Symmetric Psoriatic Arthritis (PsA) is an autoimmune disorder characterized by the mirroring of pain, swelling, and stiffness across corresponding joints on both sides of the body. Management approaches extend from pharmaceutical interventions to surgical procedures.
Symmetric PsA represents an intense form of the condition, leading to simultaneous affliction in the same joints bilaterally, also referred to as symmetric polyarthritis—a term indicating the involvement of five or more joints.
Continue reading to delve deeper into the facets of symmetric PsA, including its symptoms, underlying causes, therapeutic avenues, and prognostic expectations.
PsA is categorized into five primary types:
- Symmetric PsA, distinct for affecting identical joints on each side of the body, may result in joint degradation and hindered mobility.
- Asymmetric oligoarticular PsA typically strikes fewer than five joints, usually on just one side of the body.
- Psoriatic spondylitis involves the spine and manifests in roughly 20% of those with PsA.
- Distal interphalangeal predominant PsA targets the smaller joints in fingers and toes and may be erroneously diagnosed as osteoarthritis.
- Arthritis mutilans, a particularly aggressive and least common variant of PsA, principally compromises the joints within the hands and feet.
Identifying Symptoms of Symmetric Psoriatic Arthritis
Symmetric PsA is characterized by joint stiffness and swelling that is mirrored on both sides of the body, affecting the same joints such as those in both hands, feet, or knees. This subtype typically impacts the smaller joints and often presents with symptoms in the hands and feet. Along with these joint-related issues, symmetric PsA can also manifest in other ways, including scaly skin patches from psoriasis, increased joint stiffness after periods of rest or in the morning, eye inflammation known as uveitis, gastrointestinal issues linked to inflammatory bowel disease, and changes in nail appearance and texture. Additionally, individuals may experience dactylitis, which is painful swelling in the fingers or toes, as well as discomfort or soreness in the feet or heels, and enthesitis, the inflammation of the areas where tendons or ligaments attach to bones.
What causes symmetrical psoriatic arthritis and who is at risk for it
The cause of symmetric psoriatic arthritis (PsA) can be traced to its nature as an autoimmune disorder. This condition arises from an overactive immune response, leading to inflammation and the attack of healthy joint tissues by mistake.
The precise triggers for this autoimmune reaction remain elusive, with experts suggesting a blend of genetic predispositions and environmental influences as potential culprits. The onset of symmetric PsA sometimes follows the appearance of asymmetric PsA.
Additionally, symmetric PsA is often seen in individuals diagnosed with psoriasis, typically emerging within 7 to 10 years after the initial psoriasis diagnosis. However, it’s not a rule, as some may encounter PsA without prior psoriasis manifestations.
Risk elements linked to PsA encompass a familial history of psoriasis or autoimmune diseases, lifestyle factors such as smoking and obesity, and a history of significant infections or injuries.
Symmetric PsA is not selective and can affect anyone, yet the likelihood increases with age, predominantly affecting adults beyond 30. Furthermore, statistics suggest that females may be more susceptible to developing this particular strain of PsA compared to males.
How is Symmetric Psoriatic Arthritis Diagnosed by Doctors?
The process of diagnosing symmetric psoriatic arthritis involves a multi-faceted approach by healthcare practitioners. First, they conduct a physical examination to identify any signs of the condition. They will also delve into your family’s medical history, seeking patterns that might suggest a predisposition to PsA.
To obtain concrete evidence, blood tests are conducted to search for inflammatory markers that are typically present in those with PsA. Moreover, to get a clearer picture of the extent of joint damage, they may resort to imaging procedures like X-rays, computed tomography (CT) scans, or ultrasounds.
However, symmetric PsA can often be confused with other inflammatory diseases such as rheumatoid arthritis (RA), which similarly results in symmetrical joint affliction. Accurate diagnosis is crucial as it directly affects the course of treatment. To differentiate symmetric PsA from RA, doctors scrutinize the symptoms and laboratory test outcomes. While approximately 80% of RA patients test positive for rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies, these may not necessarily be present in individuals with PsA.
How Symmetric Psoriatic Arthritis is Treated
The management of Symmetric Psoriatic Arthritis (PsA) is a multifaceted approach, entailing pharmacological interventions that aim to:
- Diminish inflammation at its core
- Curtail the aberrant responses of the immune system
- Mitigate presenting symptoms
Therapeutic options generally encompass:
- Corticosteroid medications
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs), with an inclusion of biologic agents such as Tumor Necrosis Factor (TNF) inhibitors
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Over-the-counter or prescription analgesics
Furthermore, physicians often advocate for adjunctive therapies such as physical and occupational therapy. Physical therapy provides instruction on exercises that promote both strength and flexibility. Occupational therapy, on the other hand, is dedicated to enhancing everyday mobility, sometimes with the use of adaptive equipment.
In advanced cases of Symmetric PsA, surgical intervention, such as joint replacement, may be considered. This course of action is typically reserved for scenarios wherein pharmaceutical management has not halted the disease’s progression and when joint deterioration severely impairs quality of life.
Prognosis for Individuals with Symmetric Psoriatic Arthritis:
Currently, Symmetric PsA, like all other variants, remains incurable. Being one of the more formidable forms of PsA, the symmetric subtype often necessitates more intensive therapeutic strategies.
The primary objective of treatment is the alleviation of inflammation and symptom relief. Effective management can also curtail the progression of the disease, which is a notable risk in PsA.
Patients with Symmetric PsA face an elevated likelihood of developing subsequent health complications if their condition is left unaddressed. In light of this, ongoing monitoring for associated health risks, such as hypertension, dyslipidemia, and Type 2 Diabetes, is typically part of a comprehensive care plan.