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How Psoriatic Arthritis Affects the Shoulder

Posted on February 11, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Sarah Winfrey

Impact | Causes | Pain Management | Support

For many people with psoriatic arthritis (PsA), it 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.

Psoriatic arthritis is a form of chronic inflammatory arthritis that causes joint pain, swelling, and stiffness. PsA affects everyone differently. Some people have only one joint affected by PsA, and for others, the disease may have an impact on multiple joints.

It’s important to recognize the signs and symptoms of psoriatic arthritis in the shoulder. Studies have shown that even a six-month delay in diagnosis or starting medication after first noticing psoriatic arthritis symptoms can affect the effectiveness of treatment.

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

Impact of PsA in the Shoulder

MyPsoriasisTeam members describe psoriatic arthritis pain in the shoulder and the way it affects their lives.

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 are not sure exactly what causes psoriatic arthritis, 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 psoriatic arthritis develop psoriasis on the skin and are later diagnosed with arthritis.

Pain Management for Psoriatic Arthritis in the Shoulder

There are many options for treating psoriatic arthritis 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. 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

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. One MyPsoriasisTeam member explained, “I’m on day eight of the 10-day Prednisone taper. Yup, my stiff neck and shoulder pain are returning with a vengeance.”

In some cases, oral corticosteroids may also be used in combination with disease-modifying antirheumatic drugs (DMARDs) to help manage inflammation and prevent joint damage. 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 Otrexup (Methotrexate) and Arava (Leflunomide), 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.

Some of these drugs are considered biologics, whereas others are not. 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 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

Health care providers like rheumatologists can prescribe topical treatments for pain. As one MyPsoriasisTeam member wrote, “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.”

Get Support

MyPsoriasisTeam is the social network and online support group for people with psoriasis and PsA. Members regularly ask questions and walk each other through being diagnosed with psoriatic arthritis, finding treatments that work, and dealing with difficulties that come up in everyday life.

Do you experience PsA pain in your shoulders? How do you deal with it? Join us at MyPsoriasisTeam today. Let members know what it’s like in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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