In some people who suffer from psoriasis (a disease that causes red patches of skin topped with silvery scales), they can also suffer from a form of arthritis known as psoriatic arthritis. Most people will have psoriasis for many years before developing psoriatic arthritis. But in some cases, joint problems will develop before skin patches appear or at the same time.

Joint pain, stiffness, and swelling are the main signs and symptoms of psoriatic arthritis. They can affect any part of the body, even the fingertips, and spine, and range from relatively mild to severe symptoms. In both psoriasis and psoriatic arthritis, symptoms may go through periods of calm before flaring up again.

There is no known cure for psoriatic arthritis, and treatment is aimed at controlling the symptoms and protecting joint health. Without treatment, psoriatic arthritis can be disabling.

What are the symptoms of psoriatic arthritis?

Symptoms of psoriatic arthritis mirror closely to those of rheumatoid arthritis.

• Joint pain
• Stiffness (specifically morning stiffness)
• Swelling
• Joints become warm to the touch

What are the causes of psoriatic arthritis?

Psoriatic arthritis occurs when the body’s immune system attacks healthy cells and tissue. Inflammation in the joints and overproduction of skin cells result from the body’s immune response.

Genetic and environmental factors likely play a role in this immune system response. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Certain genetic markers found by researchers appear to be associated with psoriatic arthritis.

Physical trauma or viral or bacterial infection could trigger psoriatic arthritis in people with an inherited tendency.

What complications occur with psoriatic arthritis?

A small number of people with psoriatic arthritis develop arthritis mutilans. Over time, the severe, painful, and disabling condition destroys the small bones in the hands (especially the fingers), leading to permanent deformity and disability.

Psoriatic arthritis also puts some people at higher risk of developing hypertension, metabolic syndrome, diabetes, and cardiovascular disease.

What are the treatment options for psoriatic arthritis?

No cure exists for psoriatic arthritis. Treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability and control skin involvement. One of the most common treatments are prescription medications called disease-modifying antirheumatic drugs (DMARDs).

Treatment will depend on how severe your disease is and what joints are affected. You might have to try different treatments before you find one that brings you relief.

Medications

Drugs used to treat psoriatic arthritis include:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation for people with mild psoriatic arthritis. NSAIDs available without a prescription include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects can include stomach irritation, heart problems, and liver and kidney damage.

• Conventional DMARDs. These drugs can slow the progression of psoriatic arthritis and save joints and other tissues from permanent damage.

  The most commonly used DMARD is methotrexate (Trexall, Otrexup, others). Others include leflunomide (Arava) and sulfasalazine (Azulfidine). Side effects can include liver damage, bone marrow suppression, and lung inflammation and scarring (fibrosis).

• Biologic agents. Also known as biologic response modifiers, this class of DMARD targets different pathways of the immune system. Biologic agents include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), guselkumab (Tremfya) and abatacept (Orencia). These drugs can increase the risk of infections.
• Targeted synthetic DMARDs. Tofacitinib (Xeljanz) might be used if conventional DMARDs and biologic agents haven’t been effective. Higher doses of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events and cancer.
• Newer oral medication. Apremilast (Otezla) decreases the activity of an enzyme in the body that controls the activity of inflammation within cells. Apremilast is used for people with mild to moderate psoriatic arthritis who do not want or cannot be treated with DMARDs or biologic agents. Potential side effects include diarrhea, nausea and headaches.

Therapies

Physical and occupational therapies might ease pain and make it easier to do everyday tasks. Ask your doctor for referrals. Massage therapy might also offer relief.

Surgical and other procedures

• Steroid injections. Injections into an affected joint can reduce inflammation.
• Joint replacement surgery. Some joints that have been severely damaged by psoriatic arthritis can be replaced with artificial ones made of metal and plastic.

If you or a loved one suffers from psoriatic arthritis, contact us. Let Nextgen Wellness give you the care you deserve.