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Psoriatic arthritis (PsA) is an inflammatory autoimmune condition that affects the joints of people with psoriasis, a skin condition causing flare-ups of red, scaly rashes. PsA can cause muscle pain and stiffness, which may lead to reduced physical activity and, consequently, muscle wasting and weakness. Inactivity and bed rest have been shown to cause muscle weakness and wasting. Obesity, which is more common in people with PsA, can also contribute to inflammation and worsening symptoms. While the exact cause of PsA is unknown, it is believed to be influenced by genetic, environmental, and immunological factors.
| Characteristics | Values |
|---|---|
| Type of arthritis | Autoimmune, inflammatory |
| Related conditions | Psoriasis, fibromyalgia |
| Symptoms | Muscle pain, joint pain, joint stiffness, joint swelling, fatigue, rash, nail changes, eye problems, bowel problems |
| Treatment | Exercise, medication, acupuncture, meditation |
| Risk factors | Family history, genes, environment, physical trauma, viral or bacterial infection |
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What You'll Learn
Psoriatic arthritis and muscle wasting
Psoriatic arthritis (PsA) is an inflammatory condition that causes swelling in the joints. It is a form of arthritis that affects some people with psoriasis, a skin condition causing flare-ups of red, scaly rashes and thickened, pitted nails. PsA can cause muscle pain, stiffness, and weakness, which may result in a reduction in physical activity and muscle wasting.
Psoriatic arthritis is characterised by joint pain, stiffness, and swelling, which can affect any part of the body, including fingertips and the spine, and can range from mild to severe. It can also cause tiredness (fatigue) and low red blood cell count (anaemia). PsA can impact a person's activity levels, as the pain and stiffness can make it difficult to perform weight-bearing exercises or physical activity, leading to muscle wasting and weakness.
Inflammatory proteins in the blood can stimulate protein breakdown, reduce protein production in the muscles, and lead to muscle wasting and decreased skeletal muscle mass and strength. Additionally, obesity can contribute to inflammation and worsen PsA symptoms, as it increases joint stress and musculoskeletal pain.
Inactivity and bed rest can further contribute to muscle wasting in individuals with PsA. A 2017 study found that PsA may cause a loss of muscle mass, particularly in postmenopausal individuals. Furthermore, a 2020 study using MRI scans revealed a significant decrease in hand muscle volume with age for people with PsA, with the decrease being more pronounced in men than in women.
To manage muscle pain and prevent muscle wasting, individuals with PsA are advised to engage in regular physical activity, including low-impact exercises such as swimming, walking, tai chi, yoga, and Pilates. Stretching exercises can also provide relief from stiffness and pain. It is important to consult a doctor before starting an exercise routine, as they can provide guidance and suggest devices or therapies to aid in daily tasks.
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Psoriatic arthritis and inactivity
Psoriatic arthritis (PsA) is a long-term autoimmune form of arthritis that affects people differently, with symptoms ranging from mild to severe. It is characterised by painful issues with both joints and skin. PsA causes inflammation in the joints, which can lead to swelling, stiffness, and pain. This inflammation can also cause long-term damage to the joints. The pain and stiffness associated with PsA can make it difficult for individuals to engage in physical activity, leading to inactivity and bed rest.
Inactivity and bed rest can have detrimental effects on muscle strength and mass. Research has shown that muscles can reduce in size and become weak due to a lack of physical activity. This muscle wasting or loss of lean muscle mass can lead to further weakness and even disability. Additionally, inflammatory proteins in the blood can stimulate protein breakdown and reduce protein production in the muscles, contributing to muscle wasting and decreased skeletal muscle mass and strength.
The impact of PsA on physical activity and muscle health is significant. Individuals with PsA may find it challenging to engage in weight-bearing exercises or maintain an active lifestyle due to the pain and stiffness they experience. This inactivity can exacerbate the condition, leading to a cycle of decreased physical activity and worsening symptoms.
However, it is important to note that inactivity is not the only factor contributing to muscle weakness in individuals with PsA. The inflammation associated with PsA can directly affect muscle strength and cause pain. Additionally, other factors such as protein metabolism, hormones, and aging may also play a role in how PsA affects muscle health.
To break the cycle of inactivity and manage their condition, individuals with PsA are advised to incorporate physical activity into their lives. Low-impact exercises such as swimming, walking, tai chi, yoga, and Pilates can help improve muscle strength, reduce pain, and prevent stiffness. It is recommended to consult a doctor before starting any exercise routine, especially if the individual is experiencing severe symptoms or has concerns about muscle loss.
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Psoriatic arthritis symptoms
Psoriatic arthritis (PsA) is an inflammatory condition that causes swelling in the joints and other symptoms. It is a form of arthritis that affects some people who have psoriasis, a skin condition causing flare-ups of red, scaly rashes and thickened, pitted nails. Psoriasis is characterised by raised lesions on the knees and elbows, and red patches covered with silvery-white scales on the elbows. It can also appear on the scalp, behind or inside the ear, or around the anus.
Psoriatic arthritis occurs in about 20% of people with psoriasis. It is more common in adults, affecting men and women equally, and usually develops 7 to 10 years after the onset of skin symptoms. The cause of psoriatic arthritis is unknown, but it is believed to be linked to an overactive immune system that attacks healthy cells and tissues.
The symptoms of psoriatic arthritis vary from person to person. They include:
- Pain, stiffness, and swelling in the joints, which can range from mild to severe.
- Swollen fingers and toes, also known as dactylitis or sausage digits, which can be quite painful.
- Foot pain, especially at the back of the heel (Achilles tendinitis) or in the sole of the foot (plantar fasciitis).
- Lower back pain, which may be indicative of spondylitis.
- Enthesitis, or inflammation of the sites where ligaments or tendons insert into bones, such as the elbows, heels, hips, knees, or shoulders.
- Skin symptoms, such as scaly, inflamed patches typical of psoriasis, often on the scalp, elbows, or knees.
It is important to note that psoriatic arthritis can severely damage joints if left untreated. Therefore, seeking treatment is crucial to managing symptoms and reducing the risk of complications.
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Psoriatic arthritis diagnosis
Diagnosing psoriatic arthritis can be complex and time-consuming. There is no single test to confirm psoriatic arthritis, but there are a variety of tests that can rule out other causes of joint pain, such as rheumatoid arthritis or gout.
The diagnosis of psoriatic arthritis is made by identifying characteristic joint inflammation in a person who has arthritis and psoriasis. Doctors will also ask patients whether they have a family history of psoriasis. The most commonly affected joints are the joints of the fingers and/or toes. Doctors will also look for inflammation in the tendons, spine, and swelling of fingers or toes, known as "sausage digit".
X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions. They are also useful in checking for additional damage as the patient progresses through treatment. MRIs use radio waves and a strong magnetic field to produce detailed images of both hard and soft tissues in the body. They can be used to check for problems with the tendons and ligaments in the feet and lower back.
Blood tests can be used to rule out rheumatoid arthritis by testing for rheumatoid factors and anti-cyclic citrullinated peptide antibodies. Uric acid crystals in joint fluid might indicate gout rather than psoriatic arthritis.
A skin examination is also necessary to look for psoriasis. A nail examination will also be conducted, as the nails will often have ridges and may be growing away from the nail bed.
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Psoriatic arthritis treatment
Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects the skin and joints, causing swelling and pain. While there is no cure for PsA, treatment can help manage symptoms and reduce the risk of complications. Treatment typically involves a combination of medication and non-drug therapies, tailored to the patient's symptoms and severity of their disease.
Medication
Medications are an important part of treating PsA and managing flares. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control inflammation and pain in mild cases of PsA. NSAIDs are available over the counter, including aspirin, ibuprofen (Advil, Motrin), and naproxen (Naprosyn), or with a prescription for stronger NSAIDs. However, NSAIDs can have side effects such as stomach irritation, heart problems, and liver and kidney damage.
For more severe PsA, biologics may be prescribed. A type of biologic called a tumor necrosis factor (TNF) inhibitor is often the first medication recommended for active PsA. Examples of TNF inhibitors include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi, Simponi Aria), and certolizumab pegol (Cimzia). If these medications are ineffective or the disease is very severe, a biologic that blocks interleukin-17 (IL-17) or interleukins 12 and 23 (IL 12/23) may be tried, such as secukinumab (Cosentyx), guselkumab (Tremfya), or risankizumab (Skyrizi).
Disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, have been a traditional treatment for PsA. However, DMARDs have shown limited effectiveness in treating axial disease and enthesitis.
Non-drug therapies
Exercise is an important component of PsA treatment. It can help keep joints flexible, improve muscle strength, and reduce pain. Low-impact exercises such as swimming, walking, biking, yoga, and tai chi are recommended as they are less stressful on the joints.
Stress management is another important aspect of PsA treatment. Stress can affect the immune system and trigger disease flares and worsened pain. Relaxation techniques such as deep breathing, meditation, guided imagery, and massage may help reduce stress levels.
Additionally, maintaining a healthy weight is crucial. Excess body fat fuels inflammation and places strain on the joints. Losing weight can reduce pain, increase energy and mobility, and improve the effectiveness of medications. Quitting smoking is also recommended, as it is associated with a higher risk of developing psoriasis and more severe symptoms.
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Frequently asked questions
Yes, psoriatic arthritis can cause muscle weakness. This is due to a combination of inflammatory proteins in the blood, reduced physical activity, and nutritional deficiencies.
Psoriatic arthritis (PsA) is a form of arthritis that affects some people with psoriasis, a chronic skin and nail disease. It causes joint pain, stiffness, and swelling, and can affect any part of the body.
Symptoms of psoriatic arthritis include joint pain, stiffness, and swelling, inflamed tendons or ligaments, swollen fingers and toes, lower back pain, and muscle pain.
There is no cure for psoriatic arthritis, but treatments can slow its progression, lessen pain, and protect joints. Treatments include medication, exercise, acupuncture, and meditation.
