About Psoriatic Arthritis
What is psoriatic arthritis?
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Psoriatic arthritis (PsA) is a form of inflammatory arthritis which causes swelling and pain in and around joints, as well as a scaly rash on the skin. Joints most affected are the fingers, wrists, toes, knees, shoulders, elbows, and ankles. In addition to joints and skin, psoriatic arthritis affects the tendons and ligaments around the joints, as well as the surrounding tissue. Psoriatic arthritis can also affect the spine - a form of the disease called psoriatic spondylitis1
Who can develop psoriatic arthritis?
Psoriatic arthritis affects men and women in equal numbers, and like many forms of inflammatory arthritis, tends to strike people in the prime of their lives. Most commonly, people are diagnosed between the ages of 30 and 502
. Between 30–55% of people with psoriatic arthritis have at least one close relative who also has psoriatic arthritis5
. However, the pattern of heritability is unknown. Certain ethnic groups, including Indigenous Peoples in Alberta, have increased prevalence of inflammatory conditions such as psoriatic disease (1.5 times more likely)3
Main symptoms of psoriatic arthritis
Psoriatic arthritis has several "hallmark" symptoms, which are often present at the onset of disease. These include4
- Pain and swelling in the joints, tendons, and ligaments fingers and toes, causing the appearance of "sausage fingers"
- Fingernails becoming detached from the nail bed or developing small pin hole sized dents (called "pitting") on the surface
- Reduced range of motion
- Morning stiffness, lasting more than one hour
Psoriatic arthritis is linked to the skin disease, psoriasis, which causes a scaly-type rash usually occurring on the elbows, knees, and scalp. Psoriasis is considered a significant risk factor for developing psoriatic arthritis - up to 20-30% of people diagnosed with psoriasis go on to develop psoriatic arthritis5
. For many people, it starts about 10 years after psoriasis develops, but some develop psoriatic arthritis first or without ever developing or noticing psoriasis5
Getting a diagnosis of psoriatic arthritis
It is important to remember that the symptoms of psoriatic arthritis often mimic other forms of arthritis, including gout and rheumatoid arthritis. For this reason, doctors often confirm a diagnosis of psoriatic arthritis by running blood tests to rule out other forms of arthritis.
Often, doctors can tentatively diagnose psoriatic arthritis if a patient has several red, swollen fingers or toes along with a case of psoriasis. If symptoms include finger or toenails lifting or "pitting", a more solid diagnosis can be made. Many patients living with psoriatic arthritis experience permanent joint damage as the disease progresses. A delay of more than 6 months between the appearance of symptoms and the first rheumatologist visit has been linked to break down within the joint and reduced physical function.10
Treatment for psoriatic arthritis
There are five major groups of medications which are used to manage symptoms and treat psoriatic arthritis. These are6
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example Advil® or Motrin IB®), naproxen (or Naprosyn®), diclofenac (or Voltaren® and Arthrotec®)
- COX-2 inhibitors, such as celecoxib (Celebrex®) or lumiracoxib (Prexige®)
- Corticosteroids, such as prednisone
- Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide (Arava®), hydroxychloroquine and azathioprine
- Biologic response modifiers (or "biologics"), including abatacept (Orencia®), adalimumab (Humira®, Abrilada®, Amgevita®, Hadlima®, Hulio®, Hyrimoz®, Idacio®, Simlandi®, Yuflyma®), certolizumab pegol (Cimzia®), etanercept (Enbrel®, Brenzys®, Erelzi®), golimumab (Simponi®), infliximab (Remicade®, Avsola®, Inflectra®, Renflexis®, Remsima®), ixekizumab (Taltz®), and secukinumab (Cosentyx®), ustekinumab (Stelara®), all of which have been approved in Canada and the United States for use in treating psoriatic arthritis.
- Targeted synthetic molecule (tsDMARD), including apremilast (Otezla®), tofacitinib (Xeljanz®), and upadacitinib (Rinvoq®).
These medications can work alone or, most often, in combination to reduce the inflammation and resulting pain as well as other symptoms associated with psoriatic arthritis. As well, a medication called alefacept (Amevive®) is available for treatment of the skin symptoms associated with the disease.
To treat and protect your skin, you can use a humidifier in your home to prevent dryness. Unscented lotions and creams can protect and sooth your skin. Avoid any strong perfumes or dyes in skin lotion, as these can aggravate psoriasis. If the psoriasis is not well controlled by simple measures, consultation with a skin specialist (or "dermatologist") is needed. In some people, better control of the skin disease can result in better control of the arthritis. Consult with your rheumatologist or dermatologist regarding what moisturizer to use.
As with any form of arthritis, maintaining a healthy lifestyle is also a critical part of any psoriatic arthritis treatment plan. Poor diet, lack of exercise, and high levels of stress may make disease activity worse, so healthy eating, appropriate levels of physical activity including aerobic, strengthening and mobility, and a mindfulness practice may aid in symptom control. Finally, smoking cessation is critical to reducing inflammation.
Body image and mental health8,9
Body image is a concept that includes how an individual perceives themselves and their body. Psoriatic arthritis happens to be a visible condition that affects our appearances and has been linked to a reduction in self-esteem. Further, research has found that individuals living with psoriatic arthritis are at greater risk of anxiety and depression. Speak to a mental health professional to learn more.
Thank you to Dr. Jonathan Chan, a rheumatologist, Associate Clinical Professor at the University of British Columbia, Clinical Investigator at Arthritis Research Canada, involved in the Canadian Rheumatology Association’s therapeutics committee, and core site leader of the national spondylitis and psoriatic arthritis research cohorts (SPARCC and iPART) in British Columbia, for his medical review of the content on this page.
- Psoriatic arthritis is a form of inflammatory arthritis which causes swelling and pain in and around joints, as well as a scaly rash on the skin.
- Psoriatic arthritis is linked to the skin disease, psoriasis, which causes a scaly-type rash usually occurring on the elbows, knees, and scalp.
- Individuals living with psoriatic arthritis are at greater risk of anxiety and depression because the symptoms are visible in appearance.