Psoriatic arthritis

What is psoriatic arthritis?

Do you have psoriasis? If so, it's important to pay attention to your joints. Some people who have psoriasis get a type of arthritis called psoriatic (sore-ee-at-ic) arthritis.

This arthritis often begins with a few swollen joints. A single finger or toe may be noticeably swollen. Some people feel stiff when they wake up. As they move around, the stiffness fades.

Most people get psoriatic arthritis about 5 to 12 years after psoriasis. This arthritis can show up earlier. Some people get psoriatic arthritis and psoriasis at the same time. A few get psoriatic arthritis first and psoriasis later.

If you have psoriasis, there is no way to tell whether you will get psoriatic arthritis. This is why it is important to pay attention to swollen joints. An early diagnosis and treatment will help. These can reduce the effect that arthritis has on your life.

Treatment for psoriatic arthritis includes physical therapy, arthritis-friendly exercise, and medicine. A few medicines can prevent psoriatic arthritis from worsening and damaging your joints. Not everyone needs this medicine.

Like psoriasis, psoriatic arthritis is often a lifelong medical condition. It can flare and clear unpredictably.

Image used with permission of the Journal of the American Academy of Dermatology, J Am Acad Dermatol; 63: 733-48; quiz 49-50.

Psoriatic arthritis: Signs and symptoms

How to recognize psoriatic arthritis

For most people, psoriatic arthritis develops years after psoriasis. Tell your dermatologist if you have psoriasis and any of these signs and symptoms:

A very noticeable swollen finger or toe.
Swollen and tender joints.
Stiffness when you wake up or sit for hours; stiffness fades as you move.
Nails that are pitted.
Nail separating from nail bed.
Lower back pain.
Heel pain.
Swelling on the back of your leg above your heel.

Psoriatic nails: People who get psoriatic arthritis often see nail pitting (shown here) or a nail separating from the nail bed.

Swollen joint, left knee: One of the first signs of psoriatic arthritis is often a swollen joint, most commonly in a hand, foot, or knee.

Swollen tendon: A swollen and painful Achilles tendon, shown here on the right leg, is often a sign of psoriatic arthritis.

Sausage digit: Psoriatic arthritis can cause a finger or toe to swell dramatically. The swollen finger or toe is called a sausage digit.

Heel pain: Some people who have psoriatic arthritis develop intense heel pain. This pain can make walking difficult.

Joint destruction: In some people, psoriatic arthritis destroys the joints. Early treatment helps prevent this.

Stiff joints: Stiffness is a common symptom. It happens when you wake up or sit still for hours. The stiffness disappears as you move, but it can last 30 to 45 minutes or longer.

Swollen joints: When joints swell, they may feel tender or painful, but not always.

Psoriatic arthritis: Who gets and causes

Who gets psoriatic arthritis?

Most people who get psoriatic arthritis have one or more of the following:

Psoriasis (plaque, guttate, or pustular).
Psoriasis that affects their nails.
Blood relatives who have psoriatic arthritis.

Psoriatic arthritis usually appears about 5 to 12 years after psoriasis begins. It is equally common in men and women. Most people develop it between 30 and 50 years of age. But psoriatic arthritis can begin at any age. Children may even get psoriatic arthritis.

It is important to know that not everyone who gets psoriasis will eventually develop psoriatic arthritis. There is no way to tell who will get psoriatic arthritis. You should tell your dermatologist if you have joint pain or stiffness when you wake up, or swollen joints that come and go. These are often the earliest symptoms.

What causes psoriatic arthritis?

We still do not know everything that happens inside the body to cause psoriatic arthritis. We know that like psoriasis, psoriatic arthritis is an autoimmune disease. When a person has an autoimmune disease, the body mistakes something inside as a foreign object. In the case of psoriatic arthritis, the body mistakes joints and tendons as foreign.

Like psoriasis, psoriatic arthritis also involves your:

Genes.
Environment.
Immune system.

Psoriatic arthritis: Diagnosis and treatment

How is psoriatic arthritis diagnosed?

A single medical test is not available to diagnose psoriatic arthritis. To find out whether you have psoriatic arthritis, your doctor will do the following:

Look at your medical records.
Ask you specific questions. This usually includes questions such as whether any of your blood relatives have psoriasis or psoriatic arthritis.
Examine your joints. This examination includes looking at your body to see whether you have swollen joints. Your doctor will gently press on the skin around certain joints to find out whether the area is tender.
Send you for medical testing. This may include x-rays and a blood test.

Before giving you a diagnosis, your doctor considers your test results and everything he or she learned while meeting with you. In case you’re wondering, the result from your blood test cannot tell whether you have psoriatic arthritis. It tells your doctor whether you have inflammation throughout your body. People who have psoriatic arthritis have body-wide inflammation. Many other diseases also cause body-wide inflammation. Inflammation is a piece of the puzzle.

Because psoriatic arthritis can look like other types of arthritis, patients often see a dermatologist or rheumatologist for a diagnosis. A rheumatologist is a medical doctor who specializes in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones. Rheumatologists and dermatologists generally have the most experience diagnosing and treating psoriatic arthritis.

If you are diagnosed with psoriatic arthritis, it is important to know that treatment can:

Ease swelling, pain, stiffness, and other symptoms.
Stop the arthritis from getting worse and damaging your joints.
Improve your quality of life.

How is psoriatic arthritis treated?

Today, there are many treatment options for psoriatic arthritis. A treatment plan often includes several of the following:

Therapy (physical, occupational, massage).
Patient education.
Exercise and rest.
Devices to protect joints.
Medicine.
Surgery.

Therapy (physical, occupational, massage): These therapies can reduce pain. They can make it easier to move and do everyday tasks. If therapy can help, your doctor will write a prescription for the type(s) of therapy you need. Your therapist will work with your doctor and report your progress.

Patient education: Learning about psoriatic arthritis is important. The more you know, the better you can control this disease. Take time to learn the signs and symptoms. Ask your doctor what you should do when the arthritis flares. Learn about arthritis-friendly exercises and exercises that you should not do — at least for a while.

Exercise and rest: Each plays an important role. Arthritis-friendly exercises can help reduce pain, make it easier to move, and sometimes restore lost movement. Rest is important when psoriatic arthritis flares.

Devices to protect joints: Braces, splints, and supports can protect affected joints and prevent further damage. They offer support for painful areas and can stop painful movements. You should not buy one without first talking with your doctor. The device must fit you properly. It must support the area that needs support. Your doctor may recommend that a physical or occupational therapist fit you.

Medicine: Medicine can reduce swelling and ease pain. A few medicines can prevent the arthritis from worsening. The medicines that are often part of a treatment plan for psoriatic arthritis are as follows:

When psoriatic arthritis is mild, patients usually can reduce signs and symptoms with:

Non-steroidal anti-inflammatory drugs (NSAIDS) (pronounced en-saids): These help reduce swelling and pain. Some NSAIDs that may be part of a treatment plan for psoriatic arthritis do not require a prescription. These include aspirin, ibuprofen, naproxen, and nabumetone.
Prescription NSAIDs include arthritis medicines such as celecoxib.
Some people see their psoriasis worsen when they begin taking an NSAID. If this happens, call your dermatologist.

Tip: If you are taking aspirin or another medicine in the NSAID family, take the medicine immediately after you drink a glass of milk or eat a meal. This helps to protect your stomach. You should not drink alcohol when an NSAID is part of your treatment plan.

Shots of corticosteroids: When arthritis develops in a few joints, injecting this medicine into the swollen joints can quickly reduce swelling and pain.

Some people require stronger medicine to control their psoriatic arthritis. Your doctor may prescribe a disease-modifying, anti-rheumatic drug (DMARD) (pronounced dee-mard). DMARDs also reduce swelling and pain. Some DMARDs can prevent the arthritis from worsening and destroying joints. DMARDs that may be part of a treatment plan for psoriatic arthritis include:

Methotrexate: This medicine can reduce swelling in the joints and also is approved to treat psoriasis.
Injectable biologics: This type of medicine can prevent the arthritis from progressing and destroying the joints. Some of the biologics approved to treat psoriatic arthritis also can treat psoriasis.

To provide you with the most effective treatment, your doctor may prescribe 2 DMARDs. Prescribing both methotrexate and a biologic can help patients who have extensive or aggressive psoriatic arthritis. This combination has become a standard of care for aggressive psoriatic arthritis.

All medicine can cause side effects. Before taking a medicine, ask your doctor about possible side effects.

Surgery: If you have badly damaged joints or medicine does not help, surgery may be an option. Surgery can lessen pain. It can help you move more easily. It can improve the appearance of damaged joints. After surgery, you may be able to perform everyday tasks more easily. Surgery requires downtime. It involves some risk.

Outcome

Following a treatment plan helps to reduce the signs and symptoms of psoriatic arthritis. Some medicines also can help prevent the arthritis from destroying the joints. There is currently no way to know whose psoriatic arthritis will later destroy joints. This is why doctors recommend an early diagnosis and proper treatment.

Psoriatic arthritis: Tips for managing

If you have psoriatic arthritis, you may have trouble using your hands. You may have joint pain and swelling. These tips may help.

Talk with your doctor about exercise

No one exercise helps everyone. Your doctor may recommend some exercises. Other exercises may be discouraged. Your doctor can help you decide which exercises will benefit you.

If you have not exercised for a while or are uncertain what to do, tell your doctor. A few sessions of physical therapy may be helpful. Your doctor can write a prescription for physical therapy.

During physical therapy, your therapist will evaluate your movement to determine how the arthritis affects you and provide specific therapies and exercises that can help.

Make arthritis-friendly exercise part of your life

No exercise is right for everyone, but some types of exercise help many people who have arthritis. Topping this list are yoga, tai chi, and joint-friendly water exercises. Studies show that these can help ease pain in your joints. Walking, cycling, and training with lightweight dumbbells also may be options. Even if you have difficulty moving, exercise can help. Arthritis friendly exercise can:

Make your joints more flexible.
Improve muscle tone.
Reduce stress.
Boost your mood.

Many organizations offer arthritis-friendly exercise classes. To find out whether such classes are available in your area, contact your local hospital, YMCA, fitness center, community center, and park district.

Rest when needed

When psoriatic arthritis flares, you need to rest your joints. Using the joints during a flare puts more stress on the joints. This can lead to lasting damage. Medicine and joint protection (braces, splints, and supports) may help ease joint stress.

Learn what aggravates your arthritis

People living with arthritis say that some activities, foods, and habits cause their arthritis to flare. Each time your psoriatic arthritis flares, make a note of what you were doing or eating. This may help you learn what triggers your psoriatic arthritis.

Find out your healthy weight. If you’re not at that weight, try to reach it.

Maintaining a healthy weight helps to reduce joint pain and allows you to move with greater ease. You can quickly find out whether you have a healthy body weight by entering your height and weight on the following page:

Calculate your body mass index

If you exceed your healthy weight, which may be called your normal weight, be sure to visit the links on the above page. This information comes from the U.S. Department of Health and Human Services.

Related resources:

Arthritis Foundation, Aquatic Program
National Psoriasis Foundation

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