Besides their fame, what do Ted Danson, Kim Kardashian and golfer Phil Mickelson have in common? The answer is psoriatic arthritis (PsA), a debilitating type of arthritis whose symptoms include joint pain, stiffness, and swelling.
The condition is somewhat similar to rheumatoid arthritis (RA) in that both conditions result from the immune system accidentally attacking one’s body, which leads to many of those same symptoms. But while those suffering from RA experience pain and stiffness in smaller joints in symmetrical fashion (on both sides of the body), those with PsA might feel it in random distribution (their right elbow and left hip, lower back and one of the shoulders, etc.).
Both are considered chronic diseases but PsA more often tends to present in “flares”; that is, symptoms can come and go with little or no warning, sometimes with gaps of several weeks or even months before recurring. The flares can be especially problematic, as a patient can feel much better and “healthier” when the symptoms vanish – only to make their return doubly disappointing.
However, that recurrence can be helpful in reaching a PsA diagnosis. If something one thought was tendinitis or plantar fasciitis keeps coming back for no obvious reason (more than a couple of times a year), chances that they have PsA increase.
What causes PsA is also mysterious. In addition to genetic predisposition, theories range from environmental factors like pollution to added stress or major changes in one’s diet.
One of the symptoms that differentiates PsA from RA (and other inflammatory arthritides) most drastically is called dactylitis – a swelling of tendons and joints in fingers and toes that can result in those digits looking similar to sausages (“sausage fingers/toes”).
Once PsA is suspected, a number of tests can be run to determine if it in fact is present. These can include a blood test; those with RA typically have a protein called rheumatoid factor in their blood, while those with PsA usually do not. X-rays and MRIs can also reveal more inflammation in the joints and in the areas where ligaments and tendons attach to the bone (enthesitis), confirming a case of PsA. There is also one’s genetic history to consider; a family history of PsA or skin psoriasis can play a significant role.
It should be noted that, despite the term “psoriatic arthritis,” one does not necessarily need to have both skin psoriasis and arthritis at the same time or at the same severity. In fact, only about 30% of people with psoriasis will ever develop psoriatic arthritis.
As far as treating PsA goes, it unfortunately is not a “curable” disease. However, symptoms can be controlled through nonbiologic (chemical-based) medications ranging from ibuprofen and naproxen to methotrexate and sulfasalazine, and biologic medications (human -made proteins derived from living organisms) such as infliximab, adalimumab, ixekizumab and secukinumab. On average, it can take three to five months before PsA symptoms are significantly lessened, though one can feel at least partial relief within three to six weeks.
I have seen more patients coming in with what turns out to be PsA – but whether that’s due to an actual rise in the disease, or the fact that advances in science make it easier to diagnose than ever before, remains an open question.
My best advice is to pay attention to the above symptoms, and their frequency. If you think you may have it, see a physician as quickly as you can.