Psoriatic arthritis

Twice as painful: rheumatism and psoriasis

In psoriatic arthritis, inflammation attacks the skin and joints.

(Bild: stock.adobe.com)

First rheumatism and then problems with the skin! People who suffer from psoriatic arthritis have it twice as hard. They also struggle with aching joints, tendons and muscles. An expert explains how this happens and what treatment options are available.

Psoriasis is a dreaded condition. The red, scaly patches on the skin and dandruff on the head are a major cosmetic problem. Those affected avoid going to the bath, for example, because they are embarrassed by the skin changes. The result is social isolation. In addition, psoriasis is often accompanied by joint and back pain, swollen joints as well as tendon and muscle pain.

The immune system is disturbed
This combination of psoriasis and joint inflammation (= psoriatic arthritis) has been known for over 200 years. The cause is a disorder of our immune system, which is overactive and turns against our own body. "Joint inflammation occurs in up to 50 percent of people with psoriasis, especially if there are severe skin changes and the fingernails and toenails are affected," says Dr. Thomas Schwingenschlögl, a rheumatologist from Lower Austria.

Such a disease is only possible if the immune system is disturbed and allows inflammation in the body. This is referred to as an autoimmune disease.

Dr. Thomas Schwingenschlögl, Rheumatologe in Wiener Neudorf (NÖ)

Bild: Malena Brenek

Markers visible in the blood
In some cases, there are also changes in the eyes such as conjunctivitis or iritis, inflammation of the urinary tract or intestines. Blood tests reveal high levels of inflammation (erythrocyte sedimentation rate, CRP). The rheumatoid factor itself is usually negative, but in many cases the genetic marker HLA-B27 can be detected.

Diagnosis and treatment should be carried out quickly
If psoriatic arthritis is not treated in time, severe joint deformation and permanent pain will occur. A rapid diagnosis and the immediate start of effective treatment are therefore particularly important.

By administering so-called "basic medication", it is possible to reduce the excessive immune response. This brings the inflammation in the joints, spine and internal organs to a standstill. Pain, swelling and restricted movement subside.

Meist an Finger- und Zehen. Häufig sind auch die großen Gelenke der Beine wie Knie, Hüfte, Sprunggelenke oder Fußwurzelgelenke betroffen. Die entzündeten Bereiche sind geschwollen, gerötet, heiß, druckempfindlich und sehr schmerzhaft.

Im Gegensatz zu anderen rheumatischen Krankheiten ist oft ein ganzer Finger oder eine Zehe wurstförmig verschwollen (Wurstfinger, Wurstzehe).

Entzündliche Veränderungen an Wirbelsäule und Kreuzdarmbeingelenken äußern sich als tief sitzende Kreuzschmerzen, Beschwerden in Ruhe beim Liegen und ausgeprägte Morgensteifheit.

Charakteristisch sind diese an den Sehnenansätzen wie etwa am Fersenbein, an der Achillessehne, am Brustbein, Beckenknochen oder Ohrknorpel. Viele Betroffene schildern wandernde Muskel- und Bindegewebsschmerzen am ganzen Körper.

Die Schuppenflechte kann von milden Verläufen mit einzelnen Flecken am Kopf oder Nabel bis hin zu einem Ganzkörperbefall alle Varianten zeigen.

Finger- und Zehennägel sind so gut wie immer befallen (stecknadelkopfgroße Grübchen, weißlich bis gelblich-braune glänzende Stellen im Nagel, sog. Ölflecke).

Bei manchen Patienten finden sich auch Veränderungen an den Augen (wie Bindehaut- oder Regenbogenhautentzündungen). Harnwege oder Darm können ebenfalls betroffen sein.

Modern medication brings relief
Dr. Schwingenschlögl: "In particular, the development of modern substances that directly block the inflammatory messenger substances of the immune system - so-called biologics - has led to a revolution in therapy. They can be administered as an infusion or subcutaneously, i.e. injected under the skin, and usually lead to a complete cessation of inflammation and joint destruction. Those affected are often pain-free after a short time. At the same time, there is a significant improvement or even disappearance of the psoriasis."