Psoriatic Arthritis: Understanding The Condition, Symptoms & Treatment

If you or someone you know has psoriasis, it's important to realize they could have a greater chance of developing psoriatic arthritis (PsA), an inflammatory joint condition. Psoriatic arthritis affects 1.5 million people in the U.S. and can cause joint discomfort, edema and stiffness.

"When a person has inflammation of the joints, it is commonly caused by arthritis," said Gina Saylor, ANP-BC, at Franciscan Physician Network Rheumatology and Osteoporosis Specialists in Franklin, Indiana.

Psoriatic arthritis is different from other types of arthritis. It is associated with psoriasis, a skin condition that shows up as red, scaly areas on the skin.

"PsA is an autoimmune disease. The abnormal inflammation can lead to problems with bone erosion and joint inflammation," said Saylor. "While PsA affects the joints and connective tissue, psoriasis affects only the skin."

Who Is At Risk For Psoriatic Arthritis?

PsA can affect anyone, but some factors can put a person at greater risk for psoriatic arthritis. Age, gender and family history are a few PsA risk factors.

"It can develop at any age, even in children," said Saylor. But the most common age PsA develops is between 30 and 50. "It doesn't always occur, but most times, about 30% of patients with psoriasis can develop psoriatic arthritis," said Saylor.

There is evidence that genetics can contribute to PsA development, too. According to studies, common genes are more prevalent in patients with PsA, making them more susceptible to the condition.

"If you have a first-degree family relative with the gene, there's a 40% chance you could develop psoriatic arthritis," said Saylor. However, not everyone with the genes will develop PsA.

The American College of Rheumatology says other risk factors for psoriatic arthritis include:

• Strep throat: It is suspected that the strep infection may be a trigger.
• Obesity
• Severe psoriasis
• Stressful events
• Trauma to the joints or bones
• Infections

According to a study published recently in the journal JAMA Dermatology, there seems to be a causal effect between inflammatory bowel disease and psoriasis/PsA.

PsA can take several years between the actual psoriasis skin rash and developing arthritis, sometimes as long as seven or eight years.

Psoriatic arthritis comes in five forms:

• Affects small joints in fingers and/or toes
• Asymmetrical arthritis in the hands and feet of one side or the other
• Symmetrical polyarthritis: similar to rheumatoid arthritis and affects both sides equally in multiple joints
• Arthritis mutilans: rare, destroys and deforms joints
• Psoriatic spondylitis: arthritis of the lower back and the spine.

What Are The Symptoms Of Psoriatic Arthritis?

Psoriatric arthritis symptoms might differ for each person but are associated with joint pain and swelling.

"A person can have something we call dactylitis or a sausage digit," said Saylor. Generally, one finger or toe becomes red, puffy or swollen, a sign of psoriatic arthritis.

Other symptoms of PsA include:

• Fatigue is a common problem for people with psoriatic arthritis. According to the National Psoriasis Foundation, some studies show that half of all people with psoriatic arthritis have moderate-to-severe fatigue.
• Conjunctivitis, characterized by redness and pain in tissues surrounding the eyes
• Inflammation of tendons and ligaments, called enthesitis
• Joint pain, frequently in the foot or ankle
• Morning stiffness that takes about 30 minutes to go away
• Nail changes such as pitting or nails separating from the nail bed
• Skin symptoms, such as red, scaly spots on the skin

"A percentage of the PsA population also experiences spine pain, usually, the lower spine, the lumbar region or the sacroiliac joints (two joints that link the pelvis and lower spine)," Saylor said.

How Is Psoriatic Arthritis Treated?

Because it affects both the skin and joints, psoriatic arthritis is a complex condition to treat, according to the Arthritis Foundation. Although there is no known cure for psoriatic arthritis, many treatments can help manage symptoms and slow the disease's progression.

"Over the last 20 years, many advances in medication treatment have helped patients improve," said Saylor. Medicine often controls and relieves symptoms and treats skin problems and joint inflammation.

Treatments include a combination of therapies comprised of medications and non-drug therapies such as exercise, massage, heat and cold. Doctors often recommend nonsteroid anti-inflammatory and disease-modifying antirheumatic medications to control the disease.

"It's wonderful to see how patients can control their symptoms with newer treatments, and it's so gratifying to be able to help them," Saylor said. Other treatments for PsA include joint injections, physical therapy, occupational therapy, massage therapy and aquatic therapy.

Lifestyle Changes To Help PsA Symptoms

Lifestyle changes and treatment options for PsA include:

• Get plenty of sleep.
• Get regular exercise to help ease pain and boost energy.
• Manage your weight.
• Eat a nutritious, well-balanced diet.
• Limit alcohol, use only in moderation.
• Prioritize your to-dos and pace yourself throughout the week.
• Quit smoking.

While psoriatic arthritis can be a life-altering diagnosis, with proper treatment and lifestyle adjustments, many people with this condition can continue to live an active, fulfilling life.