Psoriatic arthritis is a type of inflammatory arthritis that affects some people with psoriasis. It is often called PsA for short.
If you have psoriasis and have any pain and swelling in your joints, ask for a referral to a rheumatologist as soon as possible. If you do have psoriatic arthritis, this will give you the best chance of an early diagnosis and starting on the treatment you need to help manage your symptoms and prevent future joint damage.
It's reassuring to know that, with the right treatment and management, most people with psoriatic arthritis can continue to lead full and active lives.
What is psoriatic arthritis and who gets it?
You may already have read that psoriasis is a skin condition that involves your immune system and inflammation. In about 25 per cent of people who have psoriasis, the same overactivity of the immune system that causes skin problems can also cause arthritis: where the immune system attacks the healthy tissue in and around your joints causing inflammation and pain.
In most people who develop psoriatic arthritis, the skin symptoms of psoriasis will come before the joint symptoms, but occasionally, the joint symptoms will start first.
Psoriatic arthritis can begin at any age, but is most likely to start in adults aged between 30 and 50 years old and affects women and men equally.
Children can also develop psoriatic arthritis, where it is more likely to start at the same time as psoriasis or even before skin symptoms appear.
What causes psoriatic arthritis?
Just like psoriasis, we still don't know the exact cause of psoriatic arthritis, but we do know that genetics, the immune system and some type of trigger play a role in its development.
What are the symptoms of psoriatic arthritis?
Psoriatic arthritis can vary a lot from one person to another. The symptoms of psoriatic arthritis may be mild and develop slowly – or they can be severe and develop quickly. Any joint in the body can be affected.
Common symptoms of psoriatic arthritis include:
- pain, swelling and stiffness in one or more joints – the joints closest to the nails on fingers and toes are most commonly affected (these are called the distal joints)
- swelling of entire fingers or toes so they look like sausages (this is called dactylitis)
- pain, swelling and stiffness in your bottom, lower back or neck (this is called spondylitis, which means inflammation of the spine)
- pain and swelling in tendons – this may affect the back of your heel or the sole of your foot
- nail changes, including thickening, pitting or lifting away from the skin
- pain and redness in your eyes, which can feel and look like conjunctivitis (this is called uveitis)
- feeling fatigued all over.
Like psoriasis itself, many people with psoriatic arthritis have periods where their symptoms are worse (a 'flare') and periods where their symptoms settle down again.
How is psoriatic arthritis diagnosed?
There is no single test that can diagnose psoriatic arthritis. Your doctor will usually make a diagnosis and rule out any other types of arthritis by using a combination of your medical history, examination and tests. These may include:
- talking to you about your medical history, especially your history of psoriasis
- examining your joints, nails and skin
- blood tests that check for inflammation and certain genes that may be associated with psoriatic arthritis
- blood tests to rule out other types of arthritis (such as rheumatoid arthritis) that have similar symptoms.
If your GP or dermatologist thinks you may have psoriatic arthritis, it's important for them to refer you to a rheumatologist – a doctor who specialises in joint problems – to confirm the diagnosis and get you started on treatment as soon as possible.
What are the treatments for psoriatic arthritis?
Your doctor will develop a treatment plan for you based on the symptoms you have and how severe they are. While there isn't a cure for psoriatic arthritis, it can be managed very well. You may need to trial different medicines or a combination of medicines to find the ones that work best for you.
Medicines that your doctor may prescribe include:
- pain relievers such as paracetamol – for temporary pain relief
- nonsteroidal anti-inflammatory drugs (NSAIDs) – for temporary relief of pain and inflammation
- corticosteroids that you take by mouth – these are usually used for short periods to quickly reduce inflammation and get arthritis under control
- disease-modifying anti-rheumatic drugs (DMARDs) – these medicines aim to dampen down your overactive immune system
- biological DMARDs or bDMARDs – these medicines work in a more targeted way to dampen down your overactive immune system.
Your doctor will tell you more about the medicines they are prescribing, how long they may take to work, side effects they may have and any blood tests you will need to have while you are taking them.
What can I do to help myself?
If you've been diagnosed with psoriatic arthritis, start by learning as much as you can about your condition using trusted information sources like the links at the end of this article. Learning more can help you to be more involved in making decisions about your treatment and to have a more active role in managing your health.
You can also learn practical ways to:
- avoid your triggers – which may be the same things that trigger your psoriasis
- pace yourself and get better quality sleep – these ideas for people with rheumatoid arthritis (RA) can be helpful for people with psoriatic arthritis too
- use the right types of exercise to help you maintain muscle strength and join flexibility, look after your heart, help manage pain and improve overall wellbeing – these exercise guidelines for people with RA are also a good place to start if you have psoriatic arthritis.
Psoriatic arthritis and emotions
It's natural to feel frustrated and sad about having psoriatic arthritis. You may have times where you feel angry about your condition and wonder 'why me?'. It's important to acknowledge these feelings and ask for help when you need it. Your GP is a good starting point who can refer you to a counsellor or psychologist for more support.
You may also want to think about joining a support group for people with psoriatic arthritis, which provides a safe place for you to share your experiences and challenges with other people who understand. Have a look at the Take the Next Step links below to find your local arthritis organisation.
- 1. Musculoskeletal Australia fact sheet: Psoriatic arthritis. Accessed 17 December 2018.
- 2. Arthritis Australia information sheet: Psoriatic arthritis. Accessed 17 December 2018.
- 3. The Australasian College of Dermatologists. A to Z of Skin: Psoriasis. Accessed 13 November 2018.
- 4. National Psoriasis Foundation (US). About psoriatic arthritis. Accessed 17 December 2018.