Psoriatic Arthritis

What is Psoriatic Arthritis?

Psoriatic arthritis is a chronic autoimmune condition in Singapore that affects the joints and is often associated with psoriasis, a skin disorder characterised by red, scaly patches. This condition arises when the immune system mistakenly attacks healthy joint cells and tissues, leading to inflammation, pain, and swelling in various joints.

Psoriatic arthritis can manifest in different forms, affecting small and large joints and sometimes even the spine. Not everyone with psoriatic arthritis will have visible skin symptoms, and joint problems can precede or coincide with skin issues. The severity of psoriatic arthritis varies from mild discomfort to severe joint damage, potentially causing disability.

What causes Psoriatic Arthritis?

Psoriatic arthritis is an autoimmune condition in which the body’s immune system,  which typically protects the body from external threats like viruses and bacteria, mistakenly attacks the body’s healthy tissues and joints. This autoimmune response leads to inflammation and swelling of the joints.

The exact causes of psoriatic arthritis are not fully understood, but is believed to be a complex interplay of genetic, immune and environmental  factors. It is important to note that while these factors are associated with the development of psoriatic arthritis, however not everyone with psoriasis or genetic predisposition will develop the condition. The exact mechanisms and triggers may vary among individuals.

What are the symptoms of Psoriatic Arthritis?

Psoriatic arthritis can manifest in various ways, and its symptoms vary from person to person. The severity and specific joints affected may also differ. Common symptoms of psoriatic arthritis include:

• Joint pain: persistent joint pain, often characterised by aching, swelling, and tenderness. The pain can affect one or multiple joints and may worsen with movement or activity.
• Swollen joints: inflamed joints can become swollen and tender, making it difficult to perform everyday tasks.
• Joint stiffness: joint stiffness, particularly in the morning or after periods of inactivity, can last several minutes to hours.
• Skin changes: many individuals with psoriatic arthritis have psoriasis, and skin symptoms may include red, scaly patches of skin, often with silvery scales. These skin lesions can be itchy and painful.
• Nail changes: nail changes, such as pitting (small dents or depressions), discolouration, and nail separation from the nail bed.
• Enthesitis: enthesitis, is an inflammation where tendons or ligaments attach to bones, resulting in pain and swelling at attachment sites, often in areas like the heels (Achilles tendon), knees, or elbows.
• Dactylitis: dactylitis, also known as "sausage fingers" or "sausage toes," is the swelling of an entire finger or toe.
• Fatigue: chronic inflammation and pain can lead to fatigue.
• Eye inflammation: some individuals may experience eye inflammation (uveitis or conjunctivitis), leading to redness, pain, and vision problems.
• Back pain: psoriatic arthritis can affect the spine, leading to lower back pain and stiffness. This is often seen in a subset of psoriatic arthritis called spondylitis.

Psoriatic arthritis symptoms come and go, with flare-ups and remission periods. If you suspect you have psoriatic arthritis or are experiencing joint pain and have psoriasis, make an appointment with Asia Arthritis Rheumatology Clinic today.

Is Psoriatic Arthritis painful?

Yes, joint pain and discomfort are common and often the most prominent symptoms of psoriatic arthritis. The pain varies in intensity and may be described as aching, throbbing, or sharp. It can affect one or multiple joints, including the fingers, wrists, elbows, toes, ankles,  knees, hips, and spine.

Who is at risk of Psoriatic Arthritis?

Psoriatic arthritis is not limited to a specific group of people; certain factors can increase the risk of developing the condition. These risk factors include:

• Family history: Psoriatic arthritis tends to run in families. About 40% of people with psoriatic arthritis have a family member with the condition. And close relatives of people with psoriatic arthritis are about 55 times more likely to develop the disease than an unrelated person.
• Psoriasis: psoriasis, a skin condition characterised by abnormal skin cell growth and inflammation, often precedes or coexists with psoriatic arthritis. While not everyone with psoriasis develops psoriatic arthritis, having psoriasis is a significant risk factor. It is estimated that approximately 10% to 40% of people with psoriasis will go on to develop psoriatic arthritis.
• Genetics: there is a strong genetic component to psoriatic arthritis. Certain genes, particularly those within the human leukocyte antigen (HLA) group, are associated with an increased risk of Psoriatic arthritis. These genes, such as HLA-B27 and specific variations within the HLA-C gene, have been associated with an increased susceptibility.
• Environmental triggers: environmental factors, such as infections or injuries, may trigger the onset of psoriatic arthritis in individuals genetically predisposed to the condition. Infections, particularly streptococcal throat infections, have been suggested as potential triggers. Other potential triggers include extreme stress and stressful life events.
• Obesity: obesity is associated with higher risk of developing psoriatic arthritis and can also worsen the severity of the disease in individuals who already have it.
• Age: Psoriatic arthritis can develop at any age, but it most commonly appears between the ages of 30 and 50.

How is Psoriatic Arthritis diagnosed?

The diagnosis of psoriatic arthritis involves the following:

• Medical history: a detailed medical history will be taken, including information about your symptoms when they started and whether you have a history of psoriasis or a family history of psoriatic arthritis or other autoimmune diseases. You will also be asked about any recent illnesses or injuries related to joint symptoms.
• Physical examination: a physical exam will be conducted to assess the joints, skin, nails, and any areas of pain, swelling, or tenderness. This is to look for signs of psoriasis, nail changes, and characteristic joint changes, such as dactylitis or enthesitis.
• Imaging tests: X-rays, ultrasound, or magnetic resonance imaging (MRI) scans may be ordered to assess joint damage and inflammation. These imaging studies can help confirm the diagnosis and provide information about the severity of the disease.
• Blood tests: blood tests can help to rule out other conditions and assess the degree of inflammation. These tests may include:
  • Rheumatoid factor (RF): often elevated in rheumatoid arthritis but typically not in psoriatic arthritis.
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): elevated levels may indicate inflammation in the body.
  • HLA-B27: associated with several types of spondyloarthritis, including some forms of psoriatic arthritis.
• Skin biopsy: if skin symptoms are present but not indicative of psoriasis, a skin biopsy may be performed to confirm the presence of psoriasis.

What are the treatment options for Psoriatic Arthritis in Singapore?

The treatment of psoriatic arthritis aims to reduce inflammation, alleviate pain, slows down joint damage, preserve joint function, and improve the overall quality of life. Primary treatment options for psoriatic arthritis include:

• Medications:
  •  NSAIDs:nonsteroidal anti-inflammatory drugs are helpful to reduce pain and inflammation.
  • DMARDs: disease-modifying antirheumatic drugs such as methotrexate, sulfasalazine, leflunomide and cyclosporine are often used to reduce inflammation and slow joint damage.
  • Corticosteroids: Low dose of corticosteroids like prednisolone may also be used.
  • Biologics: Other more targeted options which provide rapid disease control and slow joint damage, include Biologic therapy such as tumour necrosis factor (TNF) inhibitor, Interleukin (IL) 12/23 inhibitors, IL-17 inhibitors and Janus kinase (JAK) inhibitors.
• Physical therapy: physical and occupational therapy can improve joint function, mobility and relieve pain.
• Lifestyle modifications: lifestyle changes are important and complement medical treatment. Maintaining a healthy weight, regular exercise, and managing stress can help alleviate symptoms.
• Surgery: in severe cases of psoriatic arthritis with joint damage that does not respond to other treatments, surgical options such as joint replacement surgery (e.g., hip or knee replacement) may be considered to relieve pain and improve joint function.

Make an appointment with Asia Arthritis Rheumatology Centre where we prioritise our patient’s health by ensuring accurate diagnosis and personalised treatment.

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