What Are the Five Types of Psoriatic Arthritis?

Arthritis comes in many forms and can seriously impact daily life. One form that affects many older adults is Psoriatic Arthritis (PsA), which is often categorized into five types. But what is PsA, and what are the five types of psoriatic arthritis?

Many older adults struggle with one form of arthritis or another, and how you manage your condition can significantly impact your everyday life. While psoriatic arthritis can be complex, knowing more about the condition can help you make better health choices as you age. 

As a physical therapist with experience helping older adults better understand their arthritis, I will share some essential details about this condition, the five types of psoriatic arthritis, and some helpful tips for managing PsA.

What is Psoriatic Arthritis?

In its most basic form, Psoriatic Arthritis (PsA) is a condition that often accompanies the skin disorder known as psoriasis.¹ 

PsA is also known as arthropathic psoriasis or psoriatic arthropathy. These terms might sound complicated, but they refer to arthritis associated with psoriasis.

Psoriasis manifests as red, scaly patches on the skin. It can also affect nails, making them pitted or ridged. 

Like osteoarthritis and rheumatoid arthritis, psoriatic arthritis is characterized by joint pain and swelling that causes discomfort and impacts normal activities.

What Causes PsA?

The exact cause of PsA is not fully understood. Still, it’s thought to be a combination of genetic and environmental factors.

If you have a family history of psoriasis or PsA, it’s something to keep in mind. And, although we cannot control our genes, leading a healthy lifestyle might help manage the risk. About 40% of individuals with PsA have a close family member with psoriasis or PsA.²

This suggests a genetic link but is not a clear-cut inheritance pattern like other genetic conditions.

Understanding how these conditions can impact us as we age is essential since PsA predominantly occurs in adults.

In my experience working with older adults who have PsA, understanding the type of PsA and the nature of symptoms can significantly impact how the person is treated.

Types of Psoriatic Arthritis

PsA is not a ‘one-size-fits-all’ condition. It varies, and knowing the main types of PsA helps understand the symptoms and best treatment. This condition is often organized into five categories, but what are the five kinds of psoriatic arthritis?

Let’s discuss the five types of psoriatic arthritis that are most commonly diagnosed.¹

Symmetric Polyarthritis 

This type of PsA affects five or more joints in a symmetrical pattern. It is the most prevalent form of PsA and resembles the symptoms and effects of rheumatoid arthritis.

Patients with symmetric polyarthritis often experience pain, stiffness, swelling, and tenderness in matching pairs of joints, such as both hands, knees, or ankles. 

This form of PsA can cause chronic discomfort and, if not properly managed, may lead to joint damage over time.

Because this condition affects so many joints, it can result in significant limitations in mobility and affect quality of life. Regular monitoring and treatment are crucial to managing symptoms and preventing joint damage.

When many joints are affected, treatment is more likely to focus on optimizing and maintaining essential movement patterns for activities of daily living (ADLs).

Asymmetric Oligoarthritis 

This form of PsA is characterized by inflammation in fewer than five joints, occurring asymmetrically. This means that one side of the body is affected, but the other is not. For instance, a person might experience pain and swelling in the right knee, but the left knee remains unaffected. 

This asymmetry can also be seen in wrists or ankles, where one might be painful and swollen while the other remains normal.

Typically, larger joints like knees and elbows are more likely to be affected. The inflammation in asymmetric oligoarthritis can be unpredictable, flaring up and subsiding without clear triggers.

This form of arthritis can cause significant discomfort. The unpredictable symptoms may interfere with daily activities.

For many people with one-sided arthritis, it’s common to struggle with performing activities like walking normally. One of the big focuses of treatment with asymmetrical or one-sided arthritis is using the affected side as much as comfortably possible to limit problems with movement patterns.

Distal Arthritis 

This form of PsA primarily targets the distal joints, which are the joints furthest away from the center of your body, like fingers and toes.

People with distal arthritis often notice changes in their fingernails and toenails, such as thickening, pitting, or discoloration. Pain and discomfort are mainly concentrated in the small joints at the fingertips and the tips of the toes. 

This can lead to difficulties requiring fine motor skills, such as buttoning a shirt or typing. The changes in nail appearance combined with joint pain can be complex, affecting physical function and everyday self-esteem. 

One major treatment component for this type of PsA is managing pain, preventing further damage to the joints of the fingers or toes, and maintaining nail health.

Arthritis Mutilans 

This rare but severe form of PsA is known for causing significant deformation and shortening of the fingers and toes.

This aggressive type of arthritis can destroy joint tissue, resulting in noticeable changes in the shape and function of the hands and feet. The deformities can be very pronounced, leading to significant disability and impact on quality of life. 

Patients with arthritis mutilans often experience intense pain, and the physical appearance of their hands and feet can be a source of frustration or discouragement.

Early and aggressive treatment is critical with this type of PsA to slow the progression of this form of arthritis and to manage the relatively severe symptoms.

Spondyloarthritis

This type of PsA involves the spine, primarily causing pain and stiffness in the neck and back. Spondyloarthritis often affects posture and mobility, leading to changes in the curvature of the spine that impair a person’s ability to perform everyday activities. 

Spondyloarthritis can also cause inflammation at the sites where tendons and ligaments attach to bones, a condition known as enthesitis, particularly around the pelvis and the spine. 

Similar to other forms of PsA, this type of PsA involves feelings of stiffness and pain, particularly in the morning or after periods of inactivity. Inflammation can also affect other body areas, including the eyes, skin, and gastrointestinal tract. 

Management of spondyloarthritis typically involves a combination of medication, physical therapy, and lifestyle modifications to reduce pain and maintain mobility.

Having worked with several patients with this type of arthritis, I’ve found that focusing on positioning and gentle movement of the spine can be very helpful for improving comfort in everyday life.

Now that we’ve discussed the types of psoriatic arthritis, we can discuss diagnosing and managing PsA to maintain and improve overall health.

Diagnosing Psoriatic Arthritis

Diagnosing Psoriatic Arthritis (PsA) is a comprehensive process that requires carefully evaluating various factors. In addition to examining a patient’s medical history and symptoms and conducting blood tests or imaging studies, several other aspects are involved in the diagnosis.

Common Tools for Diagnosing Psoriatic Arthritis

1. Physical Examination: A doctor will perform a thorough physical examination to check for joint swelling, tenderness, and signs of psoriasis on the skin or nails. Psoriasis plaques or nail changes, such as pitting or separation from the nail bed, can indicate PsA.
2. Blood Tests: While there’s no specific blood test for PsA, certain tests can help rule out other conditions or assess inflammation levels. Tests may include Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (Anti-CCP) to rule out rheumatoid arthritis, Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) to gauge inflammation levels, and HLA-B27 antigen testing in some cases.
3. Imaging Tests: X-rays, MRIs, and ultrasound scans can help detect joint damage or inflammation not visible during a physical exam. These tests can reveal characteristic changes in the joints that are different from other types of arthritis.
4. Dermatological Evaluation: Since PsA is associated with psoriasis, a dermatologist may also be involved in the diagnostic process, especially if skin symptoms are prominent.
5. Patient History: A detailed patient history is crucial. The doctor will ask about joint pain patterns, stiffness, especially in the morning, and the duration of symptoms. A family history of psoriasis or PsA can also be a significant indicator.
6. Response to Treatment: Sometimes, the response to specific treatments can help confirm a diagnosis. For instance, if symptoms improve with treatments known to be effective for PsA, it may support the diagnosis.
7. Ruling Out Other Conditions: Conditions like rheumatoid arthritis, gout, and osteoarthritis can have similar symptoms. The doctor needs to rule out these and other conditions before confirming a diagnosis of PsA.
8. Collaborative Care: Often, the diagnosis and management of PsA require a team approach involving rheumatologists, dermatologists, and primary care physicians. Each specialist can provide insights based on their area of expertise.
9. Monitoring and Follow-Up: Regular monitoring and follow-up are essential, as PsA can evolve. Continuous assessment helps in managing the condition effectively and adjusting treatments as needed.

In summary, diagnosing Psoriatic Arthritis is a multifaceted process involving clinical evaluation, lab tests, imaging, and careful consideration of a patient’s medical history and symptoms.

It’s a collaborative effort among various healthcare professionals to ensure an accurate diagnosis and effective management plan.

Treatment and Management of Psoriatic Arthritis

Treatment for PsA aims to manage symptoms and prevent joint damage. This might include medications like nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), or experimental medications.

In addition to medication, regular physical activity and exercise are essential in managing PsA.³

Gentle exercises like walking, swimming, or stretching can improve joint flexibility, reduce pain, and enhance overall well-being. They can also help maintain a healthy weight, which is crucial in reducing the stress on your joints.

Physical therapy is another component of care that can help manage PsA. A physical therapist can tailor a program to your specific needs, focusing on strengthening muscles around affected joints, improving range of motion, and reducing pain.

Regular physical activity and therapy can help manage the symptoms of PsA and make you feel more confident in the long term.

Finding Support

Living with PsA can be challenging, but you’re not alone. In addition to your medical team, there are support groups, both in-person and online, where you can share experiences and tips with others who understand what you’re going through.

These communities can be a source of comfort and valuable information. If you’re seeking assistance to find support, contact your healthcare provider or physical therapist today.

Key Takeaways

• Psoriatic Arthritis (PsA) is a form of arthritis associated with psoriasis, causing joint pain and swelling.
• PsA is influenced by genetic and environmental factors, with about 40% of individuals having a family history of psoriasis or PsA.
• Understanding the five types of PsA—symmetric polyarthritis, asymmetric oligoarthritis, distal arthritis, arthritis mutilans, and spondyloarthritis—can help manage symptoms and treatments.
• Symmetric polyarthritis affects five or more joints symmetrically, similar to rheumatoid arthritis, and can lead to chronic discomfort and joint damage.
• Asymmetric oligoarthritis affects fewer than five joints asymmetrically, causing significant discomfort and impacting daily activities.
• Distal arthritis targets the distal joints, primarily affecting fingers and toes. It often causes changes in nails and difficulties with fine motor skills.
• Arthritis mutilans is a severe form of arthritis that causes significant deformation and shortening of fingers and toes, leading to disability and intense pain.
• Spondyloarthritis involves the spine, causing pain and stiffness in the neck and back, affecting posture and mobility.
• Diagnosis of PsA involves a combination of physical examination, blood tests, imaging tests, dermatological evaluation, patient history, and ruling out other conditions.
• Treatment for PsA includes medications, regular physical activity, and physical therapy to manage symptoms, reduce pain, and improve overall well-being.
• Support groups, both in-person and online, can provide comfort and valuable information for those living with PsA, helping them navigate their condition with better understanding and support.

FAQs

References

1. Medline Plus (National Library of Medicine). Psoriatic Arthritis.
2. Castelino M, Barton A. Genetic susceptibility factors for psoriatic arthritis. Curr Opin Rheumatol. 2010 Mar;22(2):152-6. doi: 10.1097/BOR.0b013e32833669d2. PMID: 20084005.
3. Ogdie A, Coates LC, Gladman DD. Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford). 2020 Mar 1;59(Suppl 1):i37-i46. doi: 10.1093/rheumatology/kez383. PMID: 32159790; PMCID: PMC7065461.