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Psoriatic arthritis

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due December 2024

Psoriatic arthritis is a condition that causes inflammation (swelling) and pain in your joints. It’s linked to psoriasis, which is a condition that affects the skin. Psoriatic arthritis can’t be cured. But there are lots of treatments that can control the condition, reducing symptoms and preventing damage to your joints.

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About psoriatic arthritis

Psoriasis and psoriatic arthritis are both autoimmune conditions. This means they’re caused by your immune system attacking healthy body tissue, which leads to inflammation. In psoriasis, it causes red, scaly patches called plaques on your skin. And in psoriatic arthritis, it causes inflammation and pain in your joints.

Around three in 10 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 the symptoms of psoriatic arthritis before any skin problems – or without ever developing psoriasis at all.

Psoriatic arthritis is most common in people aged between 35 and 55, but you can get it at any age, including in childhood. It affects men and women equally.

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Causes of psoriatic arthritis

It’s not clear exactly what causes some people to develop psoriatic arthritis. But it’s likely to be down to a combination of things. Genetics seems to be a factor, with many people with psoriatic arthritis having 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. They may include the following.

  • Pain and swelling in one or more joint. Common joints affected 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, often affecting 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’re getting these symptoms, contact your GP for advice.

Diagnosis of psoriatic arthritis

Your GP will ask about your symptoms and examine you. They’ll want to know about your medical and family history too. Your 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, your GP may offer you an annual assessment to check for signs of psoriatic arthritis. This involves asking you a series of questions about potential symptoms of psoriatic arthritis.

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.

Your GP may refer you to see a rheumatologist. This is a doctor who specialises in diagnosing and treating conditions affecting 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. Treatment early on can reduce your risk of joint damage.

Self-help for psoriatic arthritis

Your doctor will talk to you about things you can do to ease your symptoms. These may include the following.

  • Keeping active. Physical activity can ease stiffness and keep your joints flexible, as well as improving your fitness. Try low-impact exercises, such as swimming, walking, cycling, tai chi, and yoga.
  • Resting when needed. If you have a joint that’s very inflamed and painful, you might need to rest it before attempting any exercise. Be aware though, that resting for too long can make symptoms such as stiffness worse.
  • Losing weight. If they think that it might help your symptoms, your doctor might suggest that you lose some weight to reduce the strain on your joints.
  • Using hot and cold compresses. Putting a warm compress on your joint (such as 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.

 

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. Your doctor will talk to you about the best treatment options for you. They’ll also discuss with you what you can do if you get a flare-up (when your symptoms worsen).

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), including 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. Your doctor may prescribe NSAIDs for short periods of time to help control your pain.
  • Corticosteroid injections. Your 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), eg methotrexate. Your doctor 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 trying 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, eg adalimumab. These are a newer type of DMARDs. Your doctor may suggest biological medicines if you have several swollen joints and standard DMARDs aren’t helping. You take these medicines by 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 physiotherapist. A physiotherapist can advise you on exercises you can do to maintain movement in your joint, relieve stiffness and keep your joints flexible.
  • An occupational therapist. An occupational therapist can give you practical assistance to help with any difficulties you may be having with everyday activities. This may involve advising on equipment or support you may need to make tasks easier.
  • A podiatrist. A podiatrist can help if you have problems affecting 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 surgery could benefit you. Surgery may involve replacing the surface of the affected joint or replacing your joint with an artificial one.

Complications of psoriatic arthritis

Psoriatic arthritis is associated with an increased risk of cardiovascular disease (problems affecting your heart and blood vessels). There are certain factors that may make your risk higher, including having other conditions, such as diabetes. Your doctor 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. Your doctor will monitor this during your treatment.

In some people, psoriatic arthritis can progress to cause severe joint problems. This can really impact on your quality of life, affecting everything from work to relationships.

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Related information

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    Discover other helpful health information websites.

    • Psoriasis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2021
    • Psoriatic arthritis. BMJ Best Practice. bestpractice.bmj.com, last reviewed 8 November 2021
    • Psoriatic arthritis. Patient. patient.info, last edited 24 May 2021
    • What is psoriatic arthritis? The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, published November 2020
    • Psoriatic arthritis. Medscape. emedicine.medscape.com, updated 2 November 2021
    • Psoriasis: assessment and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 1 September 2017
    • Spondyloarthritis in over 16s: diagnosis and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 2 June 2017
    • Physiotherapy & exercise: psoriatic arthritis. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, published 2020
    • Occupational therapy & psoriatic arthritis. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, published July 2020
    • Eder L, Polachek A, Rosen CF, et al. The development of psoriatic arthritis in patients with psoriasis is preceded by a period of nonspecific musculoskeletal symptoms: a prospective cohort study. Arthritis Rheumatol 2017; 69(3):622–29. doi: 10.1002/art.39973
  • Reviewed by Pippa Coulter, Freelance Health Editor, December 2021
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
    Next review due December 2024

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