Psoriatic Arthritis

Psoriatic Arthritis: Overview

Psoriatic arthritis is a long-lasting condition that causes skin rashes and produces joint inflammation.

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Psoriatic arthritis is linked to psoriasis, a disorder causing areas of the skin to become inflamed and be covered with silvery or grey scales.  Psoriasis can also cause the nails on the hands and feet to develop small holes and to lift.

Incidence; Causes and Development

Psoriatic arthritis affects both men and women in equal numbers, and usually between the ages of 20 and 50.  Up to 30% of people with psoriasis will also get psoriatic arthritis.  Although psoriasis may start at any age (commonly in the late teens), the arthritis component usually makes its appearance later – in the 20s, 30s and 40s.  Commonly, psoriasis shows first, but in a small percentage of people (approximately 15%), arthritis may show first.

The exact cause of psoriatic arthritis is not known.  Many people with psoriatic arthritis have other family members with it or with psoriasis.

It is known that heredity plays a big role.  Children of parents with psoriasis are three times more likely to have it.  If an identical twin has psoriasis, there is a 75% chance the other one will have it too.

Other possible causes of psoriatic arthritis are exposure to infection or changes in the environment.

Signs and Symptoms

Over 80% of people with psoriatic arthritis also have involvement of the finger and toenails.  The pattern of joint involvement varies widely in people with psoriatic arthritis, though it can affect the wrists, knees, ankles, finger and toe joints, the spine, and the sacroiliac joints (joints in the lower back where the spine connects with the hips).

Symptoms include:

  • Pain and swelling in the fingers or toes
  • Silver or grey scaly spots on the skin of the scalp, elbows, knees or lower back
  • Fingernails or toenails lifting up from the skin or getting small holes in them
  • Pain and swelling at areas where tendons and ligaments attach to bone, such as the elbow or back of the heel.

Psoriatic arthritis causes not only the joints to swell, but also the surrounding tissues (muscles, skin, tendons, ligaments).  If you have psoriatic arthritis your fingers or toes may become red and swell, and have a sausage-like appearance.  Not all the fingers or toes may be involved.  Your nails might also get small holes in them (this is called pitting) or may detach from the skin.

The other common features of psoriatic arthritis include tendinitis (swelling of the tendons) and enthesitis (pain and swelling at sites where tendons and ligaments attach to the bone).  Common examples of these conditions are heel spurs, tennis elbow and tendinitis of the Achilles tendon (cord at the back of the heel).  Most people with psoriatic arthritis do not have back pain, but if you do, it will probably be worse at night and first thing in the morning, with stiffness gradually decreasing as you become more active during the day.

Diagnosis and Tests

Establishing the correct diagnosis is very important because something can be done to manage most forms of arthritis, and most therapies work best when started early in the disease.

Your doctor will probably be able to more easily diagnose you having psoriatic arthritis if you have psoriasis along with a single or several red, swollen fingers or toes.  Usually, if your nails and skin are affected along with your joints, a firm diagnosis can be made.

However, since this form of arthritis is similar to other forms such as gout, Reiter's syndrome and rheumatoid arthritis, your doctor may perform a physical examination and order various tests to assist in diagnosis.  X-rays are often ordered to look for changes to the bone.  Blood and joint fluid tests may be done to rule out other conditions such as rheumatoid arthritis, reactive arthritis or gout.

If your doctor thinks you have psoriatic arthritis, he or she will usually refer you to a rheumatologist.

Treatment and Prevention

At this time, there is no cure for psoriatic arthritis.  Once the diagnosis is confirmed, various treatments can help decrease pain and stiffness and increase movement.  Treatment of psoriatic arthritis is for both the skin condition and the arthritis.  For mild psoriatic arthritis the treatment plan usually is comprised of medication, physiotherapy and daily-living adjustments.  The patient's active involvement in developing his or her prescribed treatment plan is essential.

Non-steroidal anti-inflammatory drugs are often used to treat psoriatic arthritis.  These are a type of medication that helps reduce pain and swelling of the joints and decrease stiffness.  However, they do not prevent further joint damage.

NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose.  NSAIDs such as ASA (Aspirin, Anacin, etc.)  and ibuprofen (Motrin IB, Advil, etc.)  can be purchased without a prescription.  Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril.  The various NSAIDs and Aspirin®, if taken in full doses, usually have the same levels of anti-inflammatory effect.  However, different individuals may experience greater relief from one medication than another.  Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding.  People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).

People with severe psoriatic arthritis are often given disease modifying anti-rheumatic drugs (DMARDs).  DMARDs try to stop psoriatic arthritis from getting worse.  They can take about two to six months before they make a difference in the pain and swelling.

DMARDs may be prescribed when inflammation continues for more than six weeks or when many joints are inflamed.  DMARDs target the processes causing the inflammation, but do not reverse permanent joint damage.  The most common of them are gold salts, methotrexate, sulfasalazine, hydroxychloroquinine, chloroquinine and azathioprine.  DMARDs are often given in addition to other medications such as NSAIDs.  They usually take a few months to make a difference in the inflammation.  Side-effects may include mouth sores, diarrhea and nausea.  More serious side-effects, monitored through regular blood and urine tests, include liver damage, and excessive lowering of the white blood cell count (increasing susceptibility to certain infections) and platelet count (affecting blood clotting).

Occasionally a cortisone injection into an infected joint or tendon brings short-term relief.  Cortisone is a steroid that reduces inflammation and swelling.

For severe pain and inflammation, doctors can inject a powerful anti-inflammatory drug, called a corticosteroid, directly into the affected joint.  Cortisone is a steroid that reduces inflammation and swelling.  It is a hormone naturally produced by the body.  Corticosteroids are man-made drugs that closely resemble cortisone.  An injection can provide almost immediate relief for a tender, swollen and inflamed joint.  However, this treatment can only be used rarely, since corticosteroids can weaken the cartilage and remove the minerals from (and therefore weaken) the bone, resulting in further joint weakness.

Skin care

  • In the winter use a humidifier in your home.
  • Use creams and lotions to keep your skin from drying out.  Lanolin cream, light mineral oil, petroleum jelly, cocoa butter lotion or baby oil work well at keeping your skin moist.  Lotions containing coal tar are good for scaly patches on the skin.  Your doctor may also prescribe a corticosteroid cream.
  • Avoid using strong soaps that contain perfumes or chemicals.
  • Put baby oil into your bath water.
  • Talk to your doctor about a treatment called light therapy which can help treat psoriasis.  It involves taking a medicine called psoralen and sitting under a certain type of light.

If you have psoriatic arthritis you should also do things to care for your skin.  Using a humidifier in your house during winter months will help prevent the air, and your skin from becoming too dry.  Topical creams can be used to prevent your skin from drying out.  Light mineral oil, petroleum jelly, and cocoa butter are moisturizers that work well.  Products made of coal tar have been shown to be effective for disease sites.  Your doctor may also prescribe a corticosteroid cream.

PUVA (psoralen plus long-wave ultraviolet A light) therapy is effective for treating psoriasis.  This light therapy is a combination of a prescription medicine psoralen, taken either in tablet form or added to a bath, plus exposure to type A ultraviolet light.  Light therapy should only be attempted with your doctor's recommendation.  You may need at least 20-30 treatments over several weeks, under medical supervision.

You can also benefit from sitting in the sun for moderate periods of time.  Since sunlight slows cell growth, it can help improve your psoriasis.  However, too much sunlight can damage your skin so take steps to avoid sunburn.


  • Exercise helps reduce pain and prevents further joint damage.  It can also help you maintain a healthy weight, which puts less strain on your joints.
  • Not using a sore joint will cause the muscles around it to become weak, resulting in pain.
  • The pain and swelling of arthritis can make your joints stiff.  Exercises help decrease stiffness and keep your joints moving.
  • Moderate stretching exercises will help relieve pain and keep the muscles around the affected joint more flexible and strong.
  • Too much exercise, or the wrong kind, can also make psoriatic arthritis worse.  Talk to your doctor before starting an exercise program.

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function.  Exercise can help lessen the pain and stiffness of psoriatic arthritis and can help make you feel better overall.  There are different types of exercises:

  • Range of motion exercises reduce stiffness and help keep your joints moving.  A range of motion exercise for your shoulder would be to move your arm in a large circle.
  • Strengthening exercises maintain or increase muscle strength.
  • Endurance exercises strengthen your heart, give you energy and control your weight.  These exercises include walking, swimming and cycling.
  • Moderate stretching exercises help relieve the pain and keep the muscles and tendons around an affected joint flexible and strong.

Too much exercise, or the wrong kind, can also make psoriatic arthritis worse.  Consult your doctor or physiotherapist before beginning an exercise program.


  • Applying heat helps relax aching muscles, and reduces pain and soreness.  For example, take a hot shower.
  • Applying cold helps to lessen the pain and swelling.  For example, put an ice pack on the area that is sore.

Heat or cold application can provide temporary relief of pain.  Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area.  There is some concern that heat may worsen the symptoms in an already inflamed joint.  Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint.  Applying ice or cold packs appears to decrease inflammation and therefore is the method of choice when joints are inflamed.

Protect your joints

  • Be kind to your body.  After doing heavy work, or doing the same task over and over, stop.  Slow down by doing an easy task, or by taking a rest.
  • Use your back, arms and legs in safe ways to avoid putting stress on joints.  For example, carry a heavy load close to your body.
  • Use helpful devices such as a cart to carry your grocery bags, or an enlarged handle that fits over a knife handle so you can hold it easily.  A cart will help you to walk more safely.  A grab bar, which attaches to a shower, will help you to get in and out of the tub more easily.
  • Consider getting a splint to hold your joints in a comfortable position at night or while you work.  A splint can help decrease pain, swelling and stiffness.

Protecting your joints means using them in ways that avoid excess stress.  Benefits include less pain and greater ease in doing tasks.  Three main techniques to protect your joints are:

  1. Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.
  2. Positioning joints wisely helps you use them in ways that avoid extra stress.  Use larger, stronger joints to carry loads.  For example, use a shoulder bag instead of a hand-held one.  Also, avoid keeping the same position for a long period of time.
  3. Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier.  Small appliances such as microwaves, food processors and bread makers can be useful in the kitchen.  Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.

Splints may be useful if you have joint inflammation, or problems with joint alignment or stability.  They can help rest your joints at night, or hold the joints in a comfortable position while working.  This, in turn, helps decrease joint pain, swelling and stiffness.  Your doctor will be able refer you to a therapist who can help find the best splint for you.


  • Relaxing the muscles around an inflamed area reduces pain.
  • There are many ways to relax.  Try deep breathing exercises.  Listen to music or relaxation tapes.  Meditate or pray.  Another way to relax is to imagine or visualize a pleasant activity such as lying on a beach, or sitting in front of a fireplace.
  • Developing good relaxation and coping skills can give you a greater feeling of control over your arthritis and a more positive outlook.

If one of your joints becomes badly damaged your doctor may recommend surgery.  Surgery for psoriatic arthritis usually is done to replace a joint with a man-made joint.

Some people with severe, advanced psoriatic arthritis may require surgery.  Benefits include less pain, better movement and function, and in some cases, better physical appearance, such as in the hands.  Joint replacement surgery is done to replace joints damaged by arthritis with artificial joints.

Learn as much as you can about this disease.  Speaking with people who are specialists in arthritis care can provide you with the information you need.

Psoriatic Arthritis suggests the following may be present:


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Psoriatic Arthritis can lead to:



About one person in 20 suffering from psoriasis can get joint troubles, with a degree of arthritis affecting the back, or large or small joints of the body.  This arthritis is rare, but worth looking into if you have psoriasis and an aching spine or joints.

Recommendations for Psoriatic Arthritis:


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Weak or unproven link: may be a sign or symptom of
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Strong or generally accepted link: is often a sign or symptom of; often suggests
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Definite or direct link: usually leads to
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Moderately useful: often helps with
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