PsA doesn’t affect everyone in the same way.
Psoriatic arthritis, or PsA, is an inflammatory type of arthritis, which sets it apart from the more traditional and well-known osteoarthritis. PsA is a chronic and autoimmune disease, meaning it’s caused by an overactive immune system that attacks healthy, normal cells in the body.
With PsA, “your joints get enlarged and restricted and stiff, and there’s inflammation in the joint space, as opposed to a bone-on-bone arthritis, or osteoarthritis, where you lose the joint space,” says Nicola Kim Berman, MD, a rheumatologist based in New York. (Learn more about symptoms of psoriatic arthritis here.)
PsA can be categorized into different types based on which joints are affected, but the types aren’t necessarily distinct. “It is possible to have multiple types of psoriatic arthritis,” says Dr. Berman. “At different points in time, you could have swelling of your knee, and then you could have back pain, and then, later on, you could develop some pain in your hands—or it could present similarly at the same time.”
There are seven main types of psoriatic arthritis:
Distal psoriatic arthritis primarily affects the distal joints, which are the last joints at the ends of fingers and toes. People with this type of PsA are likely to experience nail changes in their fingernails and toenails.
Dactylitis is the swelling of small joints and tendons that affect individual fingers or toes.
Symmetric psoriatic arthritis affects joints on both sides of the body. For example, if you are having joint pain in your right wrist, you probably have it in your left wrist, too. This is the most common type of PsA and accounts for about half of PsA diagnoses.
Asymmetric psoriatic arthritis (also called oligoarticular PsA) does not equally affect both sides of the body. You might have joint pain in your right wrist but not your left wrist. This is another common type of PsA and accounts for about 35 percent of PsA diagnoses.
Enthesis causes inflammation in ligaments and tendons, most commonly the Achilles tendon.
Spondylitis causes pain and stiffness in the spinal column: the spine, neck, lower back, and sacroiliac joints (which connect the spine to the hips). Spondylitis affects 20 percent of people with PsA. If inflammation goes untreated, psoriatic spondylitis can progress to ankylosing spondylitis—when the vertebrae fuse together and the spnie becomes immobile.
Arthritis mutilans is the most severe type of PsA, but it’s also less common: It accounts for just 5 percent of PsA diagnoses. This type of PsA causes damage and deformities to the joints, especially the fingers and toes. “That’s a rapidly destructive form of arthritis that leads to deformities quite quickly,” says Dr. Berman.
Treating PsA takes several factors into account, including the type of PsA. For example, since some types are more severe—such as arthritis mutilans—they may require more aggressive treatment options.
“There’s been a lot of advances in psoriatic arthritis, and our ability to treat these conditions has very much so changed for the better in the last couple of years,” says Dr. Berman. “There’s a very promising trajectory for our treatments for psoriatic arthritis.”
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What's interesting about psoriatic
arthritis is it can mimic almost all
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other forms in all different patterns.
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And that's how we sort of break down
the type of psoriatic arthritis that
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Symptoms of psoriatic arthritis
are inflammatory arthritis.
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People will present with
swelling of their joints, and
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there'll be pain with
moving your joints as well.
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This can involve any joint in the body,
most commonly it involves your
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distal interphalangeal joints,
which are the tips of your hands.
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People with psoriatic arthritis can also
present with something called dactylitis,
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it's swelling of the entire digit.
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It can involve your small joints as well,
and it can mimic rheumatoid arthritis.
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You can also develop what we
call an oligoarticular pattern.
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It just involved sort of
one joint like your knee.
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They can also present with pain at
the insertion site of tendons called
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It most commonly is found in the Achilles
tendon where it inserts down into the base
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of the ankle.
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They can present with foot pain.
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These patients will have pain in their
toes as well as the base of their heel.
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Where you can get little calcaneal spurs,
and those are quite painful.
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Any involvement of your spine usually
indicates a more severe state.
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The area that your sacrum and iliac crest
connect called your sacroiliac joints.
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And those are commonly involved
in psoriatic arthritis.
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The other way that it can present is with
something called arthritis mutilans.
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That's a rapidly destructive form of
arthritis that leads to deformities quite
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It is possible to have multiple
types of psoriatic arthritis.
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At different points in time you could
have swelling of your knee, and
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then you could have back pain.
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And then later on you could
develop some pain in your hands or
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it could present similarly
at the same time.
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I think it really important to have
a good understand of your condition.
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I think it's very important to have
a good relationship with your doctor.
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And understand when you need to seek help.
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Classification of psoriatic arthritis. Portland, OR: National Psoriasis Foundation. (Accessed on May 15, 2019 at https://www.psoriasis.org/psoriatic-arthritis/classification-of-psoriatic-arthritis.)
Overview of psoriatic arthritis. Van Nuys, CA: Spondylitis Association of America. (Accessed on May 15, 2019 at https://www.spondylitis.org/Psoriatic-Arthritis.)What Is psoriatic arthritis? Atlanta, GA: Arthritis Foundation. (Accessed on May 15, 2019 at https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/what-is-psoriatic-arthritis.php.)