What to Do If You Think You Might Have Psoriatic Arthritis
If you have psoriasis, you’ve probably been told that you’re at a higher risk for psoriatic arthritis (PsA). In fact, approximately 30 percent of people with psoriasis develop psoriatic arthritis compared to less than 1 percent of the general population. But what exactly does that mean?
Psoriatic arthritis is also an autoimmune disease that affects joints, causing pain, swelling, and stiffness. That may sound not-so-fun and actually quite dreadful, but it’s also really important that you look out for signs of psoriatic arthritis. Early diagnosis is essential, since the condition can cause irreversible damage to bones and cartilage when left untreated. For example, people diagnosed more than six months after symptoms first appeared had more bone and joint deterioration and less successful treatment outcomes than those diagnosed within six months, according to a study published in the Annals of the Rheumatic Diseases.
Fortunately, when identified and treated early, joint damage can be minimized.
Here, we explain the early signs of psoriatic arthritis that you should be aware of, and give advice on when you should contact your doctor about them. We also explain how psoriatic arthritis is diagnosed, what treatments are available, and what you can do to manage your symptoms.
Signs of Psoriatic Arthritis
The most common signs of psoriatic arthritis are pain, swelling, and stiffness in one or more joints according to the National Psoriasis Foundation. You might also notice:
- Joints that are red or warm to the touch
- Sausage-like swelling in your fingers or toes
- Changes to your nails, such as pitting or nails separating from the nail bed
- Pain in and around your feet and ankles
- Pain in your lower back, above your tailbone
- Reduced range of motion
- Joint stiffness that’s worse in the morning
- Redness and pain in the eye
Psoriatic arthritis can affect any joint, so there isn’t one specific place on the body to watch out for, but there are some places that tend to get sore or swollen.
“The lower extremity joints, such as the feet, ankles, and knees, are often involved,” explains Lynn Ludmer, M.D., the medical director of rheumatology at Mercy Medical Center in Baltimore, Maryland. “The spine can also be involved, the back, lower back, and sacroiliac joints, setting [the symptoms] apart from [those of] rheumatoid arthritis. It can also involve soft tissues, where the tendons attach to the bone, which can cause pain, swelling, stiffness, warmth, and redness in the affected area.”
Psoriatic arthritis can affect joints symmetrically or it might appear on just one side of your body. And like with psoriasis, symptoms of psoriatic arthritis can flare up.
“For some patients, these symptoms come and go in attacks that can last days or months,” says Ludmer. “For others, inflammation can be more prolonged in the affected areas.”
Diagnosing Psoriatic Arthritis
If you notice any symptoms of psoriatic arthritis, it’s important to see a doctor as soon as possible. For many people, diagnosis starts with their primary care doctor or dermatologist.
If you’re regularly seeing a dermatologist, there’s a good chance your doctor screens for psoriatic arthritis. Lisa Stirling, M.D., a board-certified dermatologist in Encinitas California and a medical advisor for eMediHealth, says she screens her patients during the initial visit and then about once every six months after that.
“Psoriatic arthritis can be present before, during, or after the diagnosis of skin or plaque psoriasis,” Stirling says. “Some people have psoriatic arthritis but no skin involvement. It is important to be actively searching for symptoms of PsA as it is important to treat early and proactively with systemic medications to prevent joint disease.”
There’s no laboratory test to diagnose psoriatic arthritis. Typically, it’s diagnosed through a combination of the patient’s reported symptoms, the doctor’s observations, and a process of elimination.
Stirling also suggests answering the questions from the psoriasis epidemiology screening tool (PEST), which some doctors use to better understand their patients’ symptoms and risk:
- Are you experiencing joint pain, swelling, or stiffness?
- Which joints are symptomatic?
- Do you experience stiffness in the morning or at the end of the day?
- Do your fingernails or toenails have holes or pits?
- Have you had pain in your heel?
- Have you had a finger or toe that was completely swollen and painful for no apparent reason?
Answering yes to three questions suggests that you should see a rheumatologist.
In addition to the answers to these questions, your doctor may consider the following when making a diagnosis of psoriatic arthritis:
- History of psoriasis: Symptoms tend to occur between 10 and 20 years after psoriasis is diagnosed, but that’s not always the case.
- Your age: The onset of psoriatic arthritis most commonly occurs between 30 and 40 years of age.
- Symptoms specific to psoriatic arthritis: Certain symptoms, such as nail changes, swelling in fingers and toes, and pain in and around your feet, are often specific to psoriatic arthritis and not similar conditions.
- Family history of psoriasis or psoriatic arthritis: People with a family history of either condition are more likely to develop psoriatic arthritis, according to a study published in Arthritis Care & Research. Family history can also impact disease severity.
The absence of rheumatoid factor in a blood test: Blood tests are used to rule out other diseases, such as rheumatoid arthritis.
Also, your doctor might request X-rays and MRIs of affected joints to provide additional information and rule out conditions such as bone spurs.
Managing Psoriatic Arthritis
There isn’t a cure for psoriatic arthritis, but there are treatments that may help make you more comfortable. According to Ludmer, “The goal of treatment is often pain reduction and increased functional ability and to minimize or prevent permanent damage to your joints.”
There are several types of medications used to treat psoriatic arthritis. They include:
- NSAIDs: Over the counter NSAIDs can reduce pain and swelling. These include ibuprofen (Advil, Motrin) and naproxen (Aleve). “These medications can potentially mask joint damage; therefore, they should be used as part of a treatment regimen directed by an arthritis specialist,” says Ludmer. In other words, they’re likely not enough.
- DMARDs: Disease-modifying antirheumatic drugs slow the progression of the disease. Commonly prescribed DMARDs include methotrexate (Otrexup, Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine). Side effects of these medications can include liver damage, reduced bone marrow production and lung infections.
- Immunosuppressants: These medications work to reduce your overactive immune response. Commonly prescribed immunosuppressants include azathioprine (Azasan, Imuran) and cyclosporine (Gengraf, Neoral, Sandimmune). Side effects include increased susceptibility to infections.
- Biologic medications: These drugs target specific parts of the immune system which trigger inflammation. Commonly prescribed biologic medications for psoriatic arthritis include abatacept (Orencia), adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ixekizumab (Taltz), secukinumab (Cosentyx), tofacitinib (Xeljanz) and ustekinumab (Stelara). Biologics can also increase risk of infection.
Two newer medications that target inflammation inside immune cells include apremilast (Otezla) and tofacitinib (Xeljanz, Xeljanz XR). Some common side effects of these medications include upper respiratory infections and diarrhea.
In addition to medication, a healthy lifestyle can help you manage symptoms of psoriatic arthritis.
It may sound counterintuitive to suggest exercise when your joints are swollen and painful, but being active actually helps your joints, according to the Arthritis Foundation. Low-impact routines, such as walking, cycling, yoga or swimming, are best and you should always talk to your doctor before starting any new exercise regimen. Start slowly, listen to your body, and add difficulty when you feel ready. In the beginning, you might experience muscle aches, which are normal, but you shouldn’t push through joint pain.
Being overweight increases the burden on your joints and can contribute to joint pain. Excess body fat also produces inflammation, which can contribute to joint pain. Talk to your doctor about some healthy methods you can use to lose weight if you’re overweight or obese.
So far, we don’t know of a diet that will magically cure psoriatic disease. But there are foods that are known to reduce inflammation according to the Arthritis Foundation. These include foods rich in Omega-3 fatty acids, nuts, olive oil, lean protein, and cruciferous vegetables, such as broccoli, Brussels sprouts, kale, and cauliflower. The foods are considered part of an overall healthy diet (and can help you maintain a healthy weight), so it’s definitely worth it to fill your meals with plenty of them.