What is Psoriatic Arthritis?
Psoriatic arthritis (PsA) is a type of arthritis that affects about 30 percent of individuals who have psoriasis (a disease that causes red patches of skin that are topped with silvery scales). Psoriasis typically develops years before psoriatic arthritis, but this is not always the case.
Joint pain, swelling, and stiffness are the key signs of psoriatic arthritis, and these symptoms can affect any part of the body. Symptoms range from mild to severe, and often flares can be followed by periods of remission. If left untreated, psoriatic arthritis can lead to joint and tendon damage, which can cause decreased function and disability.
What are the Symptoms of Psoriatic Arthritis?
As indicated above, the primary symptoms of psoriatic arthritis are joint pain, swelling, and stiffness. Joints are affected on one or both sides of the body. Additional symptoms of psoriatic arthritis include:
- Swollen fingers and toes
- Lower back pain (specifically, some individuals may develop spondylitis)
- Foot pain
- Nail changes
- Eye inflammation
A small percentage of those with psoriatic arthritis may go on to develop a condition called arthritis mutilans. This form of psoriatic arthritis leads to permanent deformity and disability in the small bones of the hands (especially in the fingers).
Unchecked psoriatic arthritis inflammation can case complications including:
- Damage to cartilage and bones
- Gastrointestinal problems
- Shortness of breath and coughing
- Damage to blood vessels and the heart muscle
- Metabolic syndrome (a group of conditions that include obesity, high blood pressure and poor cholesterol levels)
What Causes Psoriatic Arthritis?
In psoriatic arthritis, the body’s immune system attacks healthy cells and tissue, causing inflammation in the joints and the overproduction of skin cells. While both environmental and genetic factors seem to play a role in the development of psoriatic arthritis, there are several risk factors including a family history of psoriatic arthritis, psoriasis, and age. Environmental triggers, such as an infection, stress, or physical trauma can also play a role.
How is Psoriatic Arthritis Diagnosed?
There is no one test that can diagnose psoriatic arthritis, but doctors will typically perform a variety of tests, including those to rule out other conditions that cause joint pain, such as rheumatoid arthritis, including:
- Physical Exam: a doctor will typically look for signs of joint tenderness or swelling, pitting, flaking or other nail abnormalities, and tenderness on the soles of the feet or around the heels.
- X-rays: to look for joint changes
- MRIs: to look for tendon and ligament changes in the lower back and feet
- Rheumatoid factor (RF) test: RF is often found in individuals with rheumatoid arthritis, but not usually in those with psoriatic arthritis
- Joint fluid test: a test that looks for uric acid crystals in the joint fluid which, if present, may indicate a diagnosis of gout versus psoriatic arthritis
What is the Treatment for Psoriatic Arthritis?
There is no cure for psoriatic arthritis so treatments focus on managing inflammation in the joints and controlling skin involvement. Medications, physical therapy, steroid injections, and, in some cases, joint replacement therapy are all used to treat the symptoms of psoriatic arthritis. Common medications utilized include:
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- Conventional and targeted synthetic DMARDs (disease-modifying antirheumatic drugs) – these types of drugs slow the progression of the disease and preserve joints from further, permanent damage.
- Biologic agents (biologic response modifiers, a type of DMARDs) – these drugs target a different pathway in the immune system than DMARDs.
- Apremilast (Otezla) – a medication that decreases the activity of a type of enzyme in the body that controls the activity of inflammation in the cells.
Psoriatic arthritis can interfere with an individual’s ability to work or carry out daily tasks. If you have been diagnosed with psoriatic arthritis and are worried that it may be impeding your ability to continue to safely practice on patients, you should speak with an experienced disability insurance attorney.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
National Psoriasis Foundation