Psoriatic arthritis is a type of inflammatory arthritis that may occur in people who have psoriasis, a chronic autoimmune skin condition that causes rapid skin cell growth and renewal.
If not treated, psoriatic arthritis can lead to severe disability. Patients with psoriatic arthritis have a life expectancy estimated to be approximately three years shorter than the general population.
Aggressive treatment of psoriatic arthritis in the early stages can lead to a significantly improved prognosis.
What Are Symptoms of Psoriatic Arthritis?
Symptoms of psoriatic arthritis include:
- Skin rash (psoriasis)
- Red patches of skin with silvery scales (plaques)
- Commonly appears on the scalp, elbows, knees, and around the ears
- Skin redness and warmth
- Scaly and itchy skin
- Thickening skin
- Joint pain, swelling, and stiffness
- Often on one side of the body
- Pain is worse in the morning or after resting
- Can affect any joint, but commonly occurs in large joints of lower extremities such as the knees and ankles
- Reduced range of motion in the joints
- Pain and stiffness of the neck and lower back
- Hip and shoulder pain
- Heel pain and foot pain
- Fatigue
- Sausage-like swelling of fingers and/or toes
- Nails separate from nail bed
- Pitted, crumbling nails
- Eye inflammation such as pink eye (conjunctivitis)
How Is Psoriatic Arthritis Diagnosed?
Psoriatic arthritis is diagnosed with a patient history and physical examination, along with tests to help diagnose psoriatic arthritis or to rule out other conditions that can mimic psoriatic arthritis, such as:
- Lab tests
- Blood tests
- Complete blood count (CBC)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Anti-cyclic citrullinated peptide (CCP)
- Rheumatoid factor (RF)
- Blood urea nitrogen
- Uric acid
- Creatinine
- Urinalysis
- Blood tests
- Imaging tests
- X-ray
- Magnetic resonance imaging (MRI)
- Ultrasound
How Is Psoriatic Arthritis Treated?
While there is no cure for psoriatic arthritis, early and aggressive treatment of psoriatic arthritis can lead to a significantly improved prognosis and treatment is aimed at relieving symptoms and preventing further joint damage.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin, and celecoxib (Celebrex) can be used to treat pain and inflammation in mild cases of psoriatic arthritis.
More severe cases of psoriatic arthritis may be treated with:
- Corticosteroid injections into the joints
- Disease-modifying antirheumatic drugs (DMARDs)
- Hydroxychloroquine (Plaquenil)
- Methotrexate (Rasuvo, Otrexup, Xatmep, Trexall)
- Sulfasalazine (Azulfidine EN-tabs, Azulfidine)
- Azathioprine (Azasan)
- Apremilast (Otezla)
- Leflunomide (Arava)
- Biologics (antitumor necrosis factor (TNF) agents)
- Ustekinumab (Stelara)
- Abatacept (Orencia)
- Secukinumab (Cosentyx)
- Ixekizumab (Taltz)
- Tofacitinib (Xeljanz)
- Topical treatments
- Retinoid and steroid creams
- Prescription vitamin D creams
- Over-the-counter or prescription salicylic acid creams, gels, and shampoos
- Immunosuppressants
- Cyclosporine (for severe cases that do not respond to other systemic treatments)
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https://www.niams.nih.gov/Health_Info/Psoriatic_Arthritis/default.asp
https://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics
https://creakyjoints.org/
https://www.arthritis.org/
https://pubmed.ncbi.nlm.nih.gov/25603589/
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis