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Psoriatic arthritis

Psoriatic arthritis (PA) occurs when psoriasis, a chronic skin condition, causes the joints to become inflamed. It occurs in about 20-40% of people with psoriasis.

  1. Causes pain and stiffness in the joints
  2. Thought to be an autoimmune condition
  3. Treated with drugs that suppress the immune system

Our doctors are available to chat over secure video link if you have psoriasis, or think you may be experiencing arthritic symptoms. They can provide advice and discuss whether you need to see a specialist about further treatment options.

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Description

What is psoriatic arthritis?

Psoriatic arthritis is a chronic condition, characterised by joint inflammation that’s associated with the skin disease, psoriasis. It can vary in its severity; mild cases may only require treatment for a short period, whereas severe cases may necessitate treatment for life. The disease can progress and lead to joint deformity and reduced mobility, so it’s vital to seek advice if you have psoriasis and think you could be developing arthritis symptoms. 

The condition is thought to affect around 20-40% of people who also have psoriasis. Prevalence varies around the world, but it is higher in western countries and amongst males. The prevalence of psoriatic arthritis is highest in middle-aged people between the ages of 35 and 55.

According to Arthritis Research UK, 80% of psoriatic arthritis cases are preceded by psoriasis. However, symptoms may develop in someone who hasn’t been diagnosed with psoriasis previously.

It’s also possible for the symptoms of both conditions to appear for the first time simultaneously. Nearly 14% of people with joint diseases have psoriasis, according to NICE. 

What are the symptoms of psoriatic arthritis?

Psoriatic arthritis can affect many joints. The condition has a number of characteristic patterns, such as: only around five joints or fewer being affected, in a combination of one bigger joint and several smaller ones (this is called asymmetrical oligoarticular arthritis); joints on opposing sides of the body being affected, such as the left and right knee (symmetrical polyarthritis) and involvement of the spinal discs (spondylitis).

Complications like joint deformity can develop if the condition is not treated. People who have psoriatic arthritis are thought to be at increased risk of developing cardiovascular diseases. Psoriatic arthritis can also lead to eye diseases, such as keratitis and blepharitis. 

Psoriatic arthritis can vary in severity. BMJ Best Practice states that at least 20% of people with the condition develop arthritis which is disabling. It has not yet been established whether using disease-modifying anti-rheumatic drugs (DMARDs) to treat PA at an early stage can improve the projected outcome or not. Around 7% of people who have PA will need joint replacement surgery due to a complete deterioration of the joint.

Where can I get advice about psoriatic arthritis online?

Whether you have psoriasis and think you may be developing symptoms of arthritis, or are experiencing joint pain, our doctors are available to help. Book an appointment at a convenient time for you for an online video consultation.

Page last reviewed:  15/06/2020
Diagnosis and treatment

What are the causes of psoriatic arthritis?

Psoriatic arthritis is caused by the chronic condition psoriasis. As is the case with psoriasis, it’s not known why some people develop psoriatic arthritis and others don’t. The clearest factor that has been identified is genetics. Those who have a relative with psoriatic arthritis are thought to be more at risk. 

Experts have theorised that trauma to joints and infections could trigger the inflammation experienced in psoriatic arthritis, as these factors can trigger an immune response (that instigates a psoriatic flare). However, more research is needed to establish this link.

How is psoriatic arthritis diagnosed?

If you have psoriasis and develop arthritis symptoms, your doctor will conduct further examinations and may refer you to a specialist. They’ll try to identify whether your symptoms are psoriatic, or if they’re being caused by another type of arthritis. 

There is also a questionnaire, which people who have psoriasis are asked to fill out on a periodic basis, so that any signs of psoriatic arthritis can be spotted early.

Will I need tests?

Typically, yes - to differentiate between the possibility of psoriatic arthritis and rheumatoid arthritis. A blood test may be conducted. Rheumatoid arthritis can be detected from the presence of an antibody in the blood which is not present in people with psoriatic arthritis. 

X-rays will also usually be taken of the affected joints, as psoriatic arthritis has a different appearance to other forms of arthritis. 

A doctor may want to perform a metabolic screening (checking your weight and blood pressure) because people with metabolic disease are thought to be at higher risk. 

How is psoriatic arthritis managed?

There are three main aims in psoriatic arthritis treatment: pain reduction, joint damage prevention and minimising the possibility of future disability. 

Flare-ups are common for people with psoriatic arthritis, so it’s important to rest the joints during this period. Non-steroidal anti-inflammatory drugs (NSAIDs) medications can often help to alleviate pain.

As a maintenance treatment, disease-modifying anti-rheumatic drugs (DMARDs) are the first-line choice. Examples of DMARDs include Azathioprine and Imuran. They stop inflammation and stop the immune system from damaging joints, which reduces the chances of the disease progressing in the long-term. However, they need to be taken over an extended period as results aren’t immediate.

People with psoriatic arthritis should manage their psoriasis symptoms, and have regular reviews with their consultant. 

Self-management techniques to improve the prognosis are also important. Regular exercise can help to strengthen the muscles that surround the joints. Swimming is a good choice, as it is low impact and doesn’t put extra stress on the joints. It exercises many muscles in the body too. 

If you’re having mobility problems due to arthritis, you may be referred to a physiotherapist or an occupational therapist.

Page last reviewed:  15/06/2020
Questions and Answers

How is psoriatic arthritis treated?

Disease modifying anti-rheumatic drugs (DMARDs) are the first-line choice. These work by suppressing certain chemicals in the immune system which play a role in inflammation. 

For flare-ups, NSAIDs, painkillers and steroid injections are available. They can ease inflammation and offer relief for the pain.

Can psoriatic arthritis get better?

Although symptoms can be managed with appropriate treatment, psoriatic arthritis is a chronic condition, and will require long-term management to stop it from progressing.

The condition tends to go through periods of flare and remission, so if you notice symptoms starting, you should see a doctor.

Can I consult a doctor about psoriatic arthritis online?

Yes. The pain and discomfort caused by psoriatic arthritis can be distressing, and you may wish to consult a clinician about how to manage the condition and what treatment options are available. Our doctors can provide help and advice via our video consultation service, and also refer you to a physiotherapist or an occupational therapist where needed.

Page last reviewed:  15/06/2020

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