Frequently asked questions about psoriatic arthritis

Frequently asked questions about psoriatic arthritis

What is psoriatic arthritis?

Psoriatic arthritis [pronounced sore-ee-AA-tic] causes pain, stiffness and swelling in and around the joints and places where tendons and ligaments connect to bone. Without treatment, psoriatic arthritis can potentially be disabling.

What causes psoriatic arthritis?

Both genetic and environmental factors seem to be associated with the development of psoriatic arthritis. The immune system plays an important role. Psoriatic arthritis is linked to psoriasis on the skin; in 85 percent of individuals, skin disease preceded joint disease.

What are the symptoms of psoriatic arthritis?

Tender swollen joints
Swollen and tender entheses (where a muscle or ligament attaches to a bone)
Back pain
Nail changes—for example, a nail that separates from the nail bed and/or becomes pitted and mimics fungal infections
Morning stiffness and tiredness
Generalized fatigue
A reduced range of motion
Redness and pain of the tissues surrounding the eyes, such as conjunctivitis
How is psoriatic arthritis diagnosed?

There is no specific test for psoriatic arthritis. The diagnosis is based mostly on symptoms, examination, X-rays and the elimination of other types of arthritis. If you have psoriasis and experience persistent joint pain, you may have psoriatic arthritis and you should see a rheumatologist. These doctors specialize in arthritis and can provide further evaluation and/or a diagnosis.

Is all psoriatic arthritis the same?

No. There are considered to be five different forms of psoriatic arthritis:

Symmetric: Affects multiple symmetric pairs of joints (occurs in the same joints on both sides of the body).
Oligoarticular: Affects few joints in an asymmetric pattern and is usually milder.
Distal interphalangeal (DIP): Affects primarily the distal joints of the fingers and toes (the joints closest to the nail).
Spondylitis: Predominantly affects the spinal column from the neck to the lower back.
Arthritis mutilans: Affects the small joints of the hands and feet, although it can appear in other joints. This rare form of arthritis is severe and destructive.
What treatments are available for psoriatic arthritis?

Drugs for the treatment of psoriatic arthritis are divided into three main categories:

Nonsteroidal anti-inflammatory drugs (NSAIDs) include over-the-counter medications such as aspirin and ibuprofen as well as prescription products.
Disease-modifying antirheumatic drugs (DMARDs) may relieve more severe symptoms and attempt to slow or stop joint/tissue damage and the progression of psoriatic arthritis.
Biologics such as adalimumab, etanercept and infliximab are also considered DMARDs. They are highly selective agents that target specific parts of the immune system that cause psoriasis and psoriatic arthritis.

Psoriatic arthritis
Treating psoriatic arthritis

Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further joint damage. Doctors will recommend treatments based on the type of psoriatic arthritis, its severity and an individual’s reaction to treatment.

Early diagnosis and treatment can help slow the disease and preserve function and range of motion. Some early indicators of severe disease include onset at a young age, having many joints involved and spinal involvement. Good control of the skin disease may be valuable in the management of psoriatic arthritis. Some treatments are approved to treat both psoriasis and psoriatic arthritis.

"Localized" mild psoriatic arthritis

Generally, localized psoriatic arthritis is mild and affects only one or two joints. A person may experience long periods with no symptoms. Psoriatic arthritis of this nature generally causes less deformity and long-term disability.

"Generalized" disabling psoriatic arthritis

A portion of people who have three or more affected joints may have a higher risk of joint destruction and disability. When it is not relieved by anti-inflammatory drugs, more potent medications may be required. Some cases may require surgery and rehabilitation.