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Psoriatic Arthritis — An Overview

Updated on March 11, 2021
See how 994 members reacted on this article
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Alison Channon

Psoriatic arthritis (PsA) is a type of inflammatory arthritis related to psoriasis. Approximately one-third of people with psoriasis are affected by PsA. Psoriatic arthritis generally affects the joints and areas where ligaments and tendons connect to bones.

What Causes Psoriatic Arthritis?

Psoriatic arthritis and psoriasis are autoimmune diseases — conditions that occur when the immune system mistakenly attacks healthy tissues like your skin and joints. Inflammation from the body’s overreacting immune response leads to symptoms of psoriasis and PsA. Psoriatic arthritis is distinct from osteoarthritis, which is caused by the normal wear and tear of aging, rather than inflammation.

PsA is caused by several complex contributing factors. Researchers have identified dozens of genetic variants that may make a person more likely to develop psoriasis and PsA.

Most scientists believe that genetics and environmental factors both contribute to PsA, but they are still working to understand exactly why a person develops PsA. Researchers theorize that environmental factors — a physical injury, a virus, or an infection like strep throat — may trigger the development of PsA in some people. These are all situations that set off an immune response.

Risk Factors for PsA

Having psoriasis is the primary risk factor for developing psoriatic arthritis. Psoriatic arthritis affects about 30 percent of people with psoriasis. PsA usually develops between the ages of 30 and 50. However, not everyone with PsA receives a psoriasis diagnosis first. Between 10 percent and 15 percent of those with PsA experience signs of arthritis without ever having skin symptoms.

Family history of psoriasis or psoriatic arthritis is another risk factor — 40 percent of people with PsA have a family history of psoriatic disease. Unlike many other autoimmune diseases, being a woman is not a risk factor. Men and women are at equal risk of developing PsA.

How Is Psoriatic Arthritis Diagnosed?

Your dermatologist or primary care physician may refer you to a rheumatologist if you have symptoms of PsA. A rheumatologist is trained to diagnose and treat joint and tendon symptoms, while a dermatologist is focused on the skin symptoms of psoriasis and other skin conditions. Early diagnosis and treatment of PsA is associated with better outcomes.

A rheumatologist will conduct a physical exam and take a medical history. Your doctor will check to see if your joints are swollen or tender. They will likely pay special attention to the fingers and toes. They may then recommend various tests to look for signs of PsA and to rule out other possible causes.

Tests for Psoriatic Arthritis

There isn’t one simple test for diagnosing psoriatic arthritis. A rheumatologist will need to evaluate several factors before giving a diagnosis. A final diagnosis will be based on your symptoms and the results of various tests.

Imaging Tests

A rheumatologist may order an imaging test to look for signs of psoriatic arthritis.

  • X-rays are most effective at diagnosing later stage PsA. They can detect severe bone changes that indicate PsA.
  • Ultrasound can detect inflammation in the joints and ligaments.
  • Magnetic resonance imaging (MRI) can detect damage to soft tissues from PsA.

Blood Tests

There is no specific blood test that can confirm a PsA diagnosis. Instead, blood tests are used to detect inflammation and rule out other types of arthritis. Below are some types of blood tests your doctor may order:

Biopsies

Biopsies are sometimes used to help confirm a diagnosis of PsA or rule out other conditions. Your doctor may perform the following types of biopsies:

  • Arthrocentesis, or joint fluid analysis, is performed by removing fluid from an affected joint with a needle. It can help rule out gout.
  • Skin biopsies may be performed to confirm psoriasis or another skin condition.

Learn more about psoriatic arthritis diagnosis and tests.

What Are the Symptoms of Psoriatic Arthritis?

Psoriatic arthritis is characterized by joint pain, swelling, and stiffness. PsA symptoms may be mild or have a severe impact on quality of life.

Dactylitis

Also referred to as “sausage digits,” dactylitis is painful swelling in the fingers and toes. It is often the first symptom of PsA a person experiences.

Enthesitis

It’s common for people with PsA to have enthesitis, a condition characterized by pain or tenderness where ligaments and tendons attach to bone. Enthesitis most frequently occurs in the heels and bottoms of the feet, though it can also affect the elbows.

Nail Changes

White spots, flaking, pitting (shallow or deep dents on your nails), or lifting of the nail bed may also be symptoms of psoriatic arthritis. You might notice changes to your nails without experiencing joint pain. Up to 90 percent of people with PsA experience nail changes.

Skin Psoriasis

Itchy, scaly, red, purple, or silvery lesions appear prior to the onset of psoriatic arthritis in approximately 75 percent of people with PsA. Skin disease can appear 10 to 20 years before developing joint symptoms.

Other Psoriatic Arthritis Symptoms

Not all PsA symptoms affect the skin and joints. Other possible symptoms include:

  • Uveitis (inflammatory eye condition)
  • Fatigue
  • Depression

Read more about symptoms of psoriatic arthritis.

What Are the Types of Psoriatic Arthritis?

There are five primary types of psoriatic arthritis, each defined by the impacted joints. It’s possible to have more than one type of PsA.

Asymmetric Oligoarthritis

Asymmetric oligoarthritis occurs in 70 percent to 80 percent of people with PsA. The mildest form of PsA, it typically involves one to four joints on just one side of the body.

Symmetric Polyarthritis

Symmetric polyarthritis affects 5 percent to 20 percent of people with psoriatic arthritis. Symmetric polyarthritis may start with minimal joint involvement on one side of the body and progress to several joints on both sides of the body.

Spondylitis

Psoriatic arthritis that affects the lower back and spine is a type of spondylitis (also called spondyloarthritis). Between 5 percent and 20 percent of people with PsA have spondylitis. You can learn more about spondylitis at MySpondylitisTeam.

Distal Arthritis

Distal arthritis causes inflammation and stiffness in the distal interphalangeal joints, those closest to the tips of fingers and toes. This type affects about 10 percent of people with PsA. Nail changes are also common with distal arthritis.

Arthritis Mutilans

Arthritis mutilans is the rarest and most severe type of psoriatic arthritis. This form of PsA attacks joints in the hands and feet, causing deformities and impaired movement.

How Is Psoriatic Arthritis Treated?

While there is currently no cure for psoriatic arthritis, there are treatment options that can control disease activity and reduce painful symptoms. Goals for PsA treatment include reducing pain and inflammation and protecting joint mobility.

Treatments To Control Disease Progression

Disease-modifying antirheumatic drugs (DMARDs) are the main category of drugs that slow joint damage. Conventional DMARDs and newer targeted DMARDs are taken as pills. Under the DMARD umbrella are biologic drugs administered via injection or infusion. Biologic drugs are usually only prescribed if other medications haven’t been effective.

Treatments for Symptoms

Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil or Motrin (ibuprofen), can reduce swelling and pain. They are typically prescribed for mild cases of psoriatic arthritis without joint damage.

Corticosteroids can also be used to treat PsA symptoms. Corticosteroids can be given as an injection to treat inflammation in a specific joint. Oral corticosteroids can be used to treat a PsA flare, though they may exacerbate psoriasis. Long-term use of steroids is generally discouraged due to side effects.

Other Treatments for PsA

Physical therapy, as well as lifestyle changes like eating a healthy diet and quitting smoking, can help manage psoriatic arthritis. In cases of severe joint damage, surgery may be appropriate.

Research into treatments for PsA is ongoing. Clinical trials are underway to investigate new treatments.

Learn more about treatments for psoriatic arthritis.

Conditions Related To Psoriatic Arthritis

When someone has more than one health condition at the same time, the conditions are known as comorbidities. Cardiovascular disease is the most common comorbidity for people with PsA. Diabetes, obesity, and nonalcoholic fatty liver disease are other conditions that many people have in addition to PsA.

References
  1. Psoriatic Arthritis — Arthritis Foundation
  2. Related Conditions of Psoriasis — National Psoriasis Foundation
  3. About Psoriatic Arthritis — National Psoriasis Foundation
  4. Osteoarthritis — Mayo Clinic
  5. Large scale meta-analysis characterizes genetic architecture for common psoriasis associated variants — Nature Communications
  6. Psoriatic Arthritis — National Institute of Arthritis and Musculoskeletal and Skin Diseases
  7. Psoriatic Arthritis — American College of Rheumatology
  8. Psoriatic arthritis: Symptoms & causes — Mayo Clinic
  9. Psoriatic arthritis: state of the art review — Clinical Medicine Journal
  10. What is a Rheumatologist? — American College of Rheumatology
  11. Psoriatic Arthritis Diagnosis — Johns Hopkins Arthritis Center
  12. Psoriatic Arthritis: Diagnosis and Tests — Cleveland Clinic
  13. The Role of Ultrasound in Psoriatic Arthritis — Do We Need a Score? — The Journal of Rheumatology
  14. Magnetic Resonance Imaging in Psoriatic Arthritis — Journal of Clinical Rheumatology
  15. Psoriatic arthritis: Diagnosis & treatment — Mayo Clinic
  16. C-Reactive Protein (CRP) — Lab Tests Online
  17. Erythrocyte Sedimentation Rate (ESR) — Lab Tests Online
  18. Synovial Fluid Analysis — Lab Tests Online
  19. Diagnosing Psoriasis — NYU Langone Health
  20. The Different ‘Types’ of Psoriatic Arthritis — and Why Knowing Your Type Matters — CreakyJoints
  21. Psoriatic arthritis — DermNet NZ
  22. Psoriatic Arthritis Signs and Symptoms — Johns Hopkins Arthritis Center
  23. Psoriatic arthritis — MedlinePlus
  24. Psoriatic Arthritis — Cleveland Clinic Center for Continuing Education
  25. Psoriatic Arthritis and Back Pain — Arthritis Foundation
  26. The First Medications for PsA — Arthritis Foundation
  27. Psoriatic Arthritis: Diagnosis and Treatment — American Academy of Dermatology Association
  28. Psoriatic Arthritis: Management and Treatment — Cleveland Clinic
  29. Metabolic Comorbidities of Psoriatic Arthritis — Arthritis Foundation
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Alison Channon has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

A MyPsoriasisTeam Member said:

I've been on off of it since 2014 presently back on it with increased dosage along with Remicade it helps control skin flare ups between Remicade infusion... maybe doc needs to increase dosage side… read more

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