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What are seronegative spondyloarthritis?

Seronegative spondyloarthritis is a group of autoimmune diseases characterized by involvement of the joints and the axial skeleton (spine, sacroiliac joints), as well as frequent involvement of other organs such as the skin, intestine and eyes. 

The most important are psoriatic arthritis, ankylosing spondylitis and spondyloarthritis associated with inflammatory diseases of the bowel (Crohn’s disease, ulcerative colitis). Others are reactive arthritis and peripheral spondyloarthritis.

What is the position of psoriatic arthritis?

Psoriatic arthritis is one of the most common seronegative spondyloarthritis and is characterized by psoriatic involvement of the skin and sometimes the nails, simultaneously with involvement of the joints and/or the axial skeleton. It is a very common rheumatological condition that affects approximately 1-2 per 1,000 people, occurs equally often in men and women and can affect all ages. 

Will all patients with psoriasis develop joint involvement?

No. Approximately 20-30% of patients with psoriasis will develop joint involvement at some point in the course of the disease. The likelihood of developing psoriatic arthritis remains constant throughout the course of the disease. Also, a much smaller percentage of patients (approximately 7-15% of patients with psoriatic arthritis) first develop arthritis and later psoriasis, while finally there are patients who will only develop arthritis without skin involvement, and who will be diagnosed with “psoriatic” arthritis due to the presence of a close relative with psoriasis.  

I have joint pain. How do I suspect that I may be suffering from psoriatic arthritis or other seronegative spondyloarthritis?

Musculoskeletal symptoms that should alarm us are: morning stiffness, persistent pain or swelling in the joints or tendons, as well as sometimes deep pain with stiffness in the lower back. Symptoms are typically worse in the morning and improve with movement, but nothing is absolute and sometimes the symptoms can be atypical and make diagnosis difficult. 

Can psoriatic arthritis affect other organs of the body?

In some patients, intestinal inflammation or inflammation of the eyes coexist. Rarely, the lungs may also be affected. It is also known that the chronic inflammation that the disease entails can increase the risk of cardiovascular disease (strokes, heart attacks, etc.), but also of malignancies. For this reason, it is very important to properly monitor the patient and regulate all parameters that may affect their health (body weight, smoking, exercise, sugar, cholesterol or blood pressure control).  

How is psoriatic arthritis treated?

Psoriatic arthritis can be treated with medications known as immunomodulators. There are older-generation medications such as methotrexate, but also newer medications, also known as biological agents. Usually, the doctor chooses a medication or combination of medications that treat both the skin and musculoskeletal involvement. In case the patient is well-regulated but some skin lesions persist, additional local treatment may be administered. Cortisone in pills is not recommended for long-term administration and is administered only if necessary.  

What should I pay attention to when receiving treatment for psoriatic arthritis?

Immunomodulators are safe drugs intended for chronic administration, when given under the guidance of a specialist and with proper monitoring. In case of side effects, the drug is discontinued and replaced with another. All rheumatology drugs cause a relative decline in the immune system to a greater or lesser extent. Your doctor will discuss with you ways to strengthen your immune system,your health and will answer your questions.  

Am I allowed to exercise if I am diagnosed with psoriatic arthritis or other spondylitis?

Exercise is not only allowed but also recommended. Both aerobic exercise (walking, running, swimming) and strengthening exercises (Pilates, yoga, weights) can relieve pain, improve mobility and reduce inflammation levels in the body. However, care is needed to avoid injuries, which is why forms of exercise such as swimming and Pilates are recommended, which train the body evenly with a low probability of injuries. Good cooperation between a rheumatologist, physiotherapist or trainer can provide very significant benefits.  

Are there foods that I should eat or avoid?

Good nutrition is the basis of a healthy immune system. A balanced diet that avoids sugar and processed foods, maintains a healthy body weight, avoids alcohol, and stops smoking can reduce inflammation levels and improve the quality of health of patients with rheumatic diseases.