Psoriatic Arthritis

Psoriatic arthritis is an inflammatory form of arthritis that affects some people who have psoriasis, an autoimmune disease that causes raised, red, scaly patches to appear on the skin. Up to 30 percent of people with psoriasis develop psoriatic arthritis.

Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear. In 85 percent of patients, psoriasis occurs before joint disease. If you have been diagnosed with psoriasis, it is important to tell your dermatologist if you have any aches and pains.

Joint pain, stiffness, and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. Nail changes and overall fatigue are also symptoms of psoriatic arthritis. Both psoriasis and psoriatic arthritis are chronic diseases that get worse over time, and disease flares may alternate with periods of remission.

There is little connection between your psoriasis severity and psoriatic arthritis severity. Having a severe case of psoriasis does not necessarily mean a person will have a severe case of psoriatic arthritis. A person could have few skin lesions, but have many joints affected by the arthritis.

There is no cure for psoriatic arthritis, and treatment focuses on controlling pain, inflammation, and joint damage.

Psoriatic arthritis can develop slowly with mild symptoms, or it can develop quickly and be severe. Early recognition, diagnosis and treatment of psoriatic arthritis can help prevent or limit extensive joint damage that occurs in later stages of the disease. The disease can develop in a joint after an injury and may seem like a cartilage tear.

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.

Psoriatic arthritis also causes:

• generalized fatigue
• tenderness, pain and swelling over tendons
• swollen fingers and toes that look like sausages
• foot pain
• back pain
• stiffness, pain, throbbing, swelling and tenderness in one or more joints
• reduced range of motion
• morning stiffness and tiredness
• nail changes—for example, the nail separates from the nail bed and/or becomes pitted and mimics fungus infections
• redness and pain of the eye, such as conjunctivitis

Psoriatic arthritis usually affects the distal joints (those closest to the nail) in fingers or toes. Symptoms may also be present in the lower back, wrists, knees, or ankle. Psoriatic arthritis can affect joints on just one side or on both sides of your body.

Psoriatic arthritis occurs when the 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.

It is not clear why the immune system turns on healthy tissue, but both genetic and environmental factors likely 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.

There is no definitive test for psoriatic arthritis. The diagnosis is made mostly by your doctor's observations and by a process of elimination. Your doctor will need your medical history, particularly your history with psoriasis, and he or she may perform a physical examination, blood tests, magnetic resonance images, and X-rays of the joints that have symptoms to diagnose psoriatic arthritis.

Laboratory tests can also aid in the diagnoses and rule out other causes of joint pain and inflammation.

• Rheumatoid factor (RF). RF is an antibody that's often present in the blood of people with rheumatoid arthritis, but it is 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 long needle, your doctor can remove 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.

The symptoms of psoriatic arthritis are similar to those of three other arthritic diseases: rheumatoid arthritis, gout, and reactive arthritis. It is important to distinguish these diseases, since they are treated differently.

Self-care measures may help improve the symptoms of psoriatic arthritis.

• 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. The best way to increase nutrients while limiting calories is to eat more plant-based foods such as 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.
• Use cold and hot packs. Because cold has a numbing effect, it can dull the sensation of pain. You can apply cold several times a day for 20 or 30 minutes at a time. Heat can help relax tense muscles and relieve pain.
• Pace yourself. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue. The key isn't to 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.

The goals of treatment for psoriatic arthritis are to relieve pain, reduce swelling, help keep joints working properly, and prevent further joint damage. Doctors will recommend treatments based on the type of psoriatic arthritis, its severity, and your reaction to treatment.

Medications used to treat psoriatic arthritis include:

• nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription.
• disease-modifying antirheumatic drugs (DMARDs). DMARDs may relieve severe symptoms and may slow or stop joint/tissue damage and the progression of psoriatic arthritis. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine).
• immunosuppressants. These medications decrease the activity of your immune system to control the disease process in psoriatic arthritis. Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune).
• biologics. Biologic drugs, or "biologics," are usually prescribed for psoriatic arthritis that has not responded to other treatments. Like DMARDs, biologics may slow or stop joint damage and the progression of psoriatic arthritis. Tumor necrosis factor-alpha (TNF-alpha) inhibitors stop the activity of an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples of these biologics include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia).