Psoriatic arthritis can be divided into different clinical forms:

1. Peripheral arthritis: Primarily affects the joints of the hands and feet. It is characterized by swelling and pain in the affected areas.
2. Spondyloarthritis: The inflammation affects the spine and leads to back pain and limitations in mobility.
3. Enthesitis: Inflammation at the tendon attachments, often at the Achilles tendon or the plantar fascia.
4. Dactylitis: Swelling of entire fingers or toes, also referred to as "sausage fingers."
5. Mutilating arthritis: A rare but severe form that leads to irreversible joint damage and deformities.

The exact causes of psoriatic arthritis are not fully understood. However, it is believed that genetic, immunological, and environmental factors play a central role:

• Genetic predisposition:
  • HLA-B27 and other genetic markers increase the risk of the disease.
• Immunological dysregulation:
  • A dysregulation of the immune system leads to persistent inflammatory processes in joints and tendons.
• Environmental factors:
  • Stress, infections, or injuries can trigger or exacerbate the disease.
• Psoriasis:
  • Pre-existing skin conditions such as psoriasis increase the likelihood of developing psoriatic arthritis.

The symptoms vary depending on the form and severity of the disease, but often include:

- **Joint pain and swelling:** The small joints of the hands and feet are often affected.

- **Morning stiffness:** Mobility is particularly restricted in the morning and improves throughout the day.

- **Inflamed tendon attachments:** Pain often occurs at the Achilles tendon or the plantar fascia.

- **Skin symptoms:** Psoriatic lesions on the elbows, knees, or scalp are characteristic.

- **Systemic symptoms:** Fatigue, fever, and a general feeling of illness may also occur.

The diagnosis is based on a combination of medical history, clinical examination, and imaging techniques:

• Medical History:
  • The doctor inquires about symptoms, disease progression, family history, and existing skin changes.
• Physical Examination:
  • Examination for swelling, joint pain, skin manifestations, and typical changes such as dactylitis.
• Imaging:
  • X-ray: To detect erosions or deformities.
  • MRI: Visualization of inflammation in soft tissues and joints.
  • Ultrasound: Detection of enthesitis or joint effusions.
• Laboratory Tests:
  • Rheumatoid factor and anti-CCP antibodies are typically negative.
  • Inflammatory markers such as CRP or ESR are often elevated.

Conservative Therapy

• Medication:
  • NSAIDs: For relief of pain and inflammation.
  • DMARDs: Methotrexate, leflunomide, or sulfasalazine to slow the progression of the disease.
  • Biologics: TNF-α and IL-17 inhibitors like adalimumab or secukinumab.
• Physiotherapy:
  • Promoting mobility and strengthening muscles.
• Injections:
  • Local cortisone injections for acute inflammation.
• Pain management:
  • Use of supportive measures such as cold or heat applications.

Surgical Therapy

In severe or advanced cases:

• Synovectomy:
  • Removal of inflamed joint lining.
• Joint replacement:
  • Prosthetics for irreparable joint damage.
• Tendon reconstruction:
  • Treatment of severe enthesitis or tendon ruptures.

To prevent and alleviate symptoms, the following measures are recommended:

1. Stress reduction: Stress management can reduce inflammation.
2. Healthy lifestyle: A balanced diet and regular exercise promote health.
3. Regular check-ups: Early detection of symptoms prevents permanent damage.
4. Avoidance of overexertion: Protect joints through ergonomic measures.