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Psoriatic Arthritis

Psoriatic Arthritis

Introduction - What is Psoriatic Arthritis?

Psoriatic arthritis is a form of arthritis that may develop in people who have psoriasis, a chronic, inflammatory skin disease which has no cure. Psoriatic arthritis affects 5% to 42% of people with psoriasis11375  and usually develops about 10 years after the development of psoriasis. In early childhood, females are more likely to develop psoriatic arthritis, but in adulthood, males and females are equally affected.11421 

Symptoms of psoriatic arthritis usually develop between the ages of 25 and 45.11650  These symptoms include warm, red, inflamed skin overlying the affected joints. Red patches of scaly skin (psoriatic plaques) are often present as well.11675,  11375 

Psoriatic arthritis is similar to several other diseases that cause inflammatory arthritis. These diseases include ankylosing spondylitis, reactive arthritis, and arthritis associated with inflammatory bowel disease.11636 

Causes of Psoriatic Arthritis

The exact cause of psoriatic arthritis is unknown. However, the disease is thought to be caused by a combination of factors working together. Genetics (how disease is passed down through families), immunology (how the body works to fight off disease), and the environment may act together to help develop or worsen the disease.11421 

Genetics

Psoriatic arthritis tends to run in families. More than 40% of patients with psoriatic arthritis have a family history that includes psoriatic arthritis or psoriasis.11421  If you have a close relative with psoriatic arthritis or psoriasis, you are more likely to develop psoriatic arthritis yourself.11653,  11680 

Researchers have discovered a gene that increases the likelihood of developing psoriatic arthritis. This gene is called the human leukocyte antigen B27 (HLA-B27) gene, and it is found in some ethnic groups more than others. There are other genes that may also play a role in the development of the disease, but HLA-B27 is the most common one.11657 

Immunology

Normally, when infectious agents like bacteria and viruses invade the body, the immune system responds by causing inflammation.11401  This inflammation helps to get rid of the invading organisms. However, in patients with psoriatic arthritis, there is too much inappropriate inflammation, and this is what causes the joints and tissues to become swollen and painful.11402,  11403 

Environment

Exposure to certain bacteria or viruses may be more likely to lead to infection in patients with psoriatic arthritis.11651  In addition, trauma may be associated with the development of psoriatic arthritis as well.11652 

Symptoms of Psoriatic Arthritis

Most people with psoriatic arthritis are diagnosed with psoriasis first. If you have psoriasis or think you may have psoriasis, please talk to your health care provider. Your health care provider will be able to discuss your psoriasis with you.

Symptoms of psoriatic arthritis range from mild to severe and disabling.11389,  11677  The main features of psoriatic arthritis include:

  • Red, warm, inflamed skin with or without scaly plaques

  • Swollen, sausage-shaped fingers

  • Joint pain

  • Joint swelling

  • Soft tissue swelling

  • Nail pitting and crumbling

  • Back pain and/or neck pain11375,  11675 

Psoriatic arthritis usually begins in one joint and then spreads to other joints. Psoriatic arthritis is different from the more commonly known rheumatoid arthritis in a number of ways. Most notably, a patient’s blood sample does not usually test positive for the rheumatoid factor. Rheumatoid arthritis is a similar disease, but it affects the same joints on both sides of the body at the same time. Also, psoriatic arthritis may affect the spine, while rheumatoid arthritis does not.11421 

Figure 3145 – Psoriatic Arthritis

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Winchester R. Psoriatic Arthritis. In: Wolff K, et al., eds. Fitzpatrick’s Dermatology in General Medicine, 7th Ed. New York, NY: McGraw-Hill; 2008, 194-207 (chap 19). Figure 19-1, page 195. Copyright McGraw-Hill. All rights reserved.

11421

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Occasionally, psoriatic arthritis may resemble other types of arthritis. In such cases, it is important for the health care provider to look for signs of psoriasis in hidden areas of the body, such as the scalp, perineum, or the umbilicus. If you think you might have psoriasis or psoriatic arthritis but aren’t sure, talk to your health care provider.11430 

Diagnosis of Psoriatic Arthritis

There is no specific diagnostic test for psoriatic arthritis. If you think you are experiencing symptoms of psoriatic arthritis, it may be necessary to discuss these with your health care provider. You may need to see a dermatologist or rheumatologist (doctor who treats diseases of the joints and soft tissues) to determine whether or not you have psoriatic arthritis or a similar disease.

In addition to taking a careful history and physical exam, your health care provider may need to do blood tests or Xrays to make the proper diagnosis.11636 

Complications of Psoriatic Arthritis

In addition to problems with the nails and skin, patients with psoriatic arthritis may have a higher risk of developing certain eye problems, heart disease, and kidney failure.11421,  11396,  11678 

Treatment of Psoriatic Arthritis

The severity of the patient’s condition and the features of the disease help determine the level of treatment necessary. Treatment options include medications, physical and occupational therapy, and in rare cases, surgery.

Any drug chosen by your health care provider is based upon your individual situation, including your symptoms, other medications you may be taking, response to previous treatments, and other factors. Only your health care provider can help you decide when a treatment is right for you.

Medications

Listed below are examples of categories of drug therapies used in the treatment of psoriatic arthritis11605  :

  • Topical creams and ointments

  • Corticosteroids

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Disease-modifying antirheumatic drugs

  • Biologics

Surgery

Most patients with psoriatic arthritis are able to manage their disease with medications and physical therapy. However, in rare cases, joint destruction may become extensive, requiring surgery to replace severely damaged hip or knee joints.11421,  11396 

Physical Therapy

It is important for patients with psoriatic arthritis to work on improving movement of the joints, as well as improving muscle strength and flexibility. Physical and occupational therapy may help in the management of these issues, and should be necessary components of any treatment regimen. All patients should be cautioned against repetitive joint stress that can worsen their condition.11421 

Discussing Psoriatic Arthritis With Your Doctor

Your dermatologist or rheumatologist will need to know about the effectiveness of your past treatments as well as how psoriatic arthritis is affecting your quality of life. It’s often a good idea to write down any questions you want to ask your dermatologist or rheumatologist before your appointment so you won’t forget to ask them during your visit. Your dermatologist or rheumatologist will ask questions to help determine the most effective psoriatic arthritis treatment for you. If you do not understand your doctor’s answers, don’t be afraid to ask for further explanation.

Questions Your Doctor May Ask You About Your Psoriatic Arthritis

  • Do you have pain in your joints?

  • Do you have swelling or fluid around your joints?

  • Are these symptoms the same on the left- and right-hand sides of your body?

  • How do your joint problems affect your daily activities?

  • Do you have family members with psoriatic arthritis or psoriasis?

  • What treatments are you taking or have you taken in the past?

  • How has your condition affected your life?

Questions You May Want to Ask Your Doctor About Your Psoriatic Arthritis

  • What are the potential short-term and long-term effects of psoriatic arthritis?

  • Do I have any joint damage?

  • Can psoriatic arthritis continue to damage my joints even if I am taking medical therapies?

  • Will I need to have surgery?

  • How will I know if my psoriatic arthritis is under control?

  • What are the benefits and risks of treatment for my psoriatic arthritis?

Additional Information and Resources for Psoriatic Arthritis

The National Psoriasis Foundation provides information on psoriasis and psoriatic arthritis. You may visit the National Psoriasis Foundation website for further information and to find support groups in your area:

http://support.psoriasis.org/home

Or, you may contact them at the following address:

National Psoriasis Foundation

6600 SW 92nd Ave., Suite 300

Portland, OR 97223-7195

Phone: 503.244.7404 OR 800.723.9166

Fax: 503.245.0626

E-mail: getinfo@psoriasis.org

For questions about psoriasis and/or psoriatic arthritis:

Phone: 503.244.7404 x361 OR

Email: educator@psoriasis.org

Online Resources

There are many online resources with information on psoriasis and psoriatic arthritis, including the following:

This concludes the discussion of the topic Psoriatic Arthritis. We encourage you to read other topics on the MEDVERSATION™ website.

Content on this page was last changed on January 13, 2010.

References:

11375.  Brockbank J, Gladman DD. Psoriatic arthritis. Expert Opin Investig Drugs . 2000;9(7):1511-1522.
11389.  National Psoriasis Foundation. About psoriatic arthritis - The five types of psoriatic arthritis. National Psoriasis Foundation website. www.psoriasis.org/about/psa/types.php . Updated October 2005. Accessed December 11, 2008.
11396.  Bennett RM. Psoriatic arthritis. In: Koopman WJ, Moreland LW, eds. Arthritis and Allied Conditions . 15th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2005:1357-1374.
11401.  Prens E, Debets R, Hegmans J. T lymphocytes in psoriasis. Clin Dermatol . 1995;13(2):115-129.
11402.  Nestle FO, Turka LA, Nickoloff BJ. Characterization of dermal dendritic cells in psoriasis. Autostimulation of T lymphocytes and induction of Th1 type cytokines. J Clin Dermatol . 1994;94(1):202-209.
11403.  Costello P, Bresnihan B, O’Farrelly C, FitzGerald O. Predominance of CD8+ T lymphocytes in psoriatic arthritis. J Rheumatol . 1999;26(5):1117-1124.
11421.  Winchester R. Psoriatic arthritis. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds. Fitzpatrick’s Dermatology in General Medicine . 7th ed. New York, NY: McGraw-Hill; 2008:194-207.
11430.  Baker H. Epidemiological aspects of psoriasis and arthritis. Br J Dermatol . 1966;78(5):249-261.
11605.  Mease P. Current treatment for psoriatic arthritis and other spondyloarthritides. Rheum Dis Clin North Am . 2006;32(suppl 1):11-20.
11636.  Mease P, Goffe BS. Diagnosis and treatment of psoriatic arthritis. J Am Acad Dermatol . 2005;52(1):1-19.
11650.  National Psoriasis Foundation. About psoriatic arthritis: the basics. National Psoriasis Foundation website. http://www.psoriasis.org/about/psa/basics.php . Updated October 2005. Accessed December 9, 2008.
11651.  Reveille JD. Seronegative spondyloarthropathies. In: Klippel JH, Crofford LJ, Stone JH, Weyand CM, eds. Primer on the Rheumatic Diseases . 12th ed. Atlanta, GA: Arthritis Foundation; 2001:239-245.
11652.  O’Neill T, Silman AJ. Psoriatic arthritis. Historical background and epidemiology. Baillières Clin Rheumatol . 1994;8(2):245-261.
11653.  Veale DJ, Ritchlin C, FitzGerald O. Immunopathology of psoriasis and psoriatic arthritis. Ann Rheum Dis . 2005;64(Suppl 2):ii26-ii29.
11657.  Balding J, Kane D, Livingstone W, et al. Cytokine gene polymorphisms: association with psoriatic arthritis susceptibility and severity. Arthritis Rheum . 2003;48(5):1408-1413.
11675.  Bennett RM. Psoriatic Arthritis. In: Koopman WJ, Moreland LW, eds. Arthritis and Allied Conditions. 15th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2005: 1357-1374.
11677.  Landells, I. The Skin Care Guide. The Role of the Dermatologist in the Identification and Treatment of the Early Stages of Rheumatoid Arthritis. The Skin Care Guide website. Available at: http://www.skintherapyletter.com/2008/13.4/2.html. Accessed September 24, 2008
11678.  Biondi-Oriente C, et al. Psoriasis and psoriatic arthritis. Dermatological and rheumatological cooperative clinical report. Acta Derm Venereol Suppl (Stockh). 1989;146:69-71.
11680.  Moll JMH and Wright V. Familial occurrence of psoriatic arthritis. Ann Rheum Dis. 1973;32:181-201
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