Psoriatic Arthritis 101

If you have psoriasis, then you’ve probably heard you’re at risk for psoriatic arthritis, or perhaps you’ve been diagnosed with the condition and want to know more. Psoriatic arthritis is a type of inflammatory arthritis that affects up to 30 percent of people with psoriasis. Like with psoriasis, it happens when your body’s immune system attacks healthy cells and tissues, causing inflammation. Psoriatic arthritis can affect any joint in the body and lead to pain, stiffness, and swelling. Ultimately, if left untreated, psoriatic arthritis can cause permanent, debilitating damage to your joints. That’s why it’s important to understand the symptoms and to seek treatment as soon as possible, if you show signs.

What Are the Symptoms of Psoriatic Arthritis?

The primary symptoms of psoriatic arthritis are joint pain, stiffness, and swelling. Your joints may also feel warm to the touch. Your symptoms may develop slowly or escalate rapidly. Like with psoriasis, psoriatic arthritis can flare up, at times. During flare-ups, symptoms become worse; then, later the arthritis can go into remission for periods of time where you feel better.

Psoriatic arthritis can affect one joint, multiple joints, or different joints at different times. It’s more likely than other arthritic conditions to cause sausage-like swelling in the fingers and toes.

Other characteristic symptoms of psoriatic arthritis include tenderness where the tendons and ligaments connect to the bones. This can cause pain in the back of the heel, on the soles of the feet, or around the elbows. Psoriatic arthritis can also affect the spine, causing stiffness in the neck and back, and even difficulty bending.

Who Gets Psoriatic Arthritis?

Everyone with psoriasis is at risk of developing psoriatic arthritis, but it is most commonly diagnosed between the ages of 30 and 50. We know that family history plays a role, so you may be at increased risk if anyone in your immediate family has psoriatic arthritis or another form of inflammatory arthritis. Nail changes are also a good predictor of who will later develop PsA. If you experience nail pitting or other nail changes, you may want to pay extra attention to any joint discomfort.

How is Psoriatic Arthritis Diagnosed?

Suspect you might have psoriatic arthritis? It’s wise to get checked out by your general practitioner or to see a rheumatologist. There’s no single test or image that can show whether you have the condition. Instead, your doctor will use their clinical judgment to make an informed diagnosis.

“The diagnosis of psoriatic arthritis is based on a combination of the patient’s history, physical examination, imaging of the joints (Xrays, ultrasound, MRI, etc.), and laboratory test results,” says Alexander Shikhman, M.D., Ph.D., founder and rheumatologist with the Institute for Specialized Medicine in San Diego.

How is Psoriatic Arthritis Treated?

To treat psoriatic arthritis, doctors use a combination of treatments that aim to relieve pain and prevent further damage to the joints.

According to Stuart Kaplan, M.D., of the Long Island-based practice Rheumatology Consultants, it could happen in phases.

Anti-inflammatories

“Initial treatment of psoriatic arthritis may consist of just nonsteroidal anti-inflammatory drugs to help alleviate the pain and swelling,” says Kaplan.

DMARDs

“If the disease remains active or there is evidence of bone erosion on Xrays or MRI, treatment should advance quickly to disease-modifying antirheumatic drugs (DMARDs), which can prevent progression of the disease,” says Kaplan. “This includes medications such as Methotrexate and Leflunomide that can suppress the immune system and help stop the autoimmune process.”

Biologics

“If this doesn't do the trick, we have a whole array of newer medications, known as biologics, that can halt progression of psoriatic arthritis,” says Kaplan. “These are mostly monoclonal antibodies that are administered by injection.”

Living with Psoriatic Arthritis

If you have recently been diagnosed with psoriatic arthritis and are looking for treatment options, consider taking an integrative approach. In other words, adopt a lifestyle that can support your medical treatment. This can include exercising several times per week to reduce full-body inflammation and losing weight (if you are overweight). Shikhman also recommends adopting an anti-inflammatory diet.

“The most beneficial generic dietary interventions in psoriatic arthritis include a combination of gluten-free, dairy-free, egg-free, and soy-free diet,” says Shikhman. “Individuals can also undergo food intolerance testing to identify foods that trigger negative immune responses and then eliminate them.”

Shikhman also recommends the following nutritional supplements and herbal remedies:

  • Omega-3 polyunsaturated fatty acids
  • Black currant seed oil
  • Vitamin D3 (do not use with Calcipotriene (Dovonex, Calcitrene, Sorilux)
  • Calcium
  • Turmeric
  • Boswellia
  • Devil’s claw
  • Probiotics
  • N-Acetylglucosamine

Of course, consult your doctor about dosage and safety before adding any of these to your treatment plan. Some of them, like vitamin D3, can interact with medications you’re already taking.

What the Experts Want You to Know

We spoke with several rheumatologists who regularly treat people with psoriatic arthritis and they all had the same basic message they wanted to get across: Don’t wait until it’s too late.

“If someone suspects that they have psoriatic arthritis, they should consult their doctor sooner rather than later, says Kaplan. “Delay in diagnosis and treatment can lead to serious joint deformities that cannot be corrected and may necessitate joint replacement surgery.”

Prevent permanent problems by getting a diagnosis and starting with treatment as soon as you can if you suspect you may be experiencing signs of psoriatic arthritis.