Psoriatic Arthritis: What You Need to Know

By Jane Farrell

Editor’s note: Psoriatic arthritis, a troublesome condition, is often difficult to detect. Here, the American Academy of Dermatology tells you what you need to know about its symptoms, diagnosis and management.

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 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.

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.

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 and immune system.

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.

How is psoriatic arthritis treated?

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; and improve your quality of life.

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

 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. Ask your doctor what kind of exercise is best for you.

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.

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 and involves some risk.

Managing psoriatic arthritis

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. A few sessions of physical therapy may be helpful. Your doctor can write a prescription for physical therapy.

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.

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

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.

Material courtesy of the American Academy of Dermatology.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations,  with a membership of more than 18,000 physicians worldwide. For more information, contact the AAD at 1-888-462-DERM (3376) or www.aad.org. Follow the AAD on Facebook (American Academy of Dermatology), Twitter (@AADskin) or YouTube (AcademyofDermatology).