Psoriatic Arthritis: Joint Pain, Stiffness and Swelling With Psoriasis

What it involves

MedlinePlus describes psoriatic arthritis as a joint problem that often occurs with psoriasis, a chronic skin condition that causes red, scaly patches. It causes pain, stiffness and swelling in the joints. It can be mild and involve only a few joints, or serious and involve many, including the spine.

Who this is for

• Adults with psoriasis who now have joint pain, stiffness or swelling that has not gone away
• Patients with pitted or changed nails along with sore fingers or toes
• People with heel pain or tendon soreness who also have scaly skin patches
• Anyone with unexplained joint swelling who has not had the skin and joints looked at together

What to expect

• Questions about skin patches, nail changes, which joints hurt, morning stiffness and family history
• An exam of the joints for swelling and tenderness, the skin for psoriasis patches and the nails for pitting
• Blood work to look for other types of arthritis, since MedlinePlus says no blood test confirms psoriatic arthritis
• A referral to a rheumatologist and, when needed, joint x-rays arranged through an imaging center

How it connects to psoriasis

The MedlinePlus encyclopedia says psoriatic arthritis occurs in 7% to 42% of people with psoriasis, and that nail psoriasis is linked to it. In most cases psoriasis comes first, but in a few people the arthritis comes before the skin disease, and severe, widespread psoriasis appears to raise the chance of getting it. The cause is not known; genes, the immune system and environmental factors may play a part. The psoriasis guide and the skin conditions guide explain the skin side.

Symptoms MedlinePlus lists

The joints at the ends of the fingers or toes may be more affected, and the arthritis can be on one side of the body or both. In some people the spine is involved, with stiffness and pain most often in the lower spine. Tendons can become inflamed, such as the Achilles tendon, the plantar fascia and the tendon sheath in the hand. Some people have inflammation of the eyes. The heel pain guide and the trigger finger guide describe two tendon problems that overlap with these.

What a provider checks

MedlinePlus says a provider looks for joint swelling and tenderness, red scaly skin patches, pitting in the nails and inflammation in the eyes, and joint x-rays may be done. There are no specific blood tests for psoriatic arthritis or psoriasis. Tests such as rheumatoid factor and anti-CCP antibodies check for other types of arthritis, and a gene test called HLA-B27 may be done when the spine is involved, though most people who test positive do not have psoriatic arthritis. The rheumatoid arthritis guide covers that other condition.

Telling it apart from other joint problems

Swollen, painful joints have many causes, and the cause changes the treatment. The osteoarthritis guide describes wear-related joint pain, and the gout guide describes sudden attacks from uric acid crystals. The swollen joints guide lists the questions a provider asks first. Bringing a list of which joints hurt, when stiffness is worst, and when your skin flares gives the visit a head start, since MedlinePlus notes the skin often gets worse at the same time as the arthritis.

Treatment MedlinePlus describes

A provider may suggest nonsteroidal anti-inflammatory drugs for pain and swelling, then disease-modifying antirheumatic drugs if joints do not improve, and injectable biologic medicines for arthritis that keeps progressing. Steroid injections may be used for one or a few very painful joints. Most experts do not recommend oral corticosteroids, which can worsen psoriasis. Rest, exercise, physical therapy, and heat and cold may help. The practice lists joint injections at its Loxahatchee and West Palm Beach offices, and a provider decides whether one suits a particular joint.

Why early care matters

The encyclopedia says that in many people with psoriatic arthritis, damage to joints occurs within the first several years, and in very bad cases it can cause deformities of the hands, feet and spine. It adds that early treatment can ease pain and prevent joint damage. Most people who do not improve with anti-inflammatory drugs should see a rheumatologist along with a dermatologist for the psoriasis, and anyone with eye inflammation should see an ophthalmologist. A primary care visit is where those referrals begin. Psoriasis can also come with arthritis of the spine and pelvis, which the ankylosing spondylitis guide describes.

Sources

• MedlinePlus: Psoriatic Arthritis (health topic)
• MedlinePlus: Psoriatic arthritis (medical encyclopedia)