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Basics of psoriatic arthritis
Psoriatic arthritis is a common form of arthritis that affects both joints and skin.
Generally psoriatic arthritis is a mild condition. With proper treatment and help from others you can relieve joint pain and stiffness and keep skin problems under control. Some people however have a more serious disease and require combinations of medications to control symptoms and prevent joint damage.
Psoriatic arthritis is a chronic (long-lasting) condition.
Psoriatic arthritis is not a fatal form of arthritis. It affects the skin and joints but does not affect the vital organs. Rare reactions to medications or infections may be more serious but the disease itself is not fatal.
Psoriatic arthritis is treatable but not curable.
Approximately 10% of people who have the skin condition known as psoriasis will develop an associated inflammatory arthritis. Inflammatory forms of arthritis are those that cause prolonged stiffness in the night and morning along with joint swelling and pain and are generally better with activity.
Psoriatic arthritis affects about 300 000 people in the United States. It affects men and women of all races. It usually occurs between the ages of 20 and 30 but it can occur at any age. It affects about five to eight percent of people who have psoriasis.
In general symptoms of psoriasis and psoriatic arthritis include:
- scaly red patches that can appear on the scalp, elbows, knees, and/or the lower end of the backbone (Often psoriasis may only be a small patch in the scalp. In some people the rash may cover a good deal of the body.)
- pitting and/or discoloration of fingernails and/or toenails
- pain and swelling in one or more joints, usually the last joints of the fingers or toes, the wrists, knees, or ankles. Some people with psoriatic arthritis may have only one joint affected while in others it may resemble rheumatoid arthritis. The sacroiliac joints and the spine can also be involved. Because of this, psoriatic arthritis belongs to a group of disorders known as the spondyloarthropathies (spondylo = spine; arthropathy = joint disease)
- swelling of fingers and/or toes that gives them a "sausage" appearance
Psoriatic arthritis can develop over a long period of time or it can appear quite suddenly. The psoriasis usually develops months to years before the joint swelling and pain.
The cause of psoriatic arthritis is not yet known. Since it is known to run in families it may be partly inherited. But it is not contagious so you can't catch it from anyone. Like other forms of arthritis the body's immune system and the environment may also play a role in the disease.
To find out if you have psoriatic arthritis your doctor will ask you about your symptoms and will perform a physical examination.
- X-rays to look for changes in your bones and joints
- blood tests to rule out other diseases such as rheumatoid arthritis and document the presence of inflammation
- joint fluid tests to rule out gout another arthritis-related disease that may resemble psoriatic arthritis. The joint fluid in most people with psoriatic contains many inflammatory cells and although the absence of uric acid crystals may rule out gout many other inflammatory forms of arthritis will have a similar number of white cells in the fluid. The knee is the easiest joint from which to obtain joint fluid for analysis and can only be removed by putting a needle in the joint (the procedure is called arthrocentesis) if the joint is swollen.
It may take some time to determine if you have psoriatic arthritis. Usually if your nails and skin are affected along with your joints, a concrete diagnosis can be made. In general, a rheumatologist (a physician trained in the diagnosis and treatment of arthritis) can recognize the features of psoriatic arthritis noted above in the setting of psoriasis and make a diagnosis. A firm diagnosis will have to wait the development of the skin disease. The skin disease or the arthritis may appear first.
Treatment for psoriatic arthritis depends on how severe your condition is and what areas of the body are affected.
The goals of treatment are to reduce joint pain and swelling, control the skin patches, and slow down or prevent joint damage. Treatment may include one or a combination of skin care medications and other treatments.
Take good care of your skin especially during the winter. This can help reduce the dryness and skin sores caused by the psoriasis. Keep your skin from becoming dry by following these tips:
- Use a lotion or lanolin cream.
- Use non-deodorant soaps.
- Put baby oil in your bath water or rub it on your skin after showering.
- Use a humidifier in the winter.
- Avoid using strong soaps or chemicals.
Sit in the sun for moderate periods of time. Because sunlight slows down cell growth it can help improve your psoriasis. Too much sunlight can damage your skin however, so take steps to avoid sunburn.
Psoralen and ultraviolet light type A (PUVA) is a combination of medicine (psoralen) and light (type A ultraviolet light) that can help clear up skin problems and some joint problems. For this treatment you are given psoralen in pill form. This makes your skin sensitive to ultraviolet light type A. Then you are exposed to ultraviolet light for several minutes. You may need at least 20-30 treatments over several weeks. Talk to your dermatologist (skin doctor) about the benefits and side effects of this treatment.
Corticosteroid or steroid creams can be very effective but should be used under the direction of your health care provider. The more powerful creams can cause atrophy or thinning of the skin if used improperly. There are also vitamin D based creams that can be used by some people.
Health care team
People with psoriatic arthritis may be treated by their family doctor a skin specialist (dermatologist) or an arthritis specialist (rheumatologist). The type of doctor you see will depend on your symptoms. Other health care workers such as a nurse occupational therapist or physical therapist may also help you manage your condition.
Exercise and therapy
The pain and swelling of arthritis can make your joints stiff and hard to move. If this happens your doctor or physical therapist may recommend special exercises to keep your joints strong and flexible. In addition general exercise such as walking can help improve your overall health.
Generally a normal amount of rest and sleep will be enough for you. In a very few people however psoriatic arthritis may cause extreme fatigue. If this happens you may need to rest more than usual and learn how to use your energy wisely throughout your daily activities.
Some medications can help relieve joint pain and swelling and can help slow down the joint damage. Your health care provider may recommend one of the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These help reduce mild joint pain and swelling. You may need to take these for a few days or weeks or for a longer time depending on your condition. Examples include ibuprofen and aspirin.
- Corticosteroids: These are synthetic forms of a hormone your body makes. They are sometimes helpful when injected into a painful joint and can be used in small doses by mouth. Reducing your dose of these medicines too quickly may cause the skin disease to become much worse.
- Sulfasalazine: This is a medication developed to treat rheumatoid arthritis and can be very helpful in people with arthritis. It does not treat the skin disease.
- Methotrexate: This is a very powerful medicine. It can help slow down the disease and prevent further joint and skin damage in some cases.
- Cyclosporin A: This is a powerful medicine sometimes used to treat people who have had organ transplants. In recent studies it has been shown effective in treating the skin and joint problems of psoriatic arthritis. When studies are completed this medicine may be used to treat psoriatic arthritis.
- Gold shots: This therapy was first used in people with rheumatoid arthritis but has been successful in psoriatic arthritis as well.
- Etanercept: Still experimental this agent has been used in people with psoriatic and psoriasis with success. It is under review of approval for this disease by the FDA.
These medications work differently in different people. Talk to your doctor about the risks and benefits of taking these medicines since all of them have potential side effects. The strongest medications are reserved for those with the most serious disease.
If your joints are severely damaged from psoriatic arthritis your doctor may recommend joint replacement surgery. In this surgery joints damaged by arthritis are replaced with artificial joints. If this surgery is needed your doctor will discuss this with you.
Splints or braces
Splints may be useful if you have severe joint problems. Splints help rest your joints. This helps decrease joint pain swelling and stiffness. Your doctor physical therapist or occupational therapist can help you find the best splint for you.
Heat and cold treatments
These treatments may help relieve pain and reduce swelling in your joints. Examples include soaking in a warm tub and placing a heating pad or cold pack on the painful joint. Talk to your doctor about what treatments may be best for you.
Asking for help
People with psoriatic arthritis can turn to their health care providers their families and special organizations for help and support.
For more information contact the National Psoriasis Foundation 6600 SW 92nd Ave. Suite 300 Portland OR 97223-7195 (503) 244-7404 toll-free (800) 723-9166
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
Edited by Gregory C. Gardner M.D., Division of Rheumatology and Frederick Matsen M.D., Professor, Department of Orthopaedics and Sports Medicine, University of Washington. Based on a pamphlet originally produced by the Arthritis Foundation.