Psoriatic arthritis: types, causes, symptoms & treatments

24/04/2023

Most people have heard of osteoarthritis and rheumatoid arthritis. But for some, psoriatic arthritis is the new kid on the block. Here’s what you need to know about psoriatic arthritis, including symptoms, types and treatments.

What is psoriatic arthritis?

Psoriatic arthritis (PsA), a progressive inflammatory condition of the joints and enthuses (places where the tendons and ligaments attach to bones), occurs when the immune system goes into overdrive and creates inflammation. This leads to pain and swelling. It is related to the skin disease psoriasis. Most people with psoriatic arthritis suffer from psoriasis first, although some don’t have skin issues until after the other symptoms begin.

Psoriatic arthritis types

Psoriatic arthritis comes in five forms, according to Johns Hopkins Medicine:

Affects small joints in fingers and/or toes
Asymmetrical arthritis in the hands and feet of one side or the other
Symmetrical polyarthritis: similar to rheumatoid arthritis and affects both sides equally in multiple joints
Arthritis mutilans: rare, destroys and deforms joints
Psoriatic spondylitis: arthritis of the lower back and the spine.

Psoriatic arthritis causes and risk factors

While the causes of psoriatic arthritis are not completely understood, there are several known factors, according to the American College of Rheumatology.

Genetics: 40% of people with PsA have a family member with psoriasis or arthritis
Strep throat: It is suspected that the strep infection may be a trigger.

Some other factors that may put people at high risk or trigger PsA include:

Obesity
Severe psoriasis
Stressful events
Trauma to the joints or bones
Infections.

Some scientists believe genes and an environmental trigger such as a trauma or virus might have a part in the development of PsA, according to the Arthritis Foundation.

According to a study published recently in the journal JAMA Dermatology, there seems to be a causal effect between inflammatory bowel disease and psoriasis/PsA. “These findings have implications for the management of inflammatory bowel disease and psoriasis in clinical practice,” the researchers said when the study was published.

Psoriatic arthritis symptoms

According to the U.S. National Institutes of Health, symptoms of psoriatic arthritis vary greatly from person to person. They may include:

Scaly, inflamed patches of skin (psoriasis) on the scalp, elbows or knees
Joint stiffness, pain and swelling of one or more joints. Joint stiffness is often worse in the morning or after resting
Tenderness in areas where tendons or ligaments attach to bones. Two commonly affected spots are the back of the heel and the sole of the foot
Painful, sausage-like swelling of a whole finger or toe
Frequent fatigue, abnormal tiredness, or a lack of energy
Nails that pit, crumble, or separate from the nail bed
Eye inflammation, resulting in eye pain, redness, and blurry vision. Prompt treatment is necessary to prevent vision loss
Inflammatory bowel disease may occur in some people.

Psoriatic arthritis treatments

Because it affects both the skin and joints, psoriatic arthritis is a complex condition to treat, according to the Arthritis Foundation. Treatments include a combination of therapies comprised of medications and non-drug therapies such as exercise, massage, heat and cold.

Psoriatic arthritis medications include the following:

Non-steroidal anti-inflammatory meds such as ibuprofen or naproxen.
Disease modifying anti-rheumatic drugs (DMARDs).
Biologics, such as TNF inhibitors such as Humira (adalimumab), Cimzia (certolizumab pegol), Enbrel (etanercept), Simponi (golimumab) and Remicade (infliximab)
Corticosteroids, which are injected into the joint for temporary relief during a flare-up.

Non-drug therapies include:

Exercise—as with other types of arthritis, staying active helps
Massage—stress can cause flare-ups and massage helps with stress
Heat and cold—may help decrease the inflammation
Physical and occupational therapy—to strengthen muscles, protect joints from further damage and increase flexibility
Water therapy—some people find it easier to move while in the water, which partly supports the body’s weight.

While psoriatic arthritis can be a life-altering diagnosis, with proper treatment and lifestyle adjustments, many people with this condition can continue to live an active, fulfilling life.

Journal information:
JAMA Dermatology

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