Everything You Need to Know About Psoriatic Arthritis

·6 min read
Photo credit: Getty Images
Photo credit: Getty Images
Photo credit: Getty Images
Photo credit: Getty Images

The Basics

You probably already know about psoriasis—it’s when an overactive immune system leads to scaly, inflamed patches of skin. It’s so common (an estimated 8 million people in the U.S. have it) that chances are, you know someone with it. But there’s a related disease that you might not have heard much about: psoriatic arthritis (PsA). And it happens to 5 to 10 percent of people with psoriasis.

Psoriatic arthritis is an autoimmune disease, which means the immune system fights healthy areas of your body (like your joints), leading to inflammation and damage. The disease, which hits men and women equally and usually happens to people in their 30s and 40s, results in pain and swelling in the joints as well as where tendons and ligaments are attached to the bones. The pain can range from mild to severe and can impact places all over your body—even your spine.

While most people get psoriasis first and then develop psoriatic arthritis, a small number of people actually start with psoriatic arthritis before ever noticing a rash.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Causes

Doctors know that both psoriasis and psoriatic arthritis are caused by an overactive immune system (your body is basically attacking and damaging its own tissues), but there is still some uncertainty over what triggers it. It could be a combination of:

  • Genes (psoriatic arthritis tends to run in families)

  • Obesity (body fat contributes to inflammation)

  • Infection, injury, or physical trauma (these may trigger PsA in people with a family history of the condition)

And while already having psoriasis is the number one risk factor for psoriatic arthritis, what leads from one to the other isn’t clear. “Unfortunately it’s not well understood why some people go on to develop psoriatic arthritis from their psoriasis,” says Petros Efthimiou, MD, a rheumatologist based in New York. “It would be great if we knew since we could then predict which patients would go on to develop arthritis.”

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Symptoms

Like most autoimmune diseases, psoriatic arthritis can hit different people differently. That said, there are certain symptoms that are common:

  • Stiff, painful, or swollen joints (this is considered the main symptom of psoriatic arthritis)

  • Patches of scaly, inflamed skin on your scalp, elbows, or knees (this is what most people think of when they think of psoriasis in general)

  • Tender spots in areas like the back of your heel or sole of your foot (where tendons or ligaments are attached to your bones)

  • Fingers or toes that get so swollen they look like sausages (this can sometimes happen before you notice joint pain)

  • Lower back pain

  • Fatigue

  • Issues with your fingernails (little dents, crumbling nails, or a nail completely separating from the nail bed)

  • Eye pain, redness, and blurry vision (this is due to inflammation and should be treated ASAP)

  • Inflammatory bowel disease (this is caused by inflammation in the digestive tract)

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Diagnosis

You should make an appointment to talk to your doctor as soon as you notice any of the above symptoms (especially if you already have psoriasis). If you don’t treat psoriatic arthritis, the disease can progress and become more severe, possibly causing permanent joint damage.

Because there isn’t a test for psoriatic arthritis, the path to diagnosis isn’t super simple—it involves a doctor’s best judgment and ruling out of other diseases. “A lot depends on the experience and knowledge of the physician,” says Dr. Efthimiou.

Your doctor will probably do a thorough exam, including asking about your health history as well as that of your family members. You may then get imaging done or do a blood or joint fluid tests to see if you have something else causing your symptoms, like rheumatoid arthritis or gout.

There are also some imaging tests that can help narrow down the diagnosis for your doctor. X-rays can show changes in your joints that only happen with psoriatic arthritis and an MRI (magnetic resonance imaging) can show issues with your tendons and joints.

If your doctor believes you have PsA, the next step will be to categorize your PsA, based on the impacted areas. Categorizations include:

  • Asymmetric oligoarticular: This is when it affects different joints on your right and left sides.

  • Symmetric polyarthritis: This is when it affects the same joint on both sides.

  • Spondylitis: This is when it affects the spine, hips, and shoulders.

  • Distal interphalangeal predominant: This form of it mostly affects the ends of your fingers and toes.

  • Arthritis mutilans: This type only happens to about five percent of people with psoriatic arthritis and it’s considered the most severe form of the disease. It involves joint damage, deformation, and problems moving parts of the body.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Treatments

At the moment, there is no cure for psoriatic arthritis. But that doesn’t mean you’re stuck without options. Your treatment plan will likely be all about controlling symptoms and preventing your joints or other impacted areas from further damage. “Some medications are more effective than others on particular body parts, so we pick a combination of drugs that will help the areas impacted,” says Dr. Efthimiou. So if you need treatment for your skin and spine, you would be prescribed a different combination of drugs than someone who needed to focus on their joints and fingers. Treatments could include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs, which include ibuprofen, target pain and inflammation. You can get them over the counter or your doctor may prescribe you a stronger dose.

  • Disease-modifying antirheumatic drugs (DMARDs): While they can’t reverse the damage caused by psoriatic arthritis, these drugs can slow down its progression, helping protect your joints from being damaged. A newer type of DMARDs, known as biologic agents, target the parts of your immune system that are connected to inflammation.

  • Immunosuppressants: Because psoriatic arthritis is caused by an out-of-control immune system, you might take this kind of medication to try to quiet it down.

There are also some other procedures, like steroid injections in a painful joint or joint replacement surgery, that may be used at some point in your treatment journey.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Living with Psoriatic Arthritis

Just like psoriasis, psoriatic arthritis can have periods where it’s flaring up and periods where it’s more in remission. That’s why so much advice tends to focus on how to avoid future flares. Try to keep a daily log and see if there is anything that could be triggering your symptoms like diet, high stress levels, or lack of sleep.

Having psoriatic arthritis can also put you at risk for other health complications. “We’ve found that there’s a strong connection between psoriatic arthritis and both depression and metabolic syndrome—becoming overweight or obese, having high cholesterol, having insulin resistance,” says Dr. Efthimiou. The exact reasons for these links aren’t fully understood, but it could have to do with the high levels of inflammation in your body when you have psoriatic arthritis.

You will also want to do whatever you can to put less pressure on your joints. While it can be hard to lose weight, dropping a few pounds can both reduce the strain on your joints and make some medications more effective. Instead of focusing on the number on the scale, work on adding movement in as much as you can. Doing joint-friendly exercises like biking, swimming, yoga, and walking are a great way to feel your best.

While being diagnosed with psoriatic arthritis can be a shock—after all, this is a chronic disease you will be dealing with forever—there are a lot of treatment options and lifestyle changes that can help you go on to live a full, active life.

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