What Are The Stages Of Psoriatic Arthritis?
Psoriatic arthritis (PsA) is a progressive autoimmune disorder that can lead to permanent and debilitating joint damage. In PsA, immune cells are activated and produce too much of certain proteins which lead to chronic inflammation.
Psoriatic arthritis (PsA) occurs in up to 40% of people with psoriasis. Both are chronic, inflammatory diseases. Generally, skin symptoms precede the joint symptoms, however in about 10-15% of cases, PsA develops before psoriasis.1 It is also important to note that there is a population of those who live with PsA without a formal diagnosis of psoriasis.
The stages of psoriatic arthritis
PsA usually progresses in phases, but there are no official stages. Not everyone goes through all possible stages, and some people go through stages faster than others.3
In its later stages, PsA can cause permanent joint damage. This may prevent people from carrying out daily activities and lead to other conditions. And it can put serious emotional and financial burdens on people with PsA.
What do the early stages look like?
Usually, psoriasis or skin symptoms are the first sign. The main symptom of psoriasis are flare-ups of itchy, red, scaly skin. Skin involvement can occur anywhere, but the scalp, nails, elbow, and knees are most affected.3
Because of this, dermatologists can often detect early PsA.3 About 4 in 10 people with psoriasis eventually develop PsA. People with psoriasis may be more likely to develop PsA if they:2,4
- Have pitted, deformed nails
- Have family history of PsA
- Are between the ages of 30 and 50
However, there are many exceptions and every case is different. Some people get PsA earlier or at the same time as psoriasis, while other people with PsA suffer from skin symptoms without an official psoriasis diagnosis.5
Progression and the later stages
More developed PsA has a serious impact on daily life. Severe symptoms may make it harder to carry out physical activities or maintain an active social life. Without this activity, joints can become stiff and muscles can become weak.2
About 50 percent of people with PsA have moderate-to-severe fatigue, and about 30 percent have severe fatigue. The combination of joint pain, skin symptoms, and fatigue leads to depression for many people with PsA.3
About half of all people with PsA develop additional conditions. High blood pressure, heart disease, gastrointestinal conditions, and respiratory conditions are common among people with PsA. And a small percentage of people with PsA develop arthritis mutilans, which destroys small bones in hands and leads to permanent deformity.2,3
Psoriatic arthritis progression
PsA progresses differently for every person. Sometimes, it starts to affect more joints. This progression can occur slowly with mild symptoms or quickly with severe symptoms.3
Mild PsA is referred to as oligoarticular when it affects 4 or fewer joints. Severe PsA may be called polyarticular when it affects more than 4 joints. In addition to swollen joints, there are some common symptoms of PsA as it progresses:5
- Tenderness, pain, and swelling over tendons
- Reduced range of motion
- Morning stiffness and tiredness
- Nail changes
- Redness and pain of the eye
How would you describe the overall severity of your PsA?
Slowing down the progression
There is no cure for PsA, but there are some ways to slow the progression of symptoms. In rare cases, people experience complete remission. But this is not considered a cure, and it is more likely to have alternating periods of improving and worsening symptoms.2
Treatments work best when started earlier, and are best managed by a rheumatologist. The first step is to control joint inflammation. This may be done with medications such as NSAIDs, corticosteroid injections, DMARDs, or biologics.5
An overview of initial symptoms
Whenever PsA develops, the initials symptoms are similar:2
- Swollen, stiff, and painful joints, especially in the fingers and toes
- So much swelling in a finger or toe that it looks like a sausage (a condition called dactylitis)
- Pain at the back of your heel or in the sole of your foot
- Pain in the joints of shoulder, knees, lower back, and neck
Finding ways to relieve symptoms
You may find a drug that relieves your symptoms right away. Or you may need to try a few before symptoms begin to improve. It is also helpful to avoid putting too much stress on joints by:
- Simplifying tasks with arthritis-friendly tools
- Losing weight
- Using hot and cold therapy
- Managing stress
- Resting often
Talk to your doctor to find the right treatment plan for you. Early diagnosis and treatment are important to relieve pain and prevent joint damage. Delaying treatment by 6 months may result in permanent joint damage.5
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