Psoriatic arthritis - what you need to know

What is psoriatic arthritis

What is psoriatic arthritis?

Psoriatic arthritis is a type of psoriasis that causes painful,1 stiff,2 swollen joints,1,2 and in some cases the typical skin symptoms of psoriasis.1,3

What is the connection between psoriasis and psoriatic arthritis?

About 9 in every 100 people with psoriasis will develop psoriatic arthritis.4

Both are immune-mediated conditions.2,3 For people with psoriasis, their immune system attacks their healthy skin cells by mistake.5 In psoriatic arthritis your joints are also affected.3

There is no real link between psoriasis severity and psoriatic arthritis severity. If you have severe psoriasis, it doesn’t necessarily mean you will have severe psoriatic arthritis symptoms, or psoriatic arthritis at all.2

When does it develop?

Psoriatic arthritis usually occurs between the ages of 30 and 50. For most people it starts about 10 years after their psoriasis begins.2 This isn’t always the case. Some people may develop the condition without having any previous symptoms of psoriasis.1,2

Psoriatic arthritis hands
Image sourced from iStock

What are the symptoms of the disease?

Common psoriatic arthritis symptoms include:

  • Swollen fingers and toes (sometimes looking like sausages)2,3
  • Stiffness, pain, throbbing, swelling and tenderness2 in your knees, ankles, wrists and your lower back1
  • Tenderness, pain and swelling over tendons2,3
  • General tiredness2,3
  • Morning stiffness2,3
  • Reduced movement in your joints2
  • Pitting and discolouration of your nails and separation of your nail from the nail bed2,3
  • Eye redness and pain2,3

Like psoriasis, your symptoms may come and go.1,3 However, some people find their symptoms are ongoing.1 Everyone experiences different symptoms. You may only have mild symptoms that develop slowly or you may have severe symptoms that develop quickly.2

If you have been diagnosed with psoriasis and notice any of these symptoms, you should contact your doctor as soon as possible. Early diagnosis and treatment can help prevent damage to your joints.2

What causes psoriatic arthritis?

Psoriatic arthritis happens because your immune system isn’t working properly. It attacks healthy cells in your skin and your joints. The reason for this is not fully understood. It is thought to be caused by a combination of genetic and environmental factors.3

Genetic factors for psoriatic arthritis

Genetic factors are ones that you can’t change. If someone in your close family has psoriatic arthritis the chance of you getting it is higher. About 2 in every 5 people with psoriatic arthritis have one or more relatives with the condition.3

Environmental factors for psoriatic arthritis

Environmental factors are ones that you may be able to avoid. Being exposed to them may mean you are more likely to develop psoriatic arthritis:3

  • Trauma: psoriatic arthritis may be more likely to occur after an injury to your bones or joints3
  • Infections: streptococcal infections may provoke psoriatic arthritis; however, this is not proven3,6
  • Obesity: people who are overweight have a higher risk of developing psoriatic arthritis3,6

What type do you have?

There are different types of psoriatic arthritis:

  • Asymmetrical: this is the most common form6 and is usually mild.3 It means your psoriatic arthritis affects different joints on both sides of your body.3
  • Symmetrical: this is where the same joints on both sides of your body are affected.3,6
  • Oligoarticular: mild psoriatic arthritis which affects a small number of your joints.6
  • Polyarticular: severe psoriatic arthritis which affects many of your joints.6
  • Spondylitis: psoriatic arthritis affecting your spine. Typical symptoms are stiffness and pain in your neck, lower back and sacroiliac joints (in the pelvis).2,3
  • Enthesitis: psoriatic arthritis affecting entheses (where tendons or ligaments join to bones). Most commonly on the bottom of your feet, Achilles' tendons, and the places where ligaments connect to the spine, ribs and pelvis. Enthesitis only affects people with psoriatic arthritis.2
  • Dactylitis: painful swelling of your entire finger or toe. This usually happens asymmetrically, meaning that different fingers/toes are affected on both hands/feet. Dactylitis only affects people with psoriatic arthritis.2
  • Distal interphalangeal predominant (DIP): this form occurs in 10% of people with psoriatic arthritis. It affects the small joints at the end of your fingers and/or toes.3
  • Arthritis mutilans: a severe form that can physically change joints, e.g. by shortening fingers and toes. It usually affects 5 people in every 100 with psoriatic arthritis.3
Psoriatic arthritis fatigue
Image sourced from iStock

How is it diagnosed?

If you think you have psoriatic arthritis you should contact your doctor as soon as possible. Early diagnosis and treatment can help manage your condition and reduce the risk of permanent joint damage.2,6

Your doctor will examine you and talk about your medical history. You may need x-rays, MRIs or blood tests to help diagnose the type of psoriasis you have.2 You may be referred to a rheumatologist (a specialist in joint conditions).6

What treatments are available?

There is no cure for psoriatic arthritis. Treatments can lessen pain, slow down progression and preserve your range of movement.2 Common treatments include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): used to relieve pain and inflammation.3,7
  • Corticosteroids: used to reduce inflammation. They are usually injected directly into the affected joint.3,7
  • Disease-modifying antirheumatic drugs (DMARDs): used to reduce inflammation to help prevent joint damage.3,7 They can be taken orally or by injections or infusions.3
  • Biologics: may be prescribed if your symptoms have not improved after trying two different types of DMARDs or if you cannot take them.7 They are used to dampen your immune system. They are usually given by an injection or an infusion.3

Related diseases

If you have psoriatic arthritis you are at a higher risk of other conditions. As with psoriasis, you are at a higher risk of developing cardiovascular disease, diabetes and depression. Unlike psoriasis, you may also be at a higher risk of hearing loss.8

Fatigue

People with psoriatic arthritis often feel fatigued.3 This can feel overwhelming.9 Conditions linked to psoriatic arthritis such as anaemia, obesity, diabetes, depression and sleep problems can contribute to this. Some medications for psoriatic arthritis such as methotrexate are also linked to fatigue.9 It is important to try and find out what may be causing your fatigue. This can help you manage it.9

Can lifestyle changes help?

There are a number of things you can do to help manage your psoriatic arthritis:

  • Exercise: Keeping your joints moving can ease stiffness3. Cycling, walking and swimming are forms of exercise that are gentle on your joints3. Talk to your doctor about what types of exercise are suitable for you.3
  • Eating a healthy diet: Fresh fruit and vegetables can help lower inflammation which can ease your symptoms. Limit sugar and fat, which are inflammatory.3
  • Losing excess weight: Being overweight will put excess strain on your joints. A healthy diet coupled with exercise will help you to lose excess weight.3
  • Reducing alcohol: Alcohol can cause your psoriatic arthritis to flare-up. It may also cause your medications not to work properly.3
  • Stop smoking: Smoking may be a trigger for your psoriatic arthritis.3

Outlook

Psoriatic arthritis affects people in different ways. Some people have mild symptoms. For others their symptoms can be severe and debilitating.3 Early diagnosis and treatment can help ease pain and slow the damage to your joints.3 To improve your outlook make sure you do what your doctor recommends and take your medicines as prescribed.3

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

UK/IE MAT-26472 Date of prep: July 2019

  1. www.healthline.com/health/psoriasis#psoriasis-treatments (accessed July 2019).
  2. www.psoriasis.org/about-psoriatic-arthritis (accessed July 2019).
  3. www.healthline.com/health/psoriatic-arthritis (accessed July 2019).
  4. A Ogdie et al. Rheumatology (Oxford). 2013 Mar; 52(3): 568–575.
  5. www.nhs.uk/conditions/psoriasis/ (accessed July 2019).
  6. www.papaa.org/resources/about-psoriatic-arthritis#10 (accessed July 2019).
  7. SIGN. Treating psoriasis and psoriatic arthritis. 2012.
  8. www.psoriasis.org/about-psoriasis/related-conditions (accessed July 2019).
  9. www.psoriasis.org/advance/fatigue-and-psoriatic-arthritis (accessed July 2019).

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