Psoriatic arthritis is a type of inflammatory arthritis that is associated with the skin condition psoriasis. Considerable pain, stiffness and swelling of joints and the surrounding tendons and ligaments can greatly impact the ability to walk comfortably and undertake daily activities such as housework, shopping and socialising. This has been shown to have a negative impact on quality of living for those affected.
Studies have reported that about 0.25% of the general population have psoriatic arthritis. Whilst no studies have specifically determined this in Australia, based on the population figures we can estimate that 7.4million people could be affected. It usually occurs in younger people between the ages of 30 and 50. Consequently, there is a high socioeconomic burden associated with psoriatic arthritis, with unemployment and work disability reported in over 25% of those at working age.
Treatment and the “Window of Opportunity
Recent advances in the treatment of psoriatic arthritis has vastly improved with the introduction of biologic disease-modifying drugs. These drugs help to reduce inflammation, stop the progression of joint damage and improve physical function. Early diagnosis, accurate assessment of disease severity, and initiation of appropriate treatment are essential, with the aim of preventing irreversible joint damage.
Inflammation in the joints and tendons of the foot and lower limb occurs more frequently than those of the upper limbs. Key sites most commonly affected are the Achilles tendon, under the heel and the small joints of the toes. Our preliminary research has shown that foot pain and deformity in people with psoriatic arthritis can result in negative physical, emotional and social consequences.
Despite intensive drug therapy, inflammation in the foot is detectable in a high proportion of people with psoriatic arthritis.
The foot is often not included in standard assessment tools for measuring disease severity in psoriatic arthritis, which can lead to inflammation in the foot being missed along with the opportunity to prevent disease progression.
No clinical guidelines exist for the assessment and treatment of local disease in the foot.
There are no valid measures to assess the impact of foot problems on daily life.
The prevalence and burden of foot problems in psoriatic arthritis is largely unknown due to there being few published studies having concentrated specifically on the foot and ankle.
The study of psoriatic arthritis lags behind other types of arthritis such as rheumatoid arthritis and more research is required to improve early identification and tighter control of inflammation in this disease.