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Psoriatic Arthritis(Arthritis, Psoriatic; PsA)
Definition

Psoriatic arthritis is a long-term condition that causes pain and swelling in the joints. Overtime it can cause be damaging to the joints and cause disability. It is associated with a skin condition called psoriasis, but not everyone that has psoriasis will develop psoriatic arthritis.

Psoriatic arthritis is an autoimmune disease which means the body attacks its own healthy tissue.

Psoriasis

Psoriasis

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Causes

The exact cause of psoriatic arthritis is not known. It may be due to a combination of genetics and environmental triggers.

Risk Factors

Factors that increase the risk of psoriatic arthritis includes having:

  • Psoriasis for 5-12 years
  • Psoriasis with symptoms such as lesions on the scalp and pitted or dented nails
  • A specific gene characteristic that has been linked to psoriatic arthritis
  • A family member with psoriatic arthritis
Symptoms

Psoriatic arthritis usually develops in people who already have psoriasis. Symptoms that may indicate the development of psoriatic arthritis include:

  • Joint pain and tenderness in one or more joints (can be any joint including knees, feet, hands, wrists, and elbows)
  • Joint swelling
  • Joint stiffness, especially in the morning
  • Red or warm joints
  • Changes in fingernails and toenails (pitting in the nails, crumbling nails, or nails separating from the nail bed)
  • Swelling of fingers
  • Back pain
  • Fatigue
Diagnosis

Your doctor will ask about your symptoms and medical history, especially information about your psoriasis. A physical exam will be done. Your doctor will rule out similar conditions with the physical exam.

To look for signs of an inflammation and cause of joint problem your doctor may order:

  • Blood tests to look for autoimmune disease
  • Analysis of the fluid in the joints
  • Tests to check how the immune system is functioning

Imaging tests may also be done to look for damage to the joint. Images may be taken with x-ray , ultrasound , or MRI .

Treatment

In addition to treating you psoriasis, your doctor will also create a treatment plan that focuses on your arthritis symptoms. Treatment may include:

Medications

Depending on the severity of your symptoms, your doctor may recommend:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and inflammation
  • Steroid injections into painful joints
  • Disease-modifying anti-rheumatic drugs (DMARDS) to treat more severe symptoms and slow the progression of the disease, including:
    • sulfasalazine
    • leflunomide
    • cyclosporine
    • methotrexate
  • Tumor necrosis factor (TNF) inhibitors to treat more severe symptoms, including:
    • adalimumab
    • etanercept
    • golimumab
    • infliximab
    • abatacept
Other Treatment

You may be referred to a physical or occupational therapist. These therapists can help you to improve your range of motion and your ability to do everyday activities.

Working with a mental health therapist may also be helpful for your overall well-being. You can learn ways to better cope with your chronic condition.

Surgery

If you have severe pain and disability, your doctor may recommend:

  • Joint replacement surgery
  • Tendon surgery
Prevention

There is no way to prevent psoriatic arthritis. If you have psoriasis and experience joint pain, talk to your doctor so you can be properly diagnosed.

RESOURCES:

Arthritis Foundation
http://www.arthritis.org/

National Psoriasis Foundation
http://www.psoriasis.org/

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca/

Canadian Rheumatology Association
http://www.rheum.ca/

References:

Psoriatic arthritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated June 6, 2013. Accessed June 18, 2013.

Psoriatic arthritis. National Psoriasis Foundation website. Available at: Available at: http://www.psoriasis.org/psoriatic-arthritis . Accessed June 18, 2013.

What is psoriatic arthritis? Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/psoriatic-arthritis/ . Accessed June 1, 2012.



Last reviewed December 2012 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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