Psoriatic Arthritis

Common Symptoms

• Joint pain and stiffness: PsA typically causes pain in the fingers, toes, knees, ankles, or spine. The stiffness is often worse in the morning or after periods of inactivity.
• Swollen fingers and toes: This condition, known as "dactylitis," leads to sausage-like swelling in the fingers or toes.
• Nail changes: People with PsA may experience pitting (small indentations) in their nails or nails that separate from the nail bed.
• Fatigue: Chronic inflammation can cause significant fatigue and a general feeling of being unwell.
• Eye problems: In some cases, PsA may cause eye inflammation, known as uveitis, leading to redness, pain, and vision problems.
• Skin symptoms: Since PsA is linked to psoriasis, individuals may experience scaly, red patches of skin, particularly on the scalp, elbows, knees, and lower back.
• Lower back pain: When PsA affects the spine, it’s referred to as "spondylitis," which causes pain and stiffness in the lower back or neck.

Causes and Risk Factors

• PsA tends to run in families. If you have a close relative with psoriasis or PsA, you are at a higher risk of developing the condition.
• PsA is an autoimmune disease, which means the immune system mistakenly attacks healthy cells and tissues. This causes inflammation in the joints and skin.
• Infections, injuries, or other environmental triggers may activate the immune system and contribute to PsA development in people who are genetically predisposed to the disease.
• As mentioned, up to 30% of people with psoriasis develop PsA.
• Most cases of PsA occur in individuals between 30 and 50 years old, though it can affect anyone.
• Being overweight is associated with a higher risk of both psoriasis and PsA.
• Smoking increases inflammation and can worsen symptoms in people with PsA.

Diagnosis

• Medical History: Your doctor will ask about your family history of psoriasis or arthritis, as well as any joint pain, swelling, or skin symptoms.
• Physical Exam: The doctor will check for joint swelling, tenderness, and signs of psoriasis.
• Blood Tests: Although no specific blood test can diagnose PsA, tests like the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can indicate inflammation. Rheumatoid factor (RF) tests are also done to rule out rheumatoid arthritis.
• Imaging Tests: X-rays, MRIs, or ultrasounds may be used to detect joint damage or inflammation.

Treatment Options

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These over-the-counter medications can help relieve pain and reduce inflammation in mild cases.
• Disease-modifying antirheumatic drugs (DMARDs): If NSAIDs are not effective, your doctor may prescribe DMARDs to slow the progression of the disease and prevent joint damage.
• Biologics: Biologic drugs target specific proteins in the immune system to reduce inflammation. These are usually prescribed for moderate to severe PsA.
• Corticosteroids: These powerful anti-inflammatory drugs may be used for short-term relief during a flare-up.
• Physical therapy: Physical therapy can help improve joint function, reduce stiffness, and maintain flexibility through targeted exercises.
• Lifestyle changes: Regular exercise, a healthy diet, and stress management are crucial in managing PsA. Low-impact exercises like swimming or walking can help keep joints flexible and reduce stiffness. Maintaining a healthy weight can also ease pressure on the joints.

Coping with Psoriatic Arthritis