What is psoriatic arthritis? 

Psoriatic arthritis is a chronic inflammatory arthritis which is associated with a skin condition- psoriasis(a disease that causes red patches of skin topped with silvery scales. ) .Even a mild skin psoriasis can be present with a significant degree of arthritis. Psoriatic arthritis is one of the most common  complication of psoriasis.

Joint pain, stiffness and swelling are the main features of psoriatic arthritis. It can affect any part of the body and severity can range from mild to severe. Both psoriasis and psoriatic arthritis disease have tendency of flares that can alternate with periods of remission.

Psoriatic Arthritis shares many clinical features with other Spondyloarthropathies and Rheumatoid Arthritis.

Clinical manifestations of psoriatic arthritis are varied in different individuals and may even change over time in same person.

 

Symptoms of psoriatic arthritis.

 

Both psoriatic arthritis and psoriasis are chronic  in nature. However, sometimes symptoms may temporarily get reduced or might even disappear.

Some commonly seen manifestations of psoriatic arthritis are as follows:

• joints  become painful, swollen and warm to the touch.
• Skin rash.
• sausage-like swelling of  fingers and toes.
• Foot pain, Enthesis (Achilles tendiniti, Plantar fasciitis).
• Lower back pain.
• Nails can form tiny dents (pits), crumble or separate from the nail beds.
• Tendonitis
• Fatigue
•  Extra-articular inflammatory manifestations such as uveitis or inflammatory bowel disease etc.

 

Psoriatic arthritis shares few clinical features with other inflammatory arthritis namely  rheumatoid arthritis, reactive arthritis, ankylosing spondylosis.

 

Etiology – common causes of psoriatic arthritis.

 The etiology and pathogenesis of psoriatic arthritis are not yet fully explained by researchers however they claim that disease has  a complex interaction between genetic and environmental factors, resulting in immune-mediated inflammation involving the skin, joints, and other organs.

Some environmental factors are also suspected but are not yet confirmed clinically. Recent Epidemiological studies have shown an association between streptococcal infection and recent antibiotic exposure. Skin trauma can also induce flares of psoriatic skin lesions, known as the Koebner phenomenon. Similarly joint trauma also induces a flare of arthritis, commonly referred to as the “internal” or “deep” Koebner phenomenon.

Various genetic risk factors predispose individuals to develop psoriatic arthritis. In these individuals, environmental trigger such as infections or mechanical stresses initiates a chronic inflammatory process primarily involving the joints and skin.

 

Types of psoriatic arthritis.

clinical presentation of psoriatic arthritis is varied from patient to patient. The  classification of psoriatic arthritis by Moll and Wright includes its 5 subtypes as follows :

 

Oligo articular arthritis- It is asymmetric ; involves less than five (small or large) joints.

Polyarticular arthritis- It  is usually symmetric in nature and appears similar to rheumatoid arthritis but this may involve the distal interphalangeal joints additionally rheumatoid factor is negative.

Distal arthritis- It is characterized by prominent involvement of the distal interphalangeal joints.

Arthritis mutilans – It involves severe destructive joint disease with deformities(in hands and feet).

Spondyloarthritis-it shows pattern with sacroiliitis and spondylitis.

 

CASPAR Criteria .

Today the most accepted classification criteria for psoriatic arthritis is the CASPAR criteria used by clinicians all over the world since 2006.

          

 

   Clinical Features/Characteristics/Points

 

1. Skin psoriasis: present – 2; previously present -1; family history, patient not affected – 1
2. Nail lesions: onycholysis, pitting, hyperkeratosis – 1
3. Dactylitis: present or past, documented by a rheumatologist – 1
4. Rheumatoid factor: negative by any method except for latex – 1
5. Juxta-articular bone formation: distinct from osteophytes – 1

CASPAR criteria states that psoriatic arthritis is considered present in patients with inflammatory arthritis who have at least 3 points.

 

Ayurvedic Management of psoriatic arthritis .

 

As per Ayurveda, every disease is caused by imbalance of tridoshas which further leads to involvement and vitiation of dhatus. Each individual suffering from psoriatic arthritis needs a different approach as  etiology and pathology are variable in different individuals. By adopting the holistic approach of Ayurvedic system of medicine , we can provide subjective and objective relief to individuals suffering from psoriatic arthritis.

Ayurveda management of psoriatic arthritis includes administration of internal medications, lepana therapy, panchkarma therapies like snehana, swedana, virechana, nasya, vasti, raktamokshana.

Diet and lifestyle correction is significant as psoriasis and psoriatic arthritis have high chances of relapse.

• Practice healthy dietary habits.
• Avoid over-exposure to cold, dry wind, etc.
• Take adequate rest.
•  Take healthy nutritious diet.
• Ensure adequate sleep. avoid sleeping during day.
• Exercise regularly.
• Avoid stress.
• Perform seasonal purification therapy (panchkarma)as per Ayurveda.
• Avoid sedentary lifestyle.
• Do not travel with legs hanged for long period.
• Avoid chances of trauma/ injuries.