Psoriatic Arthritis

Psoriatic arthritis (PsA) is a type of arthritis that affects people who have psoriasis or a biological family history of psoriasis.

If you have PsA, you’ll experience symptoms of both arthritis and psoriasis. Arthritis causes pain and inflammation in and around your joints. Psoriasis causes inflammation in your skin. Psoriasis rashes are patches of discolored skin covered with scales. These thick, scaly areas are called plaques. It can also change how your fingernails and toenails look.

Visit a healthcare provider if you notice new symptoms on your skin or pain, swelling or stiffness in your joints.

Types of psoriatic arthritis

A healthcare provider might classify PsA based on which joints it affects or which side of your body you experience symptoms. The five forms of psoriatic arthritis include:

• Distal interphalangeal predominant psoriatic arthritis: This is arthritis in the joints near the ends of your fingers and toes (phalanges). It’s the most common type that affects your fingernails and toenails. Your nails might look discolored, flaky or pitted.
• Symmetric polyarthritis: Polyarthritis affects five or more joints at the same time. This type affects the same joints on both sides of your body. For example, both of your knees and both elbows. It’s one of the most common types of psoriatic arthritis.
• Asymmetric oligoarticular psoriatic arthritis: This affects two to four joints on both sides of your body. For example, one knee and one elbow. It’s the other most common form of psoriatic arthritis.
• Spondylitis: Spondylitis causes inflammation and other symptoms in the joints between the bones in your spine. It can also cause pain in your hips and shoulders.
• Arthritis mutilans: This causes severe symptoms in your hands and feet. The inflammation is usually severe enough to cause bone loss. It’s the rarest type.

Symptoms of psoriatic arthritis

The most common psoriatic arthritis symptoms include:

• Joint pain
• Stiffness
• Skin discoloration near your affected joints
• Pain or tenderness where tendons and ligaments attach to your bones, like near your Achilles tendon
• Psoriasis rash, especially on your scalp, elbows, knees and lower back
• Nail psoriasis symptoms, like discoloration or pitting on your fingernails or toenails
• Swelling in your fingers and toes
• Fatigue

PsA symptoms come and go in periods called flares or flare-ups. You might notice signs of a flare-up before one happens. You might feel mild symptoms that get worse before you enter a flare.

The severity of symptoms can vary between flares. More severe flares can make it hard to move and use your joints. They can also cause larger patches of psoriasis on your skin.

Psoriatic arthritis causes

Psoriatic arthritis is an autoimmune disease. These happen when your immune system accidentally attacks tissue in your body instead of protecting it.

Experts aren’t sure what makes your immune system do this. Some studies have found that people with psoriatic arthritis have similar genetic changes. Experts can’t say for certain if these changes cause psoriatic arthritis. It’s possible they change after you develop it.

Around 4 in 10 people with psoriatic arthritis also have a biological family member who also has it. This means it might be an inherited genetic disorder. Tell your healthcare provider if you know that someone in your family has psoriasis or PsA.

Risk factors

You may have a higher risk of PsA if you have psoriasis. Around 1 in 3 people with psoriasis also get psoriatic arthritis.

People who get psoriatic arthritis usually develop psoriasis in their teens or early 20s, but don’t experience joint symptoms until later in life. Arthritis symptoms usually first show up between ages 30 and 50.

Complications of this condition

Having PsA can increase your risk of other health conditions, including:

• High blood pressure
• High cholesterol
• Obesity
• Diabetes
• Depression
• Anemia
• Muscle weakness

Psoriatic arthritis symptoms can make it hard or painful to use your joints. This can make it tougher to do physical activities. Talk to a healthcare provider about low-impact exercises that put less pressure on your joints. Yoga, walking or aqua therapy are all good ways to stay active without stressing your joints.

How doctors diagnose this condition

A healthcare provider will diagnose psoriatic arthritis with a physical exam and some tests. Your provider will look at your skin and joints. Tell them which symptoms you’ve noticed, and if they come and go.

There’s no test that can diagnose psoriatic arthritis. But your provider might use tests to rule out other issues that can cause similar symptoms. For example, blood tests can show signs of infections.

Imaging tests can take pictures of your joints to show damage or inflammation. You might need:

• X-rays
• MRI
• CT scan
• Ultrasound

Psoriatic arthritis treatment

Your healthcare provider will suggest treatments to manage the symptoms you experience. What’s best for you depends on a few factors, including:

• Which of your joints are affected
• How severe the symptoms are
• How much the symptoms affect your ability to do your daily activities

You might need to visit a rheumatologist, a provider who specializes in treating autoimmune diseases. A skin specialist, like a dermatologist, can diagnose and suggest treatments for psoriasis symptoms.

The most common treatments for psoriatic arthritis include:

• Over-the-counter anti-inflammatory medicine, like NSAIDs or acetaminophen
• Cold therapy or heat therapy
• Corticosteroids
• Disease-modifying antirheumatic drugs (DMARDs)
• Physical therapy or occupational therapy

It’s very rare to need surgery if you have psoriatic arthritis. You might need a joint replacement if your joints are damaged or lose too much bone tissue. Your provider or surgeon will tell you which type of surgery you’ll need and what to expect.

When should I see my healthcare provider?

Visit a healthcare provider if you notice new rashes or other symptoms on your skin, or if you’re experiencing joint pain. Talk to your provider if you notice changing symptoms. Tell them if psoriatic arthritis flares happen more often, or if they seem like they’re getting worse.

What can I expect if I have this condition?

You should expect to manage PsA symptoms for the rest of your life. There’s no cure for psoriatic arthritis. But you may experience long periods of time between flares, especially once you find treatments that work well.

It can be frustrating when a flare happens suddenly. You’ll learn to recognize the warning signs of a flare and start managing the symptoms before they become more severe. Talk to your healthcare provider if you feel like your current treatments aren’t managing symptoms well enough.