Psoriatic Arthritis: Autoimmune Disease and Chiropractic

 

Arthritis has a “geriatric” connotation, yet it may affect any age group. The term means joint disease/ disorder. Arthritis can be due to many causes such as degeneration or destruction that is age-related or trauma related, infectious, inflammatory, and/or autoimmune.  This post is about Psoriatic arthritis, an autoimmune related arthritis affecting the neck, back and limb joints. 

 

What is autoimmune arthritis?

 

Firstly, inflammatory arthritis is due to an autoimmune disease. The immune system doesn’t work properly and releases inflammatory chemicals. Secondly, the resulting inflammation attacks joint tissues and can cause joint swelling, cartilage/bone damage, and muscle loss. Thirdly, the inflammatory chemicals may activate nerves around the joints and other parts of the body and lead to pain as well. Lastly, because most of the inflammatory forms of arthritis are systemic (effects entire body), symptoms related to inflammation may occur in other parts of the body, including skin rashes, eye inflammation, hair loss, dry mouth, and fever.

Inflammatory arthritis includes a group of arthritis accompanied by joint pain, swelling, warmth, tenderness in the joints, and morning stiffness that lasts for an hour. And joints affected are many joints throughout the body at the same time.  Moreover, inflammatory forms of arthritis are much less common than osteoarthritis (wear and tear arthritis), which affects most people at the later stages of life. 

 

Psoriatic Arthritis

The typical age (is mostly adults) and gender of occurrence varies with this autoimmune arthritis. The common joints involved are hand, foot, cervical (neck) joints, thoracolumbar (mid back, low back) joints and the sacroiliac joints (joints linking your pelvis and lower spine). Furthermore, in some cases hyperostosis (too much growth of bony tissue) occurs at the sternoclavicular joint (joint between the sternum (breastbone) and clavicle (collarbone). 

Involvement of the fingers or toes may create dactylitis (also called “sausage” appearance). So this is due to localized, painful swelling that causes digits to look like sausages. There are many patterns yet most times the proximal (closest to body) and distal (furthest from body) interphalangel (finger) joints are involved. 

 

Arthritis Mutilans

Arthritis mutilans is described as the most severe deforming type of psoriatic arthritis. It is characterized by digital (finger/toe) shortening associated with severe osteolysis (bone tissue destruction) of peripheral (limb) joints.

 

Skin Lesions (Psoriasis)

Firstly, prior to the onset of psoriatic arthritis, eighty percent of people have skin lesions (damage or abnormal change in the tissue). However, only about 20% of those with skin lesions (psoriasis) from psoriatic autoimmune disease also have the joint involvement (arthritis).

Secondly, the skin lesions maybe quite obvious as “silvery scales” on the extensor (muscle whose contraction extends/ straightens a limb) surfaces of the arms and legs.  In addition, there may be subtle patches in the gluteal cleft (groove between the buttocks), scalp or umbilicus (belly button).  In general, the more pronounced or involved the skin symptoms, the worse the arthritis is.

Thirdly, in addition to possibly having scaly (psoriasis) skin, there may also be nail changes. This includes pitting, discoloration and splintering. Lastly, other skin lesions may occur in the hands and feet.

 

Cause

Multiple genetic and environmental factors (e.g. stress) have been associated with an increased risk for psoriatic arthritis. A family history of psoriatic arthritis can put you at risk. Also, there is a genetic predisposition associated with various HLA (human leukocyte antigen).

Psoriatic arthritis can be mild or severe (arthritis mutilans). Scientists do not fully understand why changes in immune activity cause the disease/ arthritis.

Laboratory Findings

 

Seronegative

Laboratory evaluation is negative for rheumatoid factor (IgM antibody). Hence, Psoriatic Arthritis is called a seronegative arthritis.

 

Erythrocyte Sedimentation Rate (ESR)

ESR is a blood test that gives your doctor an idea of the inflammation levels in your body. An ESR test measures the rate of fall (sedimentation) of red blood cells (erythrocytes) in a test tube. Lab testing will reveal elevations in erythrocyte sedimentation rate (ESR) in Psoriatic Arthritis cases.

 

HLA B-27

HLA-B27 is a genetic test to see whether you have the protein human leukocyte antigen B27 (HLA-B27) on the surface of your cells. If you test positive for HLA-B27 then you are likely to have one of the autoimmune disorders associated with the presence of HLA-B27.  Psoriatic Arthritis is one of those conditions.

 

Serum Uric Acid

A uric acid test measures the amount of uric acid in the blood. Uric acid is a waste product found in blood when the body breaks down chemicals called purines. Elevated levels in Psoriatic Arthritis is thought to be a byproduct of rapid skin cell turnover (due to psoriasis) and systemic inflammation.

 

Complete Blood Count​​ (CBC test )

Mild Anemia develops in autoimmune disease such as psoriatic arthritis and is found in the CBC test.  Anemia occurs if your body makes too few red blood cells (RBCs), destroys too many RBCs, or loses too many RBCs.

First, if you have anemia, your body does not get enough oxygen-rich blood. Second, the lack of oxygen can make you feel tired or weak. Third, you may also have shortness of breath, dizziness, headaches, or an irregular heartbeat.

 

Imaging and X-Ray

Radiographic (x-ray) findings help confirm the diagnosis.