Psoriatic arthritis (PsA) can be a bit of a head-scratcher. What does a dry, silvery rash have to do with achy joints? Though the disease has an array of symptoms and treatments, there are lots of ways to live happily with PsA.
Keep reading to get all the details on this autoimmune disease and find out what you can do to minimize your symptoms. Go on, breathe a sigh of relief.
Psoriatic arthritis is — you guessed it — a combination of psoriasis and arthritis, just as it sounds. Let’s break it down a bit more.
Psoriasis is an autoimmune disease that causes your skin to create cells a little too quickly. Basically, your skin doesn’t have enough time to let the old cells die and flake away, so skin cells form plaques or lesions. These patches of skin often look dry and silvery or irritated and red.
Then there’s arthritis, which is inflammation that impacts your joints (elbows, wrists, shoulders, hips, sacrum, etc.).
This condition can make movement of the affected joint painful or difficult. It often affects the fingers and toes (aka digits) and can even affect only one digit at a time (sometimes called a “sausage digit,” thanks to the swelling).
Put them together and what do you get? Psoriatic arthritis. This condition involves both the skin rash and the inflamed joints. More than 8 million people in the United States have psoriasis, and 10 to 30 percent of people with psoriasis develop PsA.
Like psoriasis, PsA is caused by an overzealous autoimmune response, where your immune system starts attacking your body. As your immune system freaks out on your joints and skin, you’ll experience swelling, rashes, plaques, and limited mobility.
Experts aren’t exactly sure what causes PsA, but it’s often hereditary. For some people, specific events can trigger a flare-up of PsA — we’ll get to those later — but there’s no way to avoid PsA entirely.
While there’s currently no cure for the disease, there are plenty of treatments to make the symptoms suck less and improve your overall quality of life.
PsA can present itself differently in different people. Here are the five overall types of psoriatic arthritis. (People can get symptoms from multiple subtypes, which is why the percentages add up to more than 100.)
This type causes swollen, painful, or tender joints on one side of your body. Symptoms don’t necessarily show up on the same side — your right knee and left hand might be affected at the same time.
With this type of PsA, the problems don’t hit the same joint on both sides at the same time. (Phew!) The effects range from mild to very severe. This is by far the most common type, occurring in 70 to 80 percent of cases.
This type hits joints on both sides of the body. It may not affect every joint, but if you have pain in your left elbow, you’ll also have pain on the right. This type occurs in 5 to 20 percent of cases.
Distal interphalangeal predominant PsA
This is a very fancy way of saying that your fingers — specifically the joint closest to the nail — will be affected. You’ll have the most significant symptoms in your fingers and nails. This type affects 10 percent of cases.
This type mostly affects the spine. You may have symptoms from your neck to your tailbone and may also feel pain in your hips, pelvis, arms, legs, and feet. This type occurs in 5 to 20 percent of cases.
Psoriatic arthritis mutilans
This type mostly affects the hands and feet and, in some cases, can cause deformities. It’s considered rare, affecting about 5 percent of cases.
You might think skin rashes and joint pain are the only PsA symptoms. But there are other symptoms that can help you and your doctor get to a PsA diagnosis.
Most PsA symptoms appear in the skin, joints, nails, and entheses (the places where a ligament or tendon meets a bone), and the effects differ in each part of your body. Here are a few to watch out for:
- Skin: Look out for a painful, red rash or patches of dry, dead skin. These often pop up on the knees, elbows, scalp, buttocks, or belly button but can occur anywhere on your body.
- Joints: They may feel tender, warm, or painful. Sometimes, joints can swell a great deal (especially in the fingers) and be hard to move. Fingers, wrists, ankles, and knees are the most commonly affected joints, though symptoms may also occur in the neck, hips, and spine.
- Entheses: Especially at the back of the heel and bottom of the foot, the connection of the ligament to the bone can swell and become painful. You may have decreased mobility of the area.
- Nails: Watch out for white spots, pitting (holes), ridging (deep grooves), cracking, or the nail lifting from the nail bed.
Some people say pain is located directly in the joints. Others experience stiffness in the morning that dissipates as the day goes on or with a warm shower.
You may also experience eye redness and pain, fatigue, slight fever, and/or depression. Some people even have flu-like symptoms, such as all-over body aches.
As you can see, symptoms can vary wildly, but they’ll usually include a skin rash and some kind of joint or body ache or tenderness.
The severity of your symptoms will ebb and flow too. You might have flare-ups that cause a lot of pain some days and be completely symptom-free on other days. This is normal — PsA rarely feels exactly the same every day of the week.
If you already have a psoriasis diagnosis, see your doctor as soon as any joint pain comes up. If you don’t have a diagnosis but you’re experiencing symptoms, see a doctor anyway. It’s best to seek treatment ASAP to avoid arthritic damage to your joints.
No one really knows what causes PsA. Research suggests a genetic connection, meaning that if you have a family member with PsA, you’re more likely to have it yourself.
There’s some evidence that a trauma or an infection could trigger PsA. So, an earlier illness could have set your immune system into overdrive, and now it’s going to town on your skin and joints.
Either way, PsA definitely isn’t contagious. And having PsA doesn’t guarantee that you’ll pass it on to your children, though they may have an increased risk.
There isn’t much you can do to avoid PsA, but you can manage the symptoms and try to reduce your triggers.
The biggest risk factor is genetics. If you have a family history of psoriasis, arthritis, or psoriatic arthritis, you have a higher chance of developing PsA. In fact, about 40 percent of people with PsA also have a relative who has it.
Also, people who have had strep throat or are HIV-positive may have a higher risk of PsA, though this occurs less often.
A doctor will need to be sure you don’t have psoriasis or a different form of arthritis before recommending a treatment. Right now, there’s no “Yep, this is PsA” test, so you’ll likely go through a few tests before getting an official diagnosis.
They may test for RF antibodies to be sure you don’t have rheumatoid arthritis (RA). RA can have very similar symptoms, especially in the joints, but with PsA, your body doesn’t produce RF antibodies. So, if there are no RFs, you can rule out RA.
Your doctor will likely do a physical exam to see the tenderness and swelling of your joints and irritation of your skin. Then, you may get an X-ray or MRI to check for damage to your bones and help your doctor get a better idea how severe the inflammation is.
Your doctor might remove liquid from a swollen joint to make sure the inflammation isn’t caused by gout or another condition. And they’ll ask about your medical history to see if you have an increased genetic risk.
You may not need to go through all these tests, but you’ll likely have a physical exam and a few blood tests before your doctor starts handing out recommendations for treatment.
We know all this doesn’t sound very pretty. But there’s a wide range of treatments for PsA, from lifestyle changes to prescriptions.
Hot and cold compresses
Mild pain and swelling may go away when you use hot and cold compresses (but this probably won’t work for severe pain). To reduce symptoms, alternate between hot and cold for about 30 minutes apiece.
This works because a hot compress helps increase blood flow and relax the surrounding muscles, and then a cold compress causes a light numbing effect and reduces swelling.
Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can reduce mild swelling and pain in your joints.
For worse pain, a doctor may give you a prescription dose of NSAIDs. The side effects are usually mild, but taking too many NSAIDs can cause stomach or even heart issues.
These are available orally, topically, and by injection and can provide *big* relief for inflammation, but they are used sparingly due to their side effects. OTC topical treatments may reduce plaques and rashes on your skin. The oral version must be prescribed by a doc.
Though these medications often work in the short term, it’s important to note that they can cause weight gain, bloating, and weak bones.
If your body doesn’t quite respond to OTC treatment, never fear. Doctors will work with you to try out something stronger.
Unlike NSAIDs and corticosteroids, which decrease overall inflammation, disease-modifying antirheumatic drugs (DMARDs) block specific parts of the inflammation process and can be more effective.
Methotrexate is the most common DMARD. It releases a chemical that helps block other inflammatory chemicals, which can reduce swelling and pain. It’s mainly used to address symptoms in the fingers and toes.
OK, now the not-so-fun part: People who take methotrexate may experience nausea and vomiting. But you can avoid these side effects by taking a folic acid supplement with your daily dose.
Otezla may also be prescribed. In trials, some people experienced as much as a 75 percent improvement in joint and skin symptoms after 2 years on the drug, although results vary from person to person. Side effects were mild and infrequent, but mood changes can occur.
Liver disease is one of the possible side effects of traditional DMARDs, so it’s best to avoid alcohol when taking any of these drugs.
If you don’t respond to oral DMARDs, your doctor may move you to biologics. These genetically engineered proteins will zero in on the parts of your immune system that cause inflammation and shut them down.
Administered in a shot or an infusion, biologics work faster than traditional DMARDs but can have greater side effects. They suppress your immune system, so you’ll be more susceptible to infections.
Also, since these drugs are highly targeted and customized, they’re more expensive to make and may cost more for you to take (depending on your insurance).
Since your immune system is behind all these PsA problems, an immunosuppressant can relieve the symptoms.
Azathioprine has been found to be as safe and effective as methotrexate for people who don’t respond to methotrexate. And, while the research on this is older, cyclosporine has been shown to reduce inflammation in people with PsA. These can be additional options if more commonly recommended treatments don’t work.
The bad news about immunosuppressants is that they, well, suppress your immune system, so you’re more likely to get infections.
Chin up, though. Nowadays, immunosuppressants aren’t used frequently — they’re typically used only if you don’t respond to other treatments.
For mild PsA, a few lifestyle changes can make a world of difference.
Have you heard the phrase “Use it or lose it?” Well, exercise can increase mobility in people with arthritis because it keeps your joints nice and active — and we want that! Walking, bicycling, or swimming for 30 minutes five times a week is recommended.
Of course, if you’re having a flare-up, do only what you can, and don’t do any exercise that causes pain. But staying active will help reduce inflammation and stiffness in the short and the long term.
A healthy diet can also kick inflammation to the curb. Research suggests that eating lots of fruits, vegetables, and whole grains while keeping fat, sugar, and salt low can help your overall health and keep inflammation at bay.
Consider an omega-3 fatty acid supplement as well. That fatty fish oil may reduce bloating and inflammatory responses, which could help you feel better during a PsA flare-up.
Smoking and drinking are big no-nos for folks with PsA. Smoking isn’t a great idea for anyone, but it’s especially bad for people with PsA.
Drinking in moderation might be OK, but keep in mind that alcohol promotes inflammation, and any extra inflammation is tough for psoriatic arthritis. It’s best not to mess with it.
Stress can also trigger a flare-up, so stress reduction is key in managing PsA. Try meditating or simply sitting in a quiet place for 5 minutes while you focus on breathing deeply. If you can, avoid overly stressful situations and give yourself extra time to rest and relax.
Aside from the joint and skin conditions we’ve talked about, PsA is closely related to a few other chronic conditions. It’s not clear if PsA causes these illnesses, but you’re more likely to be affected by them if you have PsA:
- Cardiovascular disease. The inflammatory nature of PsA can increase your risk of heart disease and related conditions such as diabetes, obesity, and metabolic syndrome.
- Inflammatory bowel disease (IBD). Crohn’s disease and ulcerative colitis are also autoimmune diseases, and PsA patients are slightly more likely to have one of these conditions.
- Eye disease. As your immune system attacks soft tissue in the joints, it may also attack your eyes.
- Depression and anxiety. Experts aren’t sure if PsA causes depression or if depression is a response to the symptoms of PsA. Either way, you have an increased risk of mental health issues.
That list may not sound good, but it’s not meant to scare you! Having PsA doesn’t mean you’ll definitely have any of these other conditions. But it’s a good idea to make any efforts you can to avoid them.
Eating a balanced diet, exercising, and taking care of your mental health can help with all of these conditions. If you start to experience symptoms of these related conditions, talk to your doctor right away to make sure your treatment covers all the bases.
It’s best not to let PsA go untreated. Like, ever. If the condition worsens, it may cause irreparable damage to your bones and joints. This could result in deformity and a lack of mobility in the affected area.
Outside of your joints, PsA can cause eye issues, digestive problems, shortness of breath, and damage to your blood vessels and heart.
By starting treatment early, you may be able to avoid these complications and have a better quality of life overall.
Psoriatic arthritis can feel isolating, so it’s helpful to have a group of people who understand and support you as you handle this chronic illness.
There are many online communities for PsA where you can learn more about your condition and seek the support of people who completely understand where you’re coming from.
TalkPsoriasis is the largest online community for people with PsA and psoriasis. The Arthritis Foundation can help you find local groups to connect with, and Psoriatic-Arthritis.com is full of educational resources and people to help you out.
Feel free to ask your doctor about other local groups. And don’t be afraid to lean on your friends and family for help when you need it.
Psoriatic arthritis can be a serious condition, and there’s currently no cure. But with medical treatments and lifestyle changes, you can live an active, happy life.
Talk to your doctor to find the best treatment option for you. To live your best life with PsA, it’s also important to eat a nutritious diet, get moving when you can, quit smoking, and seek support from other people with PsA.