Psoriatic arthritis (PsA) is a chronic joint and skin disease. Some people may have mild disease with occasional flares, while others have ongoing inflammation that can lead to joint damage if not diagnosed and treated early. Psoriatic arthritis may affect one or several joints in your body. Some common signs and symptoms of PsA include:
- Psoriasis: Itchy, painful red patches of skin or areas with a silvery white buildup of dead skin cells
- Dactylitis: Sausage-like swelling of fingers or toes
- Nail disease: Fingernails or toenails with pitting, cracking, thickening, or discoloration, or nails that lift from the nail bed
- Peripheral arthritis: Inflammation of joints in the hands, wrists, elbows, shoulders, feet, ankles, and knees
- Axial arthritis (also known as spondylitis): An inflammation of the spine that usually causes a stiff back or neck with pain or difficulty bending over
- Enthesitis: Tender spots where ligaments and tendons attach to bone
Patients with PsA may also experience other symptoms, such as fatigue, anemia, and uveitis (redness and pain of the eye).
Many people with psoriatic arthritis (PsA) experience flares, or periods of increased disease activity and symptoms. PsA flares can present with a wide range of symptoms, including tender and swollen joints, pain, skin changes, reduced range of motion, fatigue, trouble sleeping, anxiety, stress, and/or flu-like symptoms. The best strategy for dealing with PsA flares is to prevent them in the first place. That means knowing what triggers your flares and avoiding those triggers. Some strategies to avoid flares include:
- Using your PsA medications. Patients who use their medications as prescribed have fewer flares.
- Avoiding injury and sunburn. Skin trauma can cause psoriasis to form at the injury site. Trauma to a joint can also cause painful inflammation.
- Managing stress. Flares are more common during stressful periods.
- Losing weight. Weight loss of 5% or more can significantly decrease disease activity in patients who are overweight or obese.
Some flares may require more than self-management strategies. When flares are out of control, your rheumatologist may adjust your medication dose or change your medication regimen.
Learning more about your disease will enable you to take a more active role in managing your health. Some sample questions are listed below to help you begin the conversation with your clinician about your condition.
- Am I at risk for other health conditions?
- What is uveitis and how do I check for it?
- Does my current treatment prevent ongoing joint damage?
- What results should I expect to see while taking this medication?
- How long before I start to see improvements with my medication?
- Will my treatment help with both skin and joint symptoms?
- What are the side effects of my medication?
- What lifestyle changes can I make to feel better?
- What can I do to reduce the chances of another flare-up?
- How likely is it that my PsA will go into remission?
- Can I stop using my medication if my symptoms have gone away?
Psoriatic arthritis (PsA) doesn’t necessarily lead to disability in all cases. However, for some patients, joint wear and tear over time can lead to permanent damage that significantly reduces range of motion. Seeing a rheumatologist is the first step toward preventing disability related to PsA. Psoriatic arthritis is a lifelong, chronic condition and there is no cure. However, proper and ongoing treatment can minimize joint damage from underlying inflammation and preserve range of motion.
Psoriatic arthritis (PsA) is just one form of arthritis. There are also several subtypes of PsA based on which joints are affected. You may have one of the following types of PsA:
- Arthritis mutilans is a rare, severe form of PsA that primarily affects your hands and feet.
- Distal interphalangeal arthritis primarily affects toe and finger joints (called distal joints).
- Oligoarticular arthritis is a milder form that affects fewer joints in a more asymmetrical pattern, meaning that it affects both sides of the body but different joints.
- Spondylitis is a type of PsA that affects your spine, leading to back and neck problems.
- Symmetric arthritis affects both sides of the body and affects the same joints on each side. This is the most common form of PsA, affecting roughly half of patients.
Psoriatic arthritis is associated with a host of other health conditions, including obesity, gout, diabetes, cardiovascular disease, liver disease, uveitis, inflammatory bowel disease, depression, and anxiety. Patients are also at risk for metabolic syndrome, a cluster of conditions that occur together and increase your risk of heart disease, stroke, and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess weight around the waist, and abnormal cholesterol and lipid levels. Eating well, exercising, and losing weight if you are overweight or obese can help improve your PsA symptoms and decrease your risk of developing complications from related health conditions.
The diagnosis of psoriatic arthritis (PsA) starts with a physical exam to look for swollen and painful joints and nail and skin changes, such as plaque psoriasis. X-rays or scans such as ultrasounds, MRI, or CT scan may be used to look for joint damage. A skin biopsy may be taken to confirm the presence of psoriasis.
Blood tests can be used to rule out other diseases and conditions. A negative blood test for a rheumatoid factor is just one indicator of PsA. There is no single test for PsA, so a proper diagnosis is often dependent on eliminating other possible conditions. Joint pain in PsA is often asymmetrical (felt only on one side of the body), while joint pain for rheumatoid arthritis is usually symmetrical (felt on both sides of the body). Swelling that involves the full length of individual fingers or toes (dactylitis or sausage digit) is most likely the result of PsA.
Psoriatic arthritis (PsA) is an autoimmune disease, a condition in which the body’s immune system attacks healthy tissue in the joints and skin. The overactive immune system causes inflammation in the joints, triggering joint pain, stiffness, and swelling. If PsA is not treated early and aggressively, it may lead to permanent joint and tissue damage. Treatments for PsA reduce inflammation by suppressing immune system overactivity.
Treatments for psoriatic arthritis (PsA) can ease pain, protect joints, and maintain mobility. Treatment options depend on the severity of your disease, including how much pain, swelling, or stiffness you experience. Mild cases of arthritis may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. Steroid injections may ease pain and swelling in an affected joint.
If your arthritis symptoms are not helped by NSAIDs, your rheumatologist may prescribe a disease-modifying antirheumatic drug (DMARD), such as sulfasalazine, methotrexate, cyclosporine, leflunomide, or hydroxychloroquine. Azathioprine may be an option for patients with severe arthritis.
Several new drugs have been developed that target the underlying causes of psoriatic arthritis. These treatments are known as biologics and include:
- TNF inhibitors: adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab
- IL-17 inhibitors: ixekizumab and secukinumab
- Other biologics: ustekinumab, abatacept, and tofacitinib