About Psoriatic Arthritis

Overview

Psoriatic arthritis (PsA) is a chronic (long-lasting or recurring) disease related to the immune system. It causes swelling, pain, and stiffness in your joints and entheses (places where tendons and ligaments connect to bones). Psoriatic arthritis can develop at any age.[1] The severity of your psoriasis (mild, moderate, severe) does not affect the risk of developing psoriatic arthritis.

Roughly 1 in 3 people living with psoriasis also have psoriatic arthritis [2]; typically, with psoriasis developing before psoriatic arthritis.[1] While as many as 2.4 million Americans live with psoriatic arthritis, more than 15% of people living with psoriasis may also have undiagnosed psoriatic arthritis.[3]

Images courtesy of Evan L. Siegel M.D.

Domains of Psoriatic Arthritis

PsA can occur in any joint or wherever your ligaments and tendons connect to bone, most commonly affecting the finger joints and knees. You may experience PsA symptoms in certain areas of your body, which are commonly called domains. The six domains of psoriatic arthritis include spondylitis (e.g., back involvement), enthesitis, dactylitis, peripheral arthritis, psoriasis, and nail changes.

Causes & Triggers

Like psoriasis, the cause of psoriatic arthritis is not completely known. The immune system and genetics play a role in the development of psoriatic arthritis. Having a first-degree relative with psoriatic arthritis increases your risk of developing psoriatic arthritis. [2] Other factors likely contribute to developing psoriatic arthritis, including environmental factors and infections.

A psoriatic arthritis flare may include new or increased joint pain, tenderness, swelling, or stiffness. Flares can last for different amounts of time and differ in level of severity.

Triggers are different from person to person. What may worsen your psoriatic arthritis might not have any impact on someone else. Common psoriatic disease triggers include:

• Stress
• Smoking or alcohol use
• Injuries or trauma to the skin or joints
• Illness, such as infections
• Certain medications
• Changes in weather
• Diet

Learn more about triggers and flares by requesting a free Flare Guide and Symptom Tracker.

Diagnosis

Psoriatic arthritis is largely a clinical diagnosis, meaning there is no specific diagnostic test. The diagnosis is made by a doctor’s evaluation of your history, physical exam, labs, and imaging, as well as excluding other possible causes for your symptoms, such as rheumatoid arthritis and gout.   

Psoriatic arthritis is best diagnosed and treated by a rheumatologist (a doctor who specializes in the diagnosis and treatment of diseases that affect the muscles, joints, and bones and related immune-mediated conditions). Early diagnosis and treatment can not only help relieve symptoms but may also help prevent permanent joint damage. Your rheumatologist will work with your dermatologist.

To make a diagnosis of psoriatic arthritis, your rheumatologist may consider several factors:

• Examination of your skin, joints, and nails
• X-rays
• MRI scans
• Ultrasounds
• Blood tests

Each step will help to rule out other conditions and lead to an accurate diagnosis.

Until a diagnostic tool for psoriatic arthritis is developed, it may take a few appointments with a rheumatologist to get the correct diagnosis. Although it may take time, getting an accurate diagnosis is very important for managing your symptoms, preventing permanent joint damage, and caring for your overall health.

Screening for Psoriatic Arthritis

If you think you may have psoriatic arthritis, you can learn more by taking a short 5-question quiz. You can share the results with your health care provider. The quiz is based on the Psoriasis Epidemiology Screening Tool (PEST).

Treatment & Management

Treating psoriatic arthritis is important to help lessen pain, reduce inflammation, help keep joints healthy, and possibly prevent permanent joint damage. Generally, biologic, biosimilar, and oral systemic treatments are prescribed to treat psoriatic arthritis.

• Biologics and biosimilars are medications made from living cells that are given as an injection or intravenous (IV) infusion. Biosimilars are medications that are modeled after a biologic that has already been approved by the FDA. They target specific proteins in the immune system that play a role in psoriatic arthritis.
• Oral systemic treatments are medications taken by mouth, most often in the form of a pill. There are several oral systemic treatment options that treat psoriatic arthritis. These treatments work by targeting the immune system.

Prevention

There is no known way to prevent the onset of psoriatic arthritis, however, there are many ways that you can manage your triggers to reduce flares.

Outlook/Prognosis

Psoriatic disease is lifelong, and symptoms may resolve and recur throughout the lifetime.

While there is no cure for psoriatic arthritis, treatments today are more effective than ever before and research into new treatments, as well as a cure, is ongoing. Treating psoriatic arthritis can help improve symptoms, prevent joint damage, and may decrease the associated inflammation that can lead to comorbidities such as heart disease, diabetes, anxiety, and depression.

Life with Psoriatic Arthritis

As with other chronic diseases, psoriatic arthritis may affect a variety of areas of your life including your physical and mental health, participation in social activities, and your work life. Learn about the importance of physical activity, pain management, and stress reduction for living with psoriatic arthritis as well as tips on how to manage your disease on the job.

Additional Resources