Overview
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a disease that causes red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear.
Joint pain, stiffness and swelling are the main signs and symptoms of psoriatic arthritis. These symptoms can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.
There’s no cure for psoriatic arthritis. Treatment is aimed at controlling symptoms and preventing joint damage. Without treatment, psoriatic arthritis may be disabling.
Symptoms of psoriatic arthritis
Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when symptoms improve or go into remission alternating with times when symptoms become worse.
Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.
However, psoriatic arthritis is more likely to also cause:
- Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
- Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
- Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).
When do you need to see a doctor?
If you have psoriasis, be sure to tell your doctor if you develop joint pain. Psoriatic arthritis can severely damage your joints if left untreated.
Causes of psoriatic arthritis
Psoriatic arthritis occurs when your body’s immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.
Doctors do not clearly know why the immune system attacks healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.
Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.
Risk factors
Several factors can increase the risk of developing psoriatic arthritis, including:
- Psoriasis. Having psoriasis is the single greatest risk factor for developing psoriatic arthritis. People who have pitted, deformed nails are especially likely to develop psoriatic arthritis.
- Your family history. Many people with psoriatic arthritis have a parent or a sibling with this disease.
- Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.
Complications from psoriatic arthritis
A small percentage of people with psoriatic arthritis develop arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.
People who have psoriatic arthritis sometimes also develop eye problems such as pinkeye or uveitis, which can cause painful, reddened eyes and blurred vision. They are also at higher risk of cardiovascular disease.
Diagnosis of psoriatic arthritis
During the exam, your doctor may:
- Closely examine your joints for signs of swelling or pain
- Check your fingernails for pitting, flaking and other abnormalities
- Press on the soles of your feet and around your heels to find painful areas
No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout.
Imaging tests
- X-rays. Plain X-rays help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
- Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.
Laboratory tests
- Rheumatoid factor (RF). RF is an antibody that’s often present in the blood of people with rheumatoid arthritis, but it’s not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.
- Joint fluid test. Using a needle, your doctor can collect a small sample of fluid from one of your affected joints — often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.
Treatment of psoriatic arthritis
No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability.
Medications
Drugs used to treat psoriatic arthritis include:
- Nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, other drugs) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription.
Side effects may include stomach irritation, heart problems, and liver and kidney damage.
- Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage.
Common DMARDs include methotrexate (Trexall, Otrexup, other drugs), leflunomide (Arava) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
- Immunosuppressants. These medications act to tame your immune system, which is out of control in psoriatic arthritis.
Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune). These medications can increase your susceptibility to infection.
- Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ixekizumab (Taltz), secukinumab (Cosentyx), tofacitinib (Xeljanz) and ustekinumab (Stelara).
These medications target specific parts of the immune system that trigger inflammation and lead to joint damage. These drugs can increase the risk of infections. Higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic agents can be used alone or combined with DMARDs, such as methotrexate.
- Newer oral medication. Apremilast (Otezla) decreases the activity of an enzyme in the body that controls the activity of inflammation within cells. Potential side effects include diarrhea, nausea and headaches.
Surgery and other procedures
- Steroid injections. This type of medication reduces inflammation quickly and is sometimes injected into an affected joint.
- Joint replacement surgery. Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic.
Lifestyle and home remedies
- Protect your joints. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel.
For example, you can avoid straining your finger joints by using gadgets such as jar openers to twist the lids from jars, by lifting heavy pans or other objects with both hands, and by pushing doors open with your whole body instead of just your fingers.
- Maintain a healthy weight. Maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility.
Losing weight if needed can also help your medications work better. Some psoriatic arthritis medications are less effective in people who have a body mass index of 25.0 to 29.9 (overweight).
The best way to increase nutrients while limiting calories is to eat more plant-based foods — fruits, vegetables and whole grains.
- Exercise regularly. Exercise can help keep your joints flexible and your muscles strong. Types of exercises that are less stressful on joints include biking, swimming and walking.
- Stop smoking tobacco. Smoking tobacco is associated with a higher risk of developing psoriasis and with more-severe symptoms of psoriasis.
- Limit drinking alcohol. Alcohol can increase your risk of psoriasis, decrease the effectiveness of your treatment and increase side effects from some medications, such as methotrexate.
- Relax. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue.
You should not stop being active entirely, but to rest before you become too tired. Divide exercise or work activities into short segments. Find time to relax several times throughout the day.
Coping and support
Psoriatic arthritis can be particularly discouraging because the emotional pain that psoriasis can cause is compounded by joint pain and, in some cases, disability.
The support of friends and family can make a tremendous difference when you’re facing the physical and psychological challenges of psoriatic arthritis. For some people, support groups can offer the same benefits.
A counselor or therapist can help you devise coping strategies to reduce your stress levels. The chemicals your body releases when you’re under stress can aggravate both psoriasis and psoriatic arthritis.
Preparing for an appointment with a doctor
You’re likely to first discuss your signs and symptoms with your family doctor. Your doctor may refer you to a doctor specializing in the treatment of arthritis and related disorders (rheumatologist).
What you can do to prepare
Before your appointment, you should write a list of answers to the following questions:
- What types of symptoms are you having? When did the symptoms begin?
- Do you or any of your close family members have psoriasis?
- Has anyone in your family ever had psoriatic arthritis?
- What medications and dietary supplements do you take?
You should bring a friend or a family member with you to your appointment. It’s hard to remember everything about a complicated condition, and another person may remember information that you miss.
What your doctor will ask
Your doctor might ask the following questions:
- What joints are affected?
- Are there any activities or positions that make your symptoms better or worse?
- What treatment methods have you already tried? Have any of those methods helped?
