Psoriatic arthritis and rheumatoid arthritis

Severe psoriatic arthritis of both feet and ankles. Note the changes to the nails. This type does not occur in the same psoriatic arthritis and rheumatoid arthritis on both sides of the body and usually only involves fewer than 3 joints.

This condition can progress over months or years causing severe joint damage. Nail changes are often marked. Pain, swelling, or stiffness in one or more joints is commonly present in psoriatic arthritis. Psoriatic arthritis is inflammatory, and affected joints are generally red or warm to the touch. In addition to affecting the joints of the hands and wrists, psoriatic arthritis may affect the fingers, nails, and skin. Psoriasis classically presents with scaly skin lesions, which are most commonly seen over extensor surfaces such as the scalp, natal cleft and umbilicus. Along with the above-noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest.

The exhaustion may last for days or weeks without abatement. Psoriatic arthritis may remain mild or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission. X-ray gives a «pencil-in-cup» appearance. Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended. There is no definitive test to diagnose psoriatic arthritis. Psoriasis in the patient, or a family history of psoriasis or psoriatic arthritis.

This is not typical of rheumatoid arthritis. Radiologic images demonstrating degenerative joint changes. Magnetic resonance images of the fingers in psoriatic arthritis. Involvement of the spinal joints is more suggestive of psoriatic arthritis than rheumatoid arthritis. Osteoarthritis shares certain clinical features with psoriatic arthritis such as its tendency to affect multiple distal joints in an asymmetric pattern. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding. Both COX-2 inhibitors and other non-selective NSAIDS have potential adverse effects that include damage to the kidneys.

These are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly and may take weeks or even months to take full effect. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDS that affect the entire immune system, biologics target specific parts of the immune system. Biologics may increase the risk of minor and serious infections.