What is the definition of Psoriatic Arthritis?

Psoriatic arthritis is a joint problem (arthritis) that often occurs with a skin condition called psoriasis.

What are the alternative names for Psoriatic Arthritis?

Arthritis - psoriatic; Psoriasis - psoriatic arthritis; Spondyloarthritis - psoriatic arthritis; PsA

What are the causes for Psoriatic Arthritis?

Psoriasis is a common skin problem that causes red patches on the skin. It is an ongoing (chronic) inflammatory condition. Psoriatic arthritis occurs in about 7% to 42% of people with psoriasis. Nail psoriasis is linked to psoriatic arthritis.

In most cases, psoriasis comes before the arthritis. In a few people, the arthritis comes before the skin disease. However, having severe, wide-spread psoriasis appears to increase the chance of getting psoriatic arthritis.

The cause of psoriatic arthritis is not known. Genes, immune system, and environmental factors may play a role. It is likely that the skin and joint diseases may have similar causes. However, they may not occur together.

What are the symptoms for Psoriatic Arthritis?

The arthritis may be mild and involve only a few joints. The joints at the end of the fingers or toes may be more affected. Psoriatic arthritis is most often uneven causing arthritis only on one side of the body.

In some people, the disease may be severe and affect many joints, including the spine. Symptoms in the spine include stiffness and pain. They most often occur in the lower spine and sacrum.

Some people with psoriatic arthritis may have inflammation of the eyes.

Most of the time, people with psoriatic arthritis have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

Tendons may become inflamed with psoriatic arthritis. Examples include the Achilles tendon, the plantar fascia, and the tendon sheath in the hand.

What are the current treatments for Psoriatic Arthritis?

Your provider may give nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints.

Arthritis that does not improve with NSAIDs will need to be treated with medicines called disease-modifying antirheumatic drugs (DMARDs). These include:

  • Methotrexate
  • Leflunomide
  • Sulfasalazine

Apremilast is another medicine used for the treatment of psoriatic arthritis.

New biologic medicines are effective for progressive psoriatic arthritis that is not controlled with DMARDs. These medicines block a protein called tumor necrosis factor (TNF). They are often helpful for both the skin disease and the joint disease of psoriatic arthritis. These medicines are given by injection.

Other new biologic medicines are available to treat psoriatic arthritis that is progressing even with the use of DMARDs or anti-TNF agents. These medicines are also given by injection.

Very painful joints may be treated with steroid injections. These are used when only one or a few joints are involved. Most experts do not recommend oral corticosteroids for psoriatic arthritis. Their use may worsen psoriasis and interfere with the effect of other drugs.

In rare cases, surgery may be needed to repair or replace damaged joints.

People with inflammation of the eye should see an ophthalmologist.

Your provider may suggest a mix of rest and exercise. Physical therapy may help increase joint movement. You may also use heat and cold therapy.

What is the outlook (prognosis) for Psoriatic Arthritis?

The disease is sometimes mild and affects only a few joints. However, in many people with psoriatic arthritis damage to joints occurs within the first several years. In some people, very bad arthritis may cause deformities in the hands, feet, and spine.

Most people with psoriatic arthritis who do not improve with NSAIDs should see a rheumatologist, a specialist in arthritis, along with a dermatologist for the psoriasis.

Early treatment can ease pain and prevent joint damage, even in very bad cases.

When should I contact a medical professional for Psoriatic Arthritis?

Call your provider if you develop symptoms of arthritis along with psoriasis.

Psoriasis - guttate on the arms and chest
Psoriasis - guttate on the cheek

REFERENCES

Bruce IN, Ho PYP. Clinical features of psoriatic arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 128.

Fitzgerald O, Magee C. Psoriatic arthritis. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 82.

Smolen JS, Schöls M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018;77(1):3-17. PMID: 28684559 pubmed.ncbi.nlm.nih.gov/28684559/.

Veale DJ, Orr C. Management of psoriatic arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 131.

  • Condition: Psoriasis and Psoriatic Arthritis
  • Journal: Medicine
  • Treatment Used: Biological Therapies
  • Published —
This study evaluated the risk of herpes zoster (HZ) infection with biological therapies in the treatment of patients with psoriasis and psoriatic arthritis.
  • Condition: Secukinumab
  • Journal: Clinics (Sao Paulo, Brazil)
  • Treatment Used: Psoriatic Arthritis
  • Number of Patients: 1141
  • Published —
The aim of this meta-analysis was to evaluate the effectiveness and safety of different dosing regimens of secukinumab in the treatment of psoriatic arthritis (PsA).