Psoriatic arthritis (PsA) is a chronic inflammatory condition that primarily affects the joints, causing pain, swelling, and stiffness. This autoimmune disease can also impact other parts of the body, including the skin, nails, and eyes. This article explores the potential connection between psoriatic arthritis and the development of neuropathy in the feet.
Psoriatic Arthritis and Nerve Involvement
Psoriatic arthritis can lead to neuropathy. While PsA primarily targets joints and skin, its systemic inflammatory nature means it can affect various bodily systems, including the nervous system. Peripheral neuropathy, which involves damage to nerves outside the brain and spinal cord, is a recognized, though less common, complication associated with psoriatic arthritis.
How Psoriatic Arthritis Can Lead to Neuropathy
Systemic inflammation stemming from psoriatic arthritis can directly contribute to nerve damage. Inflammatory mediators, such as cytokines, can assault nerve fibers or the surrounding myelin sheath that protects them. This chronic inflammatory state can disrupt normal nerve function and lead to degeneration over time.
Joint swelling and structural changes common in PsA, such as bone spurs (osteophytes) or inflamed joint linings (synovitis), may compress nearby nerves. For instance, inflammation in the ankle or foot joints could physically press on nerves, impeding their ability to transmit signals. Such mechanical compression can result in localized nerve damage and neuropathic symptoms.
Inflammation associated with PsA can also affect the small blood vessels that supply oxygen and nutrients to nerves. This reduced blood flow, known as ischemia, can starve nerve cells, leading to their dysfunction and damage. This microvascular involvement can contribute to ischemic neuropathy. Psoriatic arthritis patients also have a higher prevalence of comorbidities like diabetes and metabolic syndrome, which are established risk factors for neuropathy. These co-occurring conditions can independently or synergistically contribute to nerve damage. Furthermore, some medications prescribed to manage PsA can have neurological side effects, potentially contributing to or exacerbating neuropathic symptoms.
Recognizing Neuropathy in Your Feet
Neuropathy in the feet can manifest through a variety of sensory and motor symptoms:
Numbness or a reduced ability to feel sensations, making it difficult to detect temperature changes or minor injuries.
Tingling, often described as a “pins and needles” sensation, which can occur intermittently or persistently.
Burning pain, where the feet feel uncomfortably hot, sometimes accompanied by sharp, shooting pains.
Muscle weakness in the feet, affecting balance and coordination.
Increased sensitivity to touch, where even light pressure can cause discomfort (allodynia).
A peculiar sensation, like wearing socks or gloves when not.
Changes in skin temperature or color, indicating involvement of autonomic nerve fibers.
Diagnosis and Management of Neuropathy
Diagnosing neuropathy linked to psoriatic arthritis typically begins with a thorough medical history and a physical examination, focusing on a neurological assessment. Clinicians will evaluate reflexes, sensation, and muscle strength in the affected feet. To further assess nerve function, nerve conduction studies (NCS) and electromyography (EMG) are often performed. NCS measure how quickly electrical signals travel through nerves, while EMG assesses the electrical activity of muscles in response to nerve stimulation.
Blood tests are also performed to rule out other common causes of neuropathy, such as vitamin deficiencies, uncontrolled diabetes, or thyroid disorders. Imaging techniques, such as magnetic resonance imaging (MRI), may be utilized if nerve compression due to joint changes or inflammation is suspected.
Controlling the underlying psoriatic arthritis inflammation is important for preventing further nerve damage and potentially improving existing neuropathy. This often involves disease-modifying antirheumatic drugs (DMARDs) or biologic therapies. Symptom management is also a focus, utilizing neuropathic pain medications like gabapentin or pregabulin, or topical creams to alleviate discomfort. Physical therapy helps improve strength, balance, and overall mobility. Lifestyle adjustments, including diligent foot care, wearing supportive footwear, and managing any co-occurring conditions like diabetes, are also important.