Psoriatic arthritis

When the skin flakes and the joints hurt

Pain in the joints torments sufferers.

(Bild: stock.adobe.com/pikselstock)

Severe pain, swollen joints, scaly patches - this is what everyday life is like for many people with psoriatic arthritis. Modern therapeutic approaches can often noticeably alleviate symptoms, allowing sufferers to benefit from a significant improvement in their quality of life. 

Psoriasis has always been a dreaded disease. The red, scaly patches on the skin and dandruff on the head are a major cosmetic problem. The result is social isolation. In addition, the condition is often accompanied by joint and back pain, swollen joints and tendon and muscle complaints, as rheumatologist Dr. Thomas Schwingenschlögl reports.

The combination (= psoriatic arthritis) has been known for more than 200 years. Joint inflammation occurs in up to 50% of people with psoriasis, especially when there are severe skin changes and the fingernails and toenails are affected. This is only possible if the immune system is disturbed, which is referred to as an autoimmune disease. Internal organs such as the intestines, kidneys or eyes are also affected by the inflammation.

See a specialist quickly if you have the following symptoms:

• Joint inflammation: Mostly in the finger and toe joints. The large joints of the legs such as the knees, hips, ankles or tarsal joints are also frequently affected. They are swollen, reddened, hot, sensitive to pressure and very painful. If left untreated, the joints become deformed and stiff.
• Dactylitis: In contrast to other rheumatic diseases, an entire finger or toe is often swollen like a sausage (sausage finger, sausage toe).
• Infestation of the spine manifests itself as deep-seated low back pain, pain at rest when lying down and pronounced morning stiffness.

• Inflammation of soft tissue (enthesitis): inflammation of the tendon insertions, e.g. on the heel bone, Achilles tendon, sternum, pelvic bone or ear cartilage. Many describe migrating muscle and connective tissue pain all over the body.
• The skin: Psoriasis can manifest itself in all forms, from mild cases with individual patches on the head or navel to a full-body infestation.
• Finger and toe nails are almost always affected (pits the size of a pinhead, whitish to yellowish-brown shiny spots in the nail - so-called oil spots).

The immune system turns against the body
In some patients, there are also changes in the eyes such as conjunctivitis or iritis, inflammation of the urinary tract or intestines. High inflammation values (erythrocyte sedimentation rate, CRP) are conspicuous in blood tests. The rheumatoid factor itself is usually negative. However, the genetic marker HLA-B27 can be detected in many cases. If psoriatic arthritis is not treated in time, severe joint deformities and permanent pain occur.

A rapid diagnosis and the immediate start of effective treatment are therefore particularly important. The cause of psoriatic arthritis is a disorder of the immune system, which is overactive and turns against its own body. This triggers inflammation in the joints and spine.

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

The red, itchy areas are often a cosmetic problem.

(Bild: stock.adobe.com/irina_g)

In particular, the development of modern substances that directly block the inflammatory messenger substances of our immune system has led to a revolution in therapy. These new agents are known as "biologics". They can be administered either as an infusion or subcutaneously, i.e. injected under the skin.

Biologics usually lead to a halt in inflammation and joint destruction. Those affected are often pain-free after a short time. At the same time, there is also a significant improvement or even disappearance of the psoriasis. The rheumatologist selects the most suitable preparation for the patient.