Psoriatic arthritis (PsA) is one of those tricky conditions that doesn't like to stay in its lane. In fact, there are at least five different types of PsA. And according to research published in Autoimmunity Reviews, these different conditions can overlap and change over time. Fun, right? You can get ahead of your PsA by staying informed. Here are the most common types and how to manage them.
Symmetrical Psoriatic Arthritis
What is it? Symmetrical means the arthritis affects joints on both sides of your body at the same time, like both knees or both elbows. Symmetrical psoriatic arthritis accounts for 50% of PsA cases and usually more than four joints are affected at the same time. This condition often mirrors rheumatoid arthritis (RA), which most often affects both sides of the body at the same time. However, many with RA carry a rheumatoid factor that can be detected with blood work, and psoriatic arthritis usually does not. Rheumatoid factor can be seen in low titer in up to 9% of PsA patients. Another difference is that many people (around 30%) who have psoriatic arthritis have already been diagnosed with psoriasis.
How is it treated? Treatment for symmetrical arthritis—and all PsA types described below—depends on the severity of your disease. If you are still able to do what you want to do, including work, exercise, and take care of your family, and your pain is not impacting your quality of life, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation. You might also be given steroids temporarily, either taken orally or with an injection, if you find that NSAIDs—like aspirin and ibuprofen—are not working. If your case is more severe, a biologic drug may be recommended to more systemically control your condition and prevent further damage.
Good to know: With this type, regular exercise is almost always recommended to relieve the pain and stiffness. That's because exercise keeps the joints moving through their range of motion while helping you maintain your strength. However, it can feel counter-intuitive to move a joint that's in pain. “If you find that your joint pain is too significant to exercise, a physical therapist can help you initiate pain-free movement,” says Aleksandra Radjen, Ph.D., a physical therapist at the Cleveland Clinic in Ohio. Physical therapists know different movements you can do to reduce the amount of pain you might be feeling when you try to work out on your own.
Asymmetrical Psoriatic Arthritis
What is it? Unlike symmetrical arthritis, asymmetrical psoriatic arthritis doesn’t appear in the same joints on both sides of the body. With this type, it’s not uncommon for random fingers and toes to develop severe swelling and inflammation, a condition called dactylitis (also known as “sausage digits”). It typically affects the entire finger or toe, rather than just a single joint.
How is it treated? In addition to medical treatments—NSAIDs, biologics, and (in some cases) conventional disease-modifying antirheumatic drugs (DMARDs)—some patients do complementary treatments at home to help ease some of the swelling. Cold packs are essential to shrink blood vessels and reduce puffiness. You can also soak hands in cold water or wear compression gloves or socks. Also try to keep fingers moving (as much as possible) with a stress ball, crocheting/knitting, or simply flexing and releasing your fists.
Good to know: Dactylitis can be a pain (both literally and figuratively), especially if you enjoy working out. One secret for women with swollen toes: Buy men’s running shoes to exercise in. They run about one size smaller than what you usually wear (if you wear a size 9, get a size 8 in men’s), but they have a lot more room for toes. For men, ask a running store clerk to pull some shoes for you with a wide toe box, which will give your toes the room they need.
Distal Psoriatic Arthritis
What is it? Distal means away from the center of the body, so this type of psoriatic arthritis usually impacts the fingers and the toes, with a hallmark of also affecting toenails and fingernails. Distal psoriatic arthritis can be symmetrical or asymmetrical, and it may cause brittle nails, ridges, or the nail may pull away from the nail bed. The most specific finding in this form of PsA is nail pitting, which appears as tiny dots or indentations along the nail.
How is it treated? The inflammation and overgrowth you see on your skin from your psoriasis can also be happening on and under your nail. Keep your nails moisturized. You may want to try a nail oil that contains the herb indigo naturalis, which has been shown to improve nail psoriasis in patients, according to the National Psoriasis Foundation.
Good to know: Early detection means so much when it comes to psoriatic arthritis. If you are seeing nail changes or are noticing swelling in your fingers and toes, telling your doctor right away could make a big difference. Nail issues or additional swellings are a sign that your inflammation is going in the wrong direction, which could lead to permanent joint damage if untreated. And if there’s any confusion, one psoriatic arthritis type won’t follow another–it is all random and unpredictable.
What is it? Spondylitis is a type of arthritis that affects your spine, causing pain and joint stiffness in your back. Overtime, untreated spondylitis can cause the vertebrae in your back to fuse together, making you less flexible.
How is it treated? Stretching and physical therapy may be suggested by your doctor. Improving your strength can relieve your pain, maintain your flexibility, and preserve a good posture.
Good to know: In a large study of patients with psoriasis, psoriatic arthritis, and spondylitis, there was an increased risk of depression with all three groups compared to the general population. Those with spondylitis, however showed the largest risk of depression. “If people with psoriatic disease are feeling depressed, they certainly should seek professional help,” says the study’s lead researcher Jashin Wu, M.D. “If they are not on treatment for their psoriatic spondylitis, they should see a rheumatologist for treatment, and that may also help with a depressed mood.”
What is it? The good news is that this—the most severe type of psoriatic arthritis—is extremely rare, occurring only 1% of the time. Arthritis mutilans causes deformities in the small joints at the ends of the fingers and toes. The deformities can be so severe in some cases that fingers and toes are completely unrecognizable.
How is it treated? While early treatment can prevent arthritis mutilans from happening (a delay beyond six months carries a 10-fold increased risk of arthritis mutilans, according to Seminars in Arthritis and Rheumatism), it is known as an end stage of psoriatic arthritis. Because arthritis mutilans is so severe, biologics will most likely be the first-line of treatment because they can slow and/or prevent further damage from ocurring.
Good to know: If you have arthritis mutilans, there currently isn’t anything that will reverse the damage that has already occurred, and you'll likely still experience pain. Enter turmeric. A study in the Journal of Medicinal Food found that symptoms of arthritis mutilans such as pain, stiffness, swollenness, and movement were improved after taking approximately 1,000 mg/day of curcumin (a turmeric extract). Take a turmeric supplement or simply start adding one teaspoon of ground turmeric to your morning smoothie for a great addition to your overall treatment plan.