| Psoriatic skin disease is a relatively common condition | | | | with psoriasis. A clinician should always be suspicious |
| for which the treatments are somewhat unpleasant | | | | of the possibility of psoriatic arthritis in any patient with |
| and not entirely effective. It is known that an arthritic | | | | psoriasis who presents with a musculoskeletal |
| syndrome is associated with this skin disorder but | | | | complain, particularly if it involves the end finger joints |
| even then the diagnosis may be missed when patients | | | | or they have back pain which appears inflammatory. |
| with psoriasis present with joint signs. There are many | | | | The ESR (erythrocyte sedimentation rate) and the |
| effects from psoriatic arthritis on the joints and the | | | | CRP (C-reactive protein) blood tests are routine |
| arthritic damage can lead to disability and | | | | investigations and both can be elevated in |
| compromised quality of life. In the United Kingdom the | | | | inflammatory conditions. If a joint condition is suspected |
| prevalence of psoriasis itself is around 2%, with 14% of | | | | and there are no signs of psoriasis it is wise to |
| this number exhibiting some signs of involvement in | | | | carefully check the person's body for hidden signs of |
| their joints. | | | | psoriatic skin lesions to exclude this highly genetic |
| Even before the skin condition becomes obvious there | | | | condition. |
| can be signs of joint involvement in around fifteen | | | | Typically 30% of people diagnosed with this condition |
| percent of sufferers and even without joint | | | | will suffer with non-progressive disease in a few |
| involvement soft tissues can show changes which are | | | | affected joints. This presentation is usually effectively |
| typical in the arthritis. Rheumatoid arthritis sufferers | | | | treated with steroid injections into the joints as required |
| typically have a greater number of joints affected than | | | | and by symptomatic management. Identifying this |
| in psoriatic arthritis, with perhaps a similar pattern | | | | group initially is important to exclude those with worse |
| presentation and in some examples only one or two | | | | disease who are likely to show increased inflammatory |
| joints are involved. The most involved anatomical | | | | blood markers, to be male, to have a larger number of |
| areas are the entheses, which are the connections | | | | affected joints and to have used steroids previously. If |
| between the bones and the ligaments and tendons. | | | | showing these negative factors they are more likely to |
| The Achilles tendon is the largest enthesis in the body | | | | develop damaging disease to the joints with increased |
| and commonly affected by inflammatory changes and | | | | disability and a reduction in their quality of life. |
| pain. | | | | Psoriatic arthritis sufferers have benefited less from |
| There are a large number of entheses in the body and | | | | research and development that those who have other |
| these may be responsible for the more widely spread | | | | major arthritic conditions but over the last ten years |
| symptoms which can occur without joints being | | | | there has been a large increase in investigations |
| involved. There can be individual finger swelling with or | | | | concerning this disease. Development of the recent |
| without changes in other joints and this is a negative | | | | biological treatment agents has stimulated new |
| indication for disease progression. Back pain or | | | | treatment methods. Despite this there is still a lack of |
| inflammatory spondylitis can be similar to that of | | | | evidence for treatments and when to apply them. |
| ankylosing spondylitis and the symptoms are worse | | | | Research and development in rheumatoid arthritis has |
| with resting and better with exercising, significant | | | | historically been well ahead of that for psoriatic arthritis |
| stiffness in the early mornings, a slow and gradual | | | | but this picture is changing quickly with large numbers |
| onset and pain worse at night. About 30% of patients | | | | of published papers over the last ten years. The |
| can have anatomical back changes without pain or | | | | instigation of the biological treatment drugs has also |
| problems and involvement of the nails and distal finger | | | | encouraged new diagnostic and treatment options. We |
| joints in the disease occurs also. | | | | have however not achieved clear treatment protocols |
| As people get older they increasingly complain of joint | | | | or good evidence for some treatments. |
| problems so it is easy to miss the signs in a person | | | | |