Psoriatic Arthritis (PsA)
About the disease & condition
Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory arthritis associated with psoriasis, characterized by heterogeneous involvement of joints, entheses, and other tissues. It belongs to the spondyloarthritis family and can lead to joint damage, functional impairment, and reduced quality of life if untreated.
Known Symptoms
- Musculoskeletal features: Asymmetric or symmetric oligo-/polyarthritis. Dactylitis (“sausage digits”), enthesitis (e.g., Achilles tendinitis, plantar fasciitis). Axial involvement (sacroiliitis, spondylitis).
- Cutaneous features: Psoriasis (plaques, nail changes— pitting, onycholysis). Extra-articular
- Manifestations: Uveitis, inflammatory bowel disease (IBD). Metabolic syndrome, cardiovascular risk.
- Red flags: Rapid joint destruction, severe dactylitis/enthesitis, widespread psoriasis.
Known Causes
- Etiology: Genetic predisposition (e.g., HLA-B27, IL-23R, and other immune-related genes). Environmental triggers (e.g., infections, trauma) in genetically susceptible individuals. Strong link with psoriasis (∼30% of psoriasis patients develop PsA).
- Pathophysiology: Dysregulated immune activation involving TNF-α, IL-17, IL-23, and other cytokines.
Synovitis, enthesitis, and bone remodeling (both erosive damage and new bone formation).
Care
- Prevention: Early diagnosis and treatment to prevent structural damage.
Manage modifiable risks (e.g., weight, smoking, cardiovascular health). - Follow-up: Regular monitoring of disease activity (e.g., DAPSA, MDA scores). Imaging (X-ray/US/MRI) to assess joint damage and treatment response.
Screening for comorbidities (e.g., cardiovascular, metabolic syndrome). Patient education on medication adherence and self-management.
Note: PsA is a heterogeneous disease requiring personalized treatment. Multidisciplinary care (rheumatology, dermatology, physiotherapy) is essential. Treat-to-target strategies aim for remission or low disease activity. New therapies continue to improve outcomes for refractory disease.
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