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Psoriatic arthritis

Definition

Psoriatic arthritis is an arthritis that is often associated with psoriasis of the skin.

Alternative Names

Arthritis - psoriatic

Causes, incidence, and risk factors

Psoriasis is a common, chronic skin condition that causes red patches on the body. About 1 in 20 people with psoriasis will develop arthritis with the skin condition. In most cases, psoriasis comes before the arthritis.

The cause of psoriatic arthritis is not known, but genes may play a role. In general, people who have psoriasis have a higher rate of arthritis than the general population.

Symptoms

The arthritis may be mild and involve only a few joints, particularly those at the end of the fingers or toes. In some people the disease may be severe and affect many joints, including the spine. When the spine is affected, the symptoms are stiffness, burning, and pain, most often in the lower spine and sacrum.

People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

Signs and tests

During a physical examination, the health care provider will look for:

• Joint swelling
• Skin sores
• Tenderness

Joint x-rays may be performed.

Treatment

Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) or salicylates to reduce pain and inflammation of the joints.

More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs (DMARDs), such as:

• Leflunomide
• Methotrexate
• Sulfasalazine

New medications that block an inflammatory protein called tumor necrosis factor (TNF) are becoming the treatment of choice. These include:

• Adalimumab (Humira)
• Etanercept (Enbrel)
• Infliximab (Remicade)

Occasionally, particularly painful joints may be injected with steroid medications.

In rare cases, patients need surgery to repair or replace damaged joints.

Your doctor may suggest a healthy mix of rest and exercise. Physical therapy may help increase the movement of specific joints. You may also use heat and cold therapy.

Support Groups

Expectations (prognosis)

The course of the disease is often mild and affects only a few joints. A few people will have severe psoriatic arthritis in their hands, feet, and spine that causes deformities. In those with severe arthritis, treatment can still be successful in relieving the pain.

Complications

Repeated episodes may occur.

Calling your health care provider

Call for an appointment with your health care provider if arthritis symptoms develop along with psoriasis.

Prevention

There is no known prevention.

References

Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. 2008;58(5):851-864.

J Am Acad Dermatol.