Physical Therapy in Grapevine for Ankle Issues
Welcome to Grapevine Physical Therapy & Sports Medicine’s guide to psoriatic arthritis.
Where does psoriatic arthritis develop?
Psoriatic arthritis can affect any joint. Its symptoms often seem like the symptoms of rheumatoid arthritis (RA) or degenerative arthritis of the spine. X-rays can be used to show the difference between psoriatic arthritis and other diseases. In psoriatic arthritis, X-rays show a very distinctive type of bone destruction around the joints as well as certain patterns of swelling in the tissues surrounding the joints.
Patients with psoriatic arthritis fall into three groups. The first group involves patients who have what is called asymmetric arthritis. This means that only a few joints are involved and that it does not occur in the same joints on both sides of the body. (For example, only one wrist and one foot are affected.)
An equal number of patients fall into the second group and suffer from symmetric polyarthritis. This means that arthritis occurs in several corresponding joints on both sides of the body. (For example, both elbows, both knees, and both hands are affected.) The polyarthritis type of psoriatic arthritis is much like RA.
A third group has mostly axial disease. This refers to arthritis of the spine, the sacroiliac joint (where the pelvis and bottom of the spine meet), or the hip and shoulder joints. Patients do not necessarily stay in the same category. Over time, the pattern may change. Doctors use these categories to better understand the disease and to follow the progression of the arthritis but the overall treatment is basically the same.
Why do I have this problem?
The exact cause of psoriatic arthritis is not known. Many factors seem to be involved in its development. Heredity plays a major role. People who are closely related to someone with psoriatic arthritis are 50 times more likely to develop the disease themselves. Recent studies have located genetic markers shared by most people who have the disease.
What does psoriatic arthritis feel like?
All people who suffer from psoriatic arthritis have psoriasis (the skin rash). Some patients have very few areas of rash while other patients have psoriasis over a large portion of their bodies. The skin lesions of psoriasis are reddish, itchy, and have silvery scales. These areas can range in size from the size of a pencil dot to large areas the size of your palm. Psoriasis usually shows up on the elbows, knees, scalp, ears, and abdomen, but it can appear anywhere. In people with psoriatic arthritis, the psoriasis most often affects fingernails or toenails. The nails may have pits or ridges, or they may be discolored or appear to be separating from the skin.
Psoriatic arthritis can affect any joint. Symptoms often seem like those of any other type of arthritis, such as joint swelling and pain. Some joint symptoms are unique to psoriatic arthritis:
How do health care professionals identify the condition?
A detailed medical history with questions about psoriasis in your family, will help your healthcare professional make a diagnosis. Patients with psoriasis may have other forms of arthritis, and the symptoms of psoriatic arthritis often look like other types of joint disease. This means that your doctor will probably do tests to rule out other diseases.
Blood studies will help rule out RA. (The RA test is usually not positive in patients with psoriatic arthritis.) Efforts are being made to find ways to identify psoriatic arthritis through a blood test. The presence of specific biologic elements called biomarkers (biologic evidence of disease) would make it possible to look for evidence of this disease before it progresses, or even before it starts. Psoriatic arthritis is common in people who test positive for HIV, the AIDS virus. As a precaution, your doctor may test your blood for HIV, especially if your symptoms are severe.
Physicians must also use other diagnostic tools such as X-rays, ultrasonography, and Magnetic Resonance Imaging (MRIs) in order to definitively diagnose psoriatic arthritis. Each one of these tests provides a little different information. For example, X-rays of affected joints will be studied both to rule out other diseases and to identify characteristics of psoriatic arthritis.
Ultrasonography, the use of sound waves to create a picture of what's going on inside, provides a better look at the whole package: bones, joints, and soft tissues. This diagnostic test is also noninvasive and does not expose the patient to any radiation. Ultrasound also has the ability to show small changes in the nails and early signs of inflammation in tendons and small joints.
MRIs can show bone marrow edema, tenosynovitis and early joint erosion. Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. Unfortunately reliability is a problem with MRIs because what one examiner sees may not be the same as another observer. Changes in the small joints of the hands and feet don't show up well on MRIs like they do with ultrasonography.
Until blood studies are able to find biomarkers indicating the presence of psoriatic arthritis, physicians will have to continue to use a combination of different tests to diagnose the problem. The information these tests provide is important in determining treatment.
What can be done for the condition?
Dealing with psoriatic arthritis involves treating both the skin lesions and the joint pain. Many lotions and creams are made for skin affected by psoriasis.
Treatment of arthritis symptoms depends on which joints are affected and the severity of the disease.
The first drugs most doctors prescribe are nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and ibuprofen are NSAIDs, as are many prescription pain relievers. Other medications known as disease-modifying antirheumatic drugs (DMARDs) are used in patients with high levels of pain or particularly bad arthritis. These medications work in different ways to regulate the immune system and thereby control the arthritis.
Infliximab is a type of disease-modifying medication in a class called anti-tumor necrosis factor (TNF) agents. The anti-TNF agents are a special type of antibody referred to as human monoclonal antibodies. They specifically target (and inhibit) tumor necrosis factor. Tumor necrosis factor (TNF) promotes the inflammatory response, which in turn causes many of the clinical problems associated with autoimmune disorders such as rheumatoid arthritis.
Oral medications (pills taken by mouth) are under investigation and might be available in the future for the treatment psoriatic arthritis. These include ustekinumab, apremilast, and tofacitinib. Each of these medications works in a slightly different way to regulate the immune system.
Doctors will sometimes prescribe a combination of drugs. Cortisone injections into sore joints can also help relieve pain. Surgery may be called for in the rare cases of unmanageable pain or loss of joint function.
Treatment for psoriatic arthritis at Grapevine Physical Therapy & Sports Medicine can assist the management of your disease alongside the use of your prescribed medications. Physical Therapy cannot cure your disease, but it can assist in managing your pain and preventing a decline in your joints due to the disease process. Physical Therapy will focus on the effects of psoriatic arthritis on your joints rather than the skin lesions that are part of the disease.
Portions of this document copyright MMG, LLC.
Grapevine Physical Therapy & Sports Medicine provides services for Physical Therapy in Grapevine.