Arthritis

Arthritis: Psoriatic

About 10-30% of people with psoriasis will develop psoriatic arthritis. It usually arises in people 30-50 years old who have already experienced the skin symptoms of psoriasis. However, about 15% of people may develop joint symptoms before developing other signs of psoriasis on their skin.

Early diagnosis and treatment is important to minimize damage to the joints. Left untreated, psoriatic arthritis can result in permanent damage and disability.

What are the symptoms of psoriatic arthritis?

Like psoriasis, the symptoms of psoriatic arthritis can range from mild to severe.

Symptoms of psoriatic arthritis include the following:

  • Stiffness, pain, and swelling of the tendons and joints

  • Less mobility in affected parts of the body

  • Swelling of the fingers and toes (dactylitis)

  • Morning stiffness

  • Generalized fatigue

The joints most commonly affected are in the fingers and toes (the joints at the ends near the nails), the lower back, wrists, knees, and ankles. A small number of people with psoriatic arthritis develop spondylitis, an inflammation of the spinal column that can lead to pain and stiffness of the neck and back.

How is psoriatic arthritis treated?

There are a variety of treatments for psoriatic arthritis. Your doctor will recommend a treatment based on the severity of symptoms, results of past treatments, and your medical history.

Medications

Your doctor may prescribe medications to help manage your symptoms.  Medications include:

  • Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs)—Some of these, such aspirin, ibuprofen (Advil and Motrin), and naproxen (Aleve, Naprosyn) are available over-the-counter. Others, such as ketoprofen (Orudis), and diclofenac (Voltaren and Arthortec) require a prescription.

  • Corticosteroids taken by mouth (prednisone)—These reduce the inflammation and swelling in the joints. Because of the side effects that develop with prolonged use, oral corticosteroids are generally used for a limited time to get arthritis symptoms under control and then discontinued.

  • Corticosteroid injections—corticosteroids may be injected into some joints that are particularly inflamed without the side effects of taking corticosteroids by mouth

  • Antimalarials—Some of the medication used to treat malaria have been an effective treatment for different types of arthritis.

  • Soriatane (acitretin)

  • Cyclosporine

  • Methotrexate

  • Sulfasalazine

  • Azathioprine (Imuran)

Biologics for psoriasis

Biologics (also called “immunomodulators” or “disease-modifying therapies”) are a relatively new treatment option for moderate to severe psoriasis and psoriatric arthritis.   Biologics are especially effective at healing the progression of arthritis in patients with psoriasis.

Biologics are derived from human or animal proteins instead of chemicals. They work by targeting specific parts of the immune system such as T-cells or TNF, a chemical messenger used by immune cells. This focused approach reduces the likelihood of side effects that are seen following treatment with other medications that impact the entire immune system.

Biologics must be administered by injection, either into the skin (subcutaneously), into the muscle (intramuscular or IM), or by intravenous infusion (IV). Some biologics may require long-term use to keep psoriatic arthritis under control. 

Biologics available for the treatment of psoriatic arthritis include:


 

 

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