Psoriatic arthritis (PsA) is a type of arthritis (joint inflammation) associated with psoriasis. Psoriasis is a chronic skin and nail disease that causes red, scaly rashes and thick, pitted fingernails. It can start before or after the arthritis.
Psoriatic arthritis is similar to rheumatoid arthritis (RA) in its symptoms and joint inflammation, but it tends to affect fewer joints than RA. Symptoms can come and go; the period when symptoms get worse is called a flare.
Psoriatic arthritis comes in five forms:
- Arthritis that affects the small joints in the fingers and/or toes
- Asymmetric arthritis of the joints in the hands and feet (asymmetric means it doesn’t affect matching joints on both sides of the body)
- Symmetrical polyarthritis, which is similar to RA (and affects the same joints on both sides of the body
- Arthritis mutilans, a rare type of arthritis that destroys and deforms joints
- Psoriatic spondylitis, arthritis of the lower back (sacroiliac sac) and the spine
The cause of psoriatic arthritis is unknown, but factors such as how your immune system functions, genes and the environment may play a role.
Men and women get psoriatic arthritis at equal rates. Most people develop psoriatic arthritis between the ages of 30 and 50, but it can begin at any age. Children may even get psoriatic arthritis.
Because the symptoms of psoriatic arthritis can look like other health conditions, including other forms of arthritis, it’s important to see a specialist in rheumatic diseases to obtain an accurate diagnosis and appropriate treatment.
Why Choose Cooper to Diagnose and Treat Psoriatic Arthritis
Cooper University Health Care’s Division of Rheumatology has a team of expert, board-certified and fellowship-trained rheumatologists with extensive experience in diagnosing and treating psoriatic arthritis. Our capabilities include:
- Thorough diagnostic testing: Diagnosing psoriatic arthritis begins with a comprehensive medical history, physical exam and laboratory tests. These tests may include:
- Erythrocyte sedimentation rate (ESR or sed rate): A blood test that can reveal inflammatory activity in the body
- Uric acid: High uric acid levels in the blood are linked with psoriatic arthritis
- Diagnostic imaging, including X-rays, musculoskeletal ultrasound or MRI, to look for bone damage and inflammation
- A multidisciplinary team approach to care: Because psoriatic arthritis can affect different parts of the body, you may need a variety of specialists working together on your care team. As an academic medical center, Cooper has physician experts in more than 75 specialties, giving you convenient access to all the expertise you need, all in one place.
- Personalized treatment based on your symptoms, age, general health, and how severe your condition is. With psoriatic arthritis, both the skin condition and joint inflammation are treated, with the goal of preventing flares and disease progression. Treatment may include:
- Medications such as anti-inflammatory, pain-relieving, disease-modifying antirheumatic drugs (DMARDs), immunosuppressive and an exciting new class of drugs known as biologics that inhibit inflammation and slow or stop disease progression. Vitamins and minerals, such as calcium and vitamin D, also help slow bone deformation.
- Physical and occupational therapy to help improve and maintain muscle and joint function, and improve the ability to perform daily activities
- Splints may be used to help protect joints and strengthen weak joints
- Ultraviolet (UV) light treatment (UVB or PUVA) to treat the psoriasis
- Surgery to repair or replace a damaged joint (in more advanced cases)
Psoriatic Arthritis Causes and Risk Factors
The symptoms of psoriatic arthritis occur when the body’s immune system mistakenly attacks healthy skin and joint tissue. This results in inflammation, swelling, skin rash and pain.
Doctors and scientists aren't sure why this happens in some people, but they believe genetics may play a role because psoriasis and psoriatic arthritis tend to run in families.
The primary risk factors for developing psoriatic arthritis are:
- Having psoriasis: About 15% of people with psoriasis will develop psoriatic arthritis, according to the American College of Rheumatology
- Age: While people of any age can get PsA, those between ages 30 and 50 are most likely to develop the condition
- Family history: People with relatives who have psoriasis or PsA are more likely to get psoriatic arthritis themselves
- Environmental factors: Certain environmental factors can bring on PsA or trigger flares, especially in people with a family history of the disease. These triggers include:
- Infections or skin wounds
- Severe emotional stress
- Cold weather
- Cigarette smoke
- Heavy alcohol use
- Certain medications including lithium, anti-malarial drugs, and certain beta blockers and heart medications
Psoriatic Arthritis Symptoms
Psoriatic arthritis symptoms vary from person to person, may come and go, and many are similar to other forms of arthritis, making the disease challenging to diagnose. The most common PsA symptoms are:
- Painful, swollen joints, most commonly the ankle, knees, fingers, toes and lower back
- Stiffness, usually first thing in the morning or after a period of rest
- “Fat” fingers or toes, a condition called dactylitis, which is a sausage-like swelling along the entire length of fingers or toes
- Pain or tenderness where tendons or ligaments attach to bones, commonly at the heel, bottom of the foot or elbow
- Skin rashes and nail changes including thick, red skin with flaky, silver-white scaly patches, and nails that are pitted, look infected or lift from the nail bed
- General fatigue
- Lowered range of motion, reducing the ability to move joints and limbs freely
- Eye problems, including redness, irritation, pain and disturbed vision or conjunctivitis (pink eye)
People with psoriatic arthritis are more likely to develop several other health issues as a result of the inflammation of this autoimmune disease. These include:
- Interstitial lung disease that causes coughing, shortness of breath and fatigue
- Inflammatory bowel disease, particularly Crohn’s disease
- Damaged blood vessels, increasing heart attack and stroke risk
- Osteopenia (bone thinning) and osteoporosis
- Metabolic syndrome, a group of conditions including obesity, high blood pressure, and high cholesterol
Managing Psoriatic Arthritis
While there’s no cure for psoriatic arthritis, you can manage your symptoms and help prevent flares by carefully following your treatment plan and making healthy lifestyle choices, including:
- Get regular physical activity to help keep joints flexible; good forms of exercise include yoga, swimming, walking, and bicycling
- Manage stress; mindfulness meditation has been shown to be effective
- Eat a healthy diet that’s low in sugar, salt and fat
- Quit smoking
- Limit or avoid alcohol
- Protect your skin by keeping it moisturized, avoiding hot baths/showers
- Consider acupuncture for pain