Psoriasis, is one of the most well-known skin conditions. Psoriasis is derived from the Greek “Psore”, which means scale, flaking. When pronouncing psoriasis, the stress is on the first “i”. It is estimated that psoriasis occurs in 2 to 4 percent of the Dutch population. It can begin at any age and is chronic in nature.
On World Psoriasis Day 2016, rheumatic complaints in psoriasis receive little attention. As you know, psoriasis is an immune disease in which the upper horny layer divides very quickly, but this immune disorder has multiple targets, including cardiovascular disease, arteriosclerosis, liver disease and joints. The latter is also called psoriasis arthropathica.
2% To 25% of people with psoriasis also have joint problems.
Studies show that 2-25% of people with psoriasis also have joint problems. The age is between 30-55 years old, but can also occur in children. In 67% of adults, the skin problem precedes joint problems, in children joint complaints precede skin problems.
Sufficient knowledge, too late diagnosis
Despite this knowledge, on average, the diagnosis of ‘early’ psoriasis arthropathica is only made 3 months to 5 years later than skin psoriasis.
The problem is the diagnostic standards to properly assess psoriasis arthropathica, but joint pain in psoriasis patients is also not recognized as psoriasis arthropathica, but is labeled as overload or too much sport. The joints affected are the small joints of the hands, feet, also wrists, ankles and sacrum (lower back).
Warm, swollen and stiff
70% of the cases can affect 1-4 joints and only in 15% it is symmetrical (for example, both left and right wrist or left and right index finger are involved in the same period).
In addition to joints, attachment of a tendon to the bone (enthesitis) or the sole of the foot (plantar fasciitis) can also be affected. The joints are painful, warm, swollen or stiff.
Currently, the standards for psoriasis arthropathica are set at equal or greater than 3 of these 5 points:
- Diagnose psoriasis or a family member with psoriasis or psoriasis arthropathica
- Nail abnormalities (dentations in the nail, white spots or thickened nail plate, loose nail tip (onycholysis), discoloration)
- Absence of rheumatic factor in the blood
- Dactylitis (sausage finger or sausage toe)
- Joint abnormalities on the x-ray
It is wise to recognize psoriasis arthropathica at an early stage to limit damage to the joints.