This article describes the signs and symptoms of psoriatic arthritis, which affects 3% of the population, and the role of physiotherapy in its management. Psoriatic arthritis is a disease that remains undiagnosed in many people, leading to unnecessary suffering.
Psoriatic Arthritis is an inflammatory disease that can affect people at any age. The condition may be preceded by years of reoccurring raised, red patchy scaly skin lesions anywhere on the body, but most notably on the knees, elbows and scalp. Because these patches come and go, people don’t tend to bother going to their GP. This skin condition is called psoriasis.
The unsuspecting sufferer might notice a sausage-like swelling in an entire finger or toe, or swelling in a knee or elbow, or pain in the spine or buttocks. They find they are stiff and sore in the mornings and stagger out of bed, but tend to loosen up after a hot shower and a bit of activity (usually after half an hour), only to stiffen up again after a period of rest. This pattern may continue all day. This differs to osteo-arthritic symptoms where sufferers only feel a little stiff in the morning, but tend to feel worse the more activity they do throughout the day.
Other features of psoriatic arthritis include pain and inflammation where ligaments and tendons insert into the bone, for example where the Achilles tendon attaches to the heel bone. It can also include inflammatory bowel disease, recurrent redness and pain in one eye, strange dents, ridges or pits in some of the finger or toe nails, and even cases of ischaemic heart disease and fatty liver.
Skin psoriasis and psoriatic arthritis are extremely hereditary. Those who suffer from this disease usually have a parent or grandparent with the skin disease, the joint disease, or both.
For many the skin disease doesn’t develop into the joint disease, but it appears the strongest predictor of psoriasis developing into psoriatic arthritis is weight gain. This is due to inflammatory chemicals thriving in fatty tissue.
Smoking also presents a risk.
Unlike rheumatoid arthritis, psoriatic arthritis is difficult to diagnose with the standard blood tests which test for inflammation. Blood test readings can be entirely normal and yet the sufferer may have red raised skin patches, swollen fingers and toes, pitted nails, terrible joint stiffness each morning and be struggling with an irritable bowel. X-rays in the early stages do not usually show up damage in a joint with active psoriatic arthritis. There are also people who muddy the diagnostic waters by suffering from other conditions alongside their undiagnosed psoriatic arthritis, such as fibromyalgia or rheumatoid arthritis, and their classical features of psoriatic arthritis may be overlooked by the GP. Therefore, the above mentioned visible signs are the best way to establish a diagnosis.
Treatment and Management
The goal of treatment is to restore normality and wellness, and to prevent joint damage and loss of mobility. Early diagnosis can lead to appropriate management, so that the need for joint replacement is reduced, and sufferers can continue to participate in life’s activities.
A healthy diet is essential. Starchy carbohydrates such as bread, pasta and potatoes have the unfortunate effect of increasing pro-inflammatory chemicals in the body. Cutting out carbohydrates and adopting a low calorie Mediterranean diet rich in seafood and replacing red meat not only has a beneficial effect on reducing inflammation in the joints, but also lowers cholesterol levels and protects heart health. Fish oil supplements are beneficial, and the higher the dose (up to 4000mg per day) the greater the effect.
Physical activity is vitally important as it lowers inflammation, aids weight loss, reduces feelings of fatigue and depression, improves sleep and regulates the bowel. Exercise is a necessity, not an optional extra!
Over the counter medications such as Panadol and anti-inflammatories can help reduce pain and inflammation initially, although the GP may need to prescribe anti-inflammatories if over the counter medicines irritate the bowel. The aim is to improve function, rather than just reducing pain.
More advanced symptoms need the help of a rheumatologist, and there are two types of medication which are extremely effective in reducing inflammation and potential damage in the joints.
Methotrexate reduces the inflamed membranes which surround the joints and give rise to the painful swelling contained within them (synovitis). However, this drug is not as effective in relieving pain in the spine.
In the past two years new biological drugs have been introduced to treat psoriatic arthritis. These drugs block inflammation, but in a different way to standard anti-inflammatories. Not only do they improve joint health in both the spine and peripheral joints in the body, but they also improve the unpleasant skin psoriasis.
The Role of Physiotherapy
At Physiotas our physiotherapists can provide support and guidance in how to manage psoriatic arthritis by reducing joint swelling and pain. We do this through a combination of gentle manual therapy and soft tissue massage. We can also help with establishing a baseline level of exercises which can be progressed over time to improve joint flexibility and muscle strength. We also advise on a home management program of daily exercise, and offer hydrotherapy and clinical Pilates classes. We can liaise with each patient’s treating doctor or rheumatologist to ensure continued effective management, especially in times of unpleasant flare-ups, so that each patient receives the optimum combination of medication and exercise.
To book an assessment, or to have a chat with one of our physiotherapists please contact any of our clinics. Contact details for each location can be found on the About page on our website.
About the Author:
Dinah has a special interest in the management of spinal and chronic pain conditions. She has worked in an advanced scope role for an orthopaedic spinal surgeon, diagnosing and managing spinal patients conservatively and pre- and post-operatively. Dinah is currently studying a MSc in Medicine on Pain Management at Sydney University, which she will complete in 2018.
Dinah gives regular talks entitled ‘Chronic Pain from a Biopsychosocial Perspective’ for patients, and is involved in presenting talks to GPs on this subject. She is based in the Physiotas Shearwater clinic.