What is psoriatic arthritis? Psoriatic arthritis is an inflammatory disease of the joints which affects up to 40% of people who have the skin condition psoriasis. In the vast majority of cases, psoriatic arthritis develops in people who already have the symptoms of psoriasis - red, flaky patches of skin - but it is possible to have problems with your joints before any problems with the skin develop. It is mostly adults who develop the condition. It's possible - although less common - to have the symptoms of psoriatic arthritis before any symptoms of psoriasis appear. Psoriatic arthritis is thought to occur when the immune system mistakenly attacks healthy tissue, but it's not clear why it develops in some people have it and not in others; infection might well be a trigger. As with some other rheumatic diseases, the symptoms differ from one person to another: it's thought that about a third of all the people who have it will experience only mild symptoms. Stress can cause the symptoms to flare up. As well as relieving the pain of any aching joints and improving mobility, treatment focuses on slowing the progression of the disease. The severity of psoriatic arthritis is not linked to the severity of the psoriasis.
What are the main symptoms of psoriatic arthritis? Psoriatic arthritis can affect any joint in the body, although it's more frequent in some than in others. The symptoms can vary from one day to the next.
- Swollen joints at the end of the fingers or toes (dactylitis)
- Inflammation of the spine (spondylitis), causing a stiff back or neck
- Pitted, thickened and discoloured nails
- Pain and swelling in the heels where the Achilles' tendon is attached to the bone
- Some people may also experience intense fatigue
- Conjunctivitis or painful red eyes (uveitis)
How is psoriatic arthritis diagnosed? If you have not already been diagnosed with psoriasis then your GP will check for symptoms as the two conditions are closely related. Nail psoriasis is a particularly important symptom, as it is often present in cases of psoriatic arthritis. You might have a blood test to check for inflammation and to rule out other types of arthritis. Since the pain of psoriatic arthritis can come and go, it's a good idea to make a note of which joints have been painful before your visit, and to tell the GP as much as you can. The doctor is also likely to ask whether your family has a history of either psoriasis or psoriatic arthritis. Sometimes you will be referred to a rheumatologist to confirm the diagnosis.
How is psoriatic arthritis treated? There are three aspects to treating psoriatic arthritis - relieving the symptoms, slowing down the progression of the disease and improving your mobility. Some of the medications you take can also be used for treating psoriasis and if possible, your doctor will try to treat both conditions with the same medication.
Medication for pain relief: You will probably be prescribed a non-steroidal anti-inflammatory drug (NSAID). These drugs work by reducing inflammation and the pain that comes with it. In some people NSAIDs can have side-effects - they tend to affect the stomach - so your doctor will monitor your progress and if necessary prescribe a different medication. If you have a particularly painful joint or tendon, you might be given a corticosteroid injection directly to the affected area. NSAIDs are usually effective within a very short time of starting the treatment, but don‚Äôt worry if a particular one doesn't work for you or you suffer from adverse side-effects - your healthcare team will find an alternative. Tell your doctor if the NSAIDs you are taking don't relieve the pain or you experience side-effects: there are likely to be effective alternatives.
Longer-term treatment of psoriatic arthritis: The drugs which can slow the progression of psoriatic arthritis are disease-modifying anti-rheumatic drugs (DMARDs) and these tackle the causes of inflammation. They will usually be prescribed as early as possible after your diagnosis. It might take some time before you notice that the medication has had any effect, but it's important to keep taking it. You might also have to try several DMARDs before finding one which works, and you might also have to keep taking NSAIDs. However, some people don't respond to the treatment offered by DMARDs or can't take them because of another health condition. In these cases, a newer generation of drugs - biological (also sometimes known as biologic) drugs - can be prescribed. These drugs target particular chemicals or cells in the body's immune system response. Psoriatic arthritis is not often treated by surgery. Sometimes after years of inflammation where the joints have been badly damaged, joint replacement surgery is performed. A damaged tendon might also be repaired by surgery. It's important to start treating the progression of psoriatic arthritis as soon as possible after you have your diagnosis.
Improving your mobility As with most other types of arthritis, it's important to do exercise to maintain your mobility and also to protect your joints by building up muscle strength. Your GP or rheumatologist might send you to a physiotherapist who will give you specific exercises to help you protect your joints and keep you mobile. You might also see an occupational therapist, who can give you advice about protecting your joints with splints or braces, or by changing the way you perform tasks - or by using physical aids. Sometimes an occupational therapist will come to your home to make an assessment. If you have problems with your feet (especially in the toes or heel), then you might be sent to see a podiatrist, who can recommend the right type of footwear to protect your joints and prevent discomfort. There is plenty of specialist medical advice available to help you live well with psoriatic arthritis.
Diet & Lifestyle: There is no particular diet recommended for the treatment of psoriatic arthritis, but the usual advice about healthy eating applies, and reducing your weight is an obvious way to protect your joints. Smoking is not only bad for your overall health but it can also make some forms of psoriasis worse.
Exercise: You should discuss with your doctor or physiotherapist any exercises to help specific joints. Bear in mind that you might be feeling extreme fatigue as a result of the condition, so you will have to find the right balance of exercise and rest for you. It's important nonetheless to take exercise, especially to walk, as there are clear benefits for your mobility, weight and mood.
Complementary Therapies: Always tell your doctor if you are going to try a complementary therapy. There is no compelling evidence that such therapies have any beneficial effect on psoriatic arthritis, but if you find a therapy that reduces your levels of stress - a likely trigger of flare-ups in the symptoms - then your doctor will usually be happy for you to continue with the treatment. The best thing you can do - whatever alternative therapy you are thinking of - is to make sure you choose someone who is either a member of a professional body or a registered practitioner. Avoid anyone who tells you to give up your prescribed medication. The risks associated with complementary therapies have more to do with the therapist than with most of the therapies themselves.
Your mood: Living with a long-term condition such as psoriatic arthritis (and psoriasis) can sometimes make you feel depressed. If so, it's a good idea to talk to someone about your feelings - to a member of your healthcare team, to a relative or to a friend. You can find support groups through the arthritis and psoriasis charities and share your feelings and experiences with other people living with the condition. With an early diagnosis it's possible to minimise damage to the joints and to improve your mobility.
Other useful sources of information: If you'd like to find out more about living with or caring for someone with psoriatic arthritis, then you might find the following websites useful:
- www.papaa.org (The Psoriasis And Psoratic Arthritis Alliance)
Any information of a medical nature on this website is given to provide a general understanding of a medical condition or conditions. No patient/doctor relationship is to be inferred and you should seek medical advice from a qualified practitioner. Nothing on this site should be used as a substitute for competent advice from a qualified medical practitioner.