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|Basics of psoriatic arthritis
Psoriatic arthritis is a common form of arthritis that affects both joints and skin.
Generally psoriatic arthritis is a mild condition. With proper treatment and help from others you can relieve joint pain and stiffness and keep skin problems under control. Some people however have a more serious disease and require combinations of medications to control symptoms and prevent joint damage.
Psoriatic arthritis is a chronic (long-lasting) condition.
LethalityPsoriatic arthritis is not a fatal form of arthritis. It affects the skin and joints but does not affect the vital organs. Rare reactions to medications or infections may be more serious but the disease itself is not fatal.
CurabilityPsoriatic arthritis is treatable but not curable.
Approximately 10% of people who have the skin condition known as psoriasis will develop an associated inflammatory arthritis. Inflammatory forms of arthritis are those that cause prolonged stiffness in the night and morning along with joint swelling and pain and are generally better with activity.
Psoriatic arthritis affects about 300 000 people in the United States. It affects men and women of all races. It usually occurs between the ages of 20 and 30 but it can occur at any age. It affects about five to eight percent of people who have psoriasis.
In general symptoms of psoriasis and psoriatic arthritis include:
The cause of psoriatic arthritis is not yet known. Since it is known to run in families it may be partly inherited. But it is not contagious so you can't catch it from anyone. Like other forms of arthritis the body's immune system and the environment may also play a role in the disease.
To find out if you have psoriatic arthritis your doctor will ask you about your symptoms and will perform a physical examination.
Since the symptoms of this type of arthritis are similar to other forms of arthritis such as gout Reiter's syndrome and rheumatoid arthritis the doctor may also perform some or all of the following tests:
It may take some time to determine if you have psoriatic arthritis. Usually if your nails and skin are affected along with your joints a concrete diagnosis can be made. In general a rheumatologist (a physician trained in the diagnosis and treatment of arthritis) can recognize the features of psoriatic arthritis noted above in the setting of psoriasis and make a diagnosis. A firm diagnosis will have to wait the development of the skin disease. The skin disease or the arthritis may appear first.
Treatment for psoriatic arthritis depends on how severe your condition is and what areas of the body are affected.
The goals of treatment are to reduce joint pain and swelling control the skin patches and to slow down or prevent joint damage. Treatment may include one or a combination of skin care medications and other treatments.
Take good care of your skin especially during the winter. This can help reduce the dryness and skin sores caused by the psoriasis. Keep your skin from becoming dry by following these tips:
Sit in the sun for moderate periods of time. Because sunlight slows down cell growth it can help improve your psoriasis. Too much sunlight can damage your skin however so take steps to avoid sunburn.
Psoralen and ultraviolet light type A (PUVA) is a combination of medicine (psoralen) and light (type A ultraviolet light) that can help clear up skin problems and some joint problems. For this treatment you are given psoralen in pill form. This makes your skin sensitive to ultraviolet light type A. Then you are exposed to ultraviolet light for several minutes. You may need at least 20-30 treatments over several weeks. Talk to your dermatologist (skin doctor) about the benefits and side effects of this treatment.
Corticosteroid or steroid creams can be very effective but should be used under the direction of your health care provider. The more powerful creams can cause atrophy or thinning of the skin if used improperly. There are also vitamin D based creams that can be used by some people.
Health care teamPeople with psoriatic arthritis may be treated by their family doctor a skin specialist (dermatologist) or an arthritis specialist (rheumatologist). The type of doctor you see will depend on your symptoms. Other health care workers such as a nurse occupational therapist or physical therapist may also help you manage your condition.
Exercise and therapy
The pain and swelling of arthritis can make your joints stiff and hard to move. If this happens your doctor or physical therapist may recommend special exercises to keep your joints strong and flexible. In addition general exercise such as walking can help improve your overall health.
Generally a normal amount of rest and sleep will be enough for you. In a very few people however psoriatic arthritis may cause extreme fatigue. If this happens you may need to rest more than usual and learn how to use your energy wisely throughout your daily activities.
Some medications can help relieve joint pain and swelling and can help slow down the joint damage. Your health care provider may recommend one of the following:
These medications work differently in different people. Talk to your doctor about the risks and benefits of taking these medicines since all of them have potential side effects. The strongest medications are reserved for those with the most serious disease.
SurgeryIf your joints are severely damaged from psoriatic arthritis your doctor may recommend joint replacement surgery. In this surgery joints damaged by arthritis are replaced with artificial joints. If this surgery is needed your doctor will discuss this with you.
Splints or bracesSplints may be useful if you have severe joint problems. Splints help rest your joints. This helps decrease joint pain swelling and stiffness. Your doctor physical therapist or occupational therapist can help you find the best splint for you.
Heat and cold treatments
These treatments may help relieve pain and reduce swelling in your joints. Examples include soaking in a warm tub and placing a heating pad or cold pack on the painful joint. Talk to your doctor about what treatments may be best for you.
Asking for helpPeople with psoriatic arthritis can turn to their health care providers their families and special organizations for help and support.
ResourcesFor more information contact the National Psoriasis Foundation 6600 SW 92nd Ave. Suite 300 Portland OR 97223-7195 (503) 244-7404 toll-free (800) 723-9166
Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800.
Edited by Gregory C. Gardner M.D., Division of Rheumatology and Frederick Matsen M.D., Professor, Department of Orthopaedics and Sports Medicine, University of Washington. Based on a pamphlet originally produced by the Arthritis Foundation.