Psoriatic arthritis

Psoriatic arthritis (lat. arthritis psoriatica, PsA) is a chronic, inflammatory autoimmune disease belonging to the group of seronegative spondyloarthropathies. This condition develops in some patients with skin psoriasis and involves both peripheral joints and axial structures, leading to pain, swelling, and progressive destruction of the musculoskeletal system. The pathogenesis of the disease is associated with abnormal activation of the immune system and overproduction of pro-inflammatory cytokines, such as TNF-α, IL-17 and IL-23. The clinical course is characterized by significant variability – from mild forms with involvement of single joints to severe, destructive forms leading to disability.

Psoriatic arthritis – causes

The etiopathogenesis of psoriatic arthritis is multifactorial and involves the interaction of genetic predisposition, immunological and environmental factors. A key role is played by the deregulation of the immune response, dominated by T lymphocytes (especially Th17) and proinflammatory cytokines.

The most important etiological factors include:

Genetic predisposition – the presence of histocompatibility antigens, especially HLA-B27, HLA-Cw6, increases the risk of disease development
Immunological disorders – excessive activation of the IL-23/IL-17 axis leads to chronic inflammation within the joints and entheses
Environmental factors:
- infections (e.g., streptococcal),
- mechanical trauma (Koebner phenomenon),
- chronic stress,
- obesity and metabolic syndrome

An important element of the pathogenesis is also inflammation of the entheses (enthesopathy), which distinguishes psoriatic arthritis from other rheumatic diseases, such as rheumatoid arthritis.

Psoriatic arthritis – symptoms

The clinical presentation of psoriatic arthritis is heterogeneous and includes various forms of joint involvement. Symptoms may precede skin lesions, occur concurrently, or develop many years after the diagnosis of psoriasis.

The most common clinical manifestations include:

Joint pain and swelling – most commonly the distal interphalangeal (DIP) joints, knees, and ankles
Morning stiffness – lasting over 30 minutes
Dactylitis („sausage digit”) – generalized swelling of the entire digit
Enthesitis – particularly in the area of the Achilles tendon and plantar fascia
Axial involvement – inflammatory back pain
Nail changes:
- pitting,
- onycholysis (separation of the nail plate from the nail bed),
- subungual hyperkeratosis

During the course of the disease, destruction of joint structures may occur, leading to deformity, limited mobility, and permanent disability. The mutilating form (arthritis mutilans) is among the most severe clinical variants.

Psoriatic arthritis – is it curable

Psoriatic arthritis remains a chronic, recurrent disease, for which the current state of medical knowledge does not allow for a complete cure. However, it is possible to achieve clinical remission or low disease activity through appropriately selected treatment.

Therapeutic goals include:

inhibition of the inflammatory process,
prevention of structural joint damage,
improvement of the patient's quality of life,
reduction of pain symptoms and stiffness.

Modern therapies, especially biological drugs and JAK kinase inhibitors, enable effective disease control in a significant proportion of patients. Early diagnosis and prompt implementation of treatment are crucial for the prognosis – delaying therapy increases the risk of irreversible destructive changes.

Psoriatic arthritis – treatment

Treatment of psoriatic arthritis is comprehensive and includes pharmacotherapy, rehabilitation, and lifestyle modification. The choice of therapy depends on the disease activity, joint involvement, and the presence of skin lesions.

1. Pharmacotherapy

Non-steroidal anti-inflammatory drugs (NSAIDs) – reduction of pain and inflammation
Disease-modifying antirheumatic drugs (DMARDs):
- methotrexate,
- sulfasalazine,
- leflunomide
Biological drugs:
- TNF-α inhibitors (e.g., adalimumab, etanercept),
- IL-17 inhibitors (secukinumab),
- IL-23 inhibitors
JAK inhibitors – a modern group of drugs with immunomodulating effects

2. Non-pharmacological treatment

physiotherapy and kinesiotherapy – improvement of joint mobility and muscle strength,
weight reduction – reducing the load on the musculoskeletal system,
patient education and control of inflammatory factors.

3. Supportive management in aesthetic medicine and dermatology

In the context of skin changes accompanying psoriasis, therapies supporting regeneration and reduction of skin inflammation are used:

phototherapy (UVB 311 nm) – immunomodulating effect,
LED light therapies – reduction of inflammation,
radiofrequency (RF) treatments – improvement of microcirculation and tissue trophics,
skin mesotherapy – support for regeneration and hydration.

In clinical practice, interdisciplinary cooperation – of a dermatologist, rheumatologist, and rehabilitation specialists – is of significant importance, allowing for the optimization of therapeutic effects and limiting disease progression.