Psoriatic Arthritis

What is Psoriatic Arthritis (PsA)?

Psoriatic arthritis is a type of arthritis that usually affects about 25-30% of people with psoriasis or who have a family history of psoriasis. However, it is possible to have PsA without psoriasis (the skin manifestations), as PsA is an autoimmune condition that affects the joints. Yet, this is a rarer scenario. Those diagnosed with psoriatic arthritis typically present with joint pain, joint swelling, and morning stiffness.

---

What are Psoriatic Arthritis Symptoms?

Psoriatic arthritis (PsA) symptoms can vary from person to person, but common symptoms include:

• Joint pain, swelling, and stiffness – often in the fingers and toes; however, joints in the spine can also be affected and lead to stiffness in the neck, lower back, shoulders, and hips
• Tendon or Ligament tenderness – this is referred to as enthesitis, which is inflammation where the tendons or ligaments attach to bones (common types include plantar fasciitis, Achilles tendonitis, and tennis elbow)
• Diffuse swelling of fingers(s) or toe(s) – sausage digits
• Reduced range of motion in affected joints – for example in feet, pain near the Achilles tendon can make it difficult to walk, run, or climb stairs
• Fatigue – lack of energy or feeling tired
• Red, inflamed skin patches (psoriasis)
• Nail changes (such as pitting or separation of the nail from the nail bed)
• Eyes – inflammation, especially uveitis, which can cause eye pain, redness, and blurry vision

Psoriatic Arthritis can be a difficult diagnosis since symptoms are similar to other health conditions, such as rheumatoid arthritis or gout. The diagnosis of psoriatic arthritis is made on the basis of clinical symptoms, as there are no diagnostic laboratory tests.  Physicians may also use blood tests to rule out other rheumatic conditions, as well as imaging tests to evaluate joints and access any damage or a skin biopsy to confirm psoriasis.

---

What are Psoriatic Arthritis Treatment Options?

In treating psoriatic arthritis, individualized plans are based upon each person and factors include the severity of the condition, age, general health, and symptoms. PsA treatment plans may consist of medications, physical therapy, and lifestyle modifications including:

• NSAIDs - nonsteroidal anti-inflammatory drugs – to assist with pain and inflammation
• DMARDs - disease-modifying antirheumatic drugs – may be considered for managing and controlling skin rashes and joint pain
• Corticosteroids – to assist in managing and reducing inflammation during flare-ups (commonly prescribed is prednisone). Corticosteroids need to be used with caution because they can sometimes cause the skin (psoriasis) to flare once tapered off.
• Biologic therapies – may be considered for patients with active or recurring PsA (administered via IV, slow drip, or self-administered shots)
• Diet, vitamins and minerals – some PsA patients do better if they avoid certain foods that might promote inflammation. Additional calcium and vitamin D can support and promote bone health.
• Lifestyle modifications – low-impact activities like walking, swimming, and cycling can help the spine. Modified yoga and Pilates may increase strength without putting pressure on joints and spine. 
• Physical Therapy – offers exercises and stretching can help maintain joint function and reduce stiffness
• Occupational therapy – can recommend equipment or devices to make tasks easier

---

Living with a Psoriatic Arthritis Diagnosis

Involving a combination of medical treatment, lifestyle changes, and preventative care, living with PsA may be a challenge but it is manageable. Working with your healthcare provider, adhering to your medications, managing your diet and a healthy weight, and engaging in low-impact exercise and stretching may all help improve the impact of Psoriatic Arthritis in daily life and improve overall wellbeing. 

---