A breakdown of PsA: Identifying the five categories of Psoriatic Arthritis

A breakdown of PsA: Identifying the five categories of Psoriatic Arthritis

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Skin's not the only thing that suffers with psoriasis – you might also develop psoriatic arthritis (PsA). Here's the lowdown on the five different types, their symptoms, and potential treatments.

PsA may be a relative of psoriasis, but they're distinct entities. Psoriasis is a chronic skin condition marked by red, scaly skin, while PsA typically manifests as joint pain. It's possible to have one without the other, but if you've got PsA, knowing your type can steer you towards the right treatment. Let's delve into the five main types and their treatment tips:

The Five Varieties of Psoriatic Arthritis

PsA impacts around 20 to 30 percent of people with psoriasis. Here's a rundown on the five types:

1. Asymmetric Psoriatic Arthritis: Accounting for at least 60 percent of cases, this common form affects joints individually instead of in pairs. Men seem to be more prone to this variant[1].
2. Symmetric Psoriatic Arthritis: Affecting smaller joints such as the hands and feet, this type typically impacts joints simultaneously on both sides of the body[1]. Women are more susceptible.
3. Distal Interphalangeal Predominant (DIP) Psoriatic Arthritis: This form targets the DIP joints, which are located near the tips of fingers and toes. It can manifest in a single joint or many[1].
4. Spondylitis Psoriatic Arthritis: Affecting roughly 7 to 32 percent of people with PsA, this type primarily targets the joints between vertebrae[1].
5. Psoriatic Arthritis Mutilans: Rare and severe, this form affects around 5 percent of people with PsA. It causes substantial discomfort, usually in the hands, feet, or wrists[1].

There are certain indicators that can help identify the type you have, but your doctor will account for all symptoms when making a diagnosis.

Recognizing Asymmetric Psoriatic Arthritis

This is the most prevalent form of PsA, striking at least 60 percent of cases. It affects individual joints rather than pairs, so you might experience joint pain in your right hand without any discomfort in the left. That being said, symptoms like knee and foot pain can co-occur[2]. According to a 2019 study, this type is more common in men[1].

Common symptoms of asymmetric PsA include:

• Fatigue
• Blurred vision
• Swollen fingers or toes
• Cracking or pitting nails
• Stiff, painful, or tender joints
• Painful ligaments or tendons

Treating Asymmetric PsA

There's no cure for PsA, but there are ways to help alleviate symptoms. Your doctor can help you determine the best course of action, which may include:

• Physical therapy
• Occupational therapy
• Oral corticosteroids (e.g., prednisone)
• Biologic drugs (e.g., adalimumab or etanercept)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen
• Intra-articular joint injections (e.g., hyaluronic acid or cortisone)

Symmetric Psoriatic Arthritis: A Closer Look

Symmetric PsA impacts both sides of the body at the same time, affecting smaller joints such as the feet or hands, rather than larger joints like the knees or elbows. Symmetrical PsA is sometimes confused with rheumatoid arthritis (RA) and can be diagnosed via blood tests[3]. It is more prevalent in women.

Treatments for symmetric PsA often parallel those for asymmetric PsA, but the ideal treatment plan may depend on additional factors:

• Age
• Weight
• Mobility
• Pain level
• Overall health

Cigarette smoking may exacerbate PsA symptoms and potentially interfere with treatment[3].

Distal Interphalangeal Predominant (DIP) Psoriatic Arthritis: Nail Troubles

Estimates suggest that about 10 percent of individuals with PsA suffer from DIP PsA. It targets DIP joints (near the tips of toes and fingers) and can result in swelling, ligament or tendon pain, and reduced range of motion[1]. It may also cause nail issues, such as:

• Swelling
• Pitting
• Discoloration
• Cracking
• Detachment
• White spots

Relieving DIP Psoriatic Arthritis

Your doctor may suggest NSAIDs or corticosteroid injections to address mild inflammation and discomfort. For more severe instances, TNF inhibitors may be utilized[2]. Home remedies, such as cold therapy (applying an ice pack for up to ten minutes), nail care, relaxation baths, and keeping your limbs dry, can provide temporary relief.

Always consult your doctor before trying an at-home PsA solution to ensure it doesn't conflict with your prescription treatments or worsen your unique symptoms.

Spondylitis Psoriatic Arthritis: Back Pain

Affecting approximately 7 to 32 percent of PsA patients, spondylitis primarily targets spinal joints, causing back and neck pain[1]. It may also affect other joints, such as the feet, hips, arms, and legs.

Addressing Spondylitis PsA

Treatment often involves:

• NSAIDs
• Physical therapy
• Occupational therapy
• Immunosuppressants
• Sulfasalazine (Azulfidine)
• Biologic medications (e.g., TNF inhibitors)
• Disease-modifying antirheumatic drugs (DMARDs)

Psoriatic Arthritis Mutilans: Severe Discomfort

PsA mutilans affects around 5 percent of PsA patients and causes extensive discomfort, primarily in the hands, feet, or wrists[1]. This severe form results in joint damage, deformities, bone loss, and reduced range of motion.

Managing Psoriatic Arthritis Mutilans

PsA mutilans requires prompt attention due to its progressive nature. Potential treatments include anti-TNF inhibitors, DMARDs, biologic medications, or etanercept (Enbrel)[4]. More research is needed to verify the effectiveness of etanercept in restoring joint function.

Wrap-up

PsA impacts up to 30 percent of people with psoriasis, and its effects can vary for each individual. Treatment plans depend on individual symptoms and other lifestyle factors, often involving a combination of medications to reduce inflammation, pain, and slow disease progression. Consult your doctor to develop the most effective treatment plan for you.

Enrichment Data:

1. Psoriatic arthritis (PsA) is a type of arthritis that affects about 20 to 30 percent of people who have psoriasis. It comes in five types, including Asymmetric PsA, Symmetric PsA, Distal Interphalangeal Predominant (DIP) PsA, Spondylitis PsA, and Psoriatic Arthritis Mutilans.
2. Asymmetric PsA is the most common type, affecting at least 60 percent of cases. It typically affects joints in an unpredictable pattern instead of symmetrically. Men are more susceptible to this form of PsA. Symptoms include swollen fingers, crumbling nails, fatigue, and blurred vision.
3. Symmetric PsA affects both sides of the body simultaneously in a symmetrical pattern. Women are more likely to experience this type of PsA. Symptoms include morning stiffness, joint inflammation, and pain in the hands, wrists, knees, and ankles.
4. Distal Interphalangeal Predominant (DIP) PsA typically affects the joints closest to the tips of the fingers and toes, causing nail changes and pain, stiffness, or swelling in the small joints.
5. Spondylitis-type PsA involves the spine and can lead to back pain and immobility. This type of PsA resembles ankylosing spondylitis.
6. Psoriatic Arthritis Mutilans is a severe and rare form of PsA that causes rapid joint destruction, leading to deformities, disability, and loss of movement or reduced range of motion.
7. Recognizing the diverse types of psoriatic arthritis (PsA) can help in choosing the appropriate treatment, as PsA is a distinct entity from psoriasis, a chronic skin condition.
8. While PsA may manifest as joint pain, there are five main types with unique characteristics: Asymmetric, Symmetric, Distal Interphalangeal Predominant (DIP), Spondylitis, and Psoriatic Arthritis Mutilans.
9. Not all types of psoriatic arthritis are gender-neutral; for instance, men are more likely to have asymmetric PsA, while women are more susceptible to symmetric PsA.
10. Health and wellness, including skin care, are crucial in managing psoriatic arthritis, as the condition is one of several chronic diseases often linked with other medical conditions like neurological disorders.
11. When seeking treatment for psoriatic arthritis, it's essential to understand that various treatments, such as physical therapy, oral and injectable medications, and home remedies, may be used depending on the type and severity of the condition.

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