Psoriatic Arthritis

Psoriatic Arthritis

What is psoriatic arthritis? — Psoriatic arthritis is a condition that causes joint pain, swelling, and stiffness. It happens in people who have a long-term skin condition called psoriasis. People with psoriasis have patches of thick, red skin that are often covered by silver or white scales (picture 1).
Doctors don't know what causes psoriasis or psoriatic arthritis.
What are the symptoms of psoriatic arthritis? — Psoriatic arthritis causes pain, stiffness, and swelling in the affected joints (picture 2). It can also affect the spine in some people. Because of the joint and spine problems, people can have trouble moving their body. Stiffness in the joints or low back is usually worse in the morning and lasts 30 minutes or longer. It usually gets better with exercise.
Psoriatic arthritis can affect joints on one or both sides of the body. It usually affects more than one joint.
In addition to joint symptoms (and the skin symptoms of psoriasis), people sometimes have other symptoms. These can include:
Swelling of a finger or toe, or the hands or feet
Swelling and pain in the back of the ankle or in the heel
Nail symptoms – The nails can look "pitted," as if they were pricked by a pin. The nail can also come up off the nail bed (picture 3).
Eye pain or redness
Is there a test for psoriatic arthritis? — Yes. Your doctor or nurse will ask about your symptoms and do an exam. He or she will order X-rays of your painful joints. He or she might order an imaging test called an MRI. Imaging tests create pictures of the inside of the body.
To check that another condition isn't causing your symptoms, your doctor or nurse might also order:
Blood tests
Lab tests on a sample of fluid from a swollen joint – To get a sample of fluid, the doctor will put a thin needle in your joint.
How is psoriatic arthritis treated? — There is no cure for psoriatic arthritis, but different treatments can help ease and control symptoms. Treatment for joint symptoms usually involves one or more of the following:
Medicines called nonsteroidal antiinflammatory drugs, or "NSAIDs" for short – Examples of NSAIDs are aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand name: Aleve).
Medicines that are usually used to treat other types of arthritis – Some of these include methotrexate and leflunomide.
Medicines that block a substance called tumor necrosis factor, or "TNF" for short – TNF plays a role in psoriasis and psoriatic arthritis. Medicines that block TNF are called "anti-TNF" medicines. Examples include etanercept (brand name: Enbrel) and adalimumab (brand name: Humira).
Other medicines – If the options above don't help, your doctor might suggest trying a different medicine. Examples include ustekinumab (brand name: Stelara), secukinumab (brand name: Cosentyx), tofacitinib (brand name: Xeljanz), abatacept (brand name: Orencia), and apremilast (brand name: Otezla).
Shots of medicines called steroids that go into the painful joint – These are not the same as the steroids some athletes take illegally. These steroids help reduce swelling and pain.
Heat – Heat, especially in the morning, can help reduce pain and stiffness. Do not use heat for longer than 20 minutes at a time. Also, do not use anything too hot that could burn your skin.
Physical and occupational therapy – This involves learning exercises, movements, and ways of doing everyday tasks.
Special shoe inserts (called "orthotics") – These can help keep your feet, ankles, and knees in the proper position.
Treatment for psoriatic arthritis is usually long term. That's because even after symptoms get better, they sometimes return later on.
Is there anything I can do on my own to feel better? — Yes. It is very important that you stay active. You might want to avoid being active because you are in pain. But this can make things worse. It can make your muscles weak and your joints stiffer than they already are. Your doctor, nurse, or physical therapist can help you figure out which activities and exercises are right for you.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 86739 Version 8.0
Release: 28.2.2 - C28.105
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