Psoriatic Arthritis Symptoms, Causes & Treatment Options

Psoriatic arthritis is a chronic inflammatory condition of the joints of the fingers and toes, which usually presents as a sausage-like swelling of one or more digits. It occurs in people with psoriasis, a disease of the skin.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Psoriatic Arthritis?

Summary

Psoriatic arthritis is a condition which causes inflammation of the joints. In most circumstances, psoriatic arthritis presents between the ages of 30 and 50 years and occurs after the manifestation of the symptoms of psoriasis, which is a disease of the skin [1-3]. Psoriatic arthritis typically causes redness, swelling, pain, and stiffness of certain joints. Most commonly, the fingers and toes are affected and may appear “sausage-like.” Psoriatic arthritis is predominantly a genetic disease but it can be activated by certain environmental triggers [4]. Avoidance of these triggers could delay or prevent disease onset. Treatment includes symptom management with nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids. In more severe cases, other drugs to halt the disease progression such as methotrexate are used.

Recommended care

You should visit your primary care physician to manage this disease as there are many treatment options. A treatment plan will often consist of therapy (physical, occupational, massage), patient education, exercise and rest, devices to protect joints, medicine and/or surgery.

Psoriatic Arthritis Symptoms

Main symptoms

Psoriatic arthritis is a chronic (long-lasting) disease, but it does have flares (worsenings) of symptoms.

  • Dactylitis: Fingers and/or toes may become “sausage-shaped,” which refers to their symmetrical swelling throughout the digit.
  • Nail degeneration: The integrity of the nail and nail bed become compromised causing degeneration of the nail.
  • Back pain: This typically occurs right above the tailbone in the lower back. It can affect up to 40 percent of people [5].
  • Arthritis deformans: Up to 50 percent of people can experience the destruction of joint cartilage and bone, which leads to joint deformation.

Other symptoms

Other common symptoms that are nonspecific to psoriatic arthritis:

  • Swelling
  • Redness
  • Pain
  • Stiffness: Most commonly stiffness is worst in the mornings.

Subtypes of psoriatic arthritis

Psoriatic arthritis often has symptoms that fall into the following subcategories arranged in order of commonality [3]:

  • Asymmetric oligoarthritis: Only a few fingers or toes are affected, and the affected digits may not be the same on both sides of your body.
  • Symmetric polyarthritis: The same fingers and/or toes one side of the body are affected on the other side of the body.
  • Distal interphalangeal: Symptoms are isolated to the end of the fingers and toes instead of the entire finger or toe.
  • Spondylitis: Symptoms will be mostly present in the lower back as this version of the disease affects the vertebral joints.
  • Arthritis mutilans: This is a rare, severe version of the disease where joints of the fingers, toes, hands, feet, neck, and back are affected. In addition, there can be a loss of bone mass, leading to deformities.

Psoriatic Arthritis Causes

The exact mechanism of disease progression of psoriatic arthritis is not known.

Genetic components and other risk factors

Females are slightly more likely to be affected than males. The disease is not contagious. Five to 10 percent of people with psoriasis go on to develop psoriatic arthritis after many years [3]. Both psoriasis and psoriatic arthritis are known to have a strong genetic component; in fact, approximately 40 percent of people with psoriatic arthritis have a relative with psoriasis or psoriatic arthritis [3]. This means that risk for developing psoriatic arthritis may be inherited from parents. As with psoriasis, psoriatic arthritis may sometimes develop after an environmental trigger, which can include bacterial or HIV infection, for example.

Relation to psoriasis

Since psoriatic arthritis almost exclusively occurs in individuals with manifestations of a related condition, psoriasis, the diseases are highly related. In essence, there is unnecessary inflammation of certain joints. This is similar to other autoimmune joint diseases, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. The body’s own immune system begins to increase activity in the joints. This increased activity and traffic of immune cells is what causes swelling, redness, stiffness, and pain, and is known as “inflammation.”

Diagnosis

The diagnosis of psoriatic arthritis is typically made clinically, meaning that the general picture of psoriatic arthritis without evidence of another disease lead to its diagnosis. In some circumstances, an X-ray of affected joints may prove helpful. Psoriatic arthritis must be distinguished from rheumatoid arthritis and other causes of arthritis, which may be accomplished using blood testing.

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Treatment Options and Prevention for Psoriatic Arthritis

Treatment

Psoriatic arthritis is a chronic condition, which means that it is a disease that people live with indefinitely. However, there are a variety of treatments available to slow or halt the progression of the disease and alleviate symptoms.

Treatment of psoriatic arthritis should begin as soon as possible. This is because treatment of the disease can decrease the amount of structural destruction of the joints. Medicines that inhibit joint damage are called disease-modifying antirheumatic drugs (DMARDs). Treatment of psoriatic arthritis is similar to the treatment of other autoimmune conditions, like rheumatoid arthritis and ankylosing spondylitis.

DMARDs that can decrease joint deformation include:

  • Methotrexate
  • Sulfasalazine (Azulfidine)
  • Leflunomide (Arava)
  • Etanercept (Enbrel)
  • Adalimumab (Humira)
  • Infliximab (Remicade)

Medicines that treat the symptoms of psoriatic arthritis but do not alter the progression of the disease include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs include ibuprofen (Advil, Motrin), diclofenac, and naproxen (Aleve). These drugs are effective for symptoms but include a risk of irritating the stomach lining and causing kidney damage.
  • Steroids: Some examples include prednisone and prednisolone. Steroids are also effective at decreasing symptoms but they come with a long list of side effects.

In mild cases of psoriatic arthritis, it may not be necessary to use a DMARD. Symptoms can be managed using NSAIDs or steroids.

Prevention

Since psoriatic arthritis typically develops after psoriasis presents, and because both are strongly genetic diseases, there is no well-known preventative strategy. As previously indicated, however, there are environmental “triggers” that can activate the disease. These include:

  • HIV infection
  • Infection (usually by staphylococcal bacteria)
  • Trauma to the joints
  • Stressful physical event: Such as heart attack, abortion, blood clotting, or exposure to chemicals.

Therefore, these environmental triggers should be avoided, when possible.

When to Seek Further Consultation for Psoriatic Arthritis

If you have psoriasis, you should maintain regular care with a dermatologist. However, if you also develop pain in your joints, you may need to also see a rheumatologist. A rheumatologist is a doctor who treats inflammatory conditions. Typically, the dermatologist and the rheumatologist will both manage the DMARD medicine, if needed, since some DMARDs can exacerbate the skin conditions of psoriasis [6]. During a psoriatic arthritis flare, it may be necessary to schedule an appointment with a dermatologist or rheumatologist to receive NSAIDs or steroids until the flare is over.

Questions Your Doctor May Ask to Determine Psoriatic Arthritis

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Any fever today or during the last week?
  • How severe is your shoulder pain?
  • How long has your shoulder pain been going on?
  • Is your shoulder pain constant or come-and-go?
  • Is your shoulder pain getting better or worse?

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References

  1. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: Epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl II):ii14-7. ARD Link
  2. Moll JMH, Wright W. Seminars in arthritis and rheumatism. ScienceDirect. 1973;3(1):55-78. ScienceDirect Link
  3. Psoriatic arthritis. Genetics Home Reference. Published December 11, 2018. GHR Link
  4. Scarpa R, Del Puente A, di Girolamo C, della Valle G, Lubrano E, Oriente P. Interplay between environmental factors, articular involvement, and HLA-B27 in patients with psoriatic arthritis. Annals of the Rheumatic Diseases. 1992;51:78-9. NCBI Link
  5. Downward E. How is the Back Affected by Psoriatic Arthritis? Psoriatic-Arthritis.com. Reviewed October 2016. Psoriatic Arthritis Link
  6. Amherd-Hoekstra A, Naher H, Lorenz HM, Enk AH. Psoriatic arthritis: A review. J Dtsch Dermatol Ges. 2010;8(5):332-9. PubMed Link