Psoriatic arthritis (PsA) is a form of chronic inflammatory arthritis that causes joint pain, swelling, and stiffness in people usually diagnosed with skin psoriasis. PsA affects everyone differently. Some people with PsA have only one joint affected, while others may experience symptoms in multiple joints.

For some people, PsA affects the shoulder, causing it to become swollen, stiff, and painful. These symptoms of PsA in the shoulder can be mild and develop slowly or arise suddenly with severe pain.

It’s important to recognize the signs and symptoms of PsA in the shoulder. Studies have shown that even a six-month delay in diagnosis or starting treatment later than indicated can lead to more severe, irreversible changes in the joint.

A rheumatologist can identify PsA symptoms in your shoulder and evaluate treatment options to manage the condition.

Impact of PsA on the Shoulder

MyPsoriasisTeam members describe PsA shoulder pain and the way it affects their lives.

What does PsA feel like in the shoulder? One noted: “I hurt like hell. My hip and shoulder make life a struggle, but I’m still here.” Another shared that they have PsA pain in their shoulders and between their shoulder blades: “I’m in agony with it. I need some relief. It’s hard to lie down.”

As this member pointed out, PsA pain in the shoulder can also affect your ability to sleep, as putting pressure on the joint can be painful. Another member shared their experience with this: “I’m having a terrible time using my arm and shoulders and trying to sleep on my sides. The pain is killing my shoulder.” Another wrote, “My shoulder is in agony. It’s hard to lie down.”

What Causes Psoriatic Arthritis in the Shoulder?

Researchers aren’t sure exactly what causes PsA, whether in the shoulder or elsewhere. They do know that PsA, like rheumatoid arthritis, is a form of chronic inflammatory arthritis. These types of arthritis occur when the body mistakenly attacks its own healthy tissues. This attack leads to inflammation, which causes the pain that people with PsA experience. Most people with PsA develop psoriasis on the skin and are later diagnosed with arthritis.

Other Causes of Shoulder Pain

You may even experience shoulder pain unrelated to PsA, such as shoulder bursitis, which is the inflammation of fluid-filled sacs in the joint. More commonly, pain can result from injuries to muscles, tendons, or ligaments due to trauma, heavy lifting, lack of stretching before exercise, or performing daily movements incorrectly. Talk to your doctor to determine the root cause of your shoulder pain.

Pain Management for Psoriatic Arthritis in the Shoulder

There are many options for treating PsA in the shoulder. Although it can take several tries before you discover the best choice, your rheumatologist should be able to work with you to find the right solution.

Medications for PsA in the Shoulder

One of the main goals of treating PsA with medication is to control inflammation and prevent bone changes. Medication helps to reduce joint pain and prevent joint damage, and it might repair some of the previous damage to the joint.

There are several medications used to treat PsA and manage PsA pain:

• Nonsteroidal anti-inflammatory drugs
• Steroid injections or oral steroid treatments
• Disease-modifying antirheumatic drugs
• Biologics

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and reduce inflammation caused by PsA. These drugs include over-the-counter medications, like ibuprofen, as well as other options only available by prescription.

These drugs may not be strong enough to work alone, however. As one MyPsoriasisTeam member wrote, “Aleve and ibuprofen aren’t helping my PsA shoulder pain.” Your rheumatologist will work with you to determine whether NSAIDs are right for you — and, if they are, which ones will be the most helpful.

Steroid Injections or Oral Steroid Treatments

Steroid injections are sometimes injected directly into the shoulder. They can quickly reduce inflammation and help ease painful joints caused by PsA. They can even keep pain and inflammation away for months at a time.

However, repeated injections into the same joint can cause damage, and the inflammation may be worse after the injection wears off.

In some cases, oral corticosteroids (steroids) may also be used in combination with disease-modifying antirheumatic drugs (DMARDs) to help manage inflammation and prevent joint damage until the DMARDs start working. However, oral steroids can also cause psoriasis flares, and their long-term use is discouraged. Your doctor will help you weigh these considerations to create the best treatment plan.

Disease-Modifying Antirheumatic Drugs

These drugs, which include methotrexate (Otrexup) and leflunomide (Arava), slow the progression of PsA by modifying or suppressing certain pathways of the immune system. Although it can take some time to determine which one will work for you, DMARDs can make you feel significantly better.

One example of DMARDs used to treat PsA is Janus kinase (JAK) inhibitors. They work by interfering with one of your body’s inflammation pathways when chemicals called cytokines attach to JAK proteins on the outside of cells. Although this usually triggers inflammation that leads to joint pain and swelling, JAK inhibitors block this pathway, preventing symptoms from occurring.

Two JAK inhibitors approved to treat PsA are tofacitinib (Xeljanz) and upadacitinib (Rinvoq). These drugs are meant for people who can’t tolerate other PsA treatments and take a few months to begin working.

Biologics

Some DMARDs are considered biologics, whereas others are not. Biologics are medications made from living cells. These biologics very specifically suppress the part of the immune system that is overactive, leading to inflammation of the joints.

Some of the new biologics not only stop the pain but also halt disease progression, as seen on X-rays.

You may have to undergo health monitoring and lab work while taking DMARDs and biologics to monitor the effects of the drug on your condition and also check for possible side effects.

Other Therapies for PsA-Related Shoulder Pain

Below are additional ways of managing shoulder pain from PsA:

• Transcutaneous electrical nerve stimulation
• Heat and cold therapy
• Topical creams and patches

Transcutaneous Electrical Nerve Stimulation Units

Transcutaneous electrical nerve stimulation (TENS) units are small, battery-operated devices that use electrical impulses to help reduce pain by stopping pain signals in the brain. One MyPsoriasisTeam member recommended using a TENS unit while exercising: “I have a TENS unit that is portable and awesome for keeping the body moving when having severe pain.”

Heat and Cold Therapy

Many MyPsoriasisTeam members use heat and cold to help ease PsA pain. One member shared their method for heat therapy: “I use a rice-filled sock heated in the microwave for a few minutes. It helps.” Others would rather apply ice: “I also find that ice packs still help even when Tiger Balm doesn’t. I think the cooling action helps reduce the inflammation.”

Topical Creams and Patches

As one MyPsoriasisTeam member wrote, health care providers like rheumatologists can prescribe topical treatments for pain: “If you can get your doctor to prescribe it, there are some creams and patches (which you apply to the area of pain) that work very well (like lidocaine/benzocaine).”

Other MyPsoriasisTeam members recommend trying over-the-counter ointments, like one who shared: “Extra-strength Tiger Balm helped me for a long time.”

Take Your Time and Do What Works for You

One MyPsoriasisTeam member shared the importance of taking their time and using treatments that work for them when experiencing pain: “I have arthritis in my shoulders, and some days, the pain upon waking and then doing my hair is horrible. I give myself extra time for the Ibuprofen to start working before I get ready for the day.”

“Hang in there,” the member added, “and know you are not alone. This site is great that way because most of us understand what you are going through.”

Find Your Team

On MyPsoriasisTeam, the social network for people with psoriasis and their loved ones, more than 130,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you experience PsA pain in your shoulders? How do you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.