Psoriatic Arthritis
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Psoriatic arthritis (PsA) is a lifelong autoimmune condition. It causes inflammation in the skin (psoriasis), along with the joints, spine, and tendons (inflammatory arthritis). This can lead to pain and damage in and around the joints.
PsA affects about 1 to 2 in 1,000 people. That’s about 0.1% to 0.2% of the population in the U.S. PsA affects both men and women equally. Sometimes, PsA can affect children too.
About 20% to 30% of people who have psoriasis also have PsA. Psoriasis rashes typically come before joint pain. But, sometimes, rashes can show up later or at the same time.
Interestingly, it’s also possible to have PsA without psoriasis, especially if you have a family member with psoriasis. There’s no cure for PsA. But lifestyle modifications and medications can help you lead a long, active life.
The exact cause of PsA isn’t entirely clear. There isn’t one single cause of PsA. Rather, studies show that a combination of things causes PsA:
Genetic predisposition: Something in your genes might make you more likely to develop PsA than someone else.
Environmental trigger: Something from your environment — like a stressful accident, infection, or toxin (like cigarette smoke) — wakes up the immune system and confuses it.
When genetic predisposition and environmental triggers meet, you can have the perfect storm. Somewhere along the line, the immune system gets confused and starts attacking your own body instead.
Although we don’t understand the exact cause, we do know that many things can increase the risk of getting PsA:
Psoriasis
Family history of psoriasis
Family history of PsA
Inflammatory bowel disease (like Crohn’s disease or ulcerative colitis)
PsA is different for every person who has it. You may have some of these symptoms — or all of them. It depends.
Some typical PsA symptoms include:
Joint pain or swelling (can affect any joint in the body, but it especially affects the fingers and toes)
Skin rashes (psoriasis)
Nail changes (nail psoriasis)
Enthesitis (tenderness and inflammation at the site where tendons attach to bone, like the back of your heel)
Dactylitis (swelling of an entire finger or toe, also called “sausage digit”)
Spondylitis and sacroiliitis (inflammation of the sacroiliac joints in the pelvis and the spine causing back pain and stiffness)
Fatigue
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PsA is what we call a “clinical diagnosis.” This means that there’s no single test that diagnoses PsA. Rather, a healthcare professional will use clues from various places to put the pieces of the puzzle together. These include:
History (the story of your symptoms)
Physical exam (looking for psoriasis rashes or nail changes along with swollen, painful joints)
Blood tests (can’t diagnose PsA, but can give clues that the diagnosis isn’t PsA)
X-rays (might show changes in your joints that happen when PsA is left untreated)
Most of the time, a rheumatologist makes the diagnosis of PsA. But primary care providers and dermatologists can sometimes make this diagnosis too.
There are many medications in the toolbox to help control PsA. The goals of treatment are to find a medication that does the following:
Treats all of your symptoms
Stops the immune system attack on your body
Protects you from permanent damage
You and a healthcare professional will work together to find the treatment that’s right for you.
In 2018, the American College of Rheumatology and National Psoriasis Foundation created treatment guidelines for PsA. These are in the process of being updated, since new drugs are being developed so quickly.
Medications for PsA are immunosuppressants. That means they turn off a piece of the immune system that’s overactive to stop the attack on your skin and joints. They can come in pill, injection, or infusion forms.
Your prescriber may recommend starting with methotrexate, a pill medication that can help rashes and joint pain. Alternatively, recent treatment guidelines state that going straight to a biologic injection like Enbrel is reasonable too.
You and your prescriber will decide which medication is best, based on your symptoms, other health issues, and insurance coverage. If you don’t have health insurance, patient assistance programs can help.
There’s no cure for PsA. But living and thriving with PsA is possible thanks to the range of medications available to treat it. There’s a day in your future when you can have clear skin and joints that don’t hurt. It will take a little time to find the medications that work best for you, but it’s possible.
Sometimes, PsA symptoms can temporarily worsen (PsA flare), which can take a big toll on your day-to-day life. But flares are temporary, and medications can be adjusted to get you back on track.
PsA is a chronic (lifelong) condition, but that doesn’t mean your quality of life has to suffer. To live well with PsA, here are some suggested tips to follow:
Communicate with a healthcare professional if you aren’t feeling your best.
Take your medications as directed.
Focus on a balanced diet and exercise routine.
Prioritize self-care. Try to limit stress, and get enough sleep.
Lean on your support system when you need help. The Arthritis Foundation, Spondylitis Association of America, and National Psoriasis Foundation are also great places to find resources.
PsA is different for every person who has it. Some folks have milder symptoms. They may need less medication to feel better and protect their bodies from harm. On the other hand, some folks have very severe symptoms — like psoriasis rashes covering most of the skin or swelling and pain in most joints.
The best way to protect yourself from complications of PsA is to see a healthcare professional regularly, update them when symptoms change, and take medications as directed.
PsA is different for every person who has it. Some folks have milder symptoms. They may need less medication to feel better and protect their bodies from harm. On the other hand, some folks have very severe symptoms — like psoriasis rashes covering most of the skin or swelling and pain in most joints.
The best way to protect yourself from complications of PsA is to see a healthcare professional regularly, update them when symptoms change, and take medications as directed.
There are no specific foods to eat or avoid if you have PsA. But eating a balanced diet can help you maintain a comfortable weight, which will take pressure off of your joints. A nutritious diet can also decrease your risk of heart disease. This is important because PsA increases heart disease risk due to inflammation.
Of note, certain foods or drinks may cause psoriasis flares in some people. If certain foods or drinks worsen your psoriasis rashes, it’s a good idea to avoid them if you have PsA too.
Early signs of PsA include:
Joint pain and swelling, especially in the hands and feet
Back pain and stiffness, especially if they’re worst in the morning and get better with exercise
Sausage-like swelling of one finger or toe (dactylitis)
Psoriasis rashes
Psoriasis nail changes
If you have psoriasis and develop new joint pain, consider taking a screening test called the “PEST” (Psoriasis Epidemiology Screening Tool). The PEST helps identify people who should see a rheumatologist to be evaluated for possible PsA.
Exercise is great for psoriatic arthritis, and the American College of Rheumatology recommends it in its treatment guidelines. Keeping your joints moving will help protect flexibility and mobility, improve fatigue, and help you maintain your weight.
Walking, swimming, and cycling are good options. If walking is difficult for you due to pain, consider walking in a swimming pool instead, since the water takes weight off the joints. Yoga is also a great option since you can adjust poses for your arthritis needs.
It may be challenging to differentiate PsA from rheumatoid arthritis (RA). But with a thorough evaluation, a healthcare professional can distinguish between the two conditions.
PsA often involves the lower spine and the outer joints of the hands (distal interphalangeal joints). A history of psoriasis, nail changes, and dactylitis is more typical of PsA.
RA usually involves the neck or upper spine and other joints of the hands, wrists, and ankles. Also, it’s symmetric (similar on both sides of the body). X-rays in RA look different, with bone erosions (gradual loss of bone) being a common finding.
PsA doesn’t have a specific blood test for diagnosis. In contrast, people with RA usually test positive for rheumatoid factor and anti-CCP antibodies.
The five types of PsA are:
Oligoarticular arthritis: It involves less than five joints. This is a common type of PsA.
Polyarticular arthritis: It’s symmetric and affects five or more joints, so it can be confused with RA. Over time, most people with PsA will develop this form.
Distal arthritis: This involves mostly the joints at the tips of the fingers.
Arthritis mutilans: This causes deformities, usually in the hands and feet.
Spondyloarthritis: This involves mostly the spine.
There may be other ways to describe PsA. But this is the original and most widely used classification.
Cardiovascular disease affects most people with PsA (up to 80%). People with PsA have a more than 10% risk of cardiovascular disease within 10 years of being diagnosed. The risk is thought to increase over time due to inflammation from PsA, age, and treatments for the condition.
However, medical care for PsA has progressed, and treatments are more efficient. Earlier diagnosis and better control of PsA are now possible. As such, a recent study found that the risk of cardiovascular disease can decrease over time in PsA with effective treatment.
Alinaghi, F., et al. (2019). Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. Journal of the American Academy of Dermatology.
American College of Rheumatology. (n.d.). Rheumatologist.
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