Insights into Psoriatic Arthritis: Understanding the Five Classifications
Living with psoriasis may also mean dealing with psoriatic arthritis (PsA). Here's a rundown of the five distinctive types, their symptoms, and potential treatment approaches.
PsA is a relative of psoriasis, but they aren't the same beast. Psoriasis is a chronic skin condition characterized by scaly, red skin, while PsA typically reveals itself through joint pain. It's possible to have both conditions or just one.
Understanding which type of PsA you have can help guide the appropriate treatment. Here's a breakdown of the main five types and some top tips for each.
What are the types of Psoriatic Arthritis?
PsA impacts about 20 to 30 percent of individuals who struggle with psoriasis. The disease comes in five types, including:
- Asymmetric PsA
- Symmetric PsA
- Distal Interphalangeal Predominant (DIP) PsA
- Spondylitis PsA
- Psoriatic Arthritis Mutilans
A quick heads-up: By recognizing the signs and symptoms of each type, you can get a better idea of what you're battling. However, your healthcare provider will consider all your symptoms to make an accurate diagnosis.
1. Asymmetric PsA
Asymmetric PsA is the most frequent type, making up 60 percent of cases. It targets joints individually rather than in pairs. This means you could experience discomfort in the joints of your right hand without your left being affected.
However, your symptoms won't always stick to one side. For instance, your left knee and right foot might exhibit symptoms at the same time. According to a 2019 study, this type of PsA is more common in males[1].
How to identify it
Typical symptoms of asymmetric PsA include:
- Fatigue
- Blurred vision
- Swollen fingers or toes
- Pitting or cracking nails
- Stiff, painful, or tender joints
- Ligament or tendon pain
How to treat it
PsA is presently incurable, but there are ways to manage it. Your doctor can help figure out the best treatment plan for you. Potential options include[2]:
- Physical therapy and occupational therapy
- Oral corticosteroids (like prednisone)
- Biologic drugs (such as adalimumab or etanercept)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen
- Intra-articular joint injections (such as hyaluronic acid or cortisone)
2. Symmetric PsA
With symmetric PsA, symptoms manifest on both sides of your body at the same time. This type represents 15 to 61 percent of cases and is more common in females[2].
How to recognize it
Symmetric PsA shares similarities with asymmetric PsA, targeting small joints like those in the feet or hands rather than larger joints such as knees or elbows. FYI: Symmetric PsA could be confused with rheumatoid arthritis (RA). A simple blood test can help distinguish the two.
How to treat it
Treatments for symmetric PsA are often similar to asymmetric PsA. The ideal treatment plan depends on factors such as:
- Age
- Weight
- Mobility
- Pain level
- Overall health
PsA PSA: Smoking cigarettes can make your PsA symptoms worse while potentially reducing the effectiveness of treatment[2].
3. Distal Interphalangeal Predominant (DIP) PsA
An estimated 10 percent of those with PsA have Distal Interphalangeal Predominant (DIP) PsA. It affects the DIP joints, found near the tips of your toes and fingers. This condition might appear in a single joint or several joints.
How to identify it
Common DIP symptoms include:
- Swollen fingers or toes
- Ligament or tendon pain
- Reduced range of motion
- Joint stiffness in fingers or toes
Nail issues are also common in DIP PsA. You might notice:
- Pitting
- Crumbling
- White spots
- Discoloration
- Nail cracking
- Detachment
How to treat it
Your healthcare provider might suggest NSAIDs or corticosteroid injections to help alleviate mild inflammation and pain. Steroids can also be injected directly into the affected joint. For more severe instances, biologic medications (such as TNF inhibitors) might be prescribed. These may slow disease progression[3].
DIY Remedies: Here are some home treatments you can try
- Apply cold therapy: Place an ice pack on the affected area for up to 10 minutes to calm inflammation.
- Take care of your nails: Avoid cutting your cuticles and refrain from applying nail polish to minimize irritation. Keep your nails moisturized with cuticle oils and creams.
- Relax and soak: Give your hands or feet a little bath. Make sure your soak isn't too long to prevent drying out your skin. Follow up with a quality moisturizer.
- Keep yourself dry: Dry your skin gently after every shower. Opt for sweat-wicking socks to pull moisture from your skin.
Remember: Consult your healthcare provider before trying home remedies to ensure they won't conflict with your prescription treatments or worsen your unique symptoms.
4. Spondylitis (Axial) PsA
Around 7 to 32 percent of those with PsA have spondylitis PsA (aka axial arthritis). This type of PsA targets the joints between your vertebrae.
How to recognize it
Spondylitis PsA can cause pain, stiffness, and swelling in your neck and back. But these symptoms can also affect your feet, hips, arms, legs, hands.
How to treat it
According to the Spondylitis Association of America, spondylitis treatments can incorporate:
- NSAIDs
- Physical therapy and occupational therapy
- Immunosuppressants
- Sulfasalazine (Azulfidine)
- Biologic medications (like TNF inhibitors)
- DMARDs
5. Psoriatic Arthritis Mutilans
PsA mutilans is a rare, severe form of PsA that affects approximately 5 percent of individuals with PsA. It typically causes intense pain, usually in the hands, feet, or wrists.
How to identify it
PsA mutilans can result in severe inflammation, which may lead to joint damage. You may experience:
- Deformities to affected joints
- Bone loss in the affected joints
- Loss of movement or reduced range of motion
- Extreme pain that radiates to other areas of the body
How to treat it
PsA mutilans is a progressive condition that can worsen over time. Treating symptoms early on is crucial. Treatments can include anti-TNF inhibitors, DMARDs, or biologic medications. A 2011 study also found that the drug etanercept (Enbrel) might help restore joint function[4]. However, further research is needed to confirm its effectiveness.
The bottom line
PsA impacts up to 30 percent of individuals with psoriasis. It's not a one-size-fits-all condition and can differ from person to person. Treatment plans depend on unique symptoms and lifestyle factors. Your doctor may recommend medications to reduce inflammation and pain while slowing disease progression.
[1] https://www.ncbi.nlm.nih.gov/pubmed/31276984
[2] https://www.ncbi.nlm.nih.gov/books/NBK459317/
[3] https://ard.bmj.com/content/72/Suppl_1/i40
[4] https://www.ncbi.nlm.nih.gov/pubmed/21010335
Enrichment Data:
Psoriatic arthritis (PsA) refers to a chronic inflammatory arthritis associated with psoriasis, manifesting in five main clinical types: asymmetric, symmetric, distal interphalangeal predominant (DIP), spondylitis, and psoriatic arthritis mutilans. Each type varies in symptoms, joint involvement, and severity, influencing treatment approaches.
Symptoms and Characteristics of Psoriatic Arthritis Types
Asymmetric Psoriatic Arthritis- Chronically impacts fewer joints, often asymmetrically- Joint pain, swelling, and stiffness usually affect large joints such as knees, ankles, and elbows- Nail involvement, such as pitting or onycholysis, is often present- Less severe than symmetric form
Symmetric Psoriatic Arthritis- Resembles rheumatoid arthritis in joint involvement- Affects multiple joints symmetrically, often small joints of the hands and feet- Joint swelling, pain, stiffness, and fatigue are common- Can lead to significant joint damage if left untreated
Distal Interphalangeal Predominant (DIP) Psoriatic Arthritis- Involves the distal interphalangeal joints, closest to the fingernails and toenails- Nail changes are frequent due to joint proximity- Symptoms include pain, swelling, and deformity of the fingertips
Spondylitis (Axial) Psoriatic Arthritis- Targets inflammation of the axial skeleton (spine and sacroiliac joints)- Symptoms include chronic back pain, stiffness, and reduced spinal mobility- Compared to ankylosing spondylitis, axial PsA has less severe back pain but more peripheral arthritis- Patients with axial PsA have more severe skin psoriasis and reduced quality of life compared to those with only peripheral disease
Psoriatic Arthritis Mutilans- A rare, severe form characterized by destructive arthritis and joint deformity- Telescoping or "opera glass" fingers from joint collapse may occur- Marked functional impairment and significant joint destruction occur- Requires aggressive treatment to prevent progression
Treatments
Treatment for psoriatic arthritis targets inflammation, symptom relief, and prevention of joint damage. It includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): For mild symptoms to reduce pain and inflammation
- Disease-Modifying Antirheumatic Drugs (DMARDs): Such as methotrexate or sulfasalazine, used for moderate to severe peripheral arthritis to slow disease progression
- Biologic therapies: Including TNF inhibitors, IL-17 inhibitors, or IL-12/23 inhibitors, especially effective for severe skin and joint symptoms, axial disease, or psoriatic arthritis mutilans
- Physical therapy and occupational therapy: To maintain joint function and mobility
- Surgery: Occasionally needed for joint replacement or correction in severe deformities, especially in arthritis mutilans
The treatment choice depends on the subtype, severity, and joint involvement pattern. For example, axial PsA may require biologics tailored for axial disease, while DIP predominant arthritis may respond differently.
- Psoriatic arthritis (PsA) impacts around 20 to 30 percent of individuals with psoriasis and presents in five types: Asymmetric, Symmetric, Distal Interphalangeal Predominant (DIP), Spondylitis, and Psoriatic Arthritis Mutilans.
- Asymmetric PsA, the most frequent type, accounts for around 60 percent of cases and targets joints individually, often affecting the joints of one hand without the other.
- Symmetric PsA, affecting 15 to 61 percent of cases, typically causes symptoms on both sides of the body simultaneously and is more common in females.
- Distal Interphalangeal Predominant (DIP) PsA affects approximately 10 percent of those with PsA and primarily targets the DIP joints found near the tips of toes and fingers.
- Spondylitis (Axial) PsA, affecting around 7 to 32 percent of individuals with PsA, targets the joints between the vertebrae and can cause pain, stiffness, and swelling in the neck, back, and other joints.
- Psoriatic Arthritis Mutilans is a rare, severe form of PsA that impacts around 5 percent of individuals with PsA and typically causes intense pain and deformities in affected joints.
- Living with psoriasis may also mean dealing with psoriatic arthritis (PsA), and treatment plans depend on unique symptoms and lifestyle factors. Treatment may include medications to reduce inflammation and pain, physical therapy, and occupational therapy, among others.
- PsA can interfere with health-and-wellness, skin-care, and overall quality of life, and chronic diseases like psoriasis and psoriatic arthritis are often associated with neurological-disorders and other skin-conditions.
