Recently, two medical professionals were interviewed where they discussed their recommendations for the guidelines pertaining to managing psoriatic arthritis.

Psoriatic Arthritis

Psoriatic arthritis is a type of inflammatory arthritis that occurs in some patients with psoriasis. It can affect any joint in the body and can lead to joint damage. The condition’s characteristic symptom is the development of red patches of skin topped with silvery scales.

Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint issues can develop before skin lesions appear.

Symptoms:

Psoriatic arthritis can affect joints on one or both sides of the body. Signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis.

Symptoms include:

• Development of red patches of skin topped with silvery scales
• Generalized fatigue
• Tenderness, pain, and swelling over tendons
• Swollen fingers and toes that look like sausages
• Stiffness, pain, throbbing, swelling, and tenderness in one or more joints
• A reduced range of motion
• Morning stiffness and tiredness
• Nail changes — for example, the nail separates from the nail bed and/or becomes pitted and mimics fungus infections
• Redness and pain of the eye, such as conjunctivitis

Causes:

The cause of psoriatic arthritis is not entirely known. 40% of those diagnosed with the condition have a family member with psoriasis or arthritis, suggesting genetics may play a role.

Psoriatic arthritis can also result from an infection that activates the immune system. While psoriasis itself is not infectious, it might be triggered by a streptococcal throat infection, commonly known as strep throat.

Treatment:

No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. These treatments include:

• NSAIDs
• Disease-modifying antirheumatic drugs
• Immunosuppressants
• TNF-alpha inhibitors

Steroid injections and joint replacement surgery are other options.

John Tesser, MD

John Tesser, MD, is a Rheumatology Specialist at the Arizona Arthritis & Rheumatology Associates in Phoenix, Arizona. In the interview, he pointed out that there are a number of differences between American guidelines and European guidelines. For example, the American guidelines call for using disease-modifying anti-rheumatic drugs (DMARD’s) when there is only a light amount of disease. If there is more than that, however, they call for a tumor necrosis factor (TNF) over an IL (interleukin)-17 and furthermore an IL-17 over an IL-23 . On the other hand, the European guidelines skip past all of that and dive straight into using a TNF before trying out any conventional therapy or DMARD’s.

Tesser does identify that both guidelines highlight the importance of functionality when deciding on what therapies are best for the patient. In addition, the European guidelines determine treatment through the amount of joints and what joints are affected. For patients who only have one or a few joints involved, a lighter treatment will be used. However, if the patient has one or two joints that are vital for functionality, such as ones involved in the wrist or elbow, then the disease will be considered more severe and would require heavier treatment.

Nehad Soloman, MD

Nehad Soloman, MD, is a Rheumatology Specialized located at the Arizona Arthritis & Rheumatology Associates. Soloman’s views on the varying guidelines focus on skin. He pointed out that when people think of peripheral arthritis, they think of swelling of the fingers, inflammation of tendons and ligaments, and spinal involvement. Due to this, it is assumed that medical professionals will focus on topical agents or milder treatments.

In spite of that, Soloman stresses that the severity of the involvement is looked at too. This means that doctors will look at the surface area of the affected body surface to determine the involvement and thus severity. The more severe, the more aggressive the treatments will need to be.

Soloman also discussed the complications that come with the addition of other disease. If the patient has inflammatory bowel disease, then it might mean the patient would most benefit from combination therapy. Also, if a patient has iritis or uveitis, then TNF agents may be more beneficial to use. His response is saying that there cannot be one single way or single guideline to treat patients with rheumatoid arthritis, and that allows rheumatology professionals to focus more on each patient individually and what they need.