Psoriatic arthritis (PsA) is a Form of chronic inflammatory arthritis that may occur in up to 30 percent of patients with Psoriasis. The arthritis may be peripheral or axial, or both. Psoriatic arthritis can affect the large joints such as the knees and shoulders but also may also occur in joints like the fingers, toes, back or pelvis. Symptoms usually start between ages 30 and 50 and can lead to mild symptoms or chronic inflammation that may result in joint damage if not treated appropriately. Men and women are equally at risk.
Signs/Symptoms
Psoriatic arthritis may affect one or many different joints, resulting in stiffness and swelling. Dactylitis or swelling of fingers and toes can be seen along with pitting of your nails. Other signs can include inflammation of the tendons called enthesitis, colitis, and uveitis (inflammation in your eyes). Diagnosing psoriatic arthritis starts with a physical exam to look for swollen or painful joints, and nail and skin changes. X-rays or scans, MRI show joint damage. Blood tests may help rule out other diseases, and a skin biopsy can confirm psoriasis.
Arthritis appears after the onset of skin lesion in the majority of patients with PsA. However, arthritis precedes the skin disease in approximately 7 to 15 percent of patients, and skin lesions are present but have not been diagnosed in an additional 15 percent.
Nail lesions occur in 80-90 percent of patients with PsA, including nail pits, onycholysis. The severity of the nail involvement correlates closely with the the extent and severity of both skin and joint disease.
Treatments
Treatments depend on the extent of pain, swelling or stiffness and aim to decrease pain and inflammation along with preventing long term joint damage. Mild arthritis flares may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium. Corticosteroid shots may ease pain and swelling in an affected joint. If NSAIDs don’t ease arthritis symptoms, your rheumatologist may prescribe disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine, methotrexate, or leflunomide, or azathioprine. People with severe arthritis may try biologics, such as adalimumab, etanercept, infliximab. Other biologics used for psoriatic arthritis include secukinumab, ixekizumab, ustekinumab, guselkumab and abatacept. Oral medications, such as tofacitinib and apremilast have also been shown to be effective. Your rheumatologist will work with you to find the best treatment option for you.
Maintaining regular follow up appointments with your rheumatologist to ensure proper disease control is essential for success in treatment of PsA. Regular exercise such as walking, biking, and yoga also help to keep joints strong and improves cardiac health. Follow up with your primary care doctor is also advised to monitor for high blood pressure, obesity, type-2 diabetes and high cholesterol. If you also have psoriasis, a dermatologist can treat with additional agents to improve skin disease.