Elbow psoriatic arthritis is observed when the skin complaints of psoriasis are present along with joint inflammation in the elbow joints. Psoriatic arthritis is a type of arthritis, which is accompanied with a skin problem called psoriasis. Psoriasis is a skin disorder that can be noted just before the joint symptoms develop or in some cases, it may be seen after joint inflammation. Psoriatic arthritis is the condition named for the inflammatory arthritis, which is present in people with psoriasis.
What is Elbow Psoriatic Arthritis?
Elbow psoriatic arthritis is a type of arthritis that causes elbow joint pain, swelling, redness and stiffness in people having skin problems or psoriasis. It is a result of an over active immune system and usually affects people who have psoriasis. Psoriasis is a skin disease considered as an autoimmune disorder. While elbow psoriatic arthritis may mimic symptoms with presentation similar to other forms of arthritis, the presence of psoriasis is a major factor that should be considered in diagnosis and treatment of elbow psoriatic arthritis.
In elbow psoriatic arthritis, there is elbow joint inflammation along with silver scaly areas on red patches over the skin, termed as psoriasis. Other common sites of psoriasis include knees, ankles, feet, hands, fingers or spine and sometimes other areas or joints in the body. Usually the skin complaints of psoriasis and the patches appears first followed by the elbow joint inflammation and swelling. However, in some, the elbow joint may get inflamed first followed by patchy skin and psoriasis on the elbow or on other parts of the body.
Elbow psoriatic arthritis is a type of arthritis in which, the pattern of involvement of joints may vary in different individuals. It ranges from affecting one, few or many joints and can affect one or both sides of the body. Psoriatic arthritis can also involve the jaw, spine, toes and affect the ligaments or tendons supporting various joints in the body, more commonly heel and ankles. It can cause joint stiffness and limit the movement of joints making it painful.
Elbow psoriatic arthritis presents itself with joint complaints, swelling, pain and skin with lesions of psoriasis. Diagnosis and treatment of elbow psoriatic arthritis can be tricky and hence appropriate diagnosis and initiation of treatment at the earliest is essential.
Types of Psoriatic Arthritis
Elbow psoriatic arthritis is one of the many locations where psoriatic arthritis can affect. There are many other joints where psoriatic arthritis can be seen. Some of the common types of psoriatic arthritis include:
Symmetric Psoriatic Arthritis
Elbow psoriatic arthritis of symmetric type occurs when psoriatic arthritis affects joints in pairs on both sides of the body. Hence elbow psoriatic arthritis is noted on both left and right elbows, making it symmetrical. The severity of this type ranges from being mild to severe and can even damage the elbow joints to a great extent, if timely treatment is not received.
Asymmetric Psoriatic Arthritis
Elbow psoriatic arthritis of asymmetric type occurs when psoriatic arthritis affects only few joints and not necessarily on both the sides of the body. In this case, elbow psoriatic arthritis can be seen on either sides of the body and other joints may or may not be involved.
Other types of psoriatic arthritis usually affect the distal joint of the fingers (Distal Interphalangeal Predominant psoriatic arthritis), spine (Spondylitis) and another rare type (Arthritis mutilans) that causes damage to the small joints in toes and fingers.
Who Can Get Elbow Psoriatic Arthritis?
Elbow psoriatic arthritis is an inflammatory type of arthritis, seen in people who are having psoriasis, presented with patchy and shiny, scaly skin lesions.
- Persons with a history of psoriasis are at an increased risk of elbow psoriatic arthritis and those with a family history with close family members or identical twins too.
- It is more common in people in their middle ages, ranging from 30 to 50 years, but can also occur at any age.
- Men and women are equally affected, but involvement of the spine may be seen more in men.
- People having autoimmune disorders or abnormalities of the immune system can be at increased risk of developing elbow psoriatic arthritis.
- Some people with an injured joint or psoriasis developed after trauma to the skin can develop arthritis later on.
- Some studies have suggested a link between certain infections like streptococcal infections or HIV and the possibility of development of elbow psoriatic arthritis, however, this may need more research.
- Certain factors like increased stress and other triggers that can make symptoms of psoriasis worse can influence the development of worsening of elbow psoriatic arthritis.
What are the Causes of Elbow Psoriatic Arthritis?
Elbow psoriatic arthritis is a result of over active immune system, hence it is caused when the body's immune system begins to attack healthy cells and affects the skin and joints. It results in increased production of cells under the skin, resulting in patchy, shiny lesions of psoriasis. It is then associated with joint inflammation, swelling, pain, stiffness or the elbows.
Environmental or genetic factors may be involved but the exact mechanism and cause for such changes in the immune system are not clear. Some bacterial or viral infections, trauma or other risk factors may be contributing factors for the development of elbow psoriatic arthritis.
What are the Symptoms of Elbow Psoriatic Arthritis?
Signs and symptoms and the types of presentation often varies in different people. More commonly elbow psoriatic arthritis presents itself with joint inflammation which often precedes skin lesions of psoriasis on the elbows or is associated with it in some way. Some of the common complaints include,
Joint Complaints – Elbow joint pain, swelling, tenderness, warmth and stiffness. Pain and stiffness can make the joint painful to move resulting in restricted movements and a decreased range of motion. Pain and tenderness may also be present in the ligaments and tendons attached to the elbow joints. Morning stiffness of the affected joints is often present, which may last longer than 30 minutes.
Along with joint inflammation and swelling, there may be inflammation of tendons attached to the bones and resulting swelling. Tendons around the elbows, heels and pelvic bones are commonly involved. Elbow psoriatic arthritis can present with any of these joint symptoms depending on the pattern of disease in that individual. Additionally, other joints, if involved may also show similar signs and symptoms.
Psoriasis – The skin on the elbow may show psoriatic lesions, which may also be present on other parts of the body. These are dry, silver colored or grey appearing scales in spots present over red patches on the skin area. They may have raised margins and can cause itching. These are usually present over the joints, ankles, heels, knees, spine along with elbows and even on the scalp.
Inflammation of Tissues - If finger or toe nails are involved, there can be swelling of joints in fingers that appear like sausages, medically termed as dactylitis and they can even get detached. Pain and swelling in the heels due to inflammation of the tendon attached to the bone and is called as Achilles tendon may be noted. Pain and inflammation where tendon attaches to the bone in other areas like knees, chest and hips is called enthesitis.
Others Symptoms of Elbow Psoriatic Arthritis – Other parts of the body or joints may also be affected with joint inflammation, pain, stiffness and skin lesions. Eye inflammation may be present, with redness and pain in the eyes. Nail abnormalities like crumbling, pitting, discoloration or disfigurement may be seen. Sometimes swelling in fingers and toes may develop that not only involves the joints but also other tissues. Fatigue is also a commonly associated complaint, which may leave the person feeling weak with lack of energy.
What is the Outlook or Prognosis of Elbow Psoriatic Arthritis?
Elbow psoriatic arthritis is chronic inflammatory conditions associated with skin disorder that can have remissions and flare-ups. It cannot be completely cured, however, effective treatment options are available to minimize the symptoms and control the deformities of joints and hands. Early diagnosis and appropriate treatment is important as it can help to identify people who can develop more severe forms of elbow psoriatic arthritis and may be at risk of more deformities of joints, which can be prevented at its best.
Treatment of elbow psoriatic arthritis depends on the severity of the condition, joint inflammation and psoriasis. Early treatment can help in preventing severe damage and involvement of many joints in the body. Genetic tests can make it possible to identify potential cases with increased risk and help in timely diagnosis and treatment.
How is Elbow Psoriatic Arthritis Diagnosed?
Elbow psoriatic arthritis is diagnosed based on a person's history, appearance of events regarding skin disorders, history of joint inflammation, trauma or any infections. Family history of skin diseases, autoimmune disorders or joint problems is also considered.
No specific tests that can determine psoriatic arthritis are available. However, other tests that can help to rule out other forms of arthritis, signs of infection or trauma and some tests to identify the presence of autoimmune disorders are performed.
Some of the investigations include:
Laboratory studies include blood tests that help to detect the presence of inflammation, infection and related parameters. Some tests include complete blood count (CBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Tests that aid in detection of presence of autoimmune disorders include ANA profile that includes various parameters, based on which the physician can get an idea about the immune system disorders. Rheumatoid Factor (RF) is performed to rule out the possibility of rheumatoid arthritis.
Excess synovial fluid from the elbow joint may be aspirated for fluid analysis to rule out other forms of arthritis like gout, septic arthritis and others.
Imaging studies include x-rays, ultrasound, MRI and CT scans that can help to detect changes in the bones and elbow joints can help to distinguish elbow psoriatic arthritis from other forms of arthritis.
How is Elbow Psoriatic Arthritis Treated?
Treatment for elbow psoriatic arthritis aims to relieve the symptoms and control disease progression thus minimizing joint damage as much as possible. Various treatment modalities suit different people and the most effective combination needs to be worked out for each individual case.
Some treatment options include:
Medical Management of Elbow Psoriatic Arthritis
Some commonly used medications are usually given to relieve symptoms and control progression of the disease. These include:
- Analgesics or Pain-killers for Elbow Psoriatic Arthritis - Analgesics help in reducing the pain and discomfort, although they may not have any anti-inflammatory effects.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs) for Elbow Psoriatic Arthritis – These medicines help in reducing inflammation and takes care of the pain too. Orally taken NSAIDs often lead to irritation of the stomach and may be contraindicated in certain illnesses or may not be well-tolerated by all. NSAIDs are also available in gel or cream form that can be applied locally to the affected joint.
- Disease-modifying Antirheumatic Drugs (DMARDs) - These drugs are frequently used for the treatment of psoriatic arthritis, in order to control disease progression and thus also limits deformities of joints. DMARDs help in slowing down the over active immune system and delays damaging the joints of the body.
- Immunosuppressant Medications - These medications are aimed at suppressing the immune system of the body to protect the body from the over functioning immune system. Immunosuppressant medications may have serious side effects and are preferably used only when required.
- TNF-alpha Inhibitors - TNF-alpha inhibitors act by blocking the protein, which is mainly responsible for causing inflammation in arthritis. These medicines also help in treating signs and symptoms of psoriasis.
- Steroid Injections for Elbow Psoriatic Arthritis – Steroid injections may be given into the elbow joint to reduce inflammation, pain and control the over activity of the immune system for elbow psoriatic arthritis.
- Skin Creams – Skin creams, ointments or light treatment may be considered to control skin symptoms in case of psoriasis in elbow psoriatic arthritis. Skin creams containing vitamin D, retinol or others maybe prescribed depending on the individual case.
Surgical Treatment for Elbow Psoriatic Arthritis
Surgical treatment is considered only in cases where medical management and other conservative measures for treating elbow psoriatic arthritis fail to produce effect. Surgery helps in relieving elbow joint pain, increasing range of motion and improving the physical look of the affected region. The decision of whether or not surgery should be performed depends on many factors including the age of the person.
Some surgical methods that can be considered for treatment of elbow psoriatic arthritis depending on a patient's condition include:
- Synovectomy - Synovectomy is performed on the elbow joint for restoring the joint function or any diseased or damaged portion in the joint can be removed. Synovectomy is often performed as an arthroscopic procedure.
- Arthroscopy – Arthroscopy on the elbow joint is performed with a flexible, fiber optic instrument called arthroscope. In this procedure a tiny camera and surgical instruments are inserted into the joint through small incisions. This procedure helps to detect the abnormalities within the joint, helps to remove loose fragments in the joint, bone spurs, damaged lining or any cysts present in the joint area.
- Osteotomy - Osteotomy is performed for realigning the long bones of the arm in order to release the pressure off the elbow joint.
- Joint Fusion - This procedure includes fusing or combining the bone ends with the help of screws, pins, rods, or plates that help to hold the bones in their place during the healing process. This may not allow free movement at the joint.
- Joint Replacement – Joint replacement of the elbow joint is performed by removing the affected joint and replace it with an artificial joint made up of plastic or metal. Joint replacement can either be partial or total depending on the condition of the affected joint.
Physical Therapy for Elbow Psoriatic Arthritis
Physical therapy is helpful in managing elbow psoriatic arthritis and maintaining joint function. It is of great value even after surgical treatments to help regain joint movement and flexibility. Physical therapy includes therapeutic exercises to improve range of motion, reduce pain, and improve joint flexibility. These exercises also help to strengthen cartilage, muscles and other tissues surrounding the elbow joint.
Aids that help to support the damaged elbow joint and supportive devices like splints, braces, cane, walker, crutches and elastic bandages may be advised. Heat or ice compresses are also applied to the affected joints as advised by the therapist. Physical therapy uses other modalities like ultrasound and electrical or nerve stimulation to reduce pain and inflammation around the joint.
FAQs about Elbow Psoriatic Arthritis
Here are the answers to some frequently asked questions about elbow psoriatic arthritis, which can help in managing the condition better.
Does Psoriatic Arthritis Run in Families?
While the exact cause of psoriatic arthritis is not known, studies suggest that some people having psoriatic arthritis can also have a close family member with a similar condition. So, if there is a family member with psoriatic arthritis, the chances may be higher than others, but it is believed that psoriatic arthritis occurs due to combination of factors which include a person's genetic make-up, immune condition and environmental factors. Hence it affects different people differently, even when seen in the same family.
Does Diet Play a Role in Elbow Psoriatic Arthritis?
Diet may not be directly related to worsening or improving of elbow psoriatic arthritis symptoms. However, eating a healthy balanced meal, avoiding excess of sugars and salt, rich, fatty and processed food is always better from general health point of view. Drinking plenty of water is believed to be helpful in relieving joint problems. Moreover, a diet that helps in maintaining ideal weight without compromising on healthy food can help to be fit and healthy. Following a diet that suits individual requirements, keeps inflammation low and helps to manage weight is ideal.
Does Climate Make any Difference in Elbow Psoriatic Arthritis?
Elbow psoriatic arthritis symptoms may worsen or get better as a natural course of the disease. Some people may note more changes in the skin and joint complaints during winter while they may be less during summer. Taking care of the skin and protecting it from dryness during winter is important.
Does Elbow Psoriatic Arthritis get Worse in Sunlight?
Sunlight can help in reducing cell growth under the skin, if taken in moderation. However, excessive exposure to the sun can cause harm to the skin or sunburn, hence using a sun screen lotion is advisable. It is important to consult the physician regarding sun baths and use of any skin creams and follow their advice.
Does Elbow Psoriatic Arthritis Affect Sex and Pregnancy in Women?
Psoriatic arthritis of the elbow may not directly cause any problems. However, sex can be painful in women whose hips joints are affected, inflamed and painful. Elbow psoriatic arthritis usually does not influence the chances of getting pregnant. There is a possibility that the condition may go into remission during pregnancy and flare-ups may be noted within few months after the childbirth.
Will Exercise Help in Elbow Psoriatic Arthritis?
Exercise plays an important role in maintaining joint functioning, its range of motion and muscle strength. While physical therapy can be performed as a part of the treatment, regular exercises for the entire body also help to keep the body fit and relieve stress. Regular walking, jogging or cycling can be performed as advised by the physician. Swimming or water exercises are a very good choice for people with arthritis as it takes off the weight from the joints while exercising. It is important to seek medical advice about the type of exercises and their intensity as they differ from person to person, depending on the severity of the condition.
What Lifestyle Changes Can Help to Manage Elbow Psoriatic Arthritis?
Elbow psoriatic arthritis is a chronic inflammatory condition, which can also affect a person's mood and can even have an impact on the professional, personal and social life. Important lifestyle changes like learning to manage stress, making healthier dietary choices and being fit can be helpful. Taking regular breaks from work, relaxation techniques or joining support groups, if required can be considered.
Fatigue being an important symptom, adequate rest and a balance of work, activity and rest is essential. A good night's sleep and spaced out activities during the day time can help relieve manage fatigue and stress.
Changing habits like smoking and alcohol consumption can help in many ways. Maintaining an ideal weight can relieve some pressure on the joints and reduce pain. Regular exercise and activity can help to maintain energy levels and improve joint function too.