Psoriatic Arthritis
Diagnosed with psoriatic arthritis? Here’s what you need to know to take control.
Psoriatic Arthritis (PsA) affects men and women equally, and it usually develops after age 30. Psoriasis and PsA both run in families; it is more common in whites than in other races/ethnicities. The disease may begin in childhood.
Signs and Symptoms
It can affect large or small joints. In less common cases where it affects the spine, it is known as a form of spondyloarthritis.
About a third of people with psoriasis develop PsA.
In PsA, the immune system attacks its own body, primarily the joints and skin, but also organs.
Scientists believe genes and an environmental trigger, like a trauma or virus, might play a role in developing PsA.
Fingers and toes may swell, and nails might become pitted or separate from the nail bed. The heel or sole of the foot may also ache.
PsA affects everyone differently. Symptoms may be mild or severe, affect just a few or many joints, and symptoms can come and go. A sudden onset of symptoms is called a flare.
Talk to your primary care doctor and get a referral to a rheumatologist or dermatologist, who specialize in psoriasis and PsA.
Diagnosis and Treatment
They will check your joints, skin, hands and feet, review your personal and family medical history, and order blood and joint fluid tests, and possibly joint X-rays or MRIs.
If left untreated, PsA can worsen, so, don’t delay.
Early, aggressive treatment improves your chance of controlling PsA.
Disease-modifying drugs called DMARDs are used to treat PsA. Your treatment will depend on how it affects you and whether you have more joint or skin symptoms.
Medications affect people differently, so work with your doctor to manage any side effects and get the maximum benefit from your treatment.
Figuring out what works best for you may take trial and error, so be patient, stay positive and be open with your doctor.
Living Well With Psoriatic Arthritis
Learn all you can about PsA.
Keep a daily journal of your symptoms, pain levels and locations, energy, stress levels and other information to share the journal with your doctor and track your progress.
Build a health care team you trust.
Get regular physical activity and eat a healthy diet to maintain a healthy weight, ease pain and inflammation, and improve your sleep and mood.
A physical therapist can help you with a fitness routine, while a dietitian can work with you on your diet.
In addition to a therapist and friends and family, the Arthritis Foundation’s online community can help you cope with the emotional challenges of living with PsA.
Newly Diagnosed with PsA: Important First Steps
Learn all you can about it and ask your doctor what to expect.
Make sure your health care team listens to your concerns.
Practice good self-care.
Talk to your doctor about ways to lose excess weight, which puts extra pressure on joints, helps fuel inflammation and worsens psoriasis.
Aim to quit smoking. It worsens PsA and makes medications less effective. Eat a healthy, plant-based diet and practice good sleep habits.
Stay active to reduce stress and improve your sleep and mood.
Try to stay positive. A licensed therapist can help you cope.
Get support and information from others living with PsA in the Arthritis Foundation’s Live Yes! Online Community
Emotional Health
Skin lesions from psoriasis may lead to social stigma, low self-esteem and isolation.
Fatigue also may affect your mood.
Take your medications as prescribed and take care of yourself emotionally.
Avoid negative self-talk. If you’re feeling insecure, acknowledge it then set it aside and focus on positive thoughts.
Schedule time to do things you enjoy. Find a physical activity you like to help control stress, anxiety and depression, and improve sleep.
Swimming, walking, dancing, yoga and tai chi are good choices.
If you feel upset, reach out to supportive family and friends or talk to a mental health therapist.
Remember: When you don’t feel strong emotionally, it’s harder to control your physical symptoms.
Causes
PsA (like psoriasis) is an autoimmune disease, which means the body’s immune system mistakenly attacks healthy tissue, causing inflammation and pain and resulting in damage. Researchers aren’t sure why some people develop PsA. They think it’s a combination of having certain genes, which makes them more likely to develop the disease, and being triggered by something in the environment, like an infection, stress, physical trauma or another factor.
Symptoms:
Skin:
Itchy, painful red patches or a silvery white buildup of dead skin cells; most commonly on the knees, elbows and scalp, although a rash can occur anywhere on the body. It is not contagious.
Joints/Spine:
Mainly occurs in the fingers (in the joints closest to the nail), wrists, ankles and knees. Symptoms such as pain, tenderness, warmth and swelling, may affect different sides of the body (right hand and left knee). This may be referred to as peripheral arthritis. Sometimes one entire, individual finger or toe will swell up, making it painful and hard to bend. This is referred to as dactylitis. Pain and stiffness in the low back, buttock can also occur. Sometimes the neck and hips are affected and this may be referred to as spondylitis or axial arthritis.
Nails:
Cracking, pitting, white spots and lifting from the nail bed can occur. This may be referred to as nail disease.
Enthesis (plural, entheses):
Inflammation and swelling of one or more entheses, which are the places in the body where a tendon or ligament connects with a bone. Common spots include at the back of the heel and the bottom of the foot. This is called enthesitis.
Many people with psoriatic arthritis get very tired (fatigue) and some may have a low-grade fever. Symptoms may come and go. A period of increased inflammation and worsening of other symptoms is called a flare. A flare can last for days or months.
Health Effects
If PsA inflammation goes unchecked, it can cause many health problems including:
- Damage to the lining that covers the ends of bones in a joint (cartilage), and the bones themselves. It will get harder to move joints and someone may become disabled.
- Redness, irritation and disturbed vision (uveitis) or redness and pain in tissues around the eyes (pink eye).
- Stomach problems, diarrhea and bloating (gastrointestinal problems).
- Shortness of breath and coughing (lung problems).
- Damage to blood vessels and the heart muscle.
- Weak bones that break more easily (osteoporosis).
People with PsA may also develop metabolic syndrome, which is a group of conditions that includes obesity, high blood pressure and poor cholesterol levels.
Diagnosis
A prompt diagnosis is an important first step in managing PsA. No single test can confirm psoriatic arthritis. The first symptoms to appear may determine which doctor makes the diagnosis. A skin doctor (dermatologist) may be seen if skin and/or nail problems appear first. A primary care doctor or a rheumatologist may be seen first, if arthritis is the chief complaint. The doctor will use medical history, a physical examination and lab tests to make the diagnosis.
Medical history. The doctor will discuss when symptoms started, if they come and go, how severe they are, what actions makes them better or worse and whether family members have psoriasis, PsA or another autoimmune disease.
Physical examination. The doctor will look for joint pain, tenderness, swelling, warmth or limited movement, skin or nail changes.
Tests. The doctor may order X-rays to look for changes to bones and joints. Blood tests check for signs of inflammation. They include C-reactive protein and rheumatoid factor (RF). People with PsA are almost always RF-negative, so if blood tests are positive for rheumatoid factor, the doctor will suspect RA. Tests of the fluid around a joint can help rule out gout or infectious arthritis.
Treatments
Medications
- Stopping progression of the disease.
- Reducing inflammation.
- Treating skin symptoms.
- Relieving pain.
- Keeping joints as mobile as possible.
Treating Psoriasis
The over-the-counter (OTC) and prescription treatments for psoriasis include:
- Topical medications made from vitamin D, derivatives of vitamin A, salicylic acid, coal tar or corticosteroids.
- Treatments using sunlight or specialized ultraviolet light.
- Medicines that target the skin.
- Medicines that target the immune system.
The over-the-counter (OTC) and prescription medicines for psoriatic arthritis include:
NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually taken by mouth, although some can be applied to the skin. Popular over-the-counter (OTC) versions, such as ibuprofen and naproxen sodium, help to ease pain. Many prescription NSAIDs can help reduce inflammation, too.
Corticosteroids. These powerful anti-inflammatory medicines can be taken by mouth (orally) or injected into a joint at a doctor’s office. In the case of oral corticosteroids, doctors try to use these drugs at the lowest dose for the shortest time possible because of side effects, which can include facial swelling, easy bruising, weight gain and weak bones.
DMARDs. Disease-modifying antirheumatic drugs (DMARDs) are powerful medications that reduce inflammation and can stop PsA from getting worse. They are available as pills, can be self-injected or given as an infusion. There are three types of DMARDs:
- Traditional DMARDs have been used the longest and have a broad immune-suppressing effect. The most commonly-used drug is methotrexate. These medicines are usually taken by mouth and can take up to three months to become fully effective.
- Biologics interrupt certain chemicals or steps in the inflammatory process and they generally work more quickly than traditional DMARDs. They are self-injected or given by infusion in a doctor’s office.
- Targeted DMARDs, like biologics, also block certain steps in the inflammatory process, but these drugs are taken by mouth.
Every person with PsA is different. Doctors recommend certain medications depending on:
- How many and which parts of the body are affected.
- How severe the disease is.
- How many joints are affected.
- Drug allergies and other health conditions.
- Current medication use.
Surgery
Exercise
Physical Therapies and Assistive Devices
- Strengthening and flexibility exercises.
- Hot and cold therapies.
- Body manipulation.
- Tips on assistive devices (e.g. braces, splints) and ways to modify movements.
Self-Care
Protect skin
Keeping skin moisturized is helpful in managing psoriasis. Regular use of lotions or creams containing aloe vera, jojoba or zinc may help lubricate affected skin. Taking short, warm (not hot) baths using oatmeal, bath oil, Dead Sea or Epsom salts may also soothe skin. Make a habit of applying moisturizers following daily showers or baths, or after swimming.
Wash and dress with care
Wash clothes with fragrance-free detergent and fabric softeners to reduce risk of skin reactions. Choose clothing that is loose-fitting to avoid scratching scaly areas of skin. Natural, soft fibers like cotton may be less irritating to skin and cooler in warm months.
Eating anti-inflammatory and other healthy foods
A healthy, balanced diet -- rich in fresh foods like fruits and vegetables and low in sugar, fat and salt -- can help people with psoriatic arthritis boost their overall health and control their weight. Eating too many unhealthy foods may increase inflammation and fatigue.
Manage stress
Excess stress can worsen flares and make it harder to manage daily activities. Meditation, listening to soothing music, walking, joining a support group and exercise such as yoga and tai chi can help reduce stress.
Use hot and cold therapies
Heat improves blood circulation helping to reduce joint stiffness and muscle spasms. Cold helps reduce swelling by constricting blood vessels.
Relax
Train your muscles to relax and slow down your thoughts with techniques such as deep breathing, meditation and picturing images that put you in a good mood.
Change smoking and drinking habits
Smoking is bad for a person's health. It's always a good time to stop smoking. Drinking too much alcohol can affect how medications work, increase drug side effects or lead to excess weight. Ask a doctor if it is safe to drink alcohol when receiving treatment for psoriatic arthritis.
