What Is Psoriatic Arthritis?

Psoriatic arthritis (PsA) is an autoimmune condition that causes inflammation in the joints and skin. While the exact cause of PsA is unknown, researchers do know that a dysfunction in the body accidentally forces the immune system to attack healthy skin and joint cells.

PsA mostly occurs in people with pre-existing psoriasis—a condition that causes thick, inflamed patches on the skin. Up to 30% of people with psoriasis can develop PsA. In rare cases, you might experience joint symptoms first and skin-related concerns later.

Most people who receive a PsA diagnosis are between the ages of 30 and 50, but anyone can develop the condition, including children. No two cases of PsA are the same, however. Some people might experience a slow disease progression with mild symptoms, while others can have severe symptoms that develop rapidly.

There is no cure for PsA symptoms. But, a variety of treatments can help you better manage your condition. Your healthcare provider may work with a variety of specialists to create a care team that can support you with your diagnosis. Your care team may recommend treatments such as medications, topical creams, and lifestyle changes—all of which can reduce symptoms and improve your overall quality of life.

Types

There are five types of PsA, which include:

• Distal interphalangeal predominant: This type of PsA affects the distal joints (or, your fingers and toes). Because these joints are close to the nails, you may also experience nail psoriasis symptoms such as discoloration, pitting (holes), and nail bed separation.
• Asymmetric oligoarticular: Also known as asymmetric PSA, this type affects a joint on one side of the body but not the other. For example, if you have pain or stiffness in your left elbow, you may not have any symptoms in your right elbow. Typically, asymmetric PsA affects five joints or less.
• Symmetric polyarthritis: This is the most common type of PsA and affects the same joints on both sides of the body. If you have this type of PsA, you may notice symptoms in five or more joints.
• Spondylitis: A type of PsA that affects the spine. You may also experience symptoms in your lower back, neck, and sacroiliac (pelvic) joints.
• Arthritis mutilans: Less than 5% of people with PsA have this type. Arthritis mutilans is the most severe type of PsA and causes painful inflammation that can deform and damage the function of the joints. As a result, you may also experience bone loss. Generally, this type mostly affects the hands and feet.

Symptoms

PsA symptoms vary from person to person and can depend on the type of PsA you have. In general, the most common symptoms are:

• Joint pain and swelling
• Stiffness in the joints, especially after being idle or waking up in the morning
• Limited range of motion, or difficulty moving joints around
• Thick and discolored patches on the skin
• "Sausage digits", or swollen fingers and toes that can resemble a sausage
• Feeling more tired than usual
• Nail psoriasis symptoms such as discoloration, pitting, or nail bed separation
  
• Inflammation in other parts of the body such as the eyes or chest

PsA symptoms may also range from mild to severe. Symptoms may not always be persistent—you may have periods where symptoms worsen (flare-ups) and periods where you have no symptoms at all (remission).

Causes

The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains that the cause for most autoimmune diseases (including PsA) is unknown. While researchers are still looking for an exact cause, they do know that a combination of medical, genetic, and environmental factors can trigger the onset of symptoms.

Specific risk factors include:

• Medical: Having pre-existing psoriasis
• Genetic: Being born with a human leukocyte antigen (HLA) gene or having at least one immediate family who also has PsA
• Environmental: Experiencing previous joint trauma or injury, being obese, having a viral or bacterial infection (e.g., strep throat, HIV), using excessive amounts of alcohol and tobacco

It's also important to note that people between the ages of 30 and 50 can be at increased risk of developing PsA. This is because a psoriasis diagnosis and PsA diagnosis don't occur at the same time. It takes an average of 10 years for people with psoriasis to develop PsA symptoms.

Diagnosis

PsA can be hard to diagnose because it can mimic other arthritis conditions (e.g., rheumatoid arthritis). There is also no single test that detects PsA.

Typically, your healthcare provider will consult with other specialists during the diagnostic process to confirm a PsA diagnosis and rule out other conditions. These specialists will make up your care team, which may include:

Your care team will use a variety of diagnostic measures before providing you with a diagnosis. Your testing process might include:

• Medical history questionnaire
• Physical exam
• Imaging tests (e.g., X-rays, MRIs, ultrasounds)
• Blood testing

Before you go in for testing, you may want to keep a log of your symptoms and how long you have been experiencing them. This can help your care team learn about your health and understand the severity of your condition.

If you think you may be at risk for developing PsA or have noticed changes to your joints and skin, it is a good idea to get tested. Getting an early diagnosis can help you start treatment sooner and avoid severe joint damage and disability.

Treatment

There is no cure for PsA. But, your care team may recommend a variety of treatments to help you manage your condition.

Medication

Medication is the first line of treatment your providers recommend before offering other treatment options. Common medications for PsA include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can help reduce joint pain and swelling. You can find them over-the-counter or your care team may prescribe them to you. Some common NSAIDs are Advil or Motrin (ibuprofen) and Aleve (naproxen).
• Disease-modifying antirheumatic drugs (DMARDs): These drugs help reduce inflammation in your immune system and keep it from attacking healthy cells. Otrexup (methotrexate) and Arava (leflunomide) are standard options for DMARDs.
• Biologic DMARDs: A newer type of DMARDs that are delivered via at-home injections or intravenous (IV) infusion at a hospital or clinic. Biologics target proteins in the immune system to help slow disease progression. Options for biologics include Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab).
• Targeted DMARDs: These medications are oral pills that attack the immune system cells that cause inflammation. You may choose to take certain targeted DMARDs such as Xeljanz (tofacitinib) or Rinvoq (upadacitinib).

Depending on your symptoms and your response to treatment, your care team may also suggest taking a combination of these medications.

Other Treatments

In addition to medication, your care team can also recommend:

Prevention

You cannot prevent the onset of PsA symptoms. However, if you have psoriasis, there are some steps you can take to reduce your risk of developing PsA and lower the likelihood of symptom flare-ups. While some factors (e.g., genetics) can't be modified, you may be able to control other factors like:

• Weight: Maintaing a healthy weight can reduce inflammation in your body and lower the pressure on your joints. The most beneficial weight management options are to eat a nutritious diet that is right for you and getting regular exercise.
• Skin damage: Some evidence suggests that damage or injury to your skin may increase the risk of psoriatic flare-ups and PsA symptoms. Make sure to take care of your skin, wear sunscreen, and properly clean and care for any wounds to help avoid potential infections.
• Stress: Cortisol is a hormone that your body releases when you are stressed. High amounts of cortisol can increase inflammation in your body and lead to joint pain and skin concerns. Learning to manage your stress can slow disease progression and lower the risk of flare-ups.
  

Living With Psoriatic Arthritis

Receiving a PsA diagnosis can be a big change. This condition is challenging and can significantly affect your daily life and activities. Your care team is in the best position to offer recommendations that are right for you. To help you better manage your condition, they may offer these lifestyle tips:

• Staying active: Light and low-impact exercise can help keep your joints strong and flexible. Try walking, yoga, or tai chi.
• Eating a nutritious diet: Some foods can have anti-inflammatory properties that can help you reduce symptoms. You may consider incorporating lean proteins, fatty fish, leafy green vegetables, and nuts into your diet.
• Reducing stress: Living with a chronic condition can be stressful. The good news: a variety of activities such as meditation, journaling, spending time with your loved ones, and keeping up with hobbies that you enjoy can help you manage stress. You may also find it helpful to talk to a mental health professional to learn about healthy coping methods and finding ways to make your condition feel less overwhelming.
• Limiting alcohol and tobacco use: Alcohol and tobacco can increase inflammation in your body, resulting in worsening symptoms. Giving up alcohol and tobacco can be hard, so you may want to ask your care team about how to limit your intake in a healthy way.
• Taking breaks: Decreasing strain and avoiding unnecessary pressure on your joints can improve joint-related symptoms.

Living with PsA can be painful and frustrating, but making healthy lifestyle changes can help reduce discomfort and prevent flare-ups.

A Quick Review

Psoriatic arthritis (PsA) is an autoimmune condition that causes inflammation in the joints and skin. As a result, you may experience joint stiffness, skin patches, and fatigue. The condition typically affects people who have a pre-existing psoriasis diagnosis. There are five different types of PsA and symptoms can vary based on the type of PsA you have, the severity of your condition, and your overall health.

Researchers don't know what exactly causes PsA, but a combination of genetic and environmental factors can trigger symptoms. If you begin to notice symptoms, it is good practice to make an appointment with your healthcare provider to get an official diagnosis and rule out other conditions.

Your healthcare provider may use a variety of diagnostic tests: a physical exam, medical questionnaire, imaging tests, and blood testing. If you do receive a PsA diagnosis, your provider will work with other specialists to find the treatment that is right for you.

While there is no cure for PsA, medications, topical treatments, and therapies can all help you manage your condition. You may also find it helpful to make healthy lifestyle changes to reduce symptom flare-ups and improve your overall quality of life.