What is Psoratic Arthritis?

In my first post, I talked about the lengthy process for diagnosis. I hope you notices, I embed many links within the post that will take to various webpages where you can get more detailed information. This is something I really wanted to know when I started this journey so I hope it helps you as well. 

After finally having diagnosis of  Psoriatic Arthritis, came a lot of question. First and foremost, I wanted to know What is Psoratic Arthritis?

Short answer, is its complicated! Psoratic Arthritis is a type of Spondyloarthritis. Spondyloarthritis, is an umbrella term for inflammatory disease that involve both the joints and the enthese (the sites where the ligaments and tendons attach to the bone).

 This is what makes it different than other forms of arthritis in that it involves both the enthesitis sites of the body and Synovitis.  Synovitis is an inflammation of the joint lining, called Synovium, or synovial linings of certain joints in the body (not all joints have synovial linings). 

           Synovitis diagram                                                   

                                                               

There are 5 types of Psoratic Arthritis.  

• Symmetric Arthritis. Affects the same joints on both sides of the body, for instance, the right and left knees, right and left wrists, etc. ...
• Asymmetric Arthritis. typically affects only a few joints. They can be large or small and anywhere in your body. Fingers and toes may swell like sausages.
• Distal Interphalangeal Predominant (DIP) . mainly affects small joints at the ends of the fingers and toes, as well as the nails. Sometimes it's confused with osteoarthritis, what most people think of when they hear "arthritis," when the cartilage and bone in the joints wears away. 
  
• Spondylitis. affects the backbone. It can cause inflammation and stiffness between your vertebrae -- the bones of your neck, spine, and lower back -- and pelvis. Spondylitis can also attack ligaments that connect muscles to bones and other connective tissue.
• Arthritis Mutilans.  is the most severe and destructive form of psoriatic arthritis. Fortunately, it's rare. It damages the small joints in your fingers and toes so badly that they become deformed.

Initially, symptoms of are often of short duration and may change location or remain in one joint. Pain is usually more severe than expected based on the appearance of the joint on examination.  Many times diagnosis is complicated because there is pain without swelling in cases of Entheses.  

Symptoms typically begin in two ways. The first is inflammation causing pain and stiffness, most often of the hands and feet or arms and legs and spine.  The pain and stiffness is worse first thing in the morning or after inactivity, but gets somewhat improved upon use and movement.  The second type is bone destruction causing deformities of the joints in the affected area. 

Diagnosis is not easy and takes time. It requires a Rheumatologist to review your medical history and do a physical exam.  Imaging tests and blood tests are taken on multiple occasions.  X-rays of the sacroiliac joints,  ( joints were the pelvis meets the sacrum at the base of the spine). X-ray changes of the sacroiliac joints, known as sacroiliitis, are a key sign of spondyloarthritis. 

For me, I have three types of Psoratic Arthritis. I have asymmetric, DIP and Spondylitis (with Scaroliitis).  You can see all of the ligaments and muscles that are affected in the diagrams above. 

Often times x-rays do not show changes, but the symptoms are chronic (more than 6 months) and highly suspicious, many doctors might order a MRI, which shows these joints better and can pick up early involvement before an X-ray can.  Once damage is severe enough to show up on xrays, its is fairly progressed. 

I have sclerosis and erosion's bilaterally in my SI joints due to going un-diagnosed for so long. Erosion can happen fast. The excess synovial fluid literally eats away at the bone. Once the bone is deteriorated there is no repair. Joint replace, pins, plates and other surgical procedures are the only options.  That is the reason that early diagnosis and aggressive treatment is so important. The sooner you treat the disease the better over all control you can have. The goal is to stop or slow down the disease as much as possible in hopes of preventing total disability and debilitation.