Psoriatic arthritis

Definition

Psoriatic arthritis is an arthritis that is often associated with psoriasis of the skin.

Alternative Names

Arthritis - psoriatic

Causes, incidence, and risk factors

Psoriasis is a common, chronic skin condition that causes red patches on the body. About 1 in 20 individuals with psoriasis will develop arthritis along with the skin condition. In the majority of cases, psoriasis comes before the arthritis.

The arthritis may be generally mild and involve only a few joints. In a few people, the disease may be severe and affect many joints, including the spine. When the spine is affected, the symptoms are very much like those of ankylosing spondylitis.

The cause of psoriatic arthritis is not known, but your genes may play a role. In general, people who have psoriasis have a higher rate of arthritis than the general population.

Symptoms

• Joint swelling and joint pain (arthritis)
• Nail abnormalities
• Pain and swelling at the site of attachment of tendons to bone
• Skin lesions

Signs and tests

During a physical examination, the doctor will identify skin lesions, tenderness, and swelling of joints. Joint x-rays may be performed.

Treatment

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:

• Leflunomide
• Methotrexate
• Sulfasalazine

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, surgery to repair or replace damaged joints is needed.

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

Expectations (prognosis)

The course of the disease is often mild and affects only a few joints. In those with severe arthritis, treatment is usually very successful in relieving the pain.

Complications

Repeated episodes may occur.

Calling your health care provider

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

Prevention

There is no known prevention.

References

Gottlieb A. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008; 58(5): 851-64