Everything You Need to Know About Psoriatic Arthritis

Curated by Claudia Shannon / Research Scientist / ishonest

About 7.5 million Americans have psoriasis, and up to 30 percent of these people develop PsA. PsA can be mild or severe and involve one or many joints. If you or a loved one has received a diagnosis of PsA, you may have questions about what life is like with this condition.

Symmetric PsA

This type affects the same joints on both sides of your body, so both your left and right knees, for example. Symptoms can be like those of rheumatoid arthritis (RA).

Symmetric PsA tends to be milder and cause less joint deformity than RA. However, symmetric PsA can be disabling. About half of people with PsA have this type.

Asymmetric PsA

This affects a joint or joints on one side of your body. Your joints may feel sore and turn red. Asymmetric PsA is generally mild. It affects about 35 percent of people with PsA.

Distal interphalangeal predominant PsA

This type involves the joints closest to your nails. These are known as the distal joints. It occurs in about 10 percent of people with PsA.

Spondylitis PsA

This type of PsA involves your spine. Your entire spine from your neck to your lower back may be affected. This can make movement very painful. Your hands, feet, legs, arms, and hips may also be affected.

Psoriatic arthritis mutilans

This is a severe, deforming type of PsA. About 5 percent of people with PsA have this type. Psoriatic arthritis mutilans usually affects your hands and feet. It can also cause pain in your neck and lower back.

What are the symptoms of psoriatic arthritis?

Symptoms of PsA are different for each person. They can be mild to severe. Sometimes your condition will go into remission and you'll feel better for a while. Other times your symptoms may get worse. Your symptoms also depend on the type of PsA you have.

General symptoms of PsA include:

  • swollen, tender joints on one or both sides of your body
  • morning stiffness
  • swollen fingers and toes
  • painful muscles and tendons
  • scaly skin patches, which may get worse when joint pain flares up
  • flaky scalp
  • fatigue
  • nail pitting
  • separation of your nail from the nail bed
  • eye redness
  • eye pain (uveitis)

Spondylitis PsA, in particular, can also cause the following symptoms:

  • spinal pain and stiffness
  • pain, swelling, and weakness in your: hipskneesanklesfeetelbowhandswristsother jointsswollen toes or fingers
    hips
  • knees
  • ankles
  • feet
  • elbow
  • hands
  • wrists
  • other joints
  • swollen toes or fingers

Symmetric PsA affects five or more joints on both sides of your body. Asymmetric PsA affects less than five joints, but they can be on opposite sides.

Psoriatic arthritis mutilans deforms your joints. It can shorten affected fingers and toes. Distal PsA causes pain and swelling in the end joints of your fingers and toes. Read more about the 11 effects of psoriatic arthritis on your body.

What causes psoriatic arthritis?

In PsA, your immune system attacks your joints and skin. Doctors don't know for sure what causes these attacks. They think it stems from a combination of genes and environmental factors.

PsA runs in families. About 40 percent of people with the condition have one or more relatives with PsA. Something in the environment usually triggers the disease for those with a tendency to develop PsA. That could be a virus, extreme stress, or an injury.

How is psoriatic arthritis treated?

The goal of PsA treatment is to improve symptoms, like skin rash and joint inflammation. New guidelines recommend the treat to target approach, which is based on a person's individual preferences. A specific treatment goal and how to measure progress are determined, then a doctor works with you to select treatments. You have many different treatment options. A typical treatment plan will include one or more of the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These medications help control joint pain and swelling. Over-the-counter (OTC) options include ibuprofen (Advil) and naproxen (Aleve). If OTC options aren't effective, your doctor may prescribe NSAIDs in higher doses.

If used incorrectly, NSAIDs can cause:

  • stomach irritation
  • stomach bleeding
  • heart attack
  • stroke
  • liver and kidney damage
Disease-modifying antirheumatic drugs (DMARDs)

These medications decrease inflammation to prevent joint damage and slow the progression of PsA. They may be administered by various routes, including oral, injection, or infusion. The most commonly prescribed DMARDs include:

  • methotrexate (Trexall)
  • leflunomide (Arava)
  • sulfasalazine (Azulfidine)

Apremilast (Otezla) is a newer DMARD that's taken orally. It works by blocking phosphodiesterase 4, an enzyme involved in inflammation. DMARD side effects include:

  • liver damage
  • bone marrow suppression
  • lung infections
Biologics

There are currently five types of biologic drugs for treating psoriatic disease. They're categorized according to what they target and inhibit (block or lessen) in the body:

  • tumor necrosis factor-alpha (TNF-alpha) inhibitors: adalimumab (Humira)certolizumab (Cimzia)golimumab (Simponi)etanercept (Enbrel)infliximab (Remicade)
  • interleukin 12 and 23 (IL-12/23) inhibitors: ustekinumab (Stelara)interleukin 17 (IL-17) inhibitorssecukinumab (Cosentyx)brodalumab (Siliq)ixekizumab (Taltz)interleukin 23 (IL-23) inhibitorsguselkumab (Tremfya)tildrakizumab-asmn (Ilumya)T-cell inhibitorsabatacept (Orencia)
  • adalimumab (Humira)
  • certolizumab (Cimzia)
  • golimumab (Simponi)
  • etanercept (Enbrel)
  • infliximab (Remicade)
  • ustekinumab (Stelara)
  • secukinumab (Cosentyx)
  • brodalumab (Siliq)
  • ixekizumab (Taltz)
  • guselkumab (Tremfya)
  • tildrakizumab-asmn (Ilumya)
  • abatacept (Orencia)

You receive biologics through an injection under your skin or as an infusion. Because these medications dampen your immune response, they can increase your risk for serious infections. Other side effects include nausea and diarrhea.

Steroids

These medications can bring down inflammation. For PsA, they're usually injected into affected joints. Side effects include pain and a slight risk of joint infection.

Immunosuppressants

Medications like azathioprine (Imuran) and cyclosporine (Gengraf) calm the overactive immune response in PsA. They're not used as often now that TNF- alpha inhibitors are available. Because they weaken the immune response, immunosuppressants can increase your risk for infections.

Topical treatments

Creams, gels, lotions, and ointments can relieve the itchy PsA rash. These treatments are available over the counter and with a prescription. Options include:

  • anthralin
  • calcitriol or calcipotriene, which are forms of vitamin D-3
  • salicylic acid
  • steroid creams
  • tazarotene, which is a derivative of vitamin A
Light therapy and other PsA medications

Light therapy uses medication, followed by exposure to bright light, to treat psoriasis skin rashes.

A few other medications also treat PsA symptoms. These include secukinumab (Cosentyx) and ustekinumab (Stelara). These drugs are injected under your skin. They can increase your risk for infections and cancer. Learn more about the many treatment options for PsA.

Can lifestyle changes ease psoriatic arthritis symptoms?

There are things you can do at home to help improve your symptoms:

Add exercise to your daily routine

Keeping your joints moving can ease stiffness. Being active for at least 30 minutes per day will also help you lose excess weight and give you more energy. Ask your doctor what type of exercise is safest for your joints.

Biking, walking, swimming, and other water exercises are gentler on the joints than high-impact exercises like running or playing tennis.

Break bad habits

Smoking is bad for your joints as well as the rest of your body. Ask your doctor about counseling, medicine, or nicotine replacement to help you quit. Also limit your alcohol intake. It can interact with some PsA medications.

Relieve stress

Tension and stress can make arthritis flares even worse. Meditate, practice yoga, or try other stress-relief techniques to calm your mind and body.

Use hot and cold packs

Warm compresses and hot packs can ease muscle soreness. Cold packs can also reduce pain in your joints.

Move to protect your joints

Open doors with your body instead of your fingers. Lift heavy objects with both hands. Use jar openers to open lids.

Consider natural supplements and spices

Omega-3 fatty acids have anti-inflammatory properties. These healthy fats, found in many supplements, reduce inflammation and stiffness in joints. While research suggests there are health benefits, the Food and Drug Administration doesn't monitor the purity or quality of supplements. It's important to talk with your doctor before you begin taking supplements.

Likewise, turmeric, a potent spice, also serves up a dose of anti-inflammatory properties and may help reduce inflammation and PsA flare-ups. Turmeric can be added to any dish. Some people even stir it into tea or lattes, like golden milk.

Other natural remedies and alternative treatments may be beneficial and ease some symptoms of PsA.

Psoriatic arthritis diet

While no single food or diet will cure PsA, a balanced diet can help reduce inflammation and ease symptoms. Healthy changes to your diet can pay off tremendously for your joints and body in the long run.

In short, eat more fresh fruits and vegetables. They help lower inflammation and manage your weight. Excess weight puts more pressure on joints that are already sore. Limit sugar and fat, which are inflammatory. Put an emphasis on sources of healthy fats, like fish, seeds, and nuts.

Psoriatic arthritis stages

PsA doesn't follow the same path for each person diagnosed with this condition. Some people may only ever have mild symptoms and limited impact on their joints. For others, joint deformity and bone enlargement may ultimately occur.

It's unclear why some people experience a faster progression of the disease and others don't. But early diagnosis and treatment can help ease pain and slow the damage to joints. It's important you talk with your doctor as soon as you begin experiencing signs or symptoms that hint at PsA.

Early stage PsA

In the initial phases of this arthritis, you may experience mild symptoms like joint swelling and reduced range of motion. These symptoms may happen at the same time you develop psoriasis skin lesions, or they may occur years later. NSAIDs are the typical treatment. These medications ease pain and symptoms, but they don't slow PsA.

Moderate PsA

Depending on the type of PsA you have, the moderate or middle stage will likely see worsening symptoms that require more progressive treatments, such as DMARDs and biologics. These medications can help ease symptoms. They may help slow the progression of damage as well.

Late-stage PsA

At this point, bone tissue is heavily affected. Joint deformity and bone enlargement are likely. Treatments aim to ease symptoms and prevent worsening complications.

Diagnosing psoriatic arthritis

To diagnose PsA, your doctor has to rule out other causes of arthritis, such as RA and gout, with imaging and blood tests. These imaging tests look for damage to joints and other tissues:

  • X-rays. These check for inflammation and damage to bones and joints. This damage is different in PsA than it is in other types of arthritis.
  • MRIs. Radio waves and strong magnets make images of the inside of your body. These images can help your doctor check for joint, tendon, or ligament damage.
  • CT scans and ultrasounds. These can help doctors determine how advanced PsA is and how badly joints are affected.

Blood tests for these substances help assess any inflammation present in your body:

  • C-reactive protein. This is a substance your liver produces when there's inflammation in your body.
  • Erythrocyte sedimentation rate. This reveals how much inflammation is in your body. However, it can't determine if the inflammation is from PsA or other possible causes.
  • Rheumatoid factor (RF). Your immune system produces this autoantibody. It's usually present in RA but negative in PsA. An RF blood test can help your doctor tell whether you have PsA or RA.
  • Joint fluid. This culture test removes a small amount of liquid from your knee or other joint. If uric acid crystals are in the fluid, you might have gout instead of PsA.
  • Red blood cells. A low red blood cell count from anemia is common in people with PsA.

No single blood or imaging test can determine if you have PsA. Your doctor uses a combination of tests to rule out other possible causes. Learn more about these tests and what they may tell your doctor about your joints.

Risk factors for psoriatic arthritis

You're more likely to get PsA if you:

  • have psoriasis
  • have a parent or sibling with PsA
  • are between the ages of 30 and 50 (though children can get it, too)
  • have had strep throat
  • have HIV

PsA puts you at risk for complications that include:

  • psoriatic arthritis mutilans
  • eye problems, such as conjunctivitis or uveitis
  • cardiovascular disease

What can trigger a psoriatic arthritis flare-up?

PsA flare-ups make the condition worse for a period of time. Certain things can set off PsA flares. Everyone's triggers are different.

To learn your triggers, keep a symptom diary. Each day, write down your symptoms and what you were doing when they started. Also note whether you changed anything in your routine, like if you started taking a new medicine.

Common PsA triggers include:

  • infections, like strep throat and upper respiratory infections
  • injuries, such as a cut, scrape, or sunburn
  • dry skin
  • stress
  • cold, dry weather
  • smoking
  • heavy drinking
  • stress
  • excess weight
  • medications, such as lithium, beta-blockers, and antimalarial drugs

Although you can't avoid all of these triggers, you can try to manage stress, stop smoking, and cut down your alcohol intake. Ask your doctor if you take any medications known to set off PsA symptoms. If so, you might want to switch to a new drug. It's not always possible to stop flares, but you can be proactive and learn ways to reduce the risk of flares.

Outlook

Everyone's outlook is different. Some people have very mild symptoms that only cause problems from time to time. Others have more severe and debilitating symptoms.

The more severe your symptoms are, the more PsA will affect your ability to get around. People with a lot of joint damage may find it hard to walk, climb stairs, and do other daily activities. Your outlook will be affected if:

  • You received a diagnosis of PsA at a young age.
  • Your condition was severe when you got your diagnosis.
  • A lot of your skin is covered in rashes.
  • A few people in your family have PsA.

To improve your outlook, follow the treatment regimen your doctor prescribes. You might have to try more than one drug to find what works best for you. Read this article in Spanish

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