease (in which the hands, wrists, and knees are affected by joint symptoms), while others may have only spinal involvement. vertebral. Yet other people may have both, notes Brett Smith, DO, a rheumatologist at Blount Memorial Hospital in Alcoa, Tennessee.

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“It can sometimes be difficult to completely put the puzzle together and provide a formal diagnosis,” says Dr. Smith, “however, once a diagnosis is made, many of these symptoms or disorders respond to similar treatments.”

The most effective way to get your psoriatic arthritis under control is to work with your rheumatologist to find the right combination of medications – and understanding the types and areas of psoriatic arthritis can help you get there.

There are five main types of psoriatic arthritis, classified according to the type of joint affected. People may have one type initially only to develop another type later.

Also known as asymmetric psoriatic arthritis, this type of PSA usually affects fewer than five small or large joints in your body. It’s called “asymmetric” because joint symptoms like pain and redness don’t occur on both sides of your body. You may have pain in your right knee but not your left, for example. About 35 percent of people with psoriatic arthritis have asymmetric oligoarthritis.

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As the name suggests, “symmetrical” polyarthritis affects five or more joints on both sides of your body (for example, the right and left elbows), similar to the symptoms of rheumatoid arthritis. This is the most common type of RP, occurring in about half of people with this condition.

This type of PsA affects the joints in the ends of your fingers and toes (the distal interphalangeal joints) and can cause nail changes such as staining, pitting, or separation of the nail bed. Less than 20 percent of people with PsA have only distal arthritis; it often occurs at the same time as other types of psoriatic arthritis.

This serious type of psoriatic arthritis can deform and destroy the joints of the fingers, hands, wrists and feet. Crippling arthritis prevents your bone cells from breaking down and rebuilding, which can make your fingers look like the aperture of an opera binocular (“opera glass hand”) or a telescope (“opera glass hand”). telescopic finger”). Other symptoms of mutilating arthritis include stretched, shiny, wrinkled skin on the fingers; stiffness and immobility of the joint due to fusion of the bones (ankyloses); and wear and tear on the joints and bone tissue of the feet and hands. Thanks to increasing advances in the treatment of psoriatic arthritis, mutilating arthritis is rare, occurring in less than 5% of people with PsA.

Psoriatic arthritis is considered a type of spondyloarthritis, an umbrella term for different types of arthritis with certain common features. (Ankylosing spondylitis and non-radiographic axial spondylitis are also types of spondyloarthritis, for example.) In spondylitis, people have inflammation of the joints in the spine, which can cause pain and stiffness in the joints. neck, lower back, and sacroiliac joints (located on either side of your spine). If left untreated, the vertebrae in your spine can fuse together. Your hands, feet, legs, arms and hips may also be affected. Psoriatic arthritis with axial involvement is a distinct condition that differs from ankylosing spondylitis and psoriasis at the same time, according to a new study.

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However, although these five types of psoriatic arthritis describe different presentations of the disease – and you can read them online while researching PsA – many rheumatologists no longer use them to classify PsA in patients. “We’re starting to look at people more as a whole,” says Rebecca Haberman, MD, a rheumatologist at NYU Langone. “It’s not just about your joints or your skin: psoriatic arthritis can affect any part of the body.”

To better diagnose and treat patients, experts have identified six different areas (or manifestations) that people with RP tend to experience:

Not everyone with psoriatic arthritis will experience all six areas. Each person may experience their own combination of areas that vary in severity. “Unfortunately, at this point we can’t tell you who will progress to other areas or not,” says Dr. Haberman. It is the combination and severity of these areas that influence how rheumatologists view treatment recommendations for PsA.

Peripheral arthritis tends to move from one joint to another, impacting the large joints of the arms and hands (elbows, wrists) and legs (knees, ankles). People with peripheral arthritis are more likely to develop inflammation of the toes or fingers and enthesitis (inflammation of the place where tendons or ligaments attach to bone). “Even though the swelling may go away, you may still have underlying damage to the joint, so you don’t want to ignore your symptoms,” warns Dr. Haberman.

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Also known as spondylitis or spondyloarthropathy, axial arthritis causes pain and stiffness in the joints of the spine and sacroiliac joints (lower back). Estimates for the presence of axial disease vary widely in PsA, ranging from 12 to 70 percent. “Patients with axial disease are more likely to have more severe disease overall, including more severe skin disease, but researchers aren’t sure why,” says Dr. Haberman.

Inflammation of the enthesis, where a tendon or ligament attaches to the bone, affects about half of people with psoriatic arthritis. Although there are many areas where enthesis can occur, people with RP often experience it in the Achilles tendon (heel) or plantar fascia (bottom of the feet) as well as the epicondyle (elbow). .

“Why heels and toes are more common is unknown, but one theory is that enthesitis is caused by microtrauma and these areas might be more tender,” says Dr. Haberman.

Dactylitis is a painful, red, warm swelling of an entire finger – finger or toe – not just a joint of the finger or toe. It’s often called “sausage fingers” because it can make the fingers look like sausages. For many patients, dactylitis is the first symptom of PsA. “A patient with dactylitis clearly needs to be evaluated for skin and nail disease,” says Dr. Gladman. “Sometimes the lesions are hidden in the scalp or around the anal area and are not clearly appreciated by the patient. »

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Although some studies show that people with PsA tend to have more serious skin conditions than people with psoriasis alone, you can develop PsA with only a very small area of ​​psoriasis. In other cases, where on your body you have psoriasis may indicate your risk of developing psoriatic arthritis. “Studies have shown that people with psoriasis, particularly of the scalp and nails, may be at higher risk of developing PsA,” says Dr. Gladman. Skin psoriasis associated with PsA is different from psoriasis alone; it includes signs and symptoms at the joint, axis and enthesis.

Up to 90% of people with psoriatic arthritis have nail damage, including nail pitting, chipping, spotted lunula (red spots in the white arch above the cuticle), and burst hemorrhages (spots of blood under the nail). This can include both fingernails and toenails, and it can involve one or all 20 nails, says Dr. Haberman.

Although there are clinical treatment guidelines from the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF) for better management of the disease, your personal treatment plan will depend on the impact of PsA on your body and the severity of your symptoms. .

In general, rheumatologists are advised to use a “treat to target” approach (treating patients as aggressively as necessary to achieve remission or low disease activity), which often includes prescribing RP inhibitors. tumor necrosis (anti-TNF drugs) or small oral doses. molecules (OSM).

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Beyond these guidelines, some medications have been shown to be more effective in certain areas than others. For example, conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (Trexall) and leflunomide (Arava) have been shown to work for peripheral PsA arthritis, but not for axial disease. These medications, however, are less effective for enthesitis and dactylitis, notes Dr. Gladman.

Haberman adds that new biologics called IL-17 inhibitors, such as secukinumab (Cosentyx) and ixekizumab (Taltz), may be more effective when patients have little

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