Symptoms of Psoriatic Arthritis

Psoriatic arthritis brings a lot of trouble to patients. We know that the treatment of psoriatic arthritis is prone to some complications, so we must actively treat psoriatic arthritis. Before treating psoriatic arthritis, we must first understand what psoriatic arthritis is, what are the symptoms of psoriatic arthritis, and what are the causes of psoriatic arthritis.

Only when we have a deep understanding of psoriatic arthritis can we effectively treat it. Psoriatic arthritis can be treated with general treatments, drug treatments, and surgical treatments.

1. Joints

In addition to lesions in the peripheral joints of the limbs, some cases may involve the spine. Sometimes it can turn into chronic arthritis and severe disability. Based on clinical characteristics, arthritis is divided into five types, 60% of which can be transformed into each other and exist in combination.

(1) Monoarthritis or oligoarthritis accounts for 70% of cases, mainly affecting the distal or proximal interphalangeal (toe) joints of the hands and feet. The knees, ankles, hips, and wrists may also be affected. The distribution is asymmetrical. Due to concomitant synovitis and tenosynovitis of the distal and proximal interphalangeal (toe) joints, the affected fingers (toes) may present a typical sausage-shaped appearance, often accompanied by nail lesions. About 1/3 or even 1/2 of patients with this type of disease may develop into polyarthritis.

(2) Symmetrical polyarthritis accounts for 15% of cases. The lesions are mainly located in the proximal interphalangeal (toe) joints, and may affect the distal interphalangeal (toe) joints and large joints such as the wrist, elbow, knee and ankle joints.

(3) The mutilating arthritis type accounts for about 5% and is a severe type of psoriatic arthritis. It is common in people aged 20 to 30 years. The affected fingers, metacarpals, and metatarsal bones may experience osteolysis, the knuckles often have a telescope-like "overlap" phenomenon, the joints may be ankylosing and deformed, and are often accompanied by fever and sacroiliitis. This type of skin psoriasis is often extensive and severe, and is pustular or erythrodermic.

(4) The distal interphalangeal joint type accounts for 5% to 10%. The lesions involve the distal interphalangeal joints and are typical of psoriatic arthritis, which is usually associated with psoriatic nail lesions.

(5) About 5% of the patients with the spinal disease type are older men, with spinal and sacroiliac joint lesions as the main features (often unilateral or segmental). Symptoms such as lower back pain or chest wall pain may be absent or very mild. Spondylitis manifests as the formation of ligamentous osteophytes. In severe cases, it can cause spinal fusion, sacroiliac joint blurring, joint space narrowing or even fusion. It can also affect the cervical spine and cause atlas and subaxial incomplete dislocation.

Recently, some scholars have divided psoriatic arthritis into three types: ① a monoarticular and oligoarthritis type similar to reactive arthritis with tendinitis; ② a symmetrical polyarthritis type similar to rheumatoid arthritis; ③ a spinal disease type similar to ankylosing spondylitis with axial joint lesions as the main feature (spondylitis, sacroiliitis and hip arthritis), with or without peripheral joint lesions.

2. Skin

Skin psoriasis often occurs on the scalp and extensor sides of the limbs, especially the elbows and knees, and is distributed in a scattered or widespread manner. Pay special attention to skin lesions in hidden areas, such as the hair, perineum, buttocks, and navel. It appears as papules or plaques, round or irregular in shape. There are abundant silvery-white scales on the surface. After removing the scales, a shiny film will be revealed. After removing the film, punctate bleeding can be seen. This feature is diagnostic for psoriasis. The presence of psoriasis is an important distinction from other inflammatory arthropathy, with a correlation between the severity of skin lesions and the degree of joint inflammation in 35% of patients.

3. Nail manifestations

About 80% of patients with psoriatic arthritis have nail lesions, while only 20% of psoriasis patients without arthritis have nail lesions. The most common nail lesion is thimble-like pitting. Other manifestations include nail detachment, subungual hyperkeratosis, thickening, ridges, and discoloration.

4. Others

(1) Systemic symptoms include fever, weight loss, and anemia.

(2) Systemic damage: 7% to 33% of patients have eye lesions, such as conjunctivitis, uveitis, iritis and keratitis sicca, etc.; <4% of patients have aortic valve insufficiency, which is common in the late stage of the disease. There are also cardiac hypertrophy and conduction block, and upper lung fibrosis can be seen in the lungs. The gastrointestinal tract may have inflammatory bowel disease and rare amyloid degeneration.

(3) Enthesopathy Heel pain is a manifestation of enthesitis, especially enthesopathy at the attachment sites of the Achilles tendon and plantar fascia.

The disease has an insidious onset, with about 1/3 presenting with acute attacks, and there is often no triggering factor before onset.

Above we introduced what psoriatic arthritis is. We know that psoriatic arthritis brings a lot of trouble to patients because it is prone to complications. In the treatment of psoriatic arthritis, we can use general therapy, drug therapy and surgical treatment methods. The above article introduces the symptoms of psoriatic arthritis in detail.