Psoriatic arthritis is an autoimmune disease of the joints that occurs in some patients with psoriasis, and has its own characteristics in terms of evolution and prognosis. It is a chronic and evolutive disease irregularly throughout the life of the patient, has times of partial remissions and times of inflammation and pain. When the patient presents with psoriasis, they can not necessarily suffer from psoriatic arthritis or other autoimmune diseases.

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SYMPTOMS OF PSORIATIC ARTHRITIS:

As in most autoimmune diseases, the way psoriatic arthritis manifests itself is different in each patient, sometimes it affects other parts of the body other than the joints such as the eyes and is often confused with other rheumatoid diseases when the symptoms of the Skin psoriasis have not manifested.

Among the symptoms that usually manifest are:

1.- Pain and inflammation in the joints:

Joint pain is one of the most frequent signs that usually manifests in patients with psoriatic arthritis. Usually, this pain is located in the wrists, knees, feet, ankles and distal (which are joints that are at the end of the fingers and toes) and can spread to all joints (polyarthritis).

The process of inflammation of these joints and the pain caused by this disease is slow, that is, the area or affected areas swell progressively.

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2.-Swelling of the fingers or toes:

In psoriatic arthritis it is very frequent that one or several fingers of the hands or feet become very inflamed. The resulting aspect is as if the person had been hit very hard this symptom is known as dactylitis.

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3. Generalized pain in the body:

In psoriatic arthritis, inflammation occurs in the tendons and ligaments that are near the affected joint (this is called enthesitis). Enthesitis usually causes general pain throughout the body, because the areas where the tendons and ligaments attach to the bones are very numerous and distributed throughout the body. This symptom occurs most often in the heel (tendinitis), in the sole of the foot (plantar fasciitis), and in some cases the elbow (tendinitis of the elbow) may be present in the area.

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4.- Change in the nails:

Another symptom of this disease is manifested in the nails where small holes appear on the surface (what is known as fovea) along with some spots. Sometimes the nail can be detached from the base.

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5.- Present pain in the lower back, neck and buttocks:

In patients diagnosed with psoriatic arthritis, inflammation and pain are centered in the spine, the joints between the sternum and the beginning of the ribs or in the sacroiliac joints (upper part of the buttocks), which is part of the symptoms of psoriatic arthritis.

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6.- Rigidity in the joints:

In patients with this condition, joints tend to be stiff in the early morning hours or after a period of rest. This symptom usually occurs in patients with other musculoskeletal diagnoses, such as osteoarthritis.

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7.- Excess Fatigue:

One of the characteristics of autoimmune diseases is fatigue. Patients tend to have a high level of fatigue without having an intense lifestyle.

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Psoriatic arthritis is a systemic rheumatic disease and can not only cause inflammation in the joints or skin, but also in other body tissues such as the heart, lungs, kidneys and eyes. This is why we must take into consideration some of these symptoms when diagnosing psoriatic arthritis.

CLASSIFICATION OF PSORIATIC ARTHRITIS:

Psoriatic arthritis is classified according to the level of involvement of the joints.

1.- Symmetric Psoriatic Arthritis:

This pathology is the most common of psoriatic arthritis, affecting 35% of patients. It affects the joints of hands and feet and also large joints, especially ankle, knee and shoulder symmetrically on both sides of the body and can limit the movement and functionality of the person. The symptoms that patients present with this type of psoriatic arthritis are very similar to those of rheumatic arthritis.

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2. Asymmetric psoriatic arthritis:

It affects 70% of people so it is a type of psoriatic arthritis quite frequent. The pathology of this type of arthritis is the asymmetric inflammation that affects the different joints such as: the right elbow, the left wrist, the left knee, the right ankle, etc.

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3.- Spondylitis:

Spondylitis affects approximately 5% of patients diagnosed with psoriatic arthritis. It affects the spine, from the neck to the lower part of the back.

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4.- Predominant arthritis of the Distal Interphalangeal Articulation:

This type of psoriatic arthritis affects the small joints at the end of the fingers and also the nails, and is often confused with osteoarthritis, which is the most common arthritis and is related to age.

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5.- Mutilating Arthritis:

This type of psoriatic arthritis is one of the most rare and severe form of psoriatic arthritis. The prevalence level is low. In the case of mutilating arthritis the immune system attacks the small joints of the hands and feet until they deform.

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HOW TO DIAGNOSE PSORIATIC ARTHRITIS:

The doctor will make a diagnosis of the symptoms manifested by the person. The doctor is able to detect abnormalities in the joints such as sensitivity, inflammation, pain when moving joints, or inability to move them in their entirety. Also, look for evidence of psoriasis on the skin or changes in the nails. As well as perform some tests such as:

• X-rays, magnetic resonance imaging or ultrasound to detect changes in bones, joint tissues and cartilage.
• Blood tests to rule out other diseases, such as rheumatoid arthritis.
• Joint fluid testing to rule out gout or infectious arthritis.

TREATMENT FOR PSORIATIC ARTHRITIS:

There is no cure for psoriatic arthritis, patients who are diagnosed with this disease in conjunction with their doctor should formulate a treatment plan because if left untreated, the inflammation that accompanies psoriatic arthritis can result in joint damage. Controlling inflammation can delay or prevent joint damage. The treatment of psoriatic arthritis is focused on: reducing inflammation, relieving pain and retaining joint function.

Generally people with this type of arthritis also suffer from psoriasis. Because of this, the treatment used to treat psoriatic arthritis serves for psoriasis. The person who is diagnosed with this disease goes to the rheumatologist's office to treat arthritis, and the dermatologist to treat psoriasis.

To treat this disease are used:

• Drugs, especially non-steroidal anti-inflammatory drugs or NSAIDs, to control pain, treat skin symptoms and prevent joint damage. They work by inhibiting the production of substances called prostaglandins at the site of inflammation.

• Steroid injections to relieve inflammation: corticosteroids are synthetic forms of cortisol, a hormone produced by the body. Oral corticosteroids, such as prednisone, may be necessary to control the swelling, stiffness and pain associated with joint inflammation. However, they have less potential to affect the course of psoriatic arthritis.

• Joint replacement surgery to replace damaged joints: this is done when the joints are seriously damaged by the disease or when other treatments do not reduce the pain. The benefits include less pain and improvement in joint function.

HOW TO LIVE WITH PSORIASTIC ARTHRITIS:

In cases of psoriatic arthritis it is recommended:

• Maintain a positive attitude towards life.

• Learn everything related to the disease from reliable sources, such as the Arthritis Foundation (www.arthritis.org/espanol).

• Change the way daily tasks are performed to protect the joints.

•Keep a healthy weight.

• Find family support, friends or a therapist.

• Make lifestyle changes (managing stress with regular exercise, yoga, meditation and pleasant social activities).

• Balanced nutrition with fruits, vegetables and whole grains, low in fat and with lean protein sources.

• Rest to reduce fatigue and inflammation in acute episodes.

• Perform regular low-impact exercises to strengthen muscles and increase flexibility.

For more information visit the links:

https://www.healthline.com/health/psoriatic-arthritis
https://www.psoriasis.org/psoriatic-arthritis
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis
https://www.medicalnewstoday.com/articles/322632.php