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Psoriatic arthritis

Published by Bupa's health information team, November 2009.

This factsheet is for people who have psoriatic arthritis, or who would like information about it.

Arthritis means inflammation of the joints. Psoriatic arthritis is related to the skin condition psoriasis, which mostly affects the skin and nails. It can be treated with medicines to control the inflammation and to try to prevent the arthritis from getting worse.

About psoriatic arthritis
Types of psoriatic arthritis
Symptoms of psoriatic arthritis
Causes of psoriatic arthritis
Diagnosis of psoriatic arthritis
Treatment of psoriatic arthritis
Living with psoriatic arthritis
Questions and answers
Related topics
Further information
Sources

About psoriatic arthritis

About one in 50 people in the UK has psoriasis. One to two out of every 100 people with psoriasis will develop some type of arthritis.

The chance of getting psoriasis or psoriatic arthritis is the same for men and women, although women are at more risk after pregnancy or the menopause. Psoriatic arthritis can occur at any age. Like other forms of arthritis, it can cause pain, stiffness and lack of movement in the affected joints. With an early diagnosis, you will be able to manage the condition and prevent severe and widespread joint damage.

In psoriatic arthritis, the inflammation in your joints is associated with the skin condition psoriasis. Psoriasis causes red, scaly patches on your skin called plaques that can become itchy and sore. The plaques may cover a small area, typically on your head, knee, elbows and buttocks, or a larger area. Psoriasis can also lead to pitted or thickened nails.

Psoriatic arthritis affects the joints in your hands, feet, knees, elbows, hips or spine but can affect other joints too. Inflammation can also affect the tendons and ligaments around the joint.

Psoriatic arthritis is different from osteoarthritis and rheumatoid arthritis. It usually only develops if you have psoriasis, although if you have psoriasis, it doesn't mean that you will automatically get psoriatic arthritis. About one in 10 people develop arthritis before the skin condition appears.

The severity of your psoriatic arthritis isn't necessarily related to how bad your psoriasis is at any one time. This means that you may have bad psoriasis and little or no arthritis, or well controlled psoriasis with more severe arthritis.

Types of psoriatic arthritis

There are five types of psoriatic arthritis and some overlap.

Symmetric arthritis affects the same joints on each side of your body - you're likely to have symptoms in several joints.
Asymmetric arthritis affects different joints on each side of your body, for example a few finger joints and a knee joint.
Distal interphalangeal predominant (DIP) arthritis happens in the joints closest to your fingernails and toenails.
Arthritis mutilans leads to serious deformity in your fingers and toes, and can also affect your spine.
Spondylitis - the arthritis develops in your spine and you will have pain and stiffness in your back and neck.

Symptoms of psoriatic arthritis

Your symptoms may include:

joint pain
tiredness and stiffness, especially when you get up in the morning or after resting
redness and swelling around your affected joints and tendons
one or more entire fingers or toes swelling up - this is called dactylitis, caused by your joints and tendons becoming inflamed
reduced range of movement
pitted or thickened nails
flaking 'silver' patches of skin with red, inflamed skin underneath
conjunctivitis or sore, red eyes known as iritis or uveitis

Causes of psoriatic arthritis

The exact reason why you may develop psoriatic arthritis aren't fully understood at present, but it's thought to be an autoimmune disorder.

Usually your body's immune system produces certain cells that attack infections. In an autoimmune disorder, something has gone wrong and these cells attack your own body tissue. In psoriatic arthritis these cells attack the joints and cause inflammation.

There may be genetic factors that increase your risk of getting the disease as there is evidence that it occurs more commonly within families. It's also believed that environmental features may be involved and something outside your body sets off your immune system's reaction.

Diagnosis of psoriatic arthritis

Your GP may find it difficult to diagnose psoriatic arthritis because your symptoms may be mild early on making it hard to tell it apart from other types of arthritis. Also, your symptoms may be different from those of someone else with psoriatic arthritis. Your GP will ask about your symptoms and examine your joints. He or she may also ask you about your medical history and consider other factors that may mean psoriatic arthritis is more likely, including:

you developed psoriasis in the last few years and then a type of arthritis appeared
you have stiffness in at least one joint
a member of your family has psoriatic arthritis

There isn't a blood test for psoriatic arthritis in the way that people who may have rheumatoid arthritis can be tested for rheumatoid factor. However, your GP may test for rheumatoid factor to help distinguish between these conditions, as well as doing other blood tests to look for inflammation.

You may have an X-ray - this can show up particular features of the disease, although these changes usually only appear once you have had arthritis for a while.

It's important that psoriatic arthritis is diagnosed as early as possible as it can lead to serious joint damage and disability if you don't get it treated.

Treatment of psoriatic arthritis

Self-help

It's vital to keep doing exercise as otherwise the muscles around your joints will weaken and become stiff. Exercise will also help reduce pain and stiffness and make it easier for you to move around.

There are three types of exercise that will help. These are:

strengthening the muscles around your joint
range of motion exercises to maintain joint motion and improve flexibility
aerobic exercise, such as walking, swimming, cycling or hydrotherapy (supervised exercises in a pool)

Aim to do exercises daily but don't overdo it - they shouldn't cause sharp pain that is different from any usual stiffness you feel. If they do, stop these exercises. Don't do strengthening exercises if your joint is hot and inflamed. A physiotherapist, occupational therapist or your doctor will tailor a programme to your needs and help you find the right balance between rest and exercise.

An occupational therapist can help you make life easier at home and at work. For example, if you find it difficult to hold things or to move around, he or she can provide advice and equipment to help you carry out everyday activities.

Simple treatments to help relieve your symptoms include:

heat treatment or warm water soaks to ease joint stiffness
ice to reduce swelling
splinting the affected joint and resting it if you have a severe flare-up
electrotherapy, for example TENS (transcutaneous electrical nerve stimulation)
relaxation techniques

Try to eat a balanced diet with plenty of fruit and vegetables. If you're overweight, try to lose excess weight to reduce the strain on your joints. This may lead to less swelling.

There is limited evidence that taking certain food supplements that contain omega-3 fatty acids can help psoriatic arthritis. Omega-3 fatty acids are also found in oily fish such as mackerel, salmon and sardines, and in some plant seed oils and nuts.

Speak to your GP if you're thinking of taking any supplements.

Medicines

You may be prescribed medicines to help your symptoms. Some of these are explained here.

Paracetamol as a painkiller. Follow the instructions in the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Anti-inflammatory medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs), help to relieve pain and stiffness. They reduce inflammation but don't actually stop the arthritis from progressing or affecting your joints. There are over 40 types of NSAID. They all vary slightly and have different side-effects. You may need to try a few before you find one that suits you. They are also available as creams and gels that you rub into the affected area.
If your arthritis is more severe, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These slow down the progression of the arthritis and its effects, and also ease its symptoms. They can take weeks or even months to have an effect, so it's important to continue taking them even if they don't appear to be making any difference. Again, you may need to try one or more before you find a DMARD that suits you.
You may be prescribed 'biologic' medicines made from animal or human proteins that block the progress of psoriatic arthritis in your immune system. You may be prescribed these medicines if you have severe psoriatic arthritis and other medicines haven't worked. However, they aren't suitable for everyone.

Non-surgical treatments

If you have a particularly bad flare-up, you may be offered a corticosteroid injection into a specific joint to reduce inflammation. This is a quick, effective and safe method of providing pain relief. Possible side-effects of steroid injections include:

infection at the site of the injection
your skin becoming thinner
facial flushes
your menstrual cycle being disrupted

However, side-effects are rare unless you have the injections frequently.

Surgery

As medical treatments have improved it's now less likely that you will need surgery to treat psoriatic arthritis. However, if you have severely damaged joints and medicines haven't helped, your doctor may recommend one of the following operations to reduce pain and discomfort.

A hip or knee replacement.
Synovectomy to remove the lining of an inflamed joint.
Removal or repair of severely inflamed tendons.
Surgery to fuse a joint to make it more stable.

Complementary therapies

Complementary therapies such as acupuncture and aromatherapy may relieve pain and make you feel more relaxed. However, they have no effect on how fast the disease progresses. Speak to your doctor before trying any complementary therapy as it may affect conventional medicines.

Living with psoriatic arthritis

You may find psoriatic arthritis upsetting and frustrating at times. It's important to tell your doctor how it's affecting your life so you get the most suitable treatment. You may need to make changes to your daily life but there are people who can help to make this easier.