Psoriatic arthritis

Produced by Rebecca Canvin, Bupa Health Information Team, January 2012.

This factsheet is for people who have psoriatic arthritis, or who would like information about it.

Psoriatic arthritis is a condition that causes painful inflammation around the joints. It’s linked to the skin condition psoriasis. It causes stiffness, pain and lack of movement in the joints.

About psoriatic arthritis

Around two in 100 people in the UK have psoriasis. Psoriasis causes red, raised patches on your skin called plaques. Your elbows, knees, lower back and scalp are the most common places to have psoriasis plaques, though they can appear anywhere on your body. Five in 100 people with psoriasis will develop psoriatic arthritis. The more severe your psoriasis is, the more likely you are to develop psoriatic arthritis.

Some people develop psoriatic arthritis before they develop the skin condition, especially if there is a close family history of psoriasis. You can develop psoriatic arthritis at any age, though it’s unusual in children. In general, women are slightly more likely to develop the condition than men, particularly after pregnancy or the menopause.

There are a number of different types of psoriatic arthritis. These may affect specific joints, such as your spine, or may affect one or more joints on the same or on both sides of your body.

Symptoms of psoriatic arthritis

The symptoms of psoriatic arthritis can be mild or severe and can come and go in the same way that psoriasis does.

You’re most likely to have the condition in your hands and feet. However, psoriatic arthritis can also affect larger joints, such as your elbows, knees, hips and spine. 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
• tiredness and stiffness, especially when you get up in the morning or after resting
• a painful, stiff back and neck (this is called spondylitis)
• swollen and sore joints at the end of your fingers or toes (this is called dactylitis)
• reduced range of movement
• pitted or thickened nails
• headaches and pain in your jaw
• sore and swollen heels
• red, itchy eyes

Causes of psoriatic arthritis

The exact cause of psoriatic arthritis isn’t known. However, there are a number of factors which may be involved. The main ones are listed below. 

• Infection may trigger the development of psoriatic arthritis or make the condition worse.
• Several studies have shown that trauma or stress may cause psoriatic arthritis in people with psoriasis.
• Genetics may play a part in psoriatic arthritis. If you have the condition in your immediate family, you may be more likely to develop the condition yourself.
• Your body’s immune system may cause cells to attack your joints, causing inflammation.

Diagnosis of psoriatic arthritis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. You may also be asked about any history of psoriasis or psoriatic arthritis in your family.

There is no specific test for diagnosing psoriatic arthritis. However, your GP may ask you to take a blood test or arrange for you to have X-rays. This may help to rule out other types of arthritis.

It’s important to have your condition diagnosed early, because this means you can start treatment quickly. The longer psoriatic arthritis is untreated, the more likely it is to become severe and to affect your quality of life.

Treatment of psoriatic arthritis

There is no cure for psoriatic arthritis. However, there are a number of treatments that can help you to manage the condition and control your symptoms. The aim of treatment for psoriatic arthritis is to reduce the amount of joint pain and swelling that you have. Treatment can also slow down damage to your joints caused by the condition.

Self-help

There are a number of things you can do to help reduce your symptoms and prevent your condition from getting worse. The main ones are listed below.

• Exercise can strengthen the muscles around your joint and help you to stay flexible. A physiotherapist can show you what types of exercises to do.
• Psoriatic arthritis can make you feel very tired and lethargic. It’s important to listen to your body and rest when you need to. This might mean resting during the day.
• Try and stay a healthy weight for your height as being overweight can increase the strain on your joints and make your symptoms worse.
• There are no specific foods that will help you to manage your condition. However, Omega-3 fish oils may help to reduce your symptoms.

Medicines

There are a number of medicines that can help to relieve your symptoms and some can prevent your condition from getting worse.

Non-steroidal anti-inflammatory drugs (NSAIDs) 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. There are many NSAIDs available, including ibuprofen, naproxen and diclofenac. NSAIDs are usually prescribed for short periods of time to help control your pain. This is because using them for long periods has been linked with heart, kidney and stomach problems.

If your arthritis is more severe, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These work by tackling the cause of inflammation in your joints. 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. 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 to 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 targeting certain chemicals that cause inflammation. You can take biologic medicines on their own but your doctor will often give them with DMARDs to make them more effective and to reduce the risk of side-effects. If your condition gets better during the 12 weeks of treatment with biologic medicines, then you will be able to keep taking them. Biologic medicines are given by injection and include infliximab, etanercept and adalimumab.

Your doctor may also suggest a corticosteroid injection into a painful swollen joint. This can help to reduce pain and inflammation while you’re waiting for other treatments to start working.

Surgery

Surgery isn’t used as a main treatment for psoriatic arthritis. However, if you have had the condition for a long time and a joint has become badly damaged, your doctor may suggest an operation to replace the affected joint with an artificial one.

Complementary therapies

Many people with psoriatic arthritis use complementary therapies, such as acupuncture and massage to ease pain and discomfort. However, there is no scientific evidence to show that these kinds of treatment work. If you’re thinking about using complementary therapies, talk to your GP first. Also, make sure you go to a therapist that is registered with a professional body.

Living with psoriatic arthritis

Living with psoriatic arthritis can be difficult and the more severe your condition is, the bigger the impact it’s likely to have on your life.

As with many long-term conditions that cause pain and discomfort, having psoriatic arthritis can affect your emotions and 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 having a major impact on your life, your GP may refer you to an occupational therapist - a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.