Psoriatic Arthritis
Psoriatic arthritis (PsA) is an inflammatory arthritis that affects some people with psoriasis, a skin condition characterized by red, scaly patches (plaques). PsA can also cause pitting in the fingernails or toenails.
This autoimmune disorder involves your immune system attacking healthy tissues, leading to joint inflammation and overproduction of skin cells. Symptoms range from mild to severe and can affect any joint, including the spine and fingertips.
Causes and Risk Factors
- Genetics: Family history of psoriasis or arthritis increases risk.
- Immune Dysfunction: Autoimmune attack on joints and skin.
- Environmental Triggers: Joint injury, stress, or certain infections.
- Psoriasis: Occurs in about 30% of people with psoriasis.
Symptoms
- Joint pain, swelling, and stiffness
- Swollen fingers or toes (“sausage digits”)
- Enthesitis: pain where tendons and ligaments attach to bone
- Lower back pain from spinal involvement
- Fatigue
- Skin and nail changes (plaques, pitting, thickening, separation)
- Uveitis: eye inflammation causing redness and pain
Diagnosis
- Medical history and physical exam to check joints, skin, and nails
- Imaging (X-ray, MRI, ultrasound) to detect inflammation and bone changes
- Blood tests to rule out other forms of arthritis (e.g., negative rheumatoid factor)
- Joint fluid analysis to exclude gout or infection
Treatment
Medications
- NSAIDs (e.g., ibuprofen, naproxen) for pain relief
- DMARDs (e.g., methotrexate, sulfasalazine) to slow disease progression
- Biologics (e.g., adalimumab, etanercept, ustekinumab) for targeted immune modulation
- Otezla (apremilast) to reduce inflammation via PDE4 inhibition
- Corticosteroids for rapid relief (oral or joint injection)
Topical Treatments
Creams and ointments (corticosteroids, vitamin D analogs) for skin plaques.
Therapies
- Physical therapy to improve range of motion and strengthen muscles
- Occupational therapy for adaptations to daily activities
Surgery
Joint repair or replacement for severe, irreversible damage.
Lifestyle
Regular exercise, healthy weight management, and balanced diet to support overall health and reduce stress on joints.
Sources
- American Academy of Dermatology: Psoriatic arthritis diagnosis and treatment
- American College of Rheumatology: Psoriatic arthritis guidelines
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Psoriatic arthritis overview
- Arthritis Foundation: Psoriatic arthritis resources
- National Library of Medicine: Psoriatic arthritis article