Psoriatic arthritis

  • Definition
    • Psoriatic arthritis is a joint problem (arthritis) that often occurs with a skin condition called psoriasis.

  • Alternative Names
    • Arthritis - psoriatic; Psoriasis - psoriatic arthritis; Spondylitis - psoriatic arthritis

  • Causes
    • Psoriasis is a common skin problem that causes red patches on the body. It is an ongoing (chronic) inflammatory condition. About 1 in 20 people with psoriasis may develop arthritis with the skin condition. Nail psoriasis is linked to psoriatic arthritis.

      In most cases, psoriasis comes before the arthritis.

      The cause of psoriatic arthritis is not known. Genes, immune system, and environmental factors may play a role. It is likely that the skin and joint diseases may have similar causes. However, they may not occur together.

  • Symptoms
    • The arthritis may be mild and involve only a few joints. The joints at the end of the fingers or toes may be more affected.

      In some people the disease may be severe and affect many joints, including the spine. Symptoms in the spine include stiffness, burning, and pain. They most often occur in the lower spine and sacrum.

      Most of the time, people with psoriatic arthritis have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

  • Exams and Tests
    • During a physical exam, the health care provider will look for:

      • Joint swelling
      • Skin patches (psoriasis) and pitting in the nails
      • Tenderness

      Joint x-rays may be done.

      There are no specific blood tests for psoriatic arthritis or for psoriasis, but the doctor may test for a gene called HLA-B27.

  • Treatment
    • Your provider may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints.

      Worse arthritis will need to be treated with more powerful drugs called disease-modifying antirheumatic drugs (DMARDs). These include:

      • Leflunomide
      • Methotrexate
      • Sulfasalazine

      New medicines that block an inflammatory protein called tumor necrosis factor (TNF) are being widely used for progressive psoriatic arthritis. These drugs include:

      • Adalimumab (Humira)
      • Certolizumab (Cimzia)
      • Etanercept (Enbrel)
      • Golimumab (Simponi)
      • Infliximab (Remicade)

      Very painful joints may be injected with steroid medicines.

      In rare cases, surgery may be needed to repair or replace damaged joints.

      Your provider may suggest a mix of rest and exercise. Physical therapy may help increase joint movement. You may also use heat and cold therapy.

  • Outlook (Prognosis)
    • The disease is often mild and affects only a few joints. In some people, very bad psoriatic arthritis may cause deformities in the hands, feet, and spine.

      Early treatment can ease pain and prevent joint damage even in very bad cases.

  • When to Contact a Medical Professional
    • Call your provider if arthritis symptoms develop along with psoriasis.

  • References
    • Fitzgerald O. Psoriatic arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 77.

      Gladman DD, Chandran V. Management of psoriatic arthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 122.

      Husni ME. Psoriatic arthritis. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2010:1187-1189.