What is psoriatic arthritis?
Psoriatic arthritis (PA) is a chronic inflammatory, autoimmune disease. The joint and skin are being attacked by the immune system. The exact causes are not known. PA typically occurs in people between the ages of 30 and 50.
While symptoms can vary widely from person to person, a red, scaly rash (psoriasis) is often the first sign. That is followed by inflammation of one or more joints, sometimes years after the rash appeared. Joint inflammation can lead to severe arthritis unless diagnosed and treated early.
There is a range of treatments to reduce pain and inflammation and slow the progression of the disease.
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Psoriatic arthritis symptoms
Most people with PA first develop psoriasis, which causes scaly red and white patches. Several years later, they begin to develop joint inflammation. For about 15% of people with PA, the two problems appear at the same time.
PA may affect just a few joints (oligoarticular) or multiple joints (polyarticular). The disease may also cause inflammation in the spine (spondylitis) leading to back stiffness and pain.
Unlike other types of arthritis, PA can also cause inflammation of tendons (enthesitis). This often happens in the feet and heel.
One other typical symptom is swelling and inflammation of an entire toe or finger (rather than just one joint), which is called a “sausage-digit.”
- Red or white scaly rash.
- Swelling, pain, and stiffness in joints.
- Swelling and stiffness in the back and neck. It’s often worse in the morning.
- Pain where tendons attach to the bone. Usually at the bottom of the foot and heel.
Other possible symptoms
- Small depressions in finger or toenails (pitting).
- Erosion of finger bones leading to collapse (telescoping fingers).
Skin and joint disease do not need to be present at the same time or at the same intensity. In 1 out of 5 patients, the arthritis appears first and the skin disease can come later, making the diagnosis of psoriatic arthritis more challenging. —Dr. Petros Efthimiou
Treatment of psoriatic arthritis
There is no cure for psoriatic arthritis. But diagnosing and treating it early can help relieve your pain and reduce inflammation. It can also prevent or limit damage to your joints. Decisions about when to start medications and which ones to take will depend on the severity of your disease.
Medication options include:
- NSAIDs: Over-the-counter anti-inflammatories such as ibuprofen and naproxen can relieve pain by reducing joint inflammation. They work best when taken regularly. Check with your doctor first because these medications can cause stomach irritation or liver or kidney problems over time.
- Disease-modifying antirheumatic drugs (DMARDs): These work by reducing the damage done to the joints. Common DMARDs include methotrexate and sulfasalazine. Potential side effects include liver damage and limitation of your bone marrow’s ability to make new blood cells.
- Biologic agents: These can help decrease arthritis pain, eliminate skin lesions, and limit the immune system’s ability to damage joints. Many of these drugs have become available in recent years, including TNF inhibitors, interleukin 17 inhibitors, interleukin 12/23 inhibitors, and JAK inhibitors. Because they alter the body’s immune system, they can increase the risk of infections.
- Immunosuppressants: These target the immune system to reduce joint damage. Common immunosuppressants include azathioprine (Imuran) and cyclosporine. They can also increase risk of infection.
- Cortisone injections: Cortisone is a type of injectable anti-inflammatory that acts within the joint. These injections are typically given by a rheumatologist or orthopedic surgeon.
- Joint replacement surgery: If damage becomes severe, you may need surgery to replace joints. Damaged cartilage and bone is removed and replaced with metal and plastic parts. (Keep in mind that PA patients may be at increased risk of surgical complications.)
There is exciting research and several new medications are under development, including targeted medications that have shown great effectiveness. —Dr. Efthimiou
How serious is psoriatic arthritis?
PA does not usually require urgent treatment unless joints become severely swollen and stiff. This usually means your swelling is bad enough to be very painful and you have difficulty moving the affected joint.
If you’ve been diagnosed with psoriasis and develop joint or tendon pain, tell your doctor.
You don’t want to wait too long because joints can become severely damaged if PA is not treated.
There isn’t one test that diagnoses the condition. X-rays may be required to determine how badly the joints are damaged. In rare cases, an MRI may be ordered to evaluate ligaments and tendons.
What triggers psoriatic arthritis?
People with a history of psoriasis are more likely to develop PA. Having a parent or sibling with PA is also a risk factor.
While the exact relationship is unclear, some experts think that certain bacterial or viral infections may trigger the immune system to attack the joints, leading to PA. Physical trauma to the joints, such as a bad fall or twisting injury, may also be a factor.
A common misconception is that you need to have a lot of skin psoriasis in order to have psoriatic arthritis. Sometimes it can be a very small plaque or a history of a skin lesion. —Dr. Efthimiou
What are the five types of psoriatic arthritis?
- Asymmetric oligoarthritis: Only a few fingers or toes are affected. It may not be the same ones on each side
- Symmetric polyarthritis: The same fingers or toes are affected on both hands or feet.
- Distal interphalangeal: Symptoms are isolated to the end of the fingers and toes instead of the entire finger or toe.
- Spondylitis: Symptoms affect the vertebral joints and are mostly felt in the lower back.
- Arthritis mutilans: This is a rare, severe version of PA that affects joints of the fingers, toes, hands, feet, neck, and back. There can be a loss of bone mass, leading to deformities.
There is no specific way to prevent psoriatic arthritis, but you can help minimize symptoms by maintaining a healthy weight.
A low-impact exercise regimen can help keep joints and muscles strong and minimize pain.
If you notice joint pain, see your doctor to avoid permanent damage.