The symptoms of psoriatic arthritis can be mild or severe and come and go in the same way that psoriasis does.
Some joints are more likely to be affected than others. For example, psoriatic arthritis affects the fingers of about 35 in 100 people, but affects the back bone of only about five in 100 people.
Psoriatic arthritis can also affect other joints, such as your, wrists, ankles and feet.
The condition can also affect your tendons and ligaments as well as your joints. The symptoms of the condition often develop gradually over a period of time.
The main symptoms of psoriatic arthritis include:
- joint pain
- stiffness, especially when you get up in the morning or after resting
- a stiff back and neck
- swollen fingers or toes (this is called dactylitis)
- reduced range of movement
- pitting, ridging or thickening of your nails (this can often be mistaken for a fungal infection)
- headaches and pain in your jaw
- painful swollen heels
Your GP will ask about your symptoms and examine you. They may also ask you about your medical history. You may be asked whether anyone in your family has had psoriasis.
There’s no specific test for diagnosing psoriatic arthritis. However, your GP may ask you to have a blood test or arrange for you to have X-rays. This can help to rule out other types of arthritis.
If your GP thinks you have psoriatic arthritis, they’ll refer you to a rheumatologist. This is a doctor who specialises in diagnosing and treating arthritis as well as other conditions affecting the muscles, bones and joints.
It’s important to have your condition diagnosed early so the damage to your joints can be reduced. The longer psoriatic arthritis is left untreated, the more likely it is to become severe and affect your quality of life.
Although there isn’t a cure for psoriatic arthritis, there are a number of treatments that can help. These may help to suppress the inflammation in your joints and tendons/ligaments as well as reduce any pain or swelling. It can also slow down damage to your joints caused by the condition.
There are a number of things you can do to help ease your symptoms. The main ones are listed below.
- Exercise can ease stiffness and keep your joints flexible. A physiotherapist can show you what types of exercises to do.
- Psoriatic arthritis can make you feel very tired. It’s important to listen to your body and rest when you need to. This might mean resting during the day.
- Try to stay a healthy weight. Being overweight can increase the strain on your joints and make your symptoms worse.
No specific foods have been found to help psoriatic arthritis. However, it’s a good idea to eat a balanced diet including plenty of fruit and veg to help look after your general health.
There are a number of medicines that can help to relieve your symptoms and some can prevent damage to your joints.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help to control your pain and stiffness. They work by reducing inflammation in your joints. However, they can’t stop your arthritis from getting worse or affecting your joints. NSAIDs are usually prescribed for short periods of time to help control your pain. Using them for long periods has been linked with heart, kidney and stomach problems.
If NSAIDs don’t help to relieve your symptoms, your doctor may suggest you have a corticosteroid injection into your joint. This can help to reduce pain and inflammation while you’re waiting for other treatments to start working.
If your arthritis is more severe, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). They can help to slow down the development of the condition as well as easing your symptoms. They can take several weeks to have an effect so it's important to keep taking them even if they don't seem to be working. Some common names of DMARDs include methotrexate, sulfasalazine and leflunomide. You may need to take more than one of these medicines. If you’re taking DMARDs, you should have regular blood tests. These check that your bone marrow, kidneys and liver are working well and to check for side-effects.
If DMARDs don’t work for you, your doctor may suggest biologic medicines. These work by blocking a certain molecule called TNF that promotes inflammation. You can take biologic medicines on their own but your doctor may give them with DMARDs. If your condition doesn’t get better after 12 weeks of treatment, your doctor may advise you to stop taking them. Biologic medicines are given by injection and include infliximab, etanercept and adalimumab.
What treatments you’re offered can vary depending on your personal circumstances. If you’d like more information about your treatment options, speak to your doctor.
You may be offered surgery if you’re in a lot of pain and your joint has become badly damaged. Your doctor may suggest an operation to replace the affected joint with an artificial one.
You may wish to try complementary therapies, such as acupuncture to ease pain and discomfort. However, there is no scientific proof to show that these kinds of treatment work. If you’re thinking about using complementary therapies, talk to your doctor first. Also, make sure you go to a therapist who is registered with a relevant professional body.
Although the exact cause of psoriatic arthritis isn’t known, there are a number of factors which may be involved. The main ones are listed below.
- An infection may trigger the development of psoriatic arthritis or make the condition worse.
- Injuries to tendons or joints may be involved in causing psoriatic arthritis.
- Genetics may play a part in psoriatic arthritis. If someone in your immediate family has the condition, you may be more likely to develop the condition yourself.
As with many long-term conditions, having psoriatic arthritis can affect your emotions and the relationships with those around you. It can also have an impact on your work, social and sex life. Talk to your doctor about the impact the condition has on your life. You may also find it helpful to contact support groups and talk to other people living with the condition.
If your condition is making your daily life difficult, your doctor may refer you to an occupational therapist. This is a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence.
Does psoriatic arthritis affect your nails?
Yes, if you have psoriatic arthritis, it’s likely that your nails will be affected by the condition.
Eight out of 10 people with psoriatic arthritis develop nail problems. It can cause changes in your nail colour and small dents in your nails, called pitting. Sometimes your nail can also become detached from your nail bed. These changes are often mistaken for a fungal nail infection.
Treatment may involve using a cream or ointment. This slows down the overproduction of nail cells and allows your nails to start growing normally. Your nails take a long time to grow and you may need to continue your treatment for up to a year for fingernails and up to two years for toenails. If your toenails are affected you may find it helpful to see a podiatrist. This a health professional who specialises in conditions that affect the feet. They can help to reduce the pressure on your nails from your shoes, and help to ease any pain or discomfort.
What kind of exercise is best for psoriatic arthritis?
It's important to exercise regularly if you have psoriatic arthritis. Exercise can help to ease stiffness and keeps your joints and muscles flexible. You may find exercises which strengthen your joints and improve your range of movement helpful.
If you have psoriatic arthritis, exercise is very important. Without regular exercise your muscles will lose their strength and your joints may become more painful.
Your doctor or physiotherapist can help you to create an individual exercise programme that works for you and takes your condition into account. This may involve a combination of different types of exercise. For example, strengthening exercises can be helpful for people with psoriatic arthritis. These can help improve stability in your joints and may include exercises where you use some of your body weight, such as specially designed squats.
Walking is a great way to exercise if you have psoriatic arthritis. Walking aids and specialised inserts for your shoes are available to help support your knees, ankles or feet if you need them. Speak to your doctor or physiotherapist if you’d like more information about them.
You may also find gentle exercise, such as swimming, beneficial. Swimming is a type of endurance exercise, which increases your heart and breathing rate to help improve your fitness.
It’s also important to include stretching exercise in your routine as these can help you relax. If an exercise starts to hurt, or if you have pain in your joints, stop the exercise straight away. Check with your doctor or physiotherapist before you start exercise again.
Will my psoriatic arthritis keep getting worse?
Psoriatic arthritis affects everyone differently. On average, the condition is thought to get gradually worse in about half of those with the condition. However, there are many treatments that may help to slow down damage to your joints. Starting treatment early can also help to prevent joint damage.
Psoriatic arthritis is a progressive condition, which means it may get worse over time.
However, it’s important to remember that the sooner you have a diagnosis confirmed and start treatment, the better. Treatment can prevent the condition damaging your joints, as well as keeping your symptoms under control.
Some people with the condition will have a more severe form that needs long-term treatment. Your day-to-day life may be affected in some way by psoriatic arthritis. However, it’s worth bearing in mind that the condition affects everyone differently. Speak to your doctor if you’d like more information about your condition.
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