Psoriatic arthritis is a type of inflammatory arthritis that occurs in some patients with psoriasis. This particular arthritis can affect any joint in the body, and symptoms vary from person to person. Research has shown that persistent inflammation from psoriatic arthritis can lead to joint damage. Fortunately, available treatments for are effective for most people.
Psoriatic arthritis usually appears in people between the ages of 30 to 50, but can begin as early as childhood. Men and women are equally at risk. Children with psoriatic arthritis are also at risk to develop uveitis (inflammation of the middle layer of the eye). Approximately 15% of people with psoriasis develop psoriatic arthritis. At times, the arthritis can appear before the skin disorder.
- Psoriatic arthritis is a chronic arthritis. In some people, it is mild, with just occasional flare ups. In other people, it is continuous and can cause joint damage if it is not treated. Early diagnosis is important to avoid damage to joints.
- Psoriatic arthritis typically occurs in people with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis.
- Psoriatic arthritis typically affects the large joints, especially those of the lower extremities, distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis.
- For most people, appropriate treatments will relieve pain, protect the joints, and maintain mobility. Physical activity helps maintain joint movement.
+ swollen, tender joints on one or both sides of your body
+ morning stiffness
+ swollen fingers and toes
+ painful muscles and tendons
+ scaly skin patches, which may get worse when joint pain flares up
+ flaky scalp
+ nail pitting
+ separation of your nail from the nail bed
+ eye redness
+ eye pain (uveitis)
+ Blood tests may be done to rule out other types of arthritis that have similar signs and symptoms, including gout, osteoarthritis, and rheumatoid arthritis. In patients with psoriatic arthritis, blood tests may reveal high levels of inflammation and mild anemia but labs may also be normal. Anemia is a condition that occurs when the body lacks red blood cells or has dysfunctional red blood cells. Occasionally skin biopsies (small samples of skin removed for analysis) are needed to confirm the psoriasis.
+ Treating psoriatic arthritis varies depending on the level of pain, swelling and stiffness. Those with very mild arthritis may require treatment only when their joints are painful and may stop therapy when they feel better. Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin or Advil) or naproxen (Aleve) are used as initial treatment.
If the arthritis does not respond, disease modifying anti-rheumatic drugs may be prescribed. These include sulfasalazine (Azulfidine), methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo), cyclosporine (Neoral, Sandimmune, Gengraf), and leflunomide. Sometimes combinations of these drugs may be used together. The anti-malarial drug hydroxychloroquine (Plaquenil) can help, but it usually is avoided as it can cause a flare of psoriasis. Azathioprine (Imuran) may help those with severe forms of psoriatic arthritis.
There are several biologic type medications available to treat psoriatic arthritis via infusion or injection.
- The TNF Inhibitors such as adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi), certolizumab (Cimzia) and infliximab (Remicade) are also available and can help the arthritis as well as the skin psoriasis.
- Secukinumab (Cosentyx), a new type of biologic injection, was recently approved to treat psoriatic arthritis and also can be helpful in treating psoriasis.
- Ustekinumab (Stelara) is a biologic injection given in your doctor’s office that is effective in treating psoriatic arthritis and psoriasis.
- Abatacept is given to patients who have not responded to one or more DMARDs or other biologic drugs. Abatacept may be used alone or in combination with DMARDs.
- For swollen joints, corticosteroid injections can be useful. Surgery can be helpful to repair or replace badly damaged joints.
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