Psoriatic arthritis

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due August 2022

Psoriatic arthritis is a condition that causes inflammation (swelling) and pain in your joints and is linked to psoriasis that affects the skin.

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About psoriatic arthritis

Psoriasis causes red, raised patches called plaques to appear on your skin. Around three in 10 people with psoriasis develop psoriatic arthritis. It’s thought that the more severe your psoriasis, the more likely you may be to get psoriatic arthritis. But people who don’t already have the skin condition can get psoriatic arthritis too.

Psoriatic arthritis can affect your joints in different ways. It can affect specific joints such as those in your spine or one or more joints on the same side or both sides of your body. Some joints are more likely to be affected than others – your fingers are more likely to be affected than your backbone, for example. And the condition can affect your tendons and ligaments as well as your joints.

Most people get psoriatic arthritis aged between 35 and 55, although you can get it at any age. Both men and women can get psoriatic arthritis and it affects the sexes pretty much equally.

Symptoms of psoriatic arthritis

Often, psoriatic arthritis symptoms develop gradually. They can be mild or severe, and may come and go in the same way that psoriasis does. The main symptoms of psoriatic arthritis usually include the appearance of the skin condition psoriasis and:

  • pain and swelling in your joint
  • lower back pain and stiffness, especially in the morning
  • tiredness
  • feeling stiff for a while (more than 30 minutes), especially when you get up in the morning or after resting
  • swollen fingers or toes, which is called dactylitis
  • a reduced range of movement in your affected joint
  • pitting, ridging or thickening of your nails
  • painful, swollen heels or elbows
  • pain in your toe or foot, particularly in the morning

Some of these symptoms may be caused by something else, such as other types of arthritis or other health conditions. Your GP will help you to find out what is causing these symptoms and if you have psoriatic arthritis.

Causes of psoriatic arthritis

Doctors don’t know the exact reason why some people get psoriatic arthritis but there are some things that might increase your risk of getting it. The main ones are:

  • an infection that may trigger psoriatic arthritis or make the condition worse
  • an injury to a tendon or joint which causes psoriatic arthritis
  • genetics – if someone in your immediate family has it, you may be more likely to get it

But for most people who get psoriatic arthritis, a cause can’t be identified.

Diagnosis of psoriatic arthritis

Your GP will ask about your symptoms and examine you. They will also ask about your medical history and your family.

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 arthritis, as well as other conditions that affect the muscles, bones and joints.

The earlier you get a diagnosis, the better. This is because you can get the treatment you need to reduce your risk of joint damage.

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Self-help for psoriatic arthritis

There are lots of things you can do to help ease your symptoms. Some self-help options include those below.

  • Exercise can ease stiffness and keep your joints flexible. A physiotherapist can show you what types of exercise 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 puts more strain on your joints and will make your symptoms worse. For tips and advice on losing weight, see our Related information.
  • Putting a hot compress on your joint (for example, a hot water bottle) may help to ease the stiffness.

Treatment of psoriatic arthritis

There isn’t a cure for psoriatic arthritis but there are lots of psoriatic arthritis treatments that can help. There are treatments to help if you have symptoms that affect your skin too. You can learn more about these in the Psoriasis topic. What treatment works for you will depend on your personal circumstances. Ask your doctor about the best options for you.

Medicines for psoriatic arthritis

There are medicines that can help to relieve your symptoms, and some can prevent or slow down the damage psoriatic arthritis can do to your joints. You might need to take just one medicine or a combination of different medicines.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as ibuprofen or naproxen can help to control your pain and stiffness. They work by reducing pain in your joints. But they can’t stop your arthritis from getting worse or damaging your joints. Doctors usually prescribe NSAIDs for short periods of time to help control your pain. If you use them for longer, they might cause heart and stomach problems. Ask your doctor for more information about side-effects.

Corticosteroid injection

If NSAIDs don’t help, your doctor might suggest you have a corticosteroid injection into your joint. This can help to reduce pain and inflammation. You’ll usually have this as an add-on treatment to another medicine.

Disease-modifying anti-rheumatic drugs (DMARDs)

If your arthritis is more severe, your doctor may prescribe DMARDs. These can help to slow down the progression of psoriatic arthritis, and also ease your symptoms. Some types of this medicine can take time to have an effect – sometimes many weeks. So, it's important to keep taking the medicine even if it doesn't seem to be working. Some common DMARDs are:

  • methotrexate
  • sulfasalazine
  • leflunomide

You might need to take more than one of these medicines.

You’ll probably need to have regular blood tests while you take DMARDs. These will check that your bone marrow, kidneys and liver are working well, and rule out any hidden side-effects.

Biological medicines

If DMARDs don’t work for you, your doctor may suggest biological medicines. These medicines are taken by injection and they work by blocking key molecules that promote inflammation. You can take biological medicines on their own or with DMARDs. Biological medicines include:

  • etanercept
  • adalimumab
  • infliximab

If your psoriatic arthritis doesn’t get better within three to six months of taking a biological medicine, your doctor may suggest you try another medicine. Other biologic medicines that your doctor might offer you include:

  • ustekinumab
  • secukinumab
  • apremilast

Surgery for psoriatic arthritis

If you’re in a lot of pain and your joint is badly damaged, you might need to have an operation. This could be to replace the surface of the affected joint or to replace your joint with an artificial one.

Complementary therapies for psoriatic arthritis

While most complementary therapies don’t have strong scientific proof that they work, some people find that they help to ease pain and discomfort. If you decide to give them a go, make sure you go to a therapist who’s registered with a relevant professional body.

Living with psoriatic arthritis

Psoriatic arthritis can affect your emotions and the relationships with those around you. It can also have an impact on your quality of life – everything from work to your social and sex life. If you find you’re struggling, talk to your doctor about the impact the condition is having on your life and ask for help with managing your symptoms. There might be treatments you can try that will improve things for you.

You might also find it helpful to contact support groups and talk to other people who are living with the condition. They might have valuable tips and advice.

If your condition is making your daily life really difficult, your doctor may refer you to see an occupational therapist. This is a health professional who can give you practical assistance to help you manage with everyday tasks and increase your independence.

Frequently asked questions

  • Yes, eight out of 10 people with psoriatic arthritis have problems with their nails. These problems include your nails developing small dents, which is called pitting. Your nails might also turn yellow. Sometimes your nail can become detached from the nail bed.

    There isn’t a treatment that can cure nail problems but there are things that may help. Keep your nails short to prevent the nail separating from the nail bed. Don’t wear false nails and stay away from manicures to prevent getting an infection in the nail bed. You can use nail varnish to disguise any discolouration or pitting but it’s best not to use acetone-based nail varnish removers.

    There are various creams and ointments available, such as salicylic acid, calcipotriol, and tazarotene. These often don’t work very well but you might feel it’s worth giving them a go. Injections under the nailbed with corticosteroids, or taking methotrexate or ciclosporin tablets tend to work better.

    If your toenails are affected, you might find it helpful to see a podiatrist – a health professional who specialises in conditions that affect the feet.

  • It's important to exercise regularly if you have psoriatic arthritis as it can help to ease stiffness and keep your joints and muscles flexible. Exercises that strengthen and stretch your joints, and improve your range of movement are ideal.

    Without regular exercise, your muscles will lose their strength and your joints may become stiff. A physiotherapist can help you to create an individual exercise programme that works for you. This may involve a combination of different types of exercises.

    Walking is a great way to start to exercise if you have psoriatic arthritis. You could use walking aids and inserts for your shoes if you need support for your knees, ankles or feet. Ask your doctor or physiotherapist if you’d like more information about these products.

    You may also find gentle exercise such as swimming is a good start. This can increase your heart and breathing rate to help improve your fitness while not putting any stress on your joints. Or perhaps yoga is more your thing – this involves stretching exercises and also helps with relaxation.

    If an exercise starts to hurt or you get any swelling, ease off on what you’re doing and get some advice from your doctor or physiotherapist.

  • Psoriatic arthritis is a progressive condition, which means it may get worse over time. While it affects everyone differently, it’s thought to get gradually worse in about half of those with the condition. There are many treatments now available that may help to slow down any damage to your joints, as well as keeping your symptoms under control. And if you start these early, you might even prevent any damage at all. The sooner you get a diagnosis and start treatment, the better.

    If you get a more severe form of psoriatic arthritis that needs long-term treatment, it might start to affect your day-to-day life. But bear in mind that the condition affects everyone differently. Ask your doctor if you’d like more information about how to manage your condition.

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Related information

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    • Apremilast for treating active psoriatic arthritis. National Institute for Health and Care Excellence (NICE)., published 22 February 2017
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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2019
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
    Next review due August 2022