Psoriatic arthritis (Psoriasis with joint inflammation)

At a glance

  • In psoriatic arthritis, several joints are usually inflamed.
  • It is most often caused by psoriasis.
  • The joints may hurt, stiffen and become swollen.
  • The treatment options include physical therapy, medication and getting enough exercise.
  • Some of the medications can prevent joint damage as well.

Introduction

Photo of a man holding his hand in pain
PantherMedia / coffeekai

Psoriatic arthritis is a condition that causes pain and stiffness in the affected joints. It also leads to tiredness and in some people.

The joint is usually caused by psoriasis. It can also affect people who don't have visible symptoms on their skin, though.

Psoriatic arthritis can be a major problem, causing sleeping problems and affecting your family, work and free time. Various treatments can relieve the symptoms and prevent damage to the joints.

Symptoms

Psoriatic arthritis can cause various symptoms, mainly including the following:

  • painful joints,
  • stiff joints, especially in the morning (moving the joints often helps the stiffness to go away within a half hour),
  • swollen joints that feel warm and are sensitive to touch, and
  • generally feeling exhausted ().

If the small joints between the vertebrae (spine bones) are inflamed, it might cause back pain.

Psoriatic arthritis can affect many different joints and vary in its severity. It often affects the hands, feet, elbows, knees, neck or vertebrae. More than five joints typically become inflamed, including the joints at the end of the fingers and toes. These joints are especially prone to becoming deformed in severe cases.

Sometimes the not only affects the joints, but the tendons and tendon sheaths as well.

Most people who have psoriatic arthritis also have nail psoriasis. This can lead to small dents in the nails, which may become thicker, change color or start peeling off too. Nail psoriasis is difficult to treat and sometimes mistaken for a fungal nail infection.

Causes and risk factors

Psoriatic arthritis is an autoimmune disease: The immune system is too active and releases more inflammation-causing chemical messengers (cytokines).

Genes play a major role here. Your risk of developing psoriatic arthritis is much higher if one of your parents or a brother or sister has had psoriasis or psoriatic arthritis.

Prevalence

About 25% of people who have psoriasis will develop psoriatic arthritis at some point. It usually starts between the ages of 30 and 50 years, but it can occur at any age.

Outlook

In about 80-90% of people who have psoriatic arthritis, it is caused by psoriasis. The psoriatic arthritis often only develops after many years. But the joints may become inflamed before skin symptoms become visible, or without any skin symptoms at all.

There is no clear link between the severity of psoriasis and the severity of psoriatic arthritis. Some people have severe psoriasis on their skin, but no problems with their joints. Others have psoriatic arthritis, but no symptoms on their skin, or hardly any.

It's very difficult to predict how psoriatic arthritis will continue to develop. Some people have in just a few joints, while in others it affects more joints over time.

Effects

If the inflammations are severe and the psoriasis progresses, the joints might become permanently damaged and deformed. Treatment with disease-modifying medications can stop or delay joint damage, though.

Diagnosis

Doctors use the following approaches and information to diagnose psoriatic arthritis and to rule out other types of joint :

  • Physical examination: Certain changes are typical of psoriatic arthritis. For instance, the may affect a whole finger (dactylitis) or the tendons and tendon sheaths of the hands or feet (enthesitis), such as the Achilles tendon.
  • Family medical history: If psoriasis is known to run in someone's family, any joint pain they have is more likely to be caused by psoriatic arthritis.
  • Blood tests: 90% of people with psoriatic arthritis don't have any of the antibodies in their blood that are typical of rheumatoid arthritis. So if none of these "rheumatoid factors" are found, it's more likely to be psoriatic arthritis.
  • Imaging techniques: X-rays and ultrasound scans can help to find out whether someone has psoriatic arthritis, rheumatoid arthritis or osteoarthritis. The images can also be used to get a better idea of how extensive the joint damage is and what type of damage is involved. But changes in the joints are often not yet clearly visible in the early stages of psoriatic arthritis.
  • Measuring uric acid levels: High levels of uric acid in the blood are a sign that the joint problems are being caused by gout rather than psoriatic arthritis.

An estimated 10% of all people who have psoriatic arthritis don't have any visible skin changes. That makes it more difficult for doctors to tell whether it is psoriatic arthritis or another type of joint disease.

Treatment

Treatments for psoriatic arthritis have various goals, including the following:

  • relieving the symptoms such as pain and swelling,
  • keeping the joints working properly, and
  • preventing long-term damage to the joints.

If you have psoriatic arthritis, there are a few things you can do on your own to reduce the , strengthen your joints and prevent exhaustion. They include getting enough exercise, not smoking and losing weight if you are very overweight. The effectiveness of these measures has hardly been tested at all in studies, though.

Medication plays a large role in the treatment of psoriatic arthritis. In mild cases that only affect the knees, elbows or wrists, treatment with NSAID painkillers is sometimes enough. These types of painkillers include diclofenac, ibuprofen and naproxen, for instance. They can be taken as tablets or applied to the inflamed joints as a gel or cream.

If this isn't effective enough or if there is good reason to believe that the disease will get worse, treatment with disease-modifying drugs is recommended. These drugs reduce the in the joints. This allows them to both relieve the symptoms and prevent or delay damage to the joints. Examples of disease-modifying drugs include methotrexate, leflunomide and medications called biologics.

Problems affecting the joints, muscles or tendons can also be treated with physical therapy, occupational therapy and orthopedic products such as insoles.

Everyday life

The often unpredictable symptoms of psoriatic arthritis can make it hard for many people to make plans in everyday life. Always waiting for the next flare-up can also be very difficult emotionally.

Some people who have psoriatic arthritis worry about not being to keep up with things they have to do or being a burden to others. Most activities can be a challenge if you feel exhausted.

But despite all the difficulties, there are also phases when the symptoms get better for a while. Over time, many people develop a good feel for their body and learn to interpret their body's signals and react to them.

It's often helpful to learn all about psoriatic arthritis and the treatment options, develop practical strategies to cope with the disease, and not to fight it. Keeping your expectations realistic and accepting the disease as part of your life can make it easier to live with it.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

There are many sources of support for people with psoriasis, These include support groups and information centers. Support services are often organized quite differently from region to region, though. Our list of places to contact may help you to find and make use of the help you need.

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Almodóvar R, Zarco P, Oton T et al. Effect of weight loss on activity in psoriatic arthritis: A systematic review. Reumatol Clin 2018; 14(4): 207-210.

Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA 2020; 323(19): 1945-1960.

Mahil SK, McSweeney SM, Kloczko E et al. Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A Critically Appraised Topic. Br J Dermatol 2019; 181(5): 946-953.

Singh JA, Guyatt G, Ogdie A et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol 2019; 71(1): 5-32.

Sumpton D, Kelly A, Tunnicliffe DJ et al. Patients' Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies. Arthritis Care Res (Hoboken) 2020; 72(5): 711-722.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on April 27, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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