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Psoriatic arthritis

Definition

Psoriatic arthritis is a joint problem (arthritis) that often occurs with a skin condition called psoriasis.

Alternative Names

Arthritis - psoriatic; Psoriasis - psoriatic arthritis; Spondyloarthritis - psoriatic arthritis; PsA

Causes

Psoriasis is a common skin problem that causes red patches on the body. It is an ongoing (chronic) inflammatory condition. This condition occurs in about 7 to 42 percent people with psoriasis. Nail psoriasis is linked to psoriatic arthritis.

In most cases, psoriasis comes before the arthritis.

The cause of psoriatic arthritis is not known. Genes, immune system, and environmental factors may play a role. It is likely that the skin and joint diseases may have similar causes. However, they may not occur together.

Symptoms

The arthritis may be mild and involve only a few joints. The joints at the end of the fingers or toes may be more affected.

In some people the disease may be severe and affect many joints, including the spine. Symptoms in the spine include stiffness and pain. They most often occur in the lower spine and sacrum.

Some people with psoriatic arthritis may have inflammation of the eyes.

Most of the time, people with psoriatic arthritis have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

Exams and Tests

During a physical exam, the health care provider will look for:

  • Joint swelling
  • Skin patches (psoriasis) and pitting in the nails
  • Tenderness
  • Inflammation in the eyes

Joint x-rays may be done.

There are no specific blood tests for psoriatic arthritis or for psoriasis. The provider may test for a gene called HLA-B27.

People with involvement of the back are more likely to have HLA-B27.

Treatment

Your provider may give nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints.

Arthritis that does not improve with NSAIDs will need to be treated with medicines called disease-modifying antirheumatic drugs (DMARDs). These include:

  • Methotrexate
  • Leflunomide
  • Sulfasalazine 

Apremilast is another medicine used for the treatment of psoriatic arthritis.

New biologic medicines are being widely used for progressive psoriatic arthritis. These medicines block an inflammatory protein called tumor necrosis factor (TNF). These are given by injection and include:

  • Adalimumab (Humira)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Golimumab (Simponi)
  • Infliximab (Remicade) 

Other new biologic medicines are available to treat growing psoriatic arthritis. These medicines are also given by injection and include:

  • Secukinumab (Cosentyx)
  • Ixekizumab (Taltz)
  • Ustekinumab (Stelara)
  • Abatacept (Orencia)

Very painful joints may be treated with steroid injection. These are used when only one or a few joints are involved.

In rare cases, surgery may be needed to repair or replace damaged joints.

People with inflammation of the eye should see an ophthalmologist.

Your provider may suggest a mix of rest and exercise. Physical therapy may help increase joint movement. You may also use heat and cold therapy.

Outlook (Prognosis)

The disease is often mild and affects only a few joints. In some people, very bad psoriatic arthritis may cause deformities in the hands, feet, and spine.

Early treatment can ease pain and prevent joint damage, even in very bad cases.

When to Contact a Medical Professional

Call your provider if you develop symptoms of arthritis along with psoriasis.

References

Bruce IN, Ho PYP. Clinical features of psoriatic arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 128.

FitzGerald O, Elmamoun M. Psoriatic arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 77.

Mease PJ, McInnes IB, Kirkham B, et al. Secukinumab inhibition of interleukin-17A in patients with psoriatic arthritis. N Engl J Med. 2015; 373(14):1329-1339. PMID: 26422723 www.ncbi.nlm.nih.gov/pubmed/26422723.

Nash P, Kirkham B, Okada M, et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet. 2017; 389(10086):2317-2327. PMID: 28551073 www.ncbi.nlm.nih.gov/pubmed/28551073.

Ritchlin C, Rahman P, Kavanaugh A, et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Ann Rheum Dis. 2014; 73(6):990- 999. PMID: 24482301 www.ncbi.nlm.nih.gov/pubmed/24482301.

Veale DJ, Orr C. Management of psoriatic arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 131.


Review Date: 1/29/2018
Reviewed By: Gordon A. Starkebaum, MD, ABIM Board Certified in Rheumatology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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