Psoriatic arthritis

What is it?

Psoriatic arthritis is a long-term condition that causes painful, swollen and stiff joints. It affects some people who have psoriasis, a skin condition. Like psoriasis, psoriatic arthritis is caused by the immune system attacking healthy tissue. It is an inflammatory condition of the joints and the places where tendons and ligaments attach to bones. Why some people with psoriasis get it and others do not is not clear.

It is most common in adults, and men and women get it equally often. Most people already have psoriasis, and on average psoriatic arthritis develops about 7 to 10 years after the beginning of skin symptoms, but a small group have joint pain before the skin rash. Many people with it have relatives with the disease. Obesity and having severe psoriasis appear to be associated with a higher risk of arthritis among people with psoriasis.

The first signs

It is often mild, but can sometimes be serious and affect many joints.

• pain, swelling and stiffness in one or more joints, often worse in the morning;
• a whole finger or toe that swells up;
• nails that change colour or get small dents or pits;
• tenderness where tendons or ligaments attach to bones, commonly at the back of the heel and the sole of the foot;
• feeling drained of energy.

A red, painful eye can be a sign of eye inflammation (uveitis), which needs treatment quickly to protect your sight.

How doctors find out

Symptoms differ a lot from person to person, which can make the disease hard to diagnose. If the doctor thinks you may have psoriatic arthritis, they will refer you to a specialist (rheumatologist). Tests can include blood tests, a test of fluid taken from a swollen joint, and X-rays, ultrasound or MRI scans.

Current treatment

NSAIDs can help with mild symptoms, steroid injections into a joint ease the pain, DMARDs are used for moderate to severe symptoms, and biological treatments can be used if DMARDs do not help.

Will it get worse?

It is often mild, but it can sometimes be serious and affect many joints. Psoriatic arthritis is a progressive inflammatory condition, and treatments can slow its progression. Starting treatment early is linked to better results and less damage: treatment can slow the disease, ease the pain and protect the joints. Some people also get eye inflammation or bowel inflammation.

Medicines: what helps, and what to watch for

Medicines are the main treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) come as tablets, creams or gels and can help with mild symptoms. A steroid injection into a joint can ease pain. Disease-modifying anti-rheumatic drugs (DMARDs) are used for moderate to severe symptoms. Biological treatments, usually given by injection, can be used if DMARDs do not help.

Good to know:

• DMARDs can take several months to work, so keep taking them even if you do not feel better straight away;

Exercise and therapy help too

• exercise regularly: low impact exercises like swimming, walking and yoga can help strengthen and protect your joints; symptoms may improve with exercise;
• a physiotherapist gives you exercises to strengthen your joints and help prevent damage;
• an occupational therapist advises on changes and equipment at home and at work;
• if you are overweight, losing weight takes pressure off your joints;

Surgery, for some people

In rare cases, surgery is used to repair or replace a damaged joint.

Is there a cure?

No. There is no cure for psoriatic arthritis. Better understanding of the disease has improved treatment, which can slow it down and protect the joints.

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Sources

Written in plain words by Frontlight from these pages:

1. NHS: Psoriatic arthritis
2. MedlinePlus: Psoriatic Arthritis
3. NIAMS: Psoriatic Arthritis