Psoriatic arthritis

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
Next review due May 2020

Psoriatic arthritis is a condition that causes inflammation in your joints – they may be painful and stiff, which can make moving around difficult. It’s 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. Up to four in 10 people with psoriasis develop psoriatic arthritis. It’s thought that the more severe your psoriasis, the more likely you are to get psoriatic arthritis. But some people who get psoriatic arthritis don’t already have the skin condition.

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 on both sides of your body. Some joints are more likely to be affected than others.

Psoriatic arthritis affects the fingers of about 35 in 100 people, but affects the backbone of only about five in 100 people, for example. And the condition can affect your tendons and ligaments as well as your joints.

Most people get psoriatic arthritis between the ages of 35 and 55, although you can get it at any age. Both men and women can get psoriatic arthritis, and the numbers are pretty much equal.

Symptoms of psoriatic arthritis

Often, the symptoms of psoriatic arthritis develop gradually over a period of time. They can be mild or severe, and may come and go in the same way that psoriasis does. The main symptoms include:

  • pain and swelling in your joint
  • tiredness
  • feeling stiff, especially when you get up in the morning or after resting
  • swollen fingers or toes, which is called dactylitis
  • a reduced range of movement
  • pitting, ridging or thickening of your nails
  • painful, swollen heels
  • pain in your toe or foot, particularly in the morning

Diagnosis of psoriatic arthritis

Your GP will ask about your symptoms and examine you, and will ask about your medical history and that of 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.

If your GP thinks you might have psoriatic arthritis, they’ll 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 because you can reduce the risk of damage to your joints. The longer psoriatic arthritis is left untreated, the more likely it is to damage your joints. This will affect your quality of life, and make it harder to treat the condition.

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Treatment of psoriatic arthritis

There isn’t a cure for psoriatic arthritis but there are lots of treatments that can help. Some of these suppress the inflammation in your joints and tendons or ligaments, and help with pain or swelling. Treatments can also slow down the damage psoriatic arthritis can do to your joints.

What treatments you’re offered will vary according to your personal circumstances. Ask your doctor about your treatment options and what’s best for you.

Self-help for psoriatic arthritis

There are lots 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 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 makes your symptoms worse. See our Related information for advice on losing weight.
  • If you put a hot compress on your joint, it may help to ease the stiffness.

Medicines for psoriatic arthritis

There are medicines that can help to relieve your symptoms, and some can prevent damage 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, kidney and stomach problems.

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 months. So it's important to keep taking them even if they don't seem to be working. Some common DMARDs are methotrexate, sulfasalazine and 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 and liver are working well, and rule out any hidden side-effects.

Biologic medicines

If DMARDs don’t work for you, your doctor may suggest biologic medicines. These work by blocking key molecules that promote inflammation. You can take biologic medicines on their own or with DMARDs, and you have them as an injection.

Biologic medicines include etanercept, adalimumab and infliximab. If your psoriatic arthritis doesn’t get better within three months of taking these biological medicines, your doctor will probably tell you to stop taking them. They might suggest you try another medicine. Other biologic medicines that your doctor might offer you include ustekinumab, secukinumab and apremilast. You can usually try these for six months for ustekinumab, and four months for secukinumab and 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 on it. This might be to replace the surface of the affected joint or you might need to have your joint replaced with an artificial one.

Complementary therapies for psoriatic arthritis

Some people find that complementary therapies help to ease pain and discomfort. While there’s no scientific proof to show that these kinds of treatment work, you might decide to try them. If you do decide to give them a go, make sure you go to a therapist who’s registered with a relevant professional body.

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 listed below.

  • An infection may trigger psoriatic arthritis or make the condition worse.
  • An injury to a tendon or joint might be involved in causing psoriatic arthritis.
  • Genetics may play a part in psoriatic arthritis. If someone in your immediate family has it, you may be more likely to get it too.

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 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 include things like discolouration and small dents, which is called pitting. Sometimes your nail can become detached from the nail bed.

    There isn’t a treatment that can cure the problem but there are things you can try to see if they help. Keep your nails short to prevent the nail bed coming away, and stay away from manicures to prevent getting an infection in the nail bed. Don’t wear false nails either. But you can use nail varnish to disguise any discolouration or pitting.

    There are various creams and ointments available, such as salicylic acid, calcipotriol, and tazarotene. Unfortunately, these often don’t work that 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. This a health professional who specialises in conditions that affect the feet.

  • It's important to exercise regularly if you have psoriatic arthritis. 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. Your doctor or a physiotherapist can help you to create an individual exercise programme that works for you. This may involve a combination of different types of exercise.

    Walking is a great way to start to exercise if you have psoriatic arthritis. You could use walking aids and specialised 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 beneficial. 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 combines stretching exercises and also helps with relaxation.

    If an exercise starts to hurt, or if you have any pain in your joints, stop straight away. Check with your doctor or physiotherapist before you start to exercise again.

  • Psoriatic arthritis is a progressive condition, which means it may get worse over time. It affects everyone differently but is 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

    • Psoriatic arthritis. BMJ Best Practice., last updated 29 January 2016
    • Psoriasis. NICE Clinical Knowledge Summaries., last revised September 2014
    • Psoriatic arthritis. Medscape., updated 21 January 2016
    • Psoriatic arthritis. PatientPlus., last checked 1 August 2016
    • Psoriatic arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases., published March 2017
    • Psoriatic arthritis. American College of Rheumatology., updated March 2017
    • Psoriatic arthritis. Arthritis Care., last reviewed 2015
    • Non-steroidal anti-inflammatory drugs. NICE British National Formulary., reviewed March 2017
    • Local corticosteroid injections. NICE British National Formulary., reviewed March 2017
    • Drugs that suppress the rheumatic disease process. NICE British National Formulary., reviewed March 2017
    • Drugs affecting the immune response. NICE British National Formulary., reviewed March 2017
    • Sulfasalazine. NICE British National Formulary., reviewed March 2017
    • Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis. National Institute for Health and Care Excellence (NICE), 25 August 2010.
    • Ustekinumab for treating active psoriatic arthritis. National Institute for Health and Care Excellence (NICE), 3 March 2017.
    • Apremilast for treating active psoriatic arthritis. National Institute for Health and Care Excellence (NICE), 22 February 2017.
    • Secukinumab. NICE British National Formulary., reviewed 28 April 2017
    • Complementary and alternative treatments. Arthritis Research UK., accessed 26 April 2017
    • Complementary and alternative therapies. National Psoriasis Foundation., accessed 26 April 2017
    • Psoriatic nail disease. PatientPlus., last checked 19 November 2015
    • Nail psoriasis. Medscape., updated 6 April 2017
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2017
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
    Next review due May 2020

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