What is psoriatic arthritis (PsA)?

Psoriatic arthritis, often called PsA, is a condition that causes pain, swelling and stiffness in and around the joints. In many people, it first manifests itself with the skin and nails affected, a condition called psoriasis. This causes patches of red and flaky skin to appear on the body.1 PsA and psoriasis are both examples of psoriatic disease; a name for a group of autoimmune conditions that can affect the skin and joints. You can learn more about psoriasis here.

Almost all people with PsA fit into another disease category called peripheral spondyloarthritis (pSpA). Spondyloarthiritis is an umbrella term for inflammatory diseases that involve both the joints and the entheses (the sites where the ligaments and tendons attach to the bones) and peripheral means that the inflammation is often experienced in the wrists, hands, elbows, shoulders, knees ankles and feet.2

What causes psoriatic arthritis?

PsA is an autoimmune condition. The job of the immune system is to protect us from foreign bodies, but in people with autoimmune conditions, something goes wrong and the immune system starts to attack healthy parts of the body, specifically the skin and joints in the case of PsA.

PsA is a part of a systemic disease, psoriatic disease, which means that it can affect the entire body rather than just a single organ or body part. For example, around 85% of people with PsA have lived with psoriasis prior to experiencing the joint-related symptoms of PsA.3 People with PsA may be at an increased risk of developing other inflammatory diseases such as cardiovascular disease and diabetes.4

What are the signs and symptoms of psoriatic arthritis?

PsA can manifest in several ways. The main symptoms of PsA include inflammation, stiffness and pain in the joints and because it is part of a systemic disease, 80% will experience psoriasis skin symptoms prior to joint symptoms.5 Some common symptoms include:

  • 83% of people with PsA may experience psoriasis of the nails6
  • Around 40-50% of people will experience inflammation of the tendons around the fingers and toes, which is called dactylitis (also known as sausage fingers)
  • 30-50% will experience inflammation of where tendons and ligaments meet with bone, which is called enthesitis7
  • Up to 70% of people with PsA will experience what is called axial involvement, meaning they will experience pain and inflammation in the spine8

Disease impact

The impact of psoriatic arthritis goes well beyond the physical symptoms. One in five people with PsA has a diagnosis of depression as well  and in one study, unemployment, pain, and fatigue related to PsA were identified as key triggers behind this depression.9 People with PsA that is poorly controlled are more likely to miss work or be up to 50% less productive when they are at work.10

Diagnosing psoriatic arthritis

If you are experiencing issues with your joints and skin, your doctor may suspect that you have PsA and refer you to a specialist called a rheumatologist. In most cases, the rheumatologist will be able to diagnose PsA based on your signs and symptoms, for instance if you have problems with your skin that indicate psoriasis and have issues with your joints, such as pain or swelling. It may be that things are not as straightforward as that and in this case they will ask more questions and perform more test to confirm the diagnosis. They will also try to rule out other conditions such as rheumatoid arthritis and osteoarthritis. Blood tests (to check for signs of inflammation), x-rays and ultrasounds can also aid the diagnosis.1

Read more about diagnosing psoriatic arthritis here

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What are the treatment options?11

There are a number of treatment options for those living with PsA. Some aim to help ease the symptoms while others try to tackle the underlying condition itself.

Topical creams and ultraviolet light therapy can help to improve the skin symptoms of psoriatic disease, while non-steroidal anti-inflammatory drugs (NSAIDs) can help to ease inflammation. Steroid treatments can also reduce pain and swelling in the joints but are not recommended for long-term use due to their potential side effects.

Disease-modifying anti-rheumatic drugs (DMARDs) are an option that can reduce inflammation and thus help prevent damage to joints. These drugs aim to tackle the cause of PsA rather than just the symptoms.

Another option is treatment with biologics (a type of DMARDs), which target specific parts of the immune system to reduce inflammation. These can also tackle the cause of inflammation rather than just the symptoms. If you have concerns or questions about which treatment option is best for you, make sure to raise it with your doctor or rheumatologist. They will be able to provide you with more information, arrange a referral to a specialist, or give you advice based on your specific situation.

Read more about treatment options here

References

[1] NHS. Psoriatic arthritis. 2016. Available at: https://www.nhs.uk/conditions/psoriatic-arthritis/. Last accessed June 2019

[2] Arthritis Foundation. Spondyloarthritis. 2019. Available at: https://www.arthritis.org/about-arthritis/types/spondyloarthritis/. Last accessed June 2019

[3] Rheumatoid Arthritis. PsA Facts: What are the Statistics behind Psoriatic Arthritis? 2018. Available at: https://www.rheumatoidarthritis.org/psoriatic-arthritis/facts-and-figures/. Last accessed June 2019

[4] Arthritis Foundation. Metabolic Comorbidities of Psoriatic Arthritis. 2019. Available at: https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/articles/psa-metabolic-comorbidities.php. Last accessed June 2019

[5] Gottlieb AB et al. Use of etanercept for psoriatic arthritis in the dermatology clinic: the Experience Diagnosing, Understanding Care, and Treatment with Etanercept (EDUCATE) study. J Dermatolog Treat. 2006;17(6):343-352

[6] Lee S et al. The Burden of Psoriatic Arthritis. P&T. 2010;35(12):680-689

[7] Ritchlin CT et al. Psoriatic Arthritis. N Engl J Med. 2017;376(10):957-970

[8] Feld J et al. Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nat Rev Rheumatol. 2018 Jun;14(6):363-371

[9] McDonough E., et al. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014. 41(5):887-96

[10] Arthritis Foundation. Psoriatic Arthritis in the Workplace. 2019. Available at: https://www.arthritis.org/living-with-arthritis/life-stages/work/psoriatic-arthritis-workplace.php. Last accessed June 2019

[11] Versus Arthritis. Psoriatic Arthritis. 2019. Available at: https://www.versusarthritis.org/about-arthritis/conditions/psoriatic-arthritis/. Last accessed June 2019

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