Psoriatic arthritis is a form of arthritis that affects people who have the skin condition psoriasis, which features red patches of skin topped with silvery scales.
According to the National Institutes of Health (NIH), approximately 2.2% of the United States population (7 million people) has psoriasis. About 15% to 25% of patients with psoriasis experience painful joints and tendons. In a majority of the cases, psoriasis affecting skin precedes the development of psoriatic arthritis affecting joints.
There are no specific diagnostic tests available for psoriatic arthritis. Usually it is associated with lab findings such as elevated systemic inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lack of rheumatoid factor (RF). Affected joint fluids also show features of active inflammation.
Psoriatic arthritis can affect any joint of your body. It can affect joints on just one side or on both sides of your body. Most commonly affected are the joints of hands, wrists, ankles and feet. It can also affect the spine, especially the lower back and pelvis.
Painful joints that hurt more with movement involving the affected joints are the main symptoms of psoriatic arthritis. Patients may also experience stiffness and pain due to inflammation of tendons and ligaments around the affected joints. Symptoms can range from relatively mild to severe.
Common psoriatic arthritis symptoms
• Painful fingers and toes: Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
• Foot pain: Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
• Lower back pain: Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).
• Stiffness and soreness: The affected part of the body and its surrounding areas may feel very stiff and sore to move.
Psoriatic arthritis tends to get worse over time, but you may have periods when your symptoms improve or go into remission alternating with periods when symptoms become worse.
• Symptomatic treatment with medications to decrease inflammation are often the first course of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. For more severe cases, oral steroids as needed.
• Disease-modifying antirheumatic drugs (DMARDs) can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage.
• Pain management can help patients become more functional and less limited as to what they can do because of pain. Corticosteroid injections can be done into inflamed joints and around inflamed tendons. Back injections can be done to help pain coming from the joints of the spine and pelvis.
• Treating pain with occasional pain medications can help patients participate in physical therapy and achieve and maintain their functional goals.
Finally, lifestyle modifications are important. Maintaining a healthy weight and doing low-intensity aerobic exercise to maintain the flexibility and strength of muscles could go long way. Choosing exercises like biking, swimming and walking — which are less stressful on the joints — are better. Using assisting devices like can openers to open lids and doing tasks in installments rather than all at once could help you get the job at hand done without feeling tired and in pain.
Psoriatic arthritis may not be curable, but it is treatable. Interventional pain management is a vital part of giving the patient a fuller enjoyment of life.
Want to learn more about psoriatic arthritis? Read “Psoriatic Arthritis Symptoms, Treatment, and Diagnosis” and “How Psoriasis Can Lead to Psoriatic Arthritis.”