Common signs and symptoms of psoriatic arthritis! How to treat

What Is Psoriatic Arthritis and Who Is at Risk?

Psoriatic arthritis (PsA) is an autoimmune condition characterized by inflammation in the joints and skin. It typically develops in people who already have psoriasis, though in some cases, joint symptoms may appear before skin manifestations. Risk factors include having psoriasis (particularly with nail involvement), a family history of psoriatic arthritis, and age. The condition most commonly develops between ages 30 and 50, though it can affect people of all ages.

For seniors, the risk increases with age, and the presentation may be different. Other risk factors include certain genetic markers, particularly the HLA-B27 gene, and environmental triggers like physical trauma or infections that can activate the immune system in susceptible individuals. Obesity also appears to increase both the risk of developing psoriatic arthritis and potentially the severity of symptoms.

What Are the Most Common Signs of Psoriatic Arthritis?

The hallmark symptoms of psoriatic arthritis include joint pain, swelling, and stiffness. Unlike rheumatoid arthritis, which typically affects joints symmetrically, psoriatic arthritis often presents asymmetrically. Morning stiffness that improves with activity is common. Other frequent signs include:

• Swollen fingers and toes (dactylitis), sometimes called “sausage digits”

• Pain and swelling in the joints closest to the nails (distal interphalangeal joints)

• Lower back pain and stiffness (if the spine is affected)

• Enthesitis (inflammation where tendons and ligaments attach to bones), causing pain at sites like the heel or sole of the foot

• Fatigue and reduced energy levels

• Nail changes such as pitting, separation from the nail bed, or abnormal growth

• Red, scaly skin patches characteristic of psoriasis

These symptoms may flare periodically, with periods of increased severity alternating with periods of relative calm.

How Does Psoriatic Arthritis Specifically Affect the Hands?

Psoriatic arthritis in hands presents with distinctive characteristics that can severely impact daily activities. The condition frequently affects multiple joints in the hands, including the small joints of the fingers (proximal and distal interphalangeal joints) and the larger knuckle joints (metacarpophalangeal joints). Unlike osteoarthritis, which typically affects the joints closest to the fingertips, psoriatic arthritis can involve any joint in the hand.

Key manifestations of psoriatic arthritis in hands include:

• Swelling that gives fingers a sausage-like appearance

• Morning stiffness lasting more than 30 minutes

• Reduced grip strength and dexterity

• Nail changes, including pitting, ridging, and separation from the nail bed

• Redness and warmth in affected joints

• Development of deformities over time if left untreated

These symptoms can significantly impact functionality, making routine tasks like buttoning clothes, typing, or opening jars painful and difficult. Hand involvement often correlates with disease severity and can be among the most disabling aspects of psoriatic arthritis.

What Are the Unique Symptoms of Psoriatic Arthritis in Seniors?

Common signs of psoriatic arthritis in seniors may present differently compared to younger populations. Older adults often experience more severe joint symptoms and potentially less prominent skin manifestations. The onset might be more gradual, and symptoms could be mistaken for age-related osteoarthritis, leading to delayed diagnosis.

Seniors with psoriatic arthritis frequently report:

• Greater morning stiffness and prolonged joint pain

• More significant functional limitations in daily activities

• Higher rates of fatigue that affect overall quality of life

• Increased risk of comorbidities like cardiovascular disease and diabetes

• Potential drug interactions with medications for other age-related conditions

• More extensive involvement of larger joints like knees and hips

Additionally, seniors face unique challenges in treatment as they may have reduced tolerance for certain medications and higher risks of side effects. The psychological impact can also be profound, with increased rates of depression and anxiety related to chronic pain and reduced independence.

What Are the Current Medical Treatments for Psoriatic Arthritis?

Psoriatic arthritis treatment has evolved significantly in recent years, offering multiple approaches to manage symptoms and prevent disease progression. Treatment typically follows a personalized, step-wise approach:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first-line treatment for mild symptoms, providing pain relief and reducing inflammation. For those who don’t respond adequately to NSAIDs, disease-modifying antirheumatic drugs (DMARDs) like methotrexate may be prescribed to slow joint damage.

For moderate to severe cases, biologic medications have revolutionized treatment. These include:

• TNF inhibitors (adalimumab, etanercept, infliximab)

• IL-17 inhibitors (secukinumab, ixekizumab)

• IL-12/23 inhibitors (ustekinumab)

• JAK inhibitors (tofacitinib)

Corticosteroid injections can target specific inflamed joints for short-term relief. In advanced cases with significant joint damage, surgical interventions like joint replacement may be necessary.

The treatment landscape continues to evolve, with newer targeted therapies showing promise in clinical trials. The goal is always to achieve the lowest disease activity possible, ideally remission, while minimizing medication side effects.

What Non-Medication Approaches Help Manage Psoriatic Arthritis?

Beyond medications, several non-pharmacological approaches play vital roles in psoriatic arthritis management. Physical therapy can maintain joint mobility and strengthen supporting muscles. Occupational therapists can recommend assistive devices and techniques to protect joints during daily activities.

Regular exercise, particularly low-impact activities like swimming, walking, and cycling, helps maintain joint flexibility and muscle strength while managing weight. Proper weight management is crucial, as excess weight increases joint stress and may worsen inflammation.

Dietary considerations include:

• Mediterranean diet patterns that emphasize anti-inflammatory foods

• Omega-3 fatty acids from fish or supplements

• Limiting processed foods, sugar, and alcohol

• Avoiding potential trigger foods (individualized)

Stress management techniques such as mindfulness meditation, yoga, and deep breathing exercises can help manage flares, as stress is a known trigger for many. Hot and cold therapy provides temporary relief for painful joints. For some patients, wearing splints during flare-ups helps reduce pain and prevent deformities.

Support groups, both in-person and online, offer valuable emotional support and practical advice from others experiencing similar challenges. The combination of medical treatment and these lifestyle approaches often yields the best outcomes for psoriatic arthritis patients.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.