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by Stahl RJ

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
  • Pain and inflammation of tendons where they join muscles
  • 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 scan.

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
  • Apremilast—reduces inflammation within the cell.
  • Disease-modifying anti-rheumatic drugs (DMARDS) to treat more severe symptoms and slow the progression of the disease including
    • sulfasalazine
    • leflunomide
    • methotrexate
    • cyclosporine
  • Tumor necrosis factor (TNF) inhibitors to treat more severe symptoms
    • etanercept
    • infliximab
    • adalimumab
    • ustekinumab

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.
Proper weight management is associated with improved symptoms. Talk to a dietitian who can help you lose excess weight and keep it off.
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 November 3, 2014. Accessed November 7, 2014.
Psoriatic arthritis. National Psoriasis Foundation website. Available at: Available at: http://www.psoriasis.org/psoriatic-arthritis. Accessed November 7, 2014.
What is psoriatic arthritis? Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/psoriatic-arthritis. Accessed November 7, 2014.

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