Psoriatic arthritis

Overview

Psoriatic arthritis is an inflammatory disease of the joints and of the places where tendons and ligaments attach to bones. The immune system becomes overactive and causes swelling and pain.

Most people already have psoriasis when they are diagnosed, often years earlier. A small group gets joint pain before the skin rash. Symptoms often come and go in flares. There's no cure, but treatment can slow the disease and protect the joints.

Symptoms

Symptoms vary a lot from person to person and often come and go.

• Joint pain, stiffness, and swelling
• Whole finger swollen like a sausage (or toe)
• Pitted or changed nails
• Dry or scaly skin patches (psoriasis)
• Hand, finger, or wrist pain
• Swollen fingers or joints
• Stiff fingers or hands

Less common

• Heel pain where tendons attach to bone
• Low back pain and stiffness
• Red, painful eyes or blurry vision
• Fatigue

How it usually goes

• Years: Arthritis often starts about 7 to 10 years after psoriasis begins.
• Flares: Symptoms get worse, then ease for a while.
• With treatment: Most people get good control of pain and limit joint damage.

When to get medical care

Causes

Psoriatic arthritis happens when the immune system overreacts. Genes play a part, and many people have a family history. Obesity, infection, injury, or stress may trigger it.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Having psoriasis, especially severe psoriasis or nail changes
• Family history of psoriasis or psoriatic arthritis
• Obesity
• Age 30 to 55

Possible complications

• Inflamed eye (uveitis): Red, painful eyes; can harm vision if untreated
• Inflammatory bowel disease: Happens in some people
• Anemia: Common with active disease

Diagnosis

There's no single test. A healthcare professional looks at your joints, skin, and nails.

Questions you may be asked

• Which joints hurt and swell
• Whether you or family members have psoriasis or psoriatic arthritis
• Skin patches or nail changes
• Back pain, heel pain, or eye problems

The exam

They'll check for swollen and tender joints, psoriasis patches, and nail changes.

Tests

Tests may include:

• Blood tests: To rule out other conditions, like rheumatoid arthritis.
• Imaging: X-rays, ultrasound, or MRI to look for changes in joints, tendons, or the spine.

Treatment

Treatment depends on how severe it is. The goal is to ease pain and prevent joint damage.

Self-care

• Stay active with exercise to keep joints moving
• Protect your joints, like pushing a door open with your body instead of your fingers
• If you smoke, make a plan to quit; smoking may make symptoms worse
• Keep a healthy weight
• Get support from a support group or counseling

Medicines

Some medicines need a prescription.

Your skin doctor and joint doctor should work together, since some medicines treat both skin and joints.

Mild disease is often treated with anti-inflammatory medicine. More severe or lasting disease may need DMARDs, biologic medicines, or targeted pills. Steroid shots, splints, and physical or occupational therapy can also help.

How it compares

Prevention

It can't be prevented, but you can lower the impact:

• Get joint symptoms checked early if you have psoriasis
• Don't smoke
• Keep a healthy weight
• Stay active

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a rheumatologist (joint and immune system doctor).
• A physical therapist can help with exercises to rebuild strength and motion.

Living with it

• Stay active with walking, swimming, or biking.
• Keep a healthy weight to ease joint strain.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• Arthritis Foundation: Helpline, exercise programs, and online community.
• National Psoriasis Foundation: Patient Navigation Center and online community.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Children: It can happen in children. See a specialist.
• Pregnancy: Some medicines aren't safe in pregnancy. Plan ahead with your doctor.
• People with psoriasis: Tell your doctor about any joint pain, heel pain, or swollen fingers.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Psoriatic arthritis tends to be lifelong. With the right treatment, most people have good control of pain and limited joint damage.

Getting ready for your visit

Photos of skin patches and swollen fingers can help.

What to bring

• Which joints are affected and when
• Skin and nail changes
• Family history of psoriasis or arthritis
• All medicines, including skin treatments

Questions to ask

• Is this psoriatic arthritis?
• Should I see a rheumatologist?
• Which medicine helps both my skin and joints?
• What exercise is safe for me?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Psoriatic arthritis