Psoriatic Arthritis

(Arthritis, Psoriatic; PsA)
  • Definition

    Psoriatic arthritis is a long-term condition that causes pain and swelling in the joints. Overtime it can cause be damaging to the joints and cause disability. It is associated with a skin condition called psoriasis, but not everyone that has psoriasis will develop psoriatic arthritis.
    Psoriatic arthritis is an autoimmune disease which means the body attacks its own healthy tissue.
    Psoriasis
    Psoriasis
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  • Causes

    The exact cause of psoriatic arthritis is not known. It may be due to a combination of genetics and environmental triggers.
  • Risk Factors

    Factors that increase the risk of psoriatic arthritis includes having:
    • Psoriasis for 5-12 years
    • Psoriasis with symptoms such as lesions on the scalp and pitted or dented nails
    • A specific gene characteristic that has been linked to psoriatic arthritis
    • A family member with psoriatic arthritis
  • Symptoms

    Psoriatic arthritis usually develops in people who already have psoriasis. Symptoms that may indicate the development of psoriatic arthritis include:
    • Joint pain and tenderness in one or more joints (can be any joint including knees, feet, hands, wrists, and elbows)
    • Joint swelling
    • Joint stiffness, especially in the morning
    • Red or warm joints
    • Changes in fingernails and toenails (pitting in the nails, crumbling nails, or nails separating from the nail bed)
    • Swelling of fingers
    • Back pain
    • Fatigue
  • Diagnosis

    Your doctor will ask about your symptoms and medical history, especially information about your psoriasis. A physical exam will be done. Your doctor will rule out similar conditions with the physical exam.
    To look for signs of an inflammation and cause of joint problem your doctor may order:
    • Blood tests to look for autoimmune disease
    • Analysis of the fluid in the joints
    • Tests to check how the immune system is functioning
    Imaging tests may also be done to look for damage to the joint. Images may be taken with x-ray , ultrasound , or MRI .
  • Treatment

    In addition to treating you psoriasis, your doctor will also create a treatment plan that focuses on your arthritis symptoms. Treatment may include:
    Medications
    Depending on the severity of your symptoms, your doctor may recommend:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and inflammation
    • Steroid injections into painful joints
    • Disease-modifying anti-rheumatic drugs (DMARDS) to treat more severe symptoms and slow the progression of the disease, including:
      • sulfasalazine
      • leflunomide
      • cyclosporine
      • methotrexate
    • Tumor necrosis factor (TNF) inhibitors to treat more severe symptoms, including:
      • adalimumab
      • etanercept
      • golimumab
      • infliximab
      • abatacept
    Other Treatment
    You may be referred to a physical or occupational therapist. These therapists can help you to improve your range of motion and your ability to do everyday activities.
    Working with a mental health therapist may also be helpful for your overall well-being. You can learn ways to better cope with your chronic condition.
    Surgery
    If you have severe pain and disability, your doctor may recommend:
    • Joint replacement surgery
    • Tendon surgery
  • Prevention

    There is no way to prevent psoriatic arthritis. If you have psoriasis and experience joint pain, talk to your doctor so you can be properly diagnosed.
  • RESOURCES

    Arthritis Foundation http://www.arthritis.org/

    National Psoriasis Foundation http://www.psoriasis.org/

    CANADIAN RESOURCES

    The Arthritis Society http://www.arthritis.ca/

    Canadian Rheumatology Association http://www.rheum.ca/

    References

    Psoriatic arthritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated June 6, 2013. Accessed June 18, 2013.

    Psoriatic arthritis. National Psoriasis Foundation website. Available at: Available at: http://www.psoriasis.org/psoriatic-arthritis . Accessed June 18, 2013.

    What is psoriatic arthritis? Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/psoriatic-arthritis/ . Accessed June 1, 2013.

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