This article presents a detailed case study of psoriatic arthritis in a young man. The article also describes certain behavioural modifications that should be made by psoriatic arthritis patients.

A case of psoriatic arthritis

One day a young man came to my clinic. He had been experiencing joint pain and stiffness, especially in his hands, feet and back. On examination, he had tender, swollen joints and showed evidence of enthesitis, or inflammation, at the sites where ligaments and tendons attach to bones.

He also had a history of psoriasis. We discussed the probable diagnosis of psoriatic arthritis. This was difficult to discuss with my patient. He was in his 30s, otherwise healthy and had a young family.

Over the next few months, we tried different medications, including non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and biologic agents. We also discussed lifestyle changes, such as exercise, weight loss and stress management, that could help manage his symptoms.

After several months, my patient reported significant improvement in his joint pain and stiffness, and his physical examination showed reduced joint swelling and tenderness. He was able to resume his normal activities and return to work.

Diagnosis

Here's how I diagnosed and found a treatment plan to help this patient.

Questions I ask: As a doctor when I suspect a patient has psoriatic arthritis, I typically ask the following questions:

1. Do you have any joint pain or stiffness? This condition causes joint pain.
2. Do you have psoriasis, or have you had it in the past? This is often associated with psoriatic arthritis.
3. Have you had any injuries or infections that may have triggered joint pain? Imaging tests, such as X-rays and MRI scans, can also help identify joint damage and inflammation.
4. Do you have any family history of psoriasis or psoriatic arthritis?
5. What is your medical history and testing history? Blood tests can also be useful in identifying inflammation markers, which can suggest an autoimmune disorder like psoriatic arthritis.

Diagnosing psoriatic arthritis can be challenging because the symptoms can vary widely between patients. Symptoms may also be similar to other types of arthritis, making it difficult to distinguish psoriatic arthritis from other conditions.

Outcomes for patients with psoriatic arthritis vary depending on the condition's severity, treatment effectiveness, and the degree of joint damage. With appropriate treatment and lifestyle changes, many patients with psoriatic arthritis can manage their symptoms and maintain a good quality of life.

Treatment approaches

The goal of treatment for psoriatic arthritis is to reduce inflammation, manage symptoms and prevent joint damage. Depending on the severity of the condition, treatment may involve a combination of medications, lifestyle changes and surgery.

NSAIDs, DMARDs, and biologic drugs are some of the most commonly prescribed medications for psoriatic arthritis. NSAIDs or corticosteroids can help relieve pain and inflammation.

• DMARDs or biologics may be prescribed to slow joint damage and improve symptoms.
• Physical therapy or occupational therapy may be recommended to improve joint mobility and function.
• In severe cases, joint replacement surgery may be necessary to repair damaged joints.

Living with psoriatic arthritis

Patients living with psoriatic arthritis should make certain behavioural modifications, including:

1. Avoiding tobacco use and limiting alcohol consumption, as they can increase inflammation and worsen symptoms.
2. Maintaining a healthy weight can help reduce stress on joints.
3. Exercising regularly, including low-impact activities such as walking, swimming, or yoga, can help improve joint flexibility and reduce pain.
4. Eating a balanced diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats can help reduce inflammation and promote overall health.
5. Practising stress management techniques such as meditation, deep breathing, or relaxation exercises can help reduce stress and improve well-being.

Disclaimer: This story is contributed by  David Ozeri and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.