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Psoriatic Arthritis

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What is psoriatic arthritis?
What is psoriasis?
Causes and risk factors
Symptoms of psoriatic arthritis
Diagnosis
Podiatric treatment
Prevention
FAQs

Psoriatic arthritis can cause the joints of the feet to become inflamed, and the surrounding skin to become red and patchy. Psoriatic arthritis tends to have similar symptoms as rheumatoid arthritis.

What Is Psoriatic Arthritis?

Psoriatic arthritis is a chronic autoimmune disorder that affects some people who have psoriasis, a skin condition characterised by red, scaly patches on the skin. In psoriatic arthritis, the immune system mistakenly attacks healthy joint tissues, leading to inflammation and damage in the joints. This results in painful and swollen joints, reduced joint mobility, and the development of potential joint deformities over time. 

Psoriatic arthritis can also affect other parts of the body, such as the skin, nails, and even organs in severe cases. It can vary widely in its presentation and severity, with some individuals experiencing mild symptoms and others facing significant disability over time. When it comes to the feet and ankles, the joint pain, swelling and stiffness can become severe to the point that it makes performing daily tasks like walking difficult, having a significant impact on a person’s mobility and quality of life.

What Is Psoriasis?

Psoriasis differs from psoriatic arthritis in that it is a chronic inflammatory skin condition that is classified into many types based on the age it appears, whether it is localised to one area or spread over your body, the size and thickness of any plaques that arise on the skin, and whether your toenails are also involved. Symptoms include having clearly defined, red and scaly plaques on the feet which may appear dry or white at times.

While the exact mechanism of action behind psoriasis is debated, what is known is that it is an inflammatory disease that is linked to your immune system, and that your genetic factors play a big role in the way your psoriasis presents. While having a family history of psoriasis does make you more likely to develop it, it does not mean that you definitely will - much like with rheumatoid arthritis and diabetes. This is why even if you have a family history of psoriasis, you should still be assessed to formally diagnose your skin condition.

Causes & Risk Factors Of Psoriatic Arthritis

While the exact cause of psoriatic arthritis is not fully understood in the research, it has been linked to genetic, environmental, and immune system factors.

• Genetics: having a family history can be a strong indicator of developing psoriatic arthritis, with certain genetic markers being associated with an increased risk of the condition. First-degree relatives of patients with psoriatic arthritis have a 50-fold increased risk of developing psoriatic arthritis compared with the general population.
  

• Immune system: psoriatic arthritis is an autoimmune disorder, meaning the immune system mistakenly attacks healthy tissues, including joint tissues, in the body. Abnormalities in the immune system can trigger inflammation in the joints, leading to the characteristic symptoms of psoriatic arthritis.
  
• Environmental triggers: environmental factors such as infections or injuries may also act as triggers for psoriatic arthritis in genetically susceptible individuals. Infections, particularly streptococcal infections, as well as viral infections including rubella, have been linked to the development or exacerbation of psoriatic arthritis.
  

Some of the known risk factors associated with developing psoriatic arthritis also include:

• Age - psoriatic arthritis is most commonly observed between the ages of 30 and 50 years.
  
• Having psoriasis - for those who already have psoriasis, approximately one in three may go on to develop psoriatic arthritis.
  
• Weight gain - those who are obese may have an increased risk of developing psoriatic arthritis, particularly if they already have psoriasis.
  
• Injuries - having existing injuries to your joints may increase your risk of psoriatic arthritis
  
• Gender - while men and women have been shown to develop psoriatic arthritis at similar rates, women tend to have more severe symptoms and as such a greater burden of disease.
  

Remember, just because you’re at risk, doesn’t mean the joint pain or inflammation that you’ll develop will definitely be from psoriatic arthritis, which is why it’s important to have a proper assessment to confirm your diagnosis so that the best management plan can be created for you.

Symptoms Of Psoriatic Arthritis

While psoriatic arthritis tends to have many whole-body effects, when it comes to the feet and legs, it commonly presents with inflammation and pain in the joints of the feet, particularly at the toes and ankles. One of the hallmark signs is the involvement of the joints at the very end of the toes called the distal interphalangeal joints. These joints may become swollen, tender, and stiff, making it difficult for patients to walk or perform daily activities, and can ultimately become deformed and severely damaged.

Psoriatic arthritis can also cause enthesitis, which is inflammation at the site where tendons and ligaments attach to the bone. Enthesitis in the feet can lead to pain and tenderness in areas such as the Achilles tendon or the plantar fascia, which is the thick band of tissue running along the bottom of the foot. As such, some people may mistake the symptoms of their psoriatic arthritis for soft tissue injuries such as plantar fasciitis or Achilles tendonitis.

In up to 90% of cases, psoriatic arthritis can also affect the nails, causing changes such as pitting, nail splitting, discoloration, and having the nail itself separate from the nail bed which leaves the nail with a white and sometimes cave-like appearance. In some cases, a condition known as psoriatic onychodystrophy may develop, leading to severe nail deformities.

The symptoms of psoriatic arthritis can be symmetrical or asymmetrical, and can come and go, stay the same severity, or gradually worsen over time.

Diagnosis

Diagnosing psoriatic arthritis is generally based on your symptoms at your joints, your skin, and a look into the changes seen on x-ray imaging. It’s important to differentiate psoriatic arthritis from other types of arthritis including osteoarthritis, gout and rheumatoid arthritis, as well as correctly identifying the cause of any tendon pathologies like plantar fasciitis as described earlier.

Podiatry Treatment

Much like with rheumatoid arthritis, as it is a systemic immune condition, there is no ‘cure’. Working with your doctor, they can prescribe medications that include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologics, and corticosteroids to help manage your condition. There are also a lot of things that your podiatrist can do to help reduce your pain and symptoms, help you feel more comfortable on your feet, and help slow down the progression of any joint damage and deterioration. These include:

• Footwear modifications and recommendations: your shoes will play an important role in helping keep you comfortable and mobile when living with psoriatic arthritis. We can both recommend ideal shoes given your foot type and any foot problems or deformities you’re experiencing (like bunions or hammertoes), as well as make custom modifications to your footwear to ensure they’re doing their best in optimising your comfort and quality of life regardless of whether your symptoms are going through a severe or mild stage.
  
• MLS laser to help with relieving pain and improving your mobility and function. The MLS laser works to reduce inflammation and pain, accelerate tissue repair and improve joint mobility, making it a perfect companion in managing your psoriatic arthritis symptoms. You can learn more about how laser works specifically on arthritis pain here.
  
• Custom foot orthotics: it is common for people to develop pain at their heel where their Achilles tendon inserts to the heel bone and in some cases, when your joints have sustained significant damage or you have some biomechanical factors associated with your feet and legs that may be exacerbating your symptoms or discomfort, we may recommend using custom-designed foot orthotics. These orthotics are created in a way that is specifically prescribed by your podiatrist, so are able to help with everything from relieving pressure from swollen or deformed joints to increasing specific areas of support or cushioning to optimise your comfort and function on your feet.
  
• Ankle foot orthotics (AFOs): AFOs can help those with psoriatic arthritis by providing stability, support, and pain relief for affected foot and ankle joints. By wrapping around and stabilising the ankle, reducing pressure on inflamed joints, and improving gait mechanics, AFOs alleviate pain, prevent joint deformities, and enhance mobility, making it easier for individuals with RA to perform daily activities and maintain a better quality of life. The AFOs we offer are custom prescribed, designed to address a person’s unique foot and ankle needs.
  
• Physical therapy: our podiatrists can show you a range of modified exercises to maintain strength and flexibility of the affected joints.
  
• Joint mobilisation: in the early stages of psoriatic arthritis, you may experience some joint restrictions that affect your comfort and mobility but that are still relatively flexible. These can be ‘mobilised’ by your podiatrist into a better alignment or position to support greater comfort and movement on your feet.
  
• Skin and nail care: for those with nails that are distorted, disfigured or otherwise affected by psoriatic arthritis, our podiatrists can help with regular nail care appointments to help keep problematic toenails under control and best manage their nail health.
  
• Personalised advice and recommendations about exercise and best managing your foot health.
  

Prevention

Although psoriatic arthritis is not knowingly preventable, there are a few things you can that may reduce your risk of getting the disease, including: 

• Manage your psoriasis as best you can
  
• Treat infections and joint injuries promptly and effectively
  
• Quit smoking
  
• Maintain a healthy weight and lifestyle
  
• Avoid exposure to environmental pollutants
  

FAQs

Does psoriatic arthritis only affect adults?

Psoriatic arthritis can develop at any age, but it most commonly appears between the ages of 30 and 50. It can affect children, teenagers, and adults.

Can psoriatic arthritis cause permanent joint damage?

If left untreated or poorly managed, psoriatic arthritis can lead to joint damage and deformities. Early intervention and effective treatment can help slow down or prevent joint damage.

Can lifestyle changes help manage psoriatic arthritis?

Yes, lifestyle changes play a vital role in managing psoriatic arthritis. Regular exercise, maintaining a healthy weight, avoiding smoking, and managing stress can positively impact the condition and overall well-being.

Can pregnancy affect psoriatic arthritis?

Pregnancy can have variable effects on psoriatic arthritis. Some women experience improvement in symptoms during pregnancy, while others may have flares. It's important for pregnant individuals with psoriatic arthritis to work closely with their healthcare team to manage their condition effectively during this time.

Can psoriatic arthritis lead to other health complications?

Psoriatic arthritis is associated with an increased risk of certain health complications, such as cardiovascular disease, metabolic syndrome, and osteoporosis. Regular medical check-ups and proactive management of risk factors are essential for overall health.

Can stress worsen psoriatic arthritis symptoms?

Stress can potentially trigger or exacerbate psoriatic arthritis symptoms. Managing stress through relaxation techniques, mindfulness, or counselling may help in improving overall well-being.

Is it safe to exercise with psoriatic arthritis?

Yes, exercise can be beneficial for people with psoriatic arthritis. Low-impact activities like swimming, cycling, or yoga can help improve joint flexibility, reduce stiffness, and maintain muscle strength.