Psoriasis is a skin disorder that causes rashes and lesions of different forms. These reactions are due to skin cells multiplying up to ten times faster than they should. Although the rashes can develop anywhere on the body, the most common locations are the lower back, elbows, knees, and scalp.
Psoriasis usually develops at around 15-35 years of age, but it can begin at any age. Symptoms of Psoriasis can vary widely depending on which type of Psoriasis someone has. The kinds of Psoriasis can manifest in small or large patches and include:
-Plaque Psoriasis: This type of Psoriasis is the most common form, appearing as the formation of thick red plaques with white or silver scales. These plaques may cause pain and itching, and may even crack or bleed. In combination, people with plaque psoriasis may develop disorders of the fingernails and toenails.
-Pustular Psoriasis: This form of Psoriasis involves red, scaly skin that includes pustules on the soles of the feet and palms of the hands.
-Guttate Psoriasis: Guttate Psoriasis often begins in childhood and is characterized by small red spots primarily on the limbs and torso. Symptoms may become aggravated by viral or bacterial infections, skin injuries, stress, or certain medications.
-Inverse Psoriasis: This variation of Psoriasis appears as shiny red lesions in folds of the skin, such as the groin, armpits, or other areas where the skin creases.
-Erythrodermic Psoriasis: The scales located on patches of Erythrodermic Psoriasis peel off and shed in sheets. This form of Psoriasis can lead to serious illness if not treated quickly and can be caused by infections, sunburns, some medications, or suddenly stopping some types of psoriasis treatment.
An exact cause of Psoriasis has not been identified, but it is theorized to be a combination of factors. Inflammation caused by an unknown issue with the immune system is ultimately at the root of the development of this skin disorder. Psoriasis is not a condition that is contagious or transmitted from one person to another, but it does commonly run in families.
Psoriatic Arthritis involves having a form of inflammatory Arthritis in combination with the skin manifestations of Psoriasis. An estimated 10-30% of those with Psoriasis will later develop this disease, but not everyone with this condition has a prior history of Psoriasis. Psoriasis precedes joint inflammation for most people who develop Psoriatic Arthritis, although it is possible to have joint issues begin before any skin symptoms appear. Psoriatic Arthritis leads to joint pain, swelling, and stiffness that can go through periods of flaring up and then subsiding. Any joint in the body can be affected, and research suggests that the resulting persistent inflammation could lead to eventual joint damage. Red skin may appear over the inflamed joints, and significant swelling and inflammation can lead to joint deformities. Another hallmark characteristic of Psoriatic Arthritis is a condition called Enthesitis, which causes tenderness at the sites where tendons and ligaments attach to bones. Children with Psoriatic Arthritis are at risk of developing Uveitis, a form of eye inflammation that can cause eye damage or permanent vision loss if not diagnosed and treated quickly.
For approximately 5% of people with this disease, their condition can develop into Arthritis Mutilans. This rare form of advanced inflammatory Arthritis begins to affect your fingers, hands, feet, and toes by causing bone loss. This bone loss leaves the surrounding tissue unsupported and can lead to permanent deformities. Fortunately, this form of progressed Arthritis is rare and can be prevented by early diagnosis and treatment of Psoriatic Arthritis.
The steps that your doctor chooses to diagnose your condition will be based on your family history, your symptoms, and a physical exam. During a physical exam, your doctor will look for visible signs of inflamed joints, assess pain and mobility of joints, check for characteristic tenderness on certain tendons, and look for skin and nail changes associated with Psoriasis.
There are a few lab tests that a doctor may use to asses the likelihood of Psoriatic Arthritis.
-Complete Blood Count (CBC): This blood test can check for anemia due to low red blood cells, heightened white blood cells indicative of inflammation, and platelet levels.
-Erythrocyte Sedimentation Rate: This test measures the rate at which red blood cells clump together and fall to the bottom of a test tube. Faster sedimentation rates directly correlate with the severity of the inflammation.
-Antibody tests: The presence of certain antibodies in the blood can indicate the presence of rheumatic and inflammatory diseases.
Along with blood testing, x-rays may be used to asses joint health and check for damage. Similarly, Magnetic Resonance Imaging (MRIs) can check the tissue surrounding the joints that x-rays do not show. Bone density scans can be done if there is suspect bone loss. An ophthalmologist can check your eyes for Uveitis and treat it if it is present.
Evaluation using the Classification of Psoriatic Arthritis (CASPAR) may also be utilized by your doctor to aid diagnosis. The symptoms go by a point system, and if your symptoms add up to at least 3 points, this is indicative of Psoriatic Arthritis. The CASPAR criteria are as follows:
Previously present= 1 point
Family history (if the patient is not affected)= 1 point
Nail Lesions (pitting, pulling away from the nail bed): 1 point
Dactylitis (swollen fingers or toes resembling sausages, whether past or present): 1 point
Negative Rheumatoid Factor (Specific blood testing for this form on blood protein was negative, which rules out the possibility of Rheumatoid Arthritis): 1 point
Juxta-articular (near a bone) bone formations that are seen on x-ray and not bone spurs: 1 point
A variety of treatment options are available for Psoriatic Arthritis. Depending on your personal needs, your doctor will tailor your treatment specifically for you. For mild forms, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may work to control symptoms. In conjunction, your doctor may prescribe a medication to prevent ulcers or other damage associated with long-term NSAID use.
For cases that can't be controlled by NSAIDs, a class of drugs called Disease-Modifying Antirheumatic Drugs (DMARDs) is the preferred next step. These drugs work to slow disease progression and can reduce pain, swelling, and damage. A newer class of DMARDs called Biologics can block a specific protein that causes inflammation.
Immunosuppressant drugs are a common alternative for patients who can't use or don't respond to DMARDs. These drugs work by to stop the autoimmune responses that cause your immune system to attack your own body as if it is similar to an infection or foreign body.
A few other available options include:
-Corticosteroids, a more potent anti-inflammatory that aids in relieving pain and swelling.
-Topical steroid creams that treat the skin rashes and lesions from Psoriasis.
-Physical therapy is used to maintain range of motion, strengthen the surrounding muscles, and prevent symptoms from returning.
-Weight loss helps the body absorb medications more efficiently and reduce undue pressure on the joints.
With proper diagnosis and a strong treatment plan, patients can often go on to live full and active lives. Many patients can achieve long-term remission of symptoms and eventually may be able to lower treatment dosages under the supervision and management of their physician.