Psoriasis is an autoimmune disease that usually affects only the skin, with the usual symptom of psoriatic plaques affecting knees, elbows and retroauricular areas among others. The nails of the patient with psoriasis have pitted concavities or ridges very typical of this disease.
However, some patients also develop joint inflammation (psoriatic arthritis) which may appear even before the skin lesions, causing many patients to visit an orthopedic surgeon. The arthritis presents with pain, stiffness, swelling and increased local joint temperature. It can affect from the fingers, toes, feet, and heels to the spine.
Both cutaneous psoriasis and psoriatic arthritis manifest themselves in flares: the patient will have phases without disease (remission phase).
Psoriatic arthritis on the hands
At the level of the hands, psoriatic arthritis inflames the proximal interphalangeal joints, giving a “sausage finger” appearance, and deforms the distal interphalangeal joints.
Diagnosis of psoriatic arthritis
Diagnosis is based on physical examination of the patient’s hands, feet and spine. It is necessary for the rheumatologist to make a differential diagnosis with other diseases involving arthritis of the finger joints: rheumatoid arthritis, gout, pseudo-gout and osteoarthritic degeneration.
Treatment of psoriatic arthritis of the hands
There is no curative treatment for psoriatic arthritis.
The treatments provided are aimed at controlling symptoms (pain and inflammation), improving hand function and preventing the disease from progressing to joint degeneration, which can be very limiting.
The multidisciplinary work of rheumatologists, family physicians, dermatologists, physiotherapists and hand surgeons is essential. There are several therapeutic options for psoriatic arthritis, depending on the degree of aggressiveness of the disease.
- Rheumatologic medication: can delay joint degeneration.
- Joint infiltrations: improve pain symptoms and swelling and therefore mobility.
- Physical therapies: decrease pain, increase joint function and prevent finger deformities that can impair overall hand function.
Surgery of the hand with psoriatic arthritis
The surgery should be performed by a Surgeon Specialist in Hand Surgery. He is the one who can decide when and how to perform the indicated technique to improve the function of the Hand. Most of the indicated surgical procedures will be prosthetic joint replacements (mainly of the proximal interphalangeal joints) or arthrodesis (mostly indicated in the distal interphalangeal joints).