Psoriatic Arthritis

What is psoriatic arthritis?

Psoriatic arthritis is a type of arthritis. It usually affects people who have psoriasis or a biological family history of psoriasis.

Arthritis is a common disorder that affects your joints. It 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 make your fingernails and toenails thicken and look flaky or pitted (covered in tiny indentations).

Both arthritis and psoriasis are autoimmune diseases. An autoimmune disease is the result of your immune system accidentally attacking your body instead of protecting it. Psoriatic arthritis happens when you develop psoriasis symptoms on your skin and inflammation in your joints.

Psoriatic arthritis symptoms on your skin and in your joints usually come and go in periods called flares. A healthcare provider will suggest treatments to relieve your symptoms during a flare.

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

How common is it?

Less than 1% of all people experience psoriatic arthritis. But it’s much more common in people who have psoriasis. Around 30% of people with psoriasis develop psoriatic arthritis at some point in their life.

[h4] What are the five forms of psoriatic arthritis?

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

• Distal interphalangeal predominant psoriatic arthritis: This affects the joints near the end of your fingers and toes (phalanges). It’s the most common type of psoriatic arthritis 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. Symmetric polyarthritis 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 — one knee and one elbow, for example. It’s the other most common form of psoriatic arthritis (along with symmetric polyarthritis).
• Spondylitis: Your spine is made of 33 bones called vertebrae (the plural form of vertebra). Spondylitis causes inflammation and other symptoms in the joints between your vertebrae. 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 (osteolysis). It’s the rarest form of psoriatic arthritis. Less than 5% of all people with psoriatic arthritis have arthritis mutilans.

What are psoriatic arthritis symptoms?

Psoriatic arthritis can affect any joint in your body. Your symptoms can be mild — only a small amount of pain and stiffness with few signs of psoriasis on your skin. More severe psoriatic arthritis flares can make it hard or impossible to move and use your joints and will cause larger patches of psoriasis on your skin.

The most common psoriatic arthritis symptoms include:

• Joint pain.
• Stiffness.
• Discoloration or redness near your affected joints.
• Pain or tenderness where tendons and ligaments attach to your bones (like near your Achilles tendon).
• Swelling in your fingers and toes (dactylitis or “sausage fingers”).
• Psoriasis rash — silver or gray scaly patches on your skin (especially your scalp, elbows, knees and lower back).
• Nail psoriasis symptoms like discoloration or pitting on your fingernails or toenails.
• Fatigue.

What causes psoriatic arthritis?

Experts aren’t sure what causes psoriatic arthritis. Some studies have found that people with psoriatic arthritis have similar genetic mutations. Experts can’t say for certain if these changes in your genes are what cause psoriatic arthritis or if they change after you develop it.

Around 40% of people with psoriatic arthritis have a family member that also has it. This means it might be a hereditary condition — passed from biological parents to their children.

Tell your healthcare provider if someone in your family has psoriasis or psoriatic arthritis.

What are the risk factors?

Psoriatic arthritis can affect anyone. It usually develops in people between 30 and 50.

People with psoriatic arthritis typically develop psoriasis in their teens or early 20s and don’t develop symptoms in their joints until later in life.

[h3] What are psoriatic arthritis complications?

People with psoriatic arthritis are more likely to develop other health conditions, including:

• High blood pressure (hypertension).
• High cholesterol (hyperlipemia).
• Obesity.
• Diabetes.
• Depression.
• Anemia.
• Muscle weakness.

Psoriatic arthritis symptoms can make it painful or difficult to use your joints. This can make it hard to get enough exercise. 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 work out without stressing your joints.

How is psoriatic arthritis diagnosed?

A healthcare provider will diagnose psoriatic arthritis with a physical exam and some tests. Your provider will ask you about your symptoms and look at your skin and joints.

You might need to visit a rheumatologist, a provider who specializes in treating musculoskeletal conditions, autoimmune disorders and inflammatory conditions. A dermatologist — a provider who specializes in taking care of your skin — can diagnose and suggest treatments for psoriasis.

There’s no test that can diagnose psoriatic arthritis, but your provider might use tests to rule out other causes of your symptoms. They might use blood tests to check for infections. Imaging tests can take pictures of your joints to show damage or inflammation. You might need one or a few imaging tests, including:

• X-rays.
• MRI.
• CT scan.
• Ultrasound.

How is psoriatic arthritis treated?

Your healthcare provider will suggest treatments to manage your symptoms. Which treatments you’ll need depends on:

• Which joints the arthritis affects.
• How severe your symptoms are.
• How much the symptoms affect your ability to participate in your usual daily activities.

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.

Psoriatic arthritis surgery

It’s very rare to need surgery if you have psoriatic arthritis. If your joints are damaged or you’ve experienced bone loss, you might need an arthroplasty (joint replacement). Your provider or surgeon will tell you which type of surgery you’ll need and what to expect.

How can I prevent psoriatic arthritis?

Because experts don’t know what causes psoriatic arthritis, you can’t prevent it. You can lower your chances of developing all types of arthritis by:

• Avoiding tobacco products.
• Following a diet and exercise plan that’s healthy for you.
• Doing low-impact, non-weight-bearing exercise.
• Always wearing proper protective equipment for any activity that could damage your joints.

What can I expect if I have psoriatic arthritis?

You should expect to manage your symptoms for a long time (maybe the rest of your life). Some people experience long periods of time between flares, but there’s no cure for psoriatic arthritis.

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

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 your psoriatic arthritis symptoms are changing, flaring up more often or getting more severe.

What questions should I ask my doctor?

• Do I have psoriatic arthritis or another type of arthritis?
• Which tests will I need?
• Which treatments will manage my symptoms best?
• Should I see a rheumatologist and a dermatologist?
• Will I need physical or occupational therapy?
• What are good exercises to prevent muscle weakness?

Is psoriatic arthritis worse than rheumatoid arthritis?

Psoriatic arthritis and rheumatoid arthritis are different types of arthritis. They’re both autoimmune diseases.

Psoriatic arthritis is arthritis linked to psoriasis, a condition that affects your skin, fingernails and toenails. Rheumatoid arthritis is a type of arthritis that happens when your immune system attacks the tissue lining the joints on both sides of your body.

Neither condition is better or worse than the other. They’re both chronic (long-term) conditions you’ll need to manage for a long time. A healthcare provider will help you find treatments that manage your symptoms and reduce how much arthritis affects your life on a day-to-day basis.

How serious is psoriatic arthritis?

Psoriatic arthritis symptoms can range from mild to severe. You might never experience severe symptoms. But there’s a chance your symptoms will vary between flares, often with seemingly no cause or reason. Psoriatic arthritis is a chronic (long-term) condition. In that sense, it’s serious — you’ll have to manage symptoms for a long time, maybe for the rest of your life. But between flares, you should be able to participate in all your usual activities.

A note from Cleveland Clinic

It can be extremely frustrating to manage psoriatic arthritis. You might feel like you’re dealing with two conditions at the same time — the skin and nail symptoms of psoriasis and joint issues caused by arthritis. Your healthcare provider will help you find treatments that manage your symptoms during flares. They’ll also suggest ways you can keep your body healthy and strong to support your joints and skin.

Talk to your provider if it feels like your symptoms are changing, getting worse or flaring up more often. Listen to your body, and don’t hesitate to ask for adjustments in your treatment.

Where can I learn more about psoriatic arthritis?

Support Groups and Resources

• The National Psoriasis Foundation
  www.psoriasis.org
• The Arthritis Foundation
  www.arthritis.org
• The American Juvenile Arthritis Organization
  www.kidsgetarthritistoo.org