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Psoriatic arthritis

Definition

Psoriatic arthritis is a joint problem (arthritis) that often occurs with a skin condition called psoriasis.

Alternative Names

Arthritis - psoriatic

Causes, incidence, and risk factors

Psoriasis is a common skin problem that causes red patches on the body. It is a chronic (ongoing) condition. 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. Genes may play a role.

Symptoms

The arthritis may be mild and involve only a few joints. The joints at the end of the fingers or toes may be more affected.

In some people the disease may be severe and affect many joints, including the spine. Symptoms in the spine include stiffness, burning, and pain. They most often occur in the lower spine and sacrum.

Most of the time, people with psoriatic arthritis have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

Signs and tests

During a physical exam, the health care provider will look for:

  • Joint swelling
  • Skin patches (psoriasis) and pitting in the nails
  • Tenderness

Joint x-rays may be done.

Treatment

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce pain and swelling of the joints.

Worse arthritis will need to be treated with more powerful drugs called disease-modifying antirheumatic drugs (DMARDs). These include:

  • Leflunomide
  • Methotrexate
  • Sulfasalazine

New medicines that block an inflammatory protein called tumor necrosis factor (TNF) are being widely used for progressive psoriatic arthritis. These drugs include:

  • Adalimumab (Humira)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade)

Very painful joints may be injected with steroid medicines.

In rare cases, surgery may be needed to repair or replace damaged joints.

Your doctor may suggest a mix of rest and exercise. Physical therapy may help with increase joint movement. You may also use heat and cold therapy.

Expectations (prognosis)

The disease is often mild and affects only a few joints. In some people, very bad psoriatic arthritis may cause deformities in the hands, feet, and spine.

Early treatment can ease pain and prevent joint damage even in very bad cases.

Calling your health care provider

Call your health care provider if arthritis symptoms develop along with psoriasis.

References

Fitzgerald O. In: Psoriatic arthritis. Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 77.

Husni ME. Psoriatic arthritis. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010.


Review Date: 4/20/2013
Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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