Psoriatic Arthritis

It’s helpful to understand what type of psoriatic arthritis you are diagnosed with to recognize how it can affect the way you feel in your day-to-day life. These are the five types of psoriatic arthritis:

• Distal interphalangeal predominant Ps.A. primarily involves the small joints of the hands and feet that are closest to the nails, so you may have a hard time with movements that involve those joints, like opening jars or even just standing to cook.
• Asymmetric oligoarthritis affects less than five small or large joints and can involve joints on both sides of the body. For example, you might have pain in your right wrist and in your left knee.
• Symmetric polyarthritis affects the same joint on both sides of the body. So you might feel pain in both knees or both wrists, for example.
• Spondyloarthritis happens when inflammation develops between the vertebrae of your spine and causes neck pain and mobility problems.
• Arthritis mutilans is a rare form of psoriatic arthritis that can severely damage your feet and make it hard to move or straighten your fingers or toes.

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Rheumatologists typically diagnose psoriatic arthritis, but the condition may be diagnosed by a dermatologist, especially if many of your early symptoms are related to psoriasis. Unfortunately, there is no single test that can determine if you have psoriatic arthritis. But tests can help doctors rule out other conditions that also cause joint pain, such as gout and rheumatoid arthritis. Certain tests can also help assess the level of damage to your joints.

Here are some imaging tests your doctor might recommend:

• X-rays: These help identify changes suggestive of psoriatic arthritis, such as bone erosion and damage.
• Magnetic resonance imaging (MRI): MRI creates three-dimensional images of the inside of your body using radio waves and a strong magnetic field. This is helpful for visualizing joints and nonbony parts of the body so your doctor can check for tendon and ligament changes.

Blood tests that can be helpful in diagnosing psoriatic arthritis include:

• Rheumatoid factor (R.F.): This test detects the presence of rheumatoid factor, an antibody associated with rheumatoid arthritis, which can help your physician distinguish between rheumatoid arthritis and psoriatic arthritis.
• Joint fluid test: A small amount of joint fluid is removed from an affected joint to look for uric acid crystals, which can signify gout rather than psoriatic arthritis.
• C-reactive protein (CRP): This blood test can be used to measure the presence of inflammation in the body⁶, which can indicate a chronic inflammatory condition like psoriatic arthritis, according to the Mayo Clinic.

Additionally, your doctor will likely conduct a physical exam to assess symptoms like joint pain, tenderness, and swelling, as well as skin and nail changes. During this time, your physician may go over your medical history to ask about when your symptoms started, whether you have been diagnosed with psoriasis, or if you have a history of psoriasis or psoriatic arthritis in your family.

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Psoriatic arthritis is not classified by stages since there is no set progression for the disease. People can have mild, moderate, or severe psoriatic arthritis at any point—even at the time of their diagnosis. Some patients are prone to more aggressive disease and there is no predictable pathway, Eric Dein, M.D., a rheumatology fellow at Johns Hopkins Department of Rheumatology, tells SELF.

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People who already have a risk of developing psoriatic arthritis may experience symptoms for the first time after experiencing a particular trigger, such as a bacterial infection¹. Or if your symptoms are in remission, you may have a flare-up after being exposed to a trigger. There are various potential triggers, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases says these are the most common ones:

• Heavy stress, such as from a hectic work schedule
• Infections, such as bronchitis or strep throat
• Experiencing any type of injury
• Not taking your medication as prescribed

There is no sure-fire way to prevent psoriatic arthritis flares, but reducing your triggers can help.

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Generally, psoriatic arthritis treatment aims to control inflammation and reduce symptoms. Specific treatments are selected depending on how the condition presents and how it’s affecting the body. For example, one treatment might work better to address skin symptoms whereas another might work better for tendon inflammation or eye inflammation.

“We have lots of medications for psoriatic arthritis, and we can escalate or add on therapies if they are not under good disease control,” Dr. Dein says, adding that psoriatic arthritis treatment is often personalized based on other underlying conditions and risk factors. Depending on a person’s particular situation, doctors may recommend a combination of the following treatments:

Psoriatic arthritis medications

Medications used to treat psoriatic arthritis vary depending on your symptoms and other factors but may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Available both over-the-counter and by prescription, NSAIDs can help reduce pain and swelling and improve joint range of motion. Some NSAIDs used to treat psoriatic arthritis include ibuprofen, meloxicam, and naproxen sodium.
• Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow the progression of the disease and prevent joint damage. Some common DMARDs⁷ used to treat psoriatic arthritis include leflunomide, methotrexate, and sulfasalazine.
• Biologics: This is a newer class of DMARDs⁷ that is given as an injection (sometimes at home) or an IV infusion (in an office). There are many different types of biologics that can be prescribed depending on the type of psoriatic arthritis you have. Some commonly prescribed biologics for Ps.A. include infliximab, etanercept, adalimumab, and certolizumab.
• Steroid injections: These provide quick inflammation relief but generally are not recommended as a long-term psoriatic arthritis treatment because they can worsen the condition over time and can interfere with other medications.

“Many of these medications do take time to start working, so in patients having a flare, we often give steroids or intra-articular joint injections,” Dr. Dein says. “It is important to limit steroids for long-term care given their side effects, but we often will use them in the acute flare.”

Psoriatic arthritis procedures

Surgery is the main procedure considered for psoriatic arthritis, though it is rarely needed. In severe psoriatic arthritis cases—those in which the disease has caused significant damage and has limited mobility—surgery can help repair or totally replace affected joints.

If you have a joint replaced with prosthetic parts, usually made of metal or plastic, it should eventually be pain-free and move like a healthy joint again. That said, because psoriatic arthritis is an autoimmune disease, replacing the joint will not eliminate or prevent future inflammation within the body, according to NYU Langone Health. Surgery is generally followed by one to two months of physical therapy, so you can heal properly, build strength, and improve your flexibility. Your doctor can help you weigh the pros and cons of surgery for your situation to ensure the benefits outweigh any risks.

Lifestyle modifications

A number of lifestyle changes may help ease psoriatic arthritis symptoms:

• Low-impact exercise, like walking, swimming, and biking, is a great way to improve joint strength, flexibility, and mobility.
• Limiting your alcohol intake may help since alcohol can interact with some psoriatic arthritis medications.
• Modifying activities so they are more comfortable on your joints can make life more pain-free. For example, some people find it more comfortable to use electric can openers versus manual versions.
• Reducing stress is also key. Your body releases chemicals that may aggravate psoriatic arthritis when you’re heavily stressed, so activities you find calming, like meditation, yoga, and journaling, may help you feel better overall.

Psoriatic arthritis diet

There’s no specific diet that can help alleviate psoriatic arthritis symptoms for every person with the condition, but physicians have a few general recommendations that may keep your overall health balanced.

“There is no consensus on the ideal diet for autoimmune disease, but there is good evidence⁸ to support that a Mediterranean diet rich in unsaturated oils and low in simple carbs can decrease inflammation,” Dr. Dein says. However, keep in mind that your diet alone will not resolve psoriatic arthritis symptoms.

People with psoriatic arthritis are also more likely to have metabolic syndrome⁹, which is a cluster of risk factors that can increase someone’s risk of heart disease, stroke, and type 2 diabetes. Due to this, people with psoriatic arthritis should aim to eat a nutritious diet full of lean proteins, high-fiber grains, fruits, and veggies¹⁰. You should also aim to do gentle exercise regularly, as your symptoms allow for it.

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Living with psoriatic arthritis can be tough, from learning to navigate daily life with painful and stiff joints to dealing with unexpected flares that can lead to changes in mental health, like developing depression.

Because of these unique challenges, finding a support group of other people with psoriatic arthritis who better understand your experience may be comforting. For example, you can find communities on Facebook groups by searching “psoriatic arthritis.” There, members share their own challenges as well as tips for managing them.

While living with psoriatic arthritis, “it’s important to know what triggers your symptoms as well as identify when your symptoms can be a problem,” Anna Chacon, M.D., a board-certified dermatologist at Cleveland Clinic in Miami, tells SELF. Tracking your symptoms in a journal (including frequency, timing, and severity) along with behaviors like exercise frequency, what you’re eating and drinking, and how you’re managing stress can help you look for patterns and identify triggers.

Although there is no psoriatic arthritis cure, it’s possible to live a fulfilling life with the condition. With a thorough understanding of Ps.A., you can get on the path to the best treatment plan for you so you can feel in control of your symptoms.

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Sources:

1. StatPearls, Psoriatic Arthritis
2. Rheumatology and Therapy, Sustained Very Low Disease Activity and Remission in Psoriatic Arthritis Patients
3. Seminars in Arthritis and Rheumatism, Remission in Psoriatic Arthritis: Definition and Predictors
4. Arthritis Care & Research, Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease
5. Rheumatology and Therapy, Psoriatic Arthritis: What Is Happening at the Joint?
6. Indian Dermatology Journal Online, Role of C-Reactive Protein as a Marker of Disease Severity and Cardiovascular Risk In Patients with Psoriasis
7. Arthritis & Rheumatology, 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis
8. StatPearls, Disease Modifying Anti-Rheumatic Drugs (DMARD)
9. Expert Review of Clinical Immunology, Metabolic Syndrome and Psoriatic Arthritis: Considerations for the Clinician
10. Endocrine, Metabolic & Immune Disorder Drug Targets,The Immune Protective Effect of the Mediterranean Diet against Chronic Low-Grade Inflammatory Diseases