Are you grappling with joint pain? You're not alone. Countless Americans endure daily discomfort in their limbs or other body parts. But why should we accept pain as an inevitable part of life and aging? The question that follows is, "Why do you experience musculoskeletal pain on a regular or recurring basis?" While many healthcare providers may hesitate to admit it, numerous Americans suffer from recurrent joint pain without ever discovering the underlying cause.

1. Psoriatic Arthritis: A
Common Culprit Behind
Joint Discomfort
By Dr. Conway McLean

2. Are you grappling with joint pain? You're not alone.
Countless Americans endure daily discomfort in
their limbs or other body parts.
But why should we accept pain as an inevitable part
of life and aging? The question that follows is, "Why
do you experience musculoskeletal pain on a regular
or recurring basis?" While many healthcare providers
may hesitate to admit it, numerous Americans suffer
from recurrent joint pain without ever discovering
the underlying cause.
The array of potential factors contributing to
recurrent joint pain is vast and overwhelming.
Differentiating between various forms of pain can be
exceedingly challenging, leading to frequent
misdiagnoses.
One condition frequently observed by lower
extremity podiatric specialists is toe joint pain.
Unfortunately, symptomatic relief is often sought
without addressing the fundamental question of why
the pain exists in the first place.

3. Individuals with joint pain often consult multiple
healthcare professionals during their medical
journey.
Among these individuals, a notable portion may be
dealing with a condition called psoriatic arthritis
(PsA). In fact, estimates suggest that two out of every
500 people have psoriatic arthritis, and not all of
them exhibit the skin changes commonly associated
with this dermatologic condition.
Determining the precise incidence of psoriatic
arthritis proves challenging, as it can be
misdiagnosed as rheumatoid arthritis, osteoarthritis,
or another autoimmune disease.
In many cases, the condition remains undiagnosed,
merely labeled as "Arthur-itis," indicating joint
inflammation without further investigation.
The clinical presentation of PsA shares similarities
with other diseases affecting joints and related
structures such as tendons, ligaments, and muscles,
making differential diagnosis a complex task.

4. PsA cannot be definitively diagnosed through lab
tests alone. While certain tests can provide valuable
guidance, they lack specificity and only offer general
indications.
X-rays may reveal changes indicative of PsA, but
such changes are only visible in advanced stages and
are not consistently present.
Clinical findings play a critical role in diagnosing
psoriatic arthritis, requiring a combination of facts
and observations to determine the cause.
The occurrence of localized swelling in the toes,
commonly referred to as "sausage toes," is not
exclusive to PsA, but it occurs in nearly half of the
cases. While not definitive, this, combined with
other factors, contributes to a more conclusive
diagnosis. Healthcare providers rely on various
classification systems to aid in this decision-making
process, but the task remains challenging.

5. Psoriasis, a common dermatologic condition, is
closely associated with skin changes characteristic of
the disease. Psoriasis affects approximately 2% of the
US population and typically manifests between the
ages of 30 and 50.
Roughly one-third of individuals with psoriasis
experience "rheumatic" symptoms involving joints,
tendons, ligaments, muscles, and more. PsA can
affect any of these structures (in contrast to
rheumatoid arthritis, which primarily affects the
joints).
Like rheumatoid arthritis, PsA is an autoimmune
disorder, wherein the immune system mistakenly
attacks parts of the body, leading to disease
development.
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6. Both rheumatoid arthritis and psoriatic arthritis
cause joint pain, swelling, and warmth. However,
psoriatic arthritis tends to affect the smaller joints
at the farthest ends of the fingers and toes.
Other associated symptoms of PsA include stiffness
after rest, lower back pain, nail changes, fatigue,
muscle pain, and weakness.
Psoriatic arthritis can impact any part of the body,
including the spine, and its severity can range from
mild to severe. Fluctuating symptoms occur in
cycles of flare-ups and remission.
Foot pain is common due to the inflammation
affecting the points where tendons and ligaments
attach to the bones, particularly at the back of the
heel, leading to Achilles tendinitis.
Another frequent source of pain is the attachment
point of a ligament at the bottom of the foot, near
the heel, resulting in plantar fasciitis. Consequently,
many podiatrists encounter patients struggling with
psoriatic arthritis and face the challenge of making
an accurate diagnosis.

7. As of now, there is no known cure for psoriatic arthritis,
mainly because its underlying causes remain elusive.
Treatment focuses on managing inflammation,
particularly in the affected joints, to alleviate pain and
prevent disability.
Unfortunately, due to delayed diagnoses, disease
progression is common. Without proper intervention,
bone changes become apparent on X-rays, potentially
leading to severe and debilitating arthritis, especially if
treatment has been suboptimal.
Treatment approaches may involve medication to reduce
inflammation (e.g., non-steroidal anti-inflammatories like
ibuprofen), steroid injections, or joint replacement
surgery.
Disease-modifying antirheumatic drugs (DMARDs) are
commonly prescribed to mitigate symptoms effectively.
Additionally, avoiding triggers such as environmental and
lifestyle factors known to exacerbate psoriatic arthritis
symptoms proves beneficial.
Recognized triggers include cigarette smoke, skin
wounds, stress, cold weather, and excessive alcohol
consumption.

8. The exact prevalence of psoriatic arthritis remains
uncertain, but it is undoubtedly a widespread cause of
pain.
If you experience symptoms similar to those described
and have psoriasis, it is highly likely that you have PsA but
have yet to receive a formal diagnosis.
Remember that it is possible to exhibit musculoskeletal
signs and symptoms of psoriatic arthritis without
presenting with the skin problems associated with
psoriasis.
Consulting a specialist may be necessary to obtain a
definitive diagnosis, as a high level of suspicion for PsA
significantly aids in understanding the persistent pain in
your toes or foot.
We acknowledge that obtaining an accurate PsA diagnosis
can be challenging for many Americans, but don't lose
hope—truth and relief are within reach.
Dr. Conway McLean, DABFAS, FAPWHc, operates clinics in
L'Anse and Marquette. He is a renowned physician
specializing in the treatment of lower leg, ankle, and foot
conditions.