Psoriatic Arthritis Mutilans: Causes, Symptoms, Diagnosis, Risk Factors, Treatment, Prognosis

Psoriatic arthritis mutilans is a type of psoriatic arthritis, which is the most severe of all its types. It is also known as opera glass hand or telescope finger. It leads to the destruction of bone tissue. Psoriatic arthritis mutilans mostly affects hands and is rarely seen affecting wrist, feet or spine. Let us look at its causes, symptoms, diagnosis, risk factors, treatment and prognosis.

Psoriatic arthritis is an autoimmune disorder, i.e. the immune system of the body attacks the healthy cells and tissue. While the exact causes of psoriatic arthritis mutilans are not known, immune system dysfunction is one of the possible reasons. It can also result in inflamed joints and overproduction of skin cells Immune system dysfunction can be genetic or environmental. A family history of psoriasis or psoriatic arthritis also contributes to the cause.

However, there are certain causes that can be contributing causes of psoriatic arthritis mutilans. Bacterial or viral infection can trigger psoriatic arthritis in people with an inherent tendency. Long-term inflammation of the joint can lead to a permanent damage, where the bones of the most frequently joints start eroding, which commonly occurs in psoriatic arthritis mutilans.

Psoriatic arthritis mutilans, just like other forms of psoriasis is a chronic condition which worsen with time. The patient experiences all the symptom of arthritis. The common symptoms of psoriatic arthritis mutilans include

• Decreased mobility
• The stiffness of the joint
• The affected bone begins to disappear
• Straightening and bending the joint becomes difficult
• Shortening of the joint
• Development of loose skin around the affected area
• The loose skin appearance in the patient of psoriatic arthritis mutilans makes the nearby organ appear distinctive in shape.

The diagnosis of psoriatic arthritis mutilans is done by the presence of signs and symptoms of skin and the joints affected. There is no such biomarker for psoriatic arthritis or psoriatic arthritis mutilans. However, other investigations may be done to confirm inflammatory condition and assess the severity of the symptoms and extent of joint damage.

Blood test: After confirming the symptoms of arthritis the doctor can advise a blood test to check for the inflammation and to confirm the presence of antibodies.

X-ray: It is an imaging test done to assess the joint damage.

Evaluation of severity of bone destruction also helps to confirm the diagnosis of psoriatic arthritis mutilans.

Some of the important risk factors of psoriatic arthritis mutilans include

History of Psoriasis: Suffering from psoriasis is one of the greatest risk factors of psoriatic arthritis mutilans. It is more common in people who have psoriatic lesions on nails.

Family history: The condition is more common in individuals who have a parent or a sibling suffering from psoriasis or psoriatic arthritis. Thus family history too is one of the risk factors of psoriatic arthritis mutilans.

Age: People of any age can develop this condition, it being more common between the ages of 30-50 years.

As psoriatic arthritis mutilans is a progressive disease, early the condition is diagnosed sooner can treatment start to manage the symptoms. Some of the medications used in the treatment of psoriatic arthritis mutilans include

Disease-modifying antirheumatic drugs (DMARDs): These drugs include methotrexate, leflunomide, and sulfasalazine, which help in slowing down the progression of psoriatic arthritis and save the joints and other tissue damage.

Immunosuppressants: These medications are given to control the disturbance in the immune system, which is the reason for psoriatic arthritis.

TNF- alpha inhibitors: TNF is an inflammatory substance produced in the body. The TNF inhibitors help reduce pain, swelling, and tenderness in the joints.

NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs which can help relieve pain and inflammation.

Steroid injection: These are injected into the affected joint to offer quick relief from inflammation.

Joint replacement surgery: Treatment of psoriatic arthritis mutilans, in some cases, may also include surgery. The joints which are severely damaged because of psoriatic arthritis mutilans are replaced with artificial prostheses.

Physical therapy: Early physical therapy can help delay or prevent psoriatic arthritis mutilans from joint destruction.

Psoriatic arthritis mutilans is a rare of all the types of psoriatic arthritis. The progression is non-predictable. Appropriate and timely treatment of psoriatic arthritis mutilans can slow down disease progression and can improve the quality of life of the patient.

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