Psoriasis and joint pain

Back to top

What is psoriatic arthritis?

Like psoriasis, psoriatic arthritis is a chronic inflammatory disease in which the immune system, as well as genetic and environmental factors, is believed to play an important role in the development of the disease. Symptoms are typically a combination of skin symptoms and joint inflammation. People with psoriatic arthritis may experience nail lesions, inflammation, and swelling in and around the joints commonly affecting the hands, feet, wrists, ankles, knees, and lower back.

Seven to 42% of people with psoriasis symptoms may have or may develop psoriatic arthritis, although it often goes undiagnosed, especially if the symptoms are mild. Psoriatic arthritis usually develops between the ages of 20 and 50; however, it can appear at any age and affects men and women almost equally.

Prompt and accurate diagnosis and treatment are key. In fact, early treatment may slow the progression of joint damage and help lessen the impact of the disease. So it’s important to talk to a specialist right away if you experience the symptoms described in this section.

Back to top

Symptoms and onset of psoriatic arthritis

In most cases, the psoriasis symptoms develop first. It’s not at all unusual for many years to pass before joint symptoms set in; however, this condition doesn’t follow a standard course. In fact, approximately 15% of patients develop symptoms of psoriatic arthritis before their psoriasis is diagnosed. Because each case of psoriatic arthritis is unique, be sure to consult a specialist for an accurate diagnosis.

Back to top

Warning signs of psoriatic arthritis

If you have psoriasis, pay special attention to any of the following symptoms, which generally appear as a result of psoriatic arthritis:

• Swollen and tender joints, particularly the “hinge” joints of the hands and feet
• Fingers and toes that are completely swollen and appear "sausage-like"
• Inflammation in more than four joints but not always in the same finger or toe, which may indicate a more severe condition
• Inflammation in the tendons, the tissue that connects muscles to bones
• Tenderness or stiffness in the spine, which may indicate spondyloarthropathy
• Arthritis in one or more joints
• Nail pitting, crumbling or white spots under the nails

Early treatment is recommended to help prevent the severe joint damage that can occur in later stages of the disease. So be sure to share any health changes with your doctor.

Back to top

Causes of psoriatic arthritis

Although the exact cause of psoriatic arthritis has not been determined, the immune system, as well as environmental and genetic factors, appears to play an important role in the development of the disease.

In fact, a close look at the role of the immune system reveals a number of similarities between what is happening in psoriatic skin and what is happening in a psoriatic joint. In both, the immune system is accidentally activated, resulting in an abnormally rapid skin cell cycle and/or inflammation in the deep layers of tissue that surround the joints.

Infections, such as a streptococcal (“strep” throat) infection or other respiratory infections may also trigger the immune system, resulting in psoriatic arthritis.

Back to top

Prompt treatment can make a difference

The goals of treatment are to relieve pain, reduce swelling, help keep joints functioning properly, and to slow further damage to the tissues or joints. There are several prescription and non-prescription drug options available to treat your psoriatic arthritis. Your doctor will recommend treatment based on the severity of your psoriatic arthritis, as well as your reaction to the treatment.

• Non-steroidal anti-inflammatory drugs (NSAIDs), including over-the-counter medications such as acetylsalicylic acid, ibuprofen, and prescription drugs, are used to decrease joint pain, stiffness, and inflammation
• Systemic agents, such as cyclosporine and methotrexate, may be effective in the treatment of psoriatic arthritis. They work by suppressing the activity of chemicals in the immune system, which results in slower skin cell growth. Methotrexate is a cytotoxic that is used to treat severe disabling psoriasis/psoriatic arthritis in people who have not responded adequately to other therapies and may be used in combination with other therapy. There are many possible side effects including fever, nausea, and even liver damage. Cyclosporine is used for the treatment of severe psoriasis where conventional therapy is inappropriate or ineffective. Common side effects may include gum enlargement, flu-like symptoms and upper respiratory infections. Biologics, selective medications that target specific actions in the body’s immune system that are believed to mediate psoriasis or psoriatic arthritis, are also effective. They generally work by reducing signs and symptoms and improving physical function in people with psoriatic arthritis. Some of the most common side effects include infection, nausea, diarrhea and headache.

Learn more by signing up for Psoriasis Connections and receive:

• Timely information about psoriasis sent to you via e-mail and mail
• Regular updates on psoriasis, relevant treatment and research information, and insights to help you effectively manage your condition.