Psoriatic arthritis (patient information)
Psoriatic arthritis On the Web
Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD 
Psoriatic arthritis is an arthritis associated with psoriasis in some patients. Psoriatic arthritis typically affects joints of fingers and toes but also affects spine, and sacroiliac joints. The cause is not clearly understood. Genes, body defense mechanisms and environmental factors act as triggering agents for the disease development and progression. Signs and symptoms come and go, depending on the degree of tissue inflammation. When the disease is active, the following symptoms appear including joint pain, swelling, joint tenderness, morning stiffness, decreased range of motion, deformed nails, sausage shaped fingers, and pain at the sites of ligament insertion. Treatment opinion includes medications, physical therapy and surgery. The opinion depends on the severity of the disease. Prognosis of psoriatic arthritis varies from person to person. Some patients may get less aggressive over time, while others may lose their abilities to do daily tasks. Joint images such as x-ray and MRI, ultrasound may help track the progression of disease in the joints over time.
What are the symptoms of Psoriatic arthritis?
- Arthritis may be mild and involve only a few joints, particularly those at the end of the fingers or toes. In some people, the disease may be severe and affect many joints, including the spine and sacroiliac joints.
- People who also have arthritis usually have the skin and nail changes. Often, the skin gets worse at the same time as arthritis.
- Signs and symptoms come and go, depending on the degree of tissue inflammation. When the disease is active, the following symptoms appear.
- Joint pain
- Joint swelling
- Morning stiffness in the joints
- Decreased range of motion
- Red scaly skin patches
- Deformed nails
- Sausage shaped fingers
- Pain at the sites of ligament insertion (eg, heel pain)
- When heart is affected, patient may show signs of chest pain, shortness of breath or edema of feet.
What causes Psoriatic arthritis?
- Psoriasis is a common, chronic skin condition that causes red patches on the body. About 1 in 20 people with psoriasis will develop arthritis with the skin condition. In most cases, psoriasis comes before the arthritis.
- The cause of psoriatic arthritis is not known, but genes, body defence mechanisms and environmental factors may play a role.
Who is at highest risk?
In general, people who have psoriasis have a higher rate of arthritis than the general population.
When to seek urgent medical care?
Call your doctor if your symptoms of psoriasis and psoriatic arthritis progress.
Diseases that can present with similar symptoms are
- Rheumatoid arthritis
- Reactive arthritis
- Arthritis associated with inflammatory bowel disease
To come to a proper diagnosis, your doctor might run the following tests
- Blood tests: These tests can assist in making a diagnosis of psoriatic arthritis.
- Rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) and antinuclear antibody (ANA): These antibodies can be found in some of patients with psoriatic arthritis.
- Sedimentation rate (ESR): This test can measure how much inflammation is in the body. Patients with psoriatic arthritis may show an increased ESR.
- Complete blood count
- Genetic testing for HLA genes.
- Synovial fluid examination: When a patient demonstrates the signs of acute inflammatory arthritis, it is necessary to aspirate synovial fluid of the involved joint to rule out infectious arthritis. During the procedure, the doctor may use a needle to draw fluid from your affected joint.
- Joint x-ray: This image can help track the progression of psoriatic arthritis in the joints over time.
- Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the joint.
- Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) or salicylates to reduce pain and inflammation of the joints.
- More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs (DMARDs), such as:
- New medications that block an inflammatory protein called tumor necrosis factor (TNF) are becoming the treatment of choice. These include:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Occasionally, particularly painful joints may be injected with steroid medications.
- In rare cases, patients need surgery to repair or replace damaged joints.
- Your doctor may suggest a healthy mix of rest and exercise. Physical therapy may help increase the movement of specific joints. You may also use heat and cold therapy.
Where to find medical care for Psoriatic arthritis?
Directions to Hospitals Treating Psoriatic arthritis
Prevention of psoriatic arthritis
The cause of psoriatic arthritis is not clear, therefore prevention of the disease is unknown.
What to expect (Outlook/Prognosis)?
Prognosis of psoriatic varies from person to person. The disease may get less aggressive over time in some patients. In other group, patients may lose their abilities to do daily tasks. Prognosis depends on:
Complication of psoriatic arthritis involve multiple systems. Cardiac complications are increased risk for arrythmia, congestive heart failure, increased risk for atherosclerosis ,and myocardial infarction. Pulmonary complications include pleural effusion and pulmonary fibrosis. Rheumatological complications are joint deformities, nail damage and decreased quality of life. Eye complications such as uveitis, conjunctivitis. Nervous system complications like stroke and depression. GI tract complications include bleeding and cirrhosis. Other complications include metabolic syndrome, diabetes mellitus and dyslipidemia.