Psoriatic arthritis
- Dr Naveen Bhadauria, Consultant Rheumatologist
Psoriatic arthritis is a condition that causes inflammation (swelling) and pain in your joints. It’s linked to psoriasis, which affects the skin. There isn’t a cure for psoriatic arthritis. But there are lots of psoriatic arthritis treatments that can control the condition, reduce symptoms, and prevent damage to your joints.
About psoriatic arthritis
Psoriasis and psoriatic arthritis are both autoimmune conditions. This means your immune system attacks healthy body tissue, which leads to inflammation. Psoriasis causes red, scaly patches called plaques on your skin. And signs of psoriatic arthritis include inflammation and pain in your joints.
Around one in four people with psoriasis develop psoriatic arthritis. It’s thought that the more severe your psoriasis is, the more likely you may be to get psoriatic arthritis. You might develop symptoms of psoriasis and arthritis at the same time. But most people develop psoriasis first and then arthritis several years later. It’s also possible to get psoriatic arthritis symptoms before any skin problems – or without ever developing psoriasis at all.
Psoriatic arthritis is most common in people between 35 and 55, but you can get it at any age, including as a child.
Causes of psoriatic arthritis
The exact cause of psoriatic arthritis isn’t clear. But it’s likely to be a combination of things. Genetics seems to be a factor because many people with psoriatic arthritis have a close relative with the condition or with psoriasis. It’s thought that certain things may trigger the condition in people who are already at risk. These can include infections and injury to a tendon or joint.
Symptoms of psoriatic arthritis
Psoriatic arthritis symptoms can range from mild to severe, and may come and go in the same way that psoriasis does. Symptoms include the following.
- Pain and swelling in one or more of your joints. Commonly affected joints include your knees, ankles, hands and feet. Your joints may feel stiff too, especially first thing in the morning or after resting.
- Swelling of an entire finger or toe (known as dactylitis).
- Back and neck pain and stiffness, especially in the morning.
- Painful, inflamed tendons, which often affect your heels or elbows.
- Nail changes. These may include pitting, ridging or thickening.
- Red, inflamed eyes.
Many of these symptoms can be caused by other health conditions, including other types of arthritis. If you have these symptoms, contact a GP for advice.
Diagnosis of psoriatic arthritis
A GP will ask about your symptoms and examine you. They’ll want to know about your medical and family history too. A GP will examine your joints for any signs of swelling or tenderness, as well as your fingers and toes. They’ll also look at any patches of psoriasis on your skin, and check your nails for any changes.
If you’ve already been diagnosed with psoriasis, a GP may offer you an assessment every year to check for signs of psoriatic arthritis. In this assessment, they’ll ask you a number of questions about potential psoriatic arthritis symptoms.
There isn’t a specific test to diagnose psoriatic arthritis. But 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.
A GP may refer you to see a rheumatologist. This is a doctor who specialises in diagnosing and treating conditions that affect muscles, bones and joints. The rheumatologist may request more tests, including X-rays, ultrasounds, and CT and MRI scans.
If you do have psoriatic arthritis, the earlier you get a diagnosis, the better. Getting psoriatic arthritis treatment early on can reduce your risk of joint damage.
Self-help for psoriatic arthritis
A doctor will talk to you about things you can do to ease your symptoms. These may include the following.
- Keep active. Physical activity can ease stiffness and keep your joints flexible, as well as improve your fitness and strength. Try low-impact exercises such as swimming, walking, cycling, tai chi, and yoga.
- Rest when you need to. If you have a joint that’s very inflamed and painful, you might need to rest it before attempting to do any exercise. Be aware though, that if you rest for too long, it can make symptoms such as stiffness worse.
- Lose weight. If they think that it might help your symptoms, your doctor will suggest you lose some weight to reduce the strain on your joints.
- Using hot and cold compresses. Putting a warm compress on your joint (for example, a hot water bottle or heat pack) may help to ease pain and stiffness. Cold packs may help with swelling.
- Massage. You may find that massaging or rubbing the inflamed area helps to relieve your symptoms.
- Stop smoking. Smoking can make psoriasis worse and also further increase your risk of cardiovascular conditions (for more information, see our section on complications).
- Manage stress. Stress can make flares worse and make it harder to manage daily activities but you can take some steps to reduce it. For example, yoga and meditation may help to reduce stress.
- Eat a healthy diet. Make sure you have plenty of fruits and vegetables. If you eat a lot of sugar, try to reduce the amount. Eating a lot of sugar can increase inflammation and tiredness. Take vitamin D supplements of around 2000 IU (international units) per day too, because vitamin D is good for your bones, joints and muscles.
Treatment of psoriatic arthritis
Psoriatic arthritis is a progressive condition, which means it can get worse over time. There isn’t a cure, but psoriatic arthritis treatments can slow down damage to your joints and keep your symptoms under control. Psoriatic arthritis affects people differently, so the treatments you need will vary too. A doctor will talk to you about the best psoriatic arthritis treatment options for you. They’ll also discuss with you what to do if you get a flare-up (when your symptoms get worse).
Medicines for psoriatic arthritis
Medicines for psoriatic arthritis may help to relieve your symptoms, and some can also prevent or slow down the damage to your joints. You might need to take just one medicine or a combination of different medicines. If possible, your doctor will prescribe a medicine that can treat both your joint and any skin symptoms together.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. NSAIDs help to relieve pain in psoriatic arthritis. But they can’t stop your arthritis from getting worse or damaging your joints. A doctor may prescribe NSAIDs for short periods of time to help control your pain.
- Corticosteroid injections. A doctor may suggest a corticosteroid injection into your joint if NSAIDs don’t give you enough pain relief. Corticosteroid injections can help to reduce pain and inflammation.
- Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate. Your specialist doctor (rheumatologist) may prescribe these medicines if your arthritis is more severe or is rapidly getting worse. They can help to slow down the progression of psoriatic arthritis, and also ease your symptoms. Your doctor will probably recommend you try them for a few months to see if they work. They may try different types or more than one at the same time.
- Biological medicines such as adalimumab. These are a newer type of DMARD. Your rheumatologist may suggest biological medicines if you have several swollen joints and standard DMARDs haven’t helped. You have these medicines as an injection.
Other therapies for psoriatic arthritis
Your doctor may refer you to different health professionals who can help with your treatment and care. These may include the following.
- A physiotherapistcan advise you on exercises to maintain movement in your joint, relieve stiffness and keep your joints flexible.
- An occupational therapist can give you practical assistance to help with any difficulties you may have with everyday activities. This may involve advising on equipment or support to make tasks easier.
- A podiatrist can help if you have problems that affect your feet.
Surgery for psoriatic arthritis
If you’re in a lot of pain or your joint is badly damaged, your doctor may refer you to a surgeon. They can assess whether or not surgery could benefit you. Surgery may involve replacing the surface of the affected joint or replacing your joint with an artificial one.
Physiotherapy services
Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.
To book or to make an enquiry, call us on 0330 127 7805
Complications of psoriatic arthritis
Psoriatic arthritis is associated with an increased risk of cardiovascular disease (problems that affect your heart and blood vessels). There are certain things that may make your risk higher, including having other conditions such as diabetes. A GP will talk to you about measures you can take to reduce your risk, including stopping smoking.
The medicines used for psoriatic arthritis can sometimes be associated with side-effects. A doctor will monitor this during your treatment.
In some people, psoriatic arthritis can progress to cause severe joint problems. This can impact your quality of life, affecting everything from work to relationships. But a combination of medicines, physical therapy, and lifestyle changes can help.
Signs and symptoms of psoriatic arthritis can be quite vague at first, and might include general joint pain and stiffness. You may start to notice more symptoms as time goes on. These can include pain or swelling in your joints, swollen fingers or toes, pain in your heels or elbows and changes to your nails.
For more information, see our section on symptoms of psoriatic arthritis.
Psoriatic arthritis often affects joints including your knees and ankles, and joints in your hands and feet. Some people get back and neck pain. Some people will have pain that affects tendons in their heels or elbows rather than joint pain.
For more information, see our section on symptoms of psoriatic arthritis.
Although similar, there are some key differences between psoriatic arthritis and rheumatoid arthritis.
- If you have rheumatoid arthritis, you’ll often have antibodies, whereas if you have psoriatic arthritis, you’ll be antibody negative. Psoriatic arthritis is also associated with skin psoriasis.
- Rheumatoid arthritis can affect any joint in your body, but the hands and feet are the most commonly affected. Psoriatic arthritis can also affect the hands and feet but your nails may also have pitting or ridges or be thicker than normal.
- Rheumatoid arthritis can sometimes start to affect parts of your body such as your lungs. If you have psoriatic arthritis, you may have problems with your skin.
For more information, see our section on symptoms of psoriatic arthritis.
A psoriatic arthritis flare up will feel like your symptoms start suddenly. Psoriatic arthritis symptoms may come and go but when you have more inflammation and other symptoms are also worse, it’s called a flare. A psoriatic arthritis flare may only last for days but it can be months.
For more information, see our section on symptoms of psoriatic arthritis.
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- Rachael Mayfield-Blake, Freelance Health Editor
