Psoriatic arthritis is a chronic inflammatory disease of the joints and connective tissue, was first described in 1818 by a French physician, Baron Jean Louis Alibert, About 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints. Both genetic and environmental factors seem to be associated with the development of arthritis. The immune system plays an important role.

Signs and symptoms
Psoriatic arthritis causes stiffness, pain, swelling and tenderness of the joints and the tissue around them. Movement of the joint(s) may be difficult. Some cases of psoriatic arthritis cause deterioration of the spine and deformity of the joints, leading to disability. It can develop slowly with mild symptoms, or it can develop quickly and be severe. Major symptoms include-
1. Generalized fatigue
2. Tenderness, pain and swelling over tendons
3. Swollen fingers and toes
4. Stiffness, pain, throbbing, swelling and tenderness in one or more joints
5. A reduced range of motion
6. Morning stiffness and tiredness
7. Nail changes; for example, the nail separates from the nail bed and/or becomes pitted and mimics fungus infections
8. Redness and pain of the eye, such as conjunctivitis
9. The disease can develop in a joint after an injury and may mimic a cartilage tear.
10. Muscle or joint pain can occur without joint inflammation.
11. Tendonitis and bursitis may be prominent features.
12. Swelling of the fingers and toes can suggest a 'sausage-like" appearance.
13. Psoriatic arthritis affects the distal joints in fingers or toes. The lower back, wrists, knees or ankles also may be affected.

Types of Psoriatic Arthritis
There are five types of psoriatic arthritis:
1. Symmetric
2. Asymmetric
3. Distal interphalangeal predominant (DIP)
4. Spondylitis
5. Arthritis mutilans.
1- Symmetric arthritis
This form of psoriatic arthritis is much like rheumatoid arthritis but generally milder with less deformity. It usually affects multiple symmetric pairs of joints (occurs in the same joints on both sides of the body) and can be disabling. The associated psoriasis is often severe.

2- Asymmetric arthritis
Asymmetric (not occurring in the same joints on both sides of the body) arthritis can involve a few or many joints. It can affect any joint, such as the knee, hip, ankle or wrist. It could involve just one finger or a number of them. The hands and feet may have enlarged 'sausage" digits. The joints may also be warm, tender and red. Patient may experience periodic joint pain.

3- Distal interphalangeal predominant (DIP)
This form of arthritis, although the "classic" type, occurs in only about 5 percent of people with psoriatic arthritis. Primarily, it involves the distal joints of the fingers and toes (the joint closest to the nail).

4- Spondylitis
In about 5 percent of individuals with psoriatic arthritis, inflammation of the spinal column is the predominant symptom. Inflammation with stiffness of the neck, lower back, sacroiliac or spinal vertebrae are common symptoms in a larger number of patients, making motion painful and difficult. Peripheral disease can be present in the hands, arms, hips, legs and feet. Spondylitis, when severe, may be associated with generalized symptoms.

5- Arthritis mutilans
This is a severe, deforming and destructive arthritis that affects fewer than 5 percent of people with psoriatic arthritis. It principally affects the small joints of the hands and feet, though there is frequently associated neck or lower back pain. Arthritic attacks and remissions tend to coincide with skin flares and remissions.

Differential Diagnosis of Psoriatic Arthritis
1. Bursitis: Inflammation of a bursa, a small sac of fluid that cushions and lubricates an area between tendon and bone or around a joint
2. Tendonitis: Inflammation of a tendon, a ropelike fiber that connects muscle to bone
3. Gout: Disease caused by deposits of uric acid crystals in the joints; characterized by pain, swelling, redness, heat and stiffness in a joint or joints
4. Reactive arthritis: Form of arthritis that, in addition to joints, can affect the eyes; typically is triggered by an infection
5. Rheumatoid arthritis: Inflammation of membranes or tissues lining the joints; over time, the inflammation may destroy the joints

Psoriatic arthritis can develop without the skin lesions characteristic of psoriasis or the nail changes. Generally, psoriasis appears before the arthritis.

Therapeutics:

Synthetic Repertory- SKIN - ERUPTIONS - psoriasis

alum.-1 am-c.-1 ambr.-1 ant-t.-2 ars.-2
ars-i.-3 ars-s-f.-1 ars-s-r.-1 aur.-1
aur-ar.-1 bell-p.-1 berb-a.-1 borx.-1 bry.-1 bufo-1 calc.-2 calc-s.-2 canth.-2 carb-ac.-1 carb-v.-1 chin.-2 chrys-ac.-2 chrys-ac.-2 cic.-1 clem.-2 cor-r.-1 cupr.-1 dulc.-1 gali.-1 graph.-2 hydrc.-1 iod.-1
iris-2
kali-ar.-2 kali-br.-1 kali-c.-2 kali-p.-1 kali-s.-2 led.-1 lob.-2 lyc.-3 mag-c.-1 mang.-2 merc.-2 merc-c.-1 merc-i-r.-1 merc-k-i.-1 mez.-2 naphtin.-1 nat-m.-1 nit-ac.-2 nuph.-1 petr.-2
ph-ac.-1 phos.-2 phyt.-3 pix-1 psor.-2 puls.-2 rad-br.-1 ran-b.-1 rhus-t.-2 sars.-2 sep.-3
sil.-2 staph.-1 stel.-1 still.-1
sul-i.-1- sulph.-2 tell.-1- teucr.-1- thuj.-1 thyr.-1 tub.-1
x-ray-1