Psoriasis arthritis deutsche rheuma liga bundesverband e. V

The "Psoriatic Arthritis – Psoriasis with Inflammation of the Joints" guidebooklet of the German Rheumatism League provides specialist information on clinical pictures and gives practical tips for everyday life.

The disease – what is psoriatic arthritis?

Psoriatic arthritis (also called psoriatic arthritis or arthritis psoriatica) is an inflammatory joint disease that occurs in ca. occurs in one third of people with psoriasis. In Germany live about two million people with psoriasis. In three out of four patients, arthritis begins after years of psoriasis; much more rarely, psoriasis and arthritis occur at the same time, or the arthritis even appears before the skin symptoms appear.

Psoriatic arthritis can occur at any age, usually between 35 and 55 years of age. Men and women are affected with approximately the same frequency. The disease runs chronically and in phases, periods with strong inflammation of the joints alternate with periods with less inflammatory activity.

The causes – how does psoriatic arthritis develop??

Psoriatic arthritis is an autoimmune disease. This means cells of the immune system, which is supposed to ward off diseases, attack their own body. Why this happens is not clear.

Possibly viruses or bacteria trigger the defense reaction. However, this has not been proven. The disease itself is not inherited, but certain risk characteristics are. If someone in the family has been diagnosed with psoriatic arthritis, the risk of contracting the disease increases significantly.

Symptoms of psoriatic arthritis – what are the warning signs??

People with psoriasis sometimes have large areas of silvery white scaling on various parts of the skin. The hairy head is often affected. Round depressions (spots) or yellow discolorations (oil spots) may appear on the nails. Sometimes psoriasis is hidden. Is only found on the navel or behind the ears.

The first signs of psoriatic arthritis can be very different. At first glance, the symptoms resemble rheumatoid arthritis. Many small joints are inflamed, i.e. they are painful, swollen and difficult to move. Especially in the morning the joints are stiff (morning stiffness). However, psoriatic arthritis often affects only one side of the body. Rheumatoid arthritis, on the other hand, usually affects the joints on both sides equally.

Another difference from rheumatoid arthritis is the inflammation of the finger end joints of one hand. This can lead to confusion with Heberden's arthritis. In psoriatic arthritis the swelling is soft, in Heberden's arthrosis it is hard. In addition to the joints, the tendon sheaths are also affected. Their attachments to the bones are inflamed. Simultaneous inflammation of all the joints of a finger or toe and the tendons, including their attachments to the bone, leads to thickening of the entire finger or toe, known as sausage finger or sausage toe.

Psoriatic arthritis can also affect only large joints, for example the knee joints, or only the spine is affected. The disease then resembles Bekhterev's disease. In some patients the eyes are also inflamed.

Diagnosis – how does the doctor diagnose the disease??

As with all rheumatic diseases, a quick diagnosis is very important. The physician makes the diagnosis based on the history of the disease with its symptoms (location and duration of joint pain and swelling, diseases in the family) and the results of the physical examination.

In contrast to rheumatoid arthritis, rheumatoid factors (certain antibodies) cannot be detected in the blood in the laboratory. The inflammatory signs such as blood cell sedimentation rate. C-reactive protein levels are elevated during an episode of joint inflammation. Both values are non-specific. Rise also with other inflammations in the body. The hereditary trait HLA-B27 can be positive, especially if the spine is involved. There is no specific laboratory test for psoriatic arthritis.

Imaging techniques (ultrasound, X-ray, magnetic resonance imaging or scintigraphy) can give clues about the stage of the disease. They show how much the disease has already affected the joint. At the beginning of the disease, however, there are often hardly any changes to be seen. With the help of imaging techniques, the doctor can also check whether a therapy is working.

The therapy – what helps against psoriatic arthritis?

Medications play an important role in the treatment of psoriatic arthritis. But an effective therapy always consists of several elements. If these are well coordinated, patients often have no complaints at all for years. Three to four out of ten patients can live as if the disease had been cured, or even one in two if diagnosed early.

1. Drug therapy

Treatment with medications has three main goals in psoriatic arthritis:

– It is designed to suppress the pain. – It should fight the inflammation. – It is to prevent the joints from being destroyed.

The so-called basic drugs prevent the destruction of the joints, and they combat the symptoms of the disease. However, they often only take effect after a start-up period that can last between six weeks and three months.

Conventional basic medications are, for example:

– Methotrexate – Leflunomide – Ciclosporin A – Sulfasalazine

These drugs keep the immune system from attacking your own body. However, they also have side effects.

The new basic drugs, known as biologics, block certain messenger substances and thus suppress inflammation. They act very quickly. Most patients tolerate them well. In the best case, these medications can completely stop both psoriasis and joint inflammation. But these drugs also have side effects. Because biologics suppress immune responses, patients are more susceptible to infections, for example.

Basic drugs can be combined. Neither group of drugs can cure the disease. But in some cases, symptoms stop even when patients stop taking the medication.

Drugs that are also known from other contexts help against pain. Medications such as ibuprofen or diclofenac are also used to treat headaches or toothaches. They belong to the group of cortisone-free antirheumatic drugs (NSAIDs).

Cortisone is problematic in the treatment of psoriatic arthritis. It works quickly and fights psoriasis and joint inflammation very effectively. However, this drug also has side effects. Patients gain weight, their skin changes, and they develop high blood prere, osteoporosis, or diabetes mellitus. After stopping the cortisone, the psoriasis just blossoms again. Cortisone should therefore only be given locally if necessary, for example as an injection into an inflamed joint.

2. Non-drug therapy

Medication is the most important component in the therapy of psoriatic arthritis. But there are many other ways to make life with the disease as bearable as possible for patients.

Physical therapy (or physiotherapy), for example, can help relieve pain and keep joints mobile.

Maintaining mobility is also the goal of functional training specially developed for rheumatism patients. It can take place as dry gymnastics or in warm water. Certain sports can also relieve the discomfort.

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