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Treatment For

Psoriatic Arthritis

Psoriatic Arthritis occurs in individuals with psoriasis, which is a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with Psoriatic arthritis, but the joint problems can sometimes begin before any skin patches start to show.

Who Gets Psoriatic Arthritis?

Psoriatic Arthritis: autoimmune arthritis that affects approximately 30% of patients with psoriasis. It can affect many joints and will often cause joint pain, swelling and damage without treatment.

Causes

Medical professionals do not yet fully understand the causes of psoriasis. However, they do know that the immune system has an active involvement in psoriatic conditions. The immune cells attack healthy joint tissue, causing inflammation, swelling, and pain.

Genetics may play a role in PsA. Psoriatic conditions tend to run in families. In fact, over 40% of people with PsA have a family member with the condition.

Some people without the characteristic skin involvement of psoriasis may still develop PsA.

Environmental factors may also play a role. Injury, infection, and exposure to environmental triggers can cause PsA to flare, especially in people with a family history of the condition.

Symptoms

  • Fatigue
  • Tenderness, pain and swelling over tendons
  • Swollen fingers and toes that sometimes resemble sausages
  • Stiffness, pain, throbbing, swelling and tenderness in one or more joints
  • Morning stiffness
  • Nail Changes – for example, the nail separates from the nail bed or becomes pitted, mimicking fungus infections
  • Redness and pain of the eye (uveitis)

Triggers

The period of time during which symptoms get worse is called a flare. Flares often have a specific environmental trigger.

Common triggers include:

  • Exposure to cigarette smoke
  • Infections or skin wounds
  • Severe stress
  • Cold weather
  • Drinking too much alcohol
  • Taking certain medications

Treatments

Unfortunately, there is no definitive test for Psoriatic arthritis. The diagnosis is made mostly by your doctor’s observations and by a process of elimination. Your doctor will talk with you about your medical history, particularly any history with Psoriasis, and may perform a physical examination, blood tests, MRIs, and X-rays of the joints with symptoms to diagnose PsA.

Doctors primarily use biologics to treat moderate to severe PsA. Biologics target specific parts of the immune system and help reduce the regularity and severity of flares.

Several different medications are effective against the symptoms of PsA. The doctor will prescribe a medication based on levels of pain, swelling, and stiffness.

Options include:

  • TNF-alpha inhibitors (TNFIs): These drugs block the production of a protein that contributes to inflammation and swelling. They also help reduce pain.
  • Nonsteroidal anti-inflammatory drugs: These can be very effective for mild pain and inflammation. Examples include Ibuprofen or Naproxen. Many are available over the counter.
  • Other immune-modulating medications: Osmotic release drugs: These are helpful for people who cannot take TNFIs, including those with congestive heart failure, recurrent or severe infections, or another Demyelinating or autoimmune condition. Examples include IL-17 and IL-23 inhibitors, Tofacitinib (Xeljanz) and Apremilast (Otezla).
  • Disease-modifying anti-rheumatic drugs (DMARDs):  Examples include Methotrexate, Sulfasalazine, Leflunomide, JAK inhibitors, IL-17 and IL 23 inhibitors, and Apremilast.

Prevention

No specific treatment can prevent psoriatic arthritis, but the right treatment may lessen the severity of the disease.

Both Psoriasis and Psoriatic arthritis are autoimmune diseases, which means that they occur when the body attacks healthy tissue.

Tests for inflammation may help assess whether a person is at risk of Psoriatic arthritis, and working to prevent inflammation may help reduce symptoms of the disease.

For people who develop psoriatic arthritis, the right treatment can minimize disease activity, and improve quality of life.