Psoriatic arthritis is an inflammatory joint disease associated with psoriasis that is often overlooked because its early symptoms are mild and difficult to diagnose. However, this disease can lead to serious consequences if left untreated.
The early symptoms of psoriatic arthritis are varied. First, skin symptoms are common, with red, thick, scaly psoriasis patches on the skin, mostly on the limbs, scalp, elbows, knees, etc. These skin lesions may be accompanied by itching, pain, and a burning sensation. Secondly, joint symptoms should not be ignored. Early manifestations may be pain, stiffness, swelling, and limitation of movement in one or more joints. The pain tends to last for a few hours after activity or early in the morning and lessens with rest. In addition, wrists and ankles may also experience pain, dysplasia, and instability, and may even lead to deformities of the fingers or toes. In addition to skin and joint symptoms, patients may also have systemic symptoms such as fatigue, loss of appetite, weight loss, etc.
According to statistics, the onset age of psoriatic arthritis is mostly between 30~40 years old, and it is less common in children under 13 years old. In about 75% of people, the rash precedes arthritis, in about 10% of patients, the rash follows arthritis, and in 15% of people, arthritis and rash can occur at the same time.
Because the early symptoms of psoriatic arthritis are not obvious, it is easy to be misdiagnosed as other diseases. Therefore, when the above symptoms appear, patients should go to the hospital for re-examination in time for early diagnosis and treatment to avoid aggravation of the condition.
2. The symptoms and manifestations are fully known
(1) Skin symptoms
In addition to the skin symptoms of psoriasis, which are red, thick and scaly psoriasis plaques, which are mostly found in the limbs, scalp, elbows, knees, etc., and may be accompanied by itching, pain and burning sensation, the plaques generally appear as papules or plaques, round or irregularly shaped, with a large number of silvery-white scales on the surface, wax dripping, film phenomenon, and punctate bleeding. According to statistics, about 35% of patients have a correlation between the severity of skin lesions and the degree of joint inflammation. Special attention should be paid to skin lesions in hidden areas, such as hair, perineum, buttocks, umbilicus, etc.
(2) Joint symptoms
Psoriatic arthritis involves joint lesions that are mostly peripheral joints of the extremities, some of which can affect the spine, except for pain, stiffness, swelling, and limited movement in one or more joints, which persist for a few hours after activity or in the early morning and lessen with rest. Specifically, psoriatic arthritis can be divided into five types: patients with symmetrical polyarticular form may have symptoms such as pain and limited movement of the proximal toeal joint, which can involve the distal toeal joint and large joints such as wrist and elbow, and the affected joints are symmetrical; Patients with spondylosis may have symptoms such as lower back pain and chest wall pain, and ligamentous osteophytes may form in the spine area, which may cause spinal fusion and joint space narrowing in severe cases; Patients with distal interphalangeal joint may have symptoms such as redness, swelling, and pain in the distal interphalangeal joint, which is usually associated with psoriatic nail lesions; Patients with disruptive articular disease may have osteolysis in the palm, metatarsal and other parts, and symptoms such as joint ankylosis and deformity may appear; In patients with monoarthritis or oligoarthritis, many joints such as distal toe joints, proximal toe joints, knees, ankles, and hip joints may be affected, and symptoms such as pain, morning stiffness, and swelling may occur.
(3) Wrist and ankle symptoms
In addition to pain, dysplasia, and instability in the wrists and ankles, which can lead to deformities of the fingers or toes, psoriatic arthritis can also cause joint redness, swelling, and a hot sensation in the wrists and ankles during activity or rest, and patients may feel warm around the joints, as well as pain and sensitivity to touch.
(4) Systemic symptoms
In addition to fatigue, loss of appetite, weight loss, etc., a small number of patients have symptoms such as fever, anemia and weight loss, a small number of patients may also have systemic damage, and eye inflammation is the most common, such as iritis, conjunctivitis, episcleritis and keratoconjunctivitis, etc., eye redness, vision loss, etc.; Symptoms of damage to the heart, lungs, and gastrointestinal tract may also occur. At the same time, 7%~33% of patients have ocular lesions, such as conjunctivitis, uveitis, iritis and keratitis sicca. In addition, heel pain is a manifestation of tendonitis, particularly in tendinopathy at sites of Achilles tendon and plantar aponeurosis attachment.
3. Detailed analysis of key symptoms
(1) Nail lesions
Approximately 80% of patients with psoriatic arthritis can develop nail abnormalities, which are a characteristic change of psoriatic arthritis. The most common nail lesion is a thimble depression, in addition, the nail plate can be thickened, turbid, black or white nails, the surface is uneven, there are transverse grooves, often accompanied by subungual keratinous hyperplasia, and in severe cases, there can be nail peeling. Distal joints and adjacent nails are often affected at the same time.
(2) Spinal lesions
If you have psoriasis spondyloarthritis, you will have low back pain and spinal rigidity. Not only will the skin be red and silvery-white scales, but some will also have joint pain, swelling, deformity, etc. There may also be joint dysfunction, or joint stiffness after getting up in the morning and not exercising for a long time, local joint swelling and burning.
(3) Special joint symptoms
- The fingers or toes are swollen and appear as dachshund fingers (toes). Asymmetric monoarthritis is characterized by inflammation of the internode joints of the distal fingers and toes, which are diffuse and sausage-like with nail damage.
- Heel pain. Psoriatic arthritis is often characterized by arthritis combined with psoriasis, which can cause itching and pain in the heel when it occurs in the heel. Psoriatic arthritis usually causes deformity and/or destruction of joints, especially in the hands, feet and spine. In the feet, psoriatic arthritis can cause deformation or destruction of the bones and ligaments near the heel, leading to heel pain. In addition, plantar fasciitis may be one of the causes of heel pain caused by psoriatic arthritis. The disease causes inflammation and swelling of the foot and can lead to micro-tears or deterioration of the plantar fascia ligaments.
- Have a family history of psoriasis. Psoriatic arthritis has a certain genetic predisposition, and it is currently thought to be autosomal dominant, and if someone in the family has the disease, the risk of the disease in children will be higher than normal. Early family studies have shown a significant increase in the prevalence of psoriatic arthritis in families with pre-existing psoriasis. About half of patients are HLA-B27 positive, and these organisms suggest a genetic correlation between psoriatic arthritis, but not all patients with psoriatic arthritis will inherit it to the next generation, and there is a strong correlation between immune abnormalities and environmental factors.
Fourth, early diagnosis and early treatment are of great significance
Psoriatic arthritis is a chronic, progressive disease that, if delayed, can lead to permanent joint damage that can seriously affect the patient’s quality of life. Early recognition of the symptoms of psoriatic arthritis and prompt medical attention is essential to manage the condition and avoid exacerbations.
Early diagnosis can avoid missed diagnoses and misdiagnoses. Because the early symptoms of psoriatic arthritis are not obvious, it is easy to be misdiagnosed as other diseases, such as rheumatoid arthritis, gout, senile osteoarthropathy, etc. According to statistics, about 10% of people with psoriatic arthritis have a rash that appears after arthritis, which makes diagnosis more difficult. Therefore, for patients with a history of psoriasis or a family history of psoriasis, joint symptoms should be vigilant and seek specialist attention in time. Blood tests (HLA – B08, HLA – B27, HLA – B38, IL – 23R, CXCL10, etc.) or screening with ultrasound, radiology, or MRI are usually needed to confirm the diagnosis.
Early treatment is effective in controlling disease progression. At present, a type-based and hierarchical treatment strategy is often used, and the treatment drugs mainly include non-steroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs (methotrexate, leflunomide, sulfasalazine), glucocorticoids, and biological agents. Traditional antirheumatic drugs are effective in relieving peripheral arthritis and improving skin symptoms of psoriasis, but they do not stop the progression of joint damage. At present, the rapid development of biologics has brought new hope for the treatment of psoriasis and psoriatic arthritis, especially the early application can prevent or reverse joint damage. The existing biologics on the market in China, such as tumor necrosis factor TNF-α antagonists (such as YISAIPU, Class, Humira), IL-17 antagonists (Keshanting, Tuozhi), and IL-23 antagonists, have achieved remarkable efficacy in controlling the disease and have become a powerful means of standard treatment. TNF-α antagonists are the most effective in the treatment of psoriatic arthritis.
In conclusion, early identification of the symptoms of psoriatic arthritis and timely medical treatment are of great significance to control the disease, avoid aggravation of the disease, and reduce missed diagnosis and misdiagnosis. Patients should raise their awareness of psoriatic arthritis, pay attention to their physical changes, and seek medical attention in time once joint symptoms appear, so as to facilitate early diagnosis and treatment.