Psoriatic arthritis is one of several types of arthritic conditions. The one factor that is different from all other types of arthritis is the presence of psoriatic-type skin or nail lesions.
Symptoms can be similar to other types of arthritis with joint pain. Psoriatic arthritis is more commonly affecting one or two joints on one foot, but not the other. The entire toe can sometimes become very swollen. Physicians sometimes use the term “sausage digit” to describe this appearance. Other types involve multiple joints throughout the body like rheumatoid arthritis, but differing in that there is no rheumatoid factor with blood work. Psoriatic arthritis always has a skin or nail condition that can be seen on examination. The skin lesion is like a rounded plaque, commonly around the elbows, ankles or other boney structures. When nails are affected there is seen pitting, or ridges in a thicker nail.
Causes of psoriatic arthritis are not clearly understood. Many theories exists with possible genetic, bacterial,or viral reasons.
Diagnosis of psoriatic arthritis is based mostly by clinical symptoms. The skin or nail lesions must be seen for a diagnosis of psoriatic arthritis. A laboratory blood test would usually show a negative rheumatoid factor. X-ray changes can be helpful in diagnosis, but not necessarily seen. In more severe cases the small bones in the foot can erode and have a “pencil-in-cup” appearance. The spine or hip can likewise be involved, with joint narrowing.
Podiatric Care involves basic education, exercise, and use of anti-inflammatory medications. The skin plaques may be treated with sunlight, topical skin products, and/or corticosteroids. Your podiatrist may refer you to a dermatologist for further treatment of the skin condition. Occasionally injections into the area of the joint can be helpful to decrease the inflammation.
Surgery for patients with psoriatic arthritis is possible depending on many different factors. Sometimes implants can be used as joint spacers, or the joint fused as a joint destructive procedure to provide relief. Your podiatrist will let you know the best treatment approach for your condition.