Psoriasis Australia

Polyarticular PsA

Polyarticular Psoriatic Arthritis (Polyarticular PsA) is a subtype of Psoriatic Arthritis (PsA) that affects five or more joints, typically in a symmetrical pattern.

Overview

his form of PsA shares similarities with rheumatoid arthritis, especially in terms of joint involvement, but is unique in its association with psoriasis. Polyarticular PsA can cause chronic pain, swelling, stiffness, and may lead to joint damage if not properly managed.

In Australia, approximately 30% of individuals with psoriasis develop Psoriatic Arthritis, with a significant number affected by the polyarticular form. Early diagnosis and comprehensive treatment are crucial to prevent long-term joint damage and maintain a good quality of life.

Symptoms of Polyarticular PsA

The symptoms of Polyarticular PsA are similar to other inflammatory arthritic conditions but are unique in their link to psoriasis. Common symptoms include:

  • Joint pain and swelling: Typically affects five or more joints, often symmetrically, involving both small joints (hands, wrists, feet) and large joints (knees, hips).
  • Stiffness: Joint stiffness is most noticeable in the morning or after periods of inactivity.
  • Fatigue: Chronic inflammation can lead to significant fatigue, impacting daily activities.
  • Nail changes: Involvement of the nails, such as pitting, ridging, or discoloration, is common in people with PsA.
  • Psoriasis plaques: Many people with Polyarticular PsA experience skin symptoms of psoriasis, such as red, scaly patches on various parts of the body.

Diagnosis

Diagnosing Polyarticular PsA in Australia involves a combination of clinical evaluation, medical history, and diagnostic tests. The following steps are typically involved:

  • Physical examination: A rheumatologist will check for swollen and tender joints, as well as signs of psoriasis.
  • Blood tests: While there is no specific blood test for PsA, blood tests may be conducted to rule out other conditions like rheumatoid arthritis (e.g., rheumatoid factor test) or to assess inflammation (C-reactive protein, erythrocyte sedimentation rate).
  • Imaging tests: X-rays, MRI, or ultrasound may be used to assess joint damage and inflammation.

Early diagnosis is important to initiate treatment and prevent joint damage.

Treatment Options

Polyarticular PsA is a chronic condition, and treatment focuses on managing symptoms, reducing inflammation, and preventing joint damage. Treatment approaches vary based on the severity of the disease.

1. Non-steroidal Anti-inflammatory Drugs (NSAIDs)

  • NSAIDs like ibuprofen and naproxen are commonly prescribed to reduce pain and inflammation in milder cases of PsA. These medications can be purchased over the counter or through prescription.

2. Disease-Modifying Antirheumatic Drugs (DMARDs)

  • Conventional DMARDs such as methotrexate, sulfasalazine, and leflunomide are widely used in Australia to manage moderate to severe PsA. These drugs help slow disease progression and prevent joint damage.

3. Biologic Medications

  • Biologic therapies target specific components of the immune system. Biologics used in Australia for Polyarticular PsA include TNF inhibitors (e.g., adalimumab, etanercept), IL-17 inhibitors (e.g., secukinumab), and IL-23 inhibitors (e.g., guselkumab). These are often prescribed for individuals who do not respond adequately to DMARDs.

4. Janus Kinase (JAK) Inhibitors

  • JAK inhibitors, such as tofacitinib and upadacitinib, are newer oral treatments that target immune pathways involved in PsA. They are used in cases where traditional DMARDs and biologics are not effective.

5. Corticosteroids

  • Intra-articular corticosteroid injections may be used to relieve inflammation in specific joints, while systemic corticosteroids may be prescribed for short-term flare management.

6. Physical Therapy and Exercise

  • Physical therapy plays a key role in maintaining joint function and mobility. Exercise, particularly low-impact activities such as swimming or cycling, can help manage symptoms and improve overall well-being.

7. Surgery

  • In cases of severe joint damage, surgery such as joint replacement may be necessary, though this is considered a last resort.

Lifestyle Modifications

Lifestyle factors play an important role in managing Polyarticular PsA. Key recommendations for individuals include:

  • Maintaining a healthy weight: Excess weight places additional stress on joints and can worsen PsA symptoms. Weight management through diet and exercise is recommended.
  • Dietary changes: Anti-inflammatory diets, which are rich in fruits, vegetables, whole grains, and omega-3 fatty acids, may help reduce inflammation.
  • Smoking cessation: Smoking can exacerbate PsA symptoms and reduce the effectiveness of certain treatments. Quitting smoking is strongly encouraged.
  • Stress management: Stress can trigger PsA flares. Techniques such as mindfulness, yoga, and other stress-reducing practices can be beneficial.

Living with Polyarticular PsA

Living with Polyarticular PsA can be challenging, but with proper management and support, individuals can maintain a high quality of life. Access to specialist care, including rheumatologists and dermatologists, is essential for managing the condition effectively.

Government programs such as the Pharmaceutical Benefits Scheme (PBS) help reduce the cost of medications, including DMARDs and biologics. 

Summary

Polyarticular Psoriatic Arthritis is a complex, chronic condition that requires ongoing care and management. With early diagnosis, appropriate treatment, and lifestyle adjustments, people living with Polyarticular PsA can manage their symptoms and prevent long-term joint damage. A range of treatment options and support services are available to help individuals live well with the condition.