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Psoriatic arthritis

Arthritis - psoriatic; Psoriasis - psoriatic arthritis; Spondyloarthritis - psoriatic arthritis; PsA

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

Causes

Psoriasis is a common skin problem that causes red patches on the body. It is an ongoing (chronic) inflammatory condition. This condition occurs in about 7 to 42 percent people with psoriasis. Nail psoriasis is linked to psoriatic arthritis.

In most cases, psoriasis comes before the arthritis.

The cause of psoriatic arthritis is not known. Genes, immune system, and environmental factors may play a role. It is likely that the skin and joint diseases may have similar causes. However, they may not occur together.

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 and pain. They most often occur in the lower spine and sacrum.

Some people with psoriatic arthritis may have inflammation of the eyes.

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.

Exams and Tests

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

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

Joint x-rays may be done.

There are no specific blood tests for psoriatic arthritis or for psoriasis. The provider may test for a gene called HLA-B27.

People with involvement of the back are more likely to have HLA-B27.

Treatment

Your provider may give nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints.

Arthritis that does not improve with NSAIDs will need to be treated with medicines called disease-modifying antirheumatic drugs (DMARDs). These include:

  • Methotrexate
  • Leflunomide
  • Sulfasalazine 

Apremilast (Otezla) is another medicine used for the treatment of psoriatic arthritis.

New biologic medicines are being widely used for progressive psoriatic arthritis. These medicines block an inflammatory protein called tumor necrosis factor (TNF). These are given by injection and include:

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

Other new biologic medicines are available to treat growing psoriatic arthritis. These medicines are also given by injection and include:

  • Secukinumab (Cosentyx)
  • Ixekizumab (Taltz)
  • Ustekinumab (Stelara)
  • Abatacept (Orencia)

Very painful joints may be treated with steroid injection. These are used when only one or a few joints are involved.

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

People with inflammation of the eye should see an ophthalmologist.

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

Outlook (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.

When to Contact a Medical Professional

Call your provider if you develop symptoms of arthritis along with psoriasis.

References

Bruce IN, Ho PYP. Clinical features of psoriatic arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 128.

FitzGerald O, Elmamoun M. Psoriatic arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 77.

Smolen JS, Schöls M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018;77(1):3-17. PMID: 28684559 www.ncbi.nlm.nih.gov/pubmed/28684559.

Veale DJ, Orr C. Management of psoriatic arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 131.

    • Psoriasis, guttate on the arms and chest

      Psoriasis, guttate on the arms and chest - illustration

      This is a picture of guttate (drop-shaped) psoriasis on the arms and chest. Guttate psoriasis is a rare form of psoriasis. It frequently follows a streptococcal infection, appears rapidly and affects the face, chest, and nearest limbs. The patches are small and round or oval and have the typical appearance of psoriasis. This photograph shows the diffuse and widespread coverage on the arm and chest.

      Psoriasis, guttate on the arms and chest

      illustration

    • Psoriasis, guttate on the cheek

      Psoriasis, guttate on the cheek - illustration

      This is a picture of guttate (drop-shaped) psoriasis on face and neck. Guttate psoriasis is a rare form of psoriasis. It frequently follows a streptococcal infection, appears rapidly and affects the face, chest, and nearest limbs. The patches are small and round or oval and have the typical appearance of psoriasis. This photograph shows the diffuse and widespread coverage on the face and neck.

      Psoriasis, guttate on the cheek

      illustration

      • Psoriasis, guttate on the arms and chest

        Psoriasis, guttate on the arms and chest - illustration

        This is a picture of guttate (drop-shaped) psoriasis on the arms and chest. Guttate psoriasis is a rare form of psoriasis. It frequently follows a streptococcal infection, appears rapidly and affects the face, chest, and nearest limbs. The patches are small and round or oval and have the typical appearance of psoriasis. This photograph shows the diffuse and widespread coverage on the arm and chest.

        Psoriasis, guttate on the arms and chest

        illustration

      • Psoriasis, guttate on the cheek

        Psoriasis, guttate on the cheek - illustration

        This is a picture of guttate (drop-shaped) psoriasis on face and neck. Guttate psoriasis is a rare form of psoriasis. It frequently follows a streptococcal infection, appears rapidly and affects the face, chest, and nearest limbs. The patches are small and round or oval and have the typical appearance of psoriasis. This photograph shows the diffuse and widespread coverage on the face and neck.

        Psoriasis, guttate on the cheek

        illustration

      Tests for Psoriatic arthritis

       

      Review Date: 1/29/2018

      Reviewed By: Gordon A. Starkebaum, MD, ABIM Board Certified in Rheumatology, Seattle, WA. Internal review and update on 03/28/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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