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In this section you can find out more information regarding Psoriatic Arthritis (PsA)

Psoriatic arthritis is a form of joint inflammation affecting individuals with psoriasis.

Almost 1 in 3 people with psoriasis will also have psoriatic arthritis.

In most cases, the arthritis will develop after the appearance of psoriasis.

PsA can cause pain, swelling and stiffness in any joint in the body, but it often affects the knees, ankles, hands and feet.

There are between 50,000 to 156,000 people in England and Wales who have been diagnosed with PsA.

Most cases first start in people aged 30-55 and effects men and women equally.

What is Psoriatic Arthritis (PsA)?

References
1. Psoriasis Association. Psoriatic arthritis. Available at https://www.psoriasis-association.org.uk/psoriasis-and-treatments/psoriatic-arthritis Accessed October 2022
2. NHS. Psoriatic arthritis - Overview. Available at https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed October 2022
3. NICE. Health Technology Appraisal. Available at https://www.nice.org.uk/guidance/ta199/documents/psoriatic-arthritis-etanercept-infliximab-golimumab-and-adalimumab-review-final-scope2 Accessed October 2022

Causes

The exact cause of PsA is not fully understood. Almost 1 in 3 people with psoriasis also have psoriatic arthritis.

It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms. Like psoriasis, PsA is thought to happen as a result of the immune system mistakenly attacking healthy tissue.

However, it is not clear why some people with psoriasis develop PsA and others do not.  Read more about psoriasis.

Risk Factors

Factors that may increase the risk of PsA include:

Psoriasis

Having psoriasis is the single greatest risk factor for developing PsA.

Genetics

PsA can run in families.

Age

Although anyone can develop PsA, it occurs most often in adults between the ages of 30 and 55.

References
1. NHS. Psoriatic arthritis - Overview. Available at https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed October 2022
2. Mayo Clinic. Psoriatic arthritis. Available at https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076 Accessed October 2022

The main symptoms of PsA are joint pain, swelling and stiffness. It can also cause more general symptoms and inflammation in other parts of the body.

PsA can affect joints on one or both sides of the body.

The signs and symptoms of PsA often resemble those of rheumatoid arthritis as both diseases cause joints to become painful, swollen and warm to the touch. Read more about rheumatoid arthritis.

Additional symptoms - As well as problems affecting the joints, other symptoms can include:

  • Swollen fingers and toes
  • Foot pain - at the points where tendons and ligaments attach to the bones - especially at the back of the heel (Achilles tendinitis) or in the sole of the foot (plantar fasciitis)
  • Lower back and neck pain
  • Nails - can form tiny dents (pits), crumble or separate from the nail beds
  • Eye inflammation

What are the symptoms of PsA?

References
1. NHS. Psoriatic arthritis - Overview. Available at https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed October 2022
2. Mayo Clinic. Psoriatic arthritis. Available at https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076 Accessed October 2022

There is no single test for the condition, however, some tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout.

A diagnosis of PsA is made by a doctor assessing symptoms experienced, an examination of the joints and the results of x-rays, scans and blood tests. If PsA is suspected, a referral to a specialist (rheumatologist) is made.

Tests

No test can definitively prove or rule out a diagnosis of PsA. However, several tests can show possible signs of the condition.

  • Joint fluid test – a small sample of fluid from an affected joint. Uric acid crystals in joint fluid might indicate PsA
  • Rheumatoid factor blood test – measures levels of rheumatoid factors in the blood. Rheumatoid factors are proteins that the immune system produces when it attacks health tissue

Joint Scans

Scans may be used to diagnose and monitor joint inflammation and damage. They include:

  • X-rays – create images of the inside of the body, can help pinpoint changes in the joints that occur in PsA but not in other arthritic conditions
  • Magnetic Resonance Imaging (MRI) scans – use magnets to look at what is happening inside the body. Scan can show problems with the tendons and ligaments in feet and lower back

References
1. NHS. Psoriatic arthritis - Overview. Available at https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed October 2022
2. Mayo Clinic. Psoriatic arthritis. Available at https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081 Accessed October 2022

There are a variety of treatments available for PsA which can help reduce inflammation in the joints, relieve pain, prevent or slow down the condition and improve quality of life.

There are three main ways to treat rheumatoid arthritis:

  • Medications
  • Physical therapies
  • Surgery

Medications

There are three main groups of medications that are used to treat PsA:

  1. Non-steroidal anti-inflammatory medications (NSAIDs) – traditional NSAIDs, such as ibuprofen, naproxen or diclofenac and COX-2 inhibitors (often called coxibs), such as celecoxib or etoricoxib.

  2. Corticosteroids – help reduce the pain and inflammation. These are sometimes injected directly into an affected joint.

  3. Disease-modifying anti-rheumatic medications (DMARDs) – can ease symptoms and slow the progression of the condition.

    Biologics are a subset of DMARDs that target specific parts of the immune system causing joint damage. A biologic can slow, modify or stop the disease.

Physical therapies

Physical therapies such as physiotherapy, hydrotherapy and occupational therapy can all help to improve symptoms and mobility.

Surgery

Despite taking medicines, joints may still become damaged. Surgery is sometimes needed to reduce pain, correct joint shape or restore the ability to use a joint. Surgery may involve removal of inflamed tissue or joint replacement.

References
1. NHS. Psoriatic arthritis - Overview. Available at https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed October 2022
2. Mayo Clinic. Psoriatic arthritis. Available at https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081 Accessed October 2022

Lifestyle changes can help with managing PsA and include:

Exercise – lack of exercise may stiffen joints and weaken muscles. It is important to keep a good balance between rest and exercise. Low-impact activities that put less strain on joints, such as swimming, cycling, walking and aqua aerobics are best.

Healthy eating – there is no specific diet for patients with PsA, however a balanced, nutritious diet will help to maintain a healthy weight.

Smoking and drinking – stop smoking and only drink a moderate amount of alcohol.

Medication – it is important to take medication as prescribed, even if symptoms reduce. Medication can help prevent flare-ups and reduce the risk of joint damage.

References
1. NHS. Psoriatic arthritis - Overview. Available at https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed October 2022
2. Mayo Clinic. Psoriatic arthritis. Available at https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081 Accessed October 2022

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