Matthew Ezerioha, MD

Doctor of Medicine (M.D.) in 2016 from Medical University of South Carolina, Expert Medical Consultant & Entrepreneur

Oct 7, 2018 6 min read

PsA Treatment: How Do You Treat Psoriatic Arthritis?

Over 125 million people have psoriasis, a common skin condition that causes red, itchy skin with signature silvery scale patches. Afflicting 2-3% of the world’s population, psoriasis affects Caucasians more so than other races and it is the most common autoimmune disorder in the United States.

In addition to skin troubles, individuals with psoriasis are also more susceptible to joint troubles. Up to 30% of individuals who have psoriasis will also develop rheumatoid arthritis. Psoriasis precedes the onset of psoriatic arthritis in 85% of cases; however, in rare instances individuals can develop psoriatic arthritis without having prior psoriasis symptoms. The onset of psoriatic arthritis typically occurs between the fourth and fifth decade.

30%
30% of Psoriasis Patients who will Get Psoriatic Arthritis

 

What are the Symptoms of Psoriatic Arthritis?

If you are experiencing joint pain and have a history of psoriasis, it may be a good idea to visit a doctor to see if you have psoriatic arthritis. In addition to joint pain, some of the more common symptoms of psoriatic arthritis include:

  • Swollen and red joints
  • Joints that are warm to the touch
  • Nail pitting and other changes such as nails lifting from the nail bed
  • Stiff joints, especially when first waking up or after long periods of rest
  • A general feeling of fatigue or malaise
  • “Sausage-like” fingers and toes
  • Lower back pain
  • Achilles tendonitis
  • Plantar fasciitis, which refers to pain in ball of foot
  • Conjunctivitis which may commonly be referred to as pink eye
back pain

There are many types of psoriatic arthritis. The sub-type of arthritis you are diagnosed with depends on where the symptoms occur and how many joints are affected. Currently, five types of psoriatic arthritis have been identified:

  • Symmetrical polyarthritis – psoriatic arthritis that affects multiple joints with comparable severity on both sides of the body
  • Asymmetric oligoarticular – psoriatic arthritis that affects few joints on one side of the body
  • Spondylitis –psoriatic arthritis affecting joints in the lower back and near the spine
  • Distal interphalangeal – psoriatic arthritis in the joints of the fingers and toes
  • Arthritis mutilans – a severe form of psoriatic arthritis that causes deformation of the joints, especially in the hands and feet

 

Psoriatic Arthritis Diagnosis

To diagnose psoriatic arthritis, your doctor will take your medical history, family history, and consuct a physical examination. Additionally, he or she will perform a number of tests to narrow the list of possible diagnoses to psoriatic arthritis. Because psoriatic arthritis shares many symptoms with other types of arthritis, often, one of the tell-tale signs of psoriatic arthritis is the presence of psoriasis.

During a physical examination, your doctor will be looking for swollen joints, “sausage-like” fingers and toes, nail pitting and other nail changes. They may “look” for tenderness in areas that psoriatic arthritis tends to cause (e.g., in the heel or in the soles of your feet). Depending on their findings from your history and physical examination, they may choose to carryout some imaging and laboratory tests to confirm the suspected diagnosis.

doctor

Imaging tests, such as X-rays and MRIs are commonly ordered by doctors to aid the diagnostic process. X-rays can be used to further examine joint damage, while MRIs provide insight into the extent of damage to the tendons and ligaments.

Laboratory tests for psoriatic arthritis include Rheumatoid Factor (RF) tests and synovial (joint) fluid tests. RF is an antibody present in individuals who have rheumatoid arthritis; however, it does not usually appear in individuals with psoriatic arthritis. Because rheumatoid arthritis and psoriatic arthritis have so many overlapping symptoms, a diagnostic line may be difficult to draw. Synovial fluid sampling refers to the collection of fluid from an affected joint for testing. The synovial fluid sometimes contains properties which may help rule out arthritis. For example, the presence of uric acid crystals in the fluid is indicative of gout instead of psoriatic arthritis. Gout also has many characteristics similar to psoriatic arthritis.

 

Treatment Options

There is no cure for psoriatic arthritis. However, with prompt and proper treatment, psoriatic arthritis symptoms can be controlled and the pain lessened significantly. Prescription medications, natural remedies, and lifestyle changes are all management options for psoriatic arthritis.

drugs

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs): One of the most common medications prescribed to treat psoriatic arthritis, NSAIDs are designed to reduce joint inflammation and the associated pain.  There are a number of OTC options (e.g., Advil and Motrin) and several prescription NSAIDs. Several side effects can occur from long-term use, such as increased stomach irritation and the risk of bleeding from ulcers.

Disease-modifying antirheumatic drugs (DMARDs): These anti-inflammatory drugs are made to prevent joint damage by inhibiting inflammatory chemicals that cause joint inflammation. Common DMARDs prescribed for psoriatic arthritis include methotrexate and sulfasalazine.

Corticosteroids: These drugs are designed to work like the body’s natural steroid cortisol (produced by the adrenal glands), which works as an anti-inflammatory agent.  Long-term use of corticosteroids can cause weight gain, facial swelling, and predispose users to osteoporosis. Most individuals with psoriatic arthritis take corticosteroids orally, but the drug can also be injected into inflamed joints to provide temporary pain relief.

Biologics: Biologics stop inflammation at the cellular level and include two common types used to treat psoriatic arthritis: anti-tumor necrosis factor-alpha (TNF-alpha) and ustekinumab, both monoclonal antibodies. TNF-alpha drugs block proteins that kickstart the inflammatory process while Ustekinumab contains an antibody that suppresses proteins known as cytokines which activate and coordinate inflammation. In general, biologics are known to suppress the immune system, leaving you susceptible to infections and illnesses.

 

Natural Remedies

There are several natural remedies to treat psoriatic arthritis and related psoriasis. Most of these remedies are based on anecdotal evidence over scientific fact; however, many people swear by their treatment utility.

Apple cider vinegar: used to treat psoriasis and is applied directly to the skin. Individuals have found apple cider vinegar to be particularly useful for psoriasis of the scalp.

Oats: Taking oat baths have become a well-known natural remedy to treat the itchiness associated with psoriasis.

Tea tree oil: Known as an anti-inflammatory agent, tea tree oil helps to control skin inflammation caused by psoriatic arthritis. Prolonged use of this essential oil may ultimately irritate individuals with sensitive skin.

Turmeric: Widely noted for its anti-inflammatory properties, turmeric is taken often by people who suffer from arthritis. Turmeric can be taken by eating foods with turmeric in them or by taking turmeric capsules.

Capsaicin: Capsaicin blocks pain receptors to decrease the pain associated with psoriatic arthritis. Within topical creams, capsaicin has been found to be effective in treating psoriasis.

Fish oil: Omega 3 fatty acids block inflammation and suppress painful swelling.

Ginger: Ginger root is known for its anti-inflammatory properties and treating joint inflammation caused by arthritis.

Aloe vera: Applied topically, aloe vera has a cooling agent to soothe skin with psoriasis.

Oregon grape: Similar to aloe vera, creams containing Oregon grape are thought to minimize skin irritations caused by psoriasis.

Epsom salts: A good Epsom salt bath soak can work wonders to reduce joint inflammation and joint pain.

 

Lifestyle Changes

Maintaining a healthy weight: Being overweight causes extra strain on the joints. If you are an individual with psoriatic arthritis, maintaining a healthy weight can decrease the amount of stress on your joints, contributing to lessened pain and inflammation. In addition to reducing the amount of strain on your joints, maintaining a healthy weight can also contribute to increased mobility.

hand pain

Regular exercise: Regular exercise is an important part of every day life when you are living with psoriatic arthritis. Exercise loosens joints, decreases pain, and increases your mobility. All of these things contribute to your quality of life. If you are having trouble exercising while living with psoriatic arthritis because of the strain on your joints, engage in exercises that are gentle to your joints (e.g., swimming and biking).

Protecting your joints: When your joints are already inflamed and painful, try to reduce the introduction of any additional stress to your joints. When opening a jar, use a jar opener to assist. When pushing a door open, use your body weight to push the door open instead of your fingertips.

Pacing your activities: Fatigue is a very real part of psoriatic arthritis. When you are already fatigued, it’s best to split your tasks up into multiple segments so as not to put undue stress on your joints when you’re already tired. Relax several times during the day to conserve your energy.

 

Living with Psoriatic Arthritis

Living with psoriatic arthritis is all about maintaining the right treatment plan. With the right treatment plan in place, you can live a life free of pain and inflammation. Most doctors prescribe a combination of therapies to patients with psoriatic arthritis. This can include drug therapies, home remedies, and lifestyle changes to increase mobility, treat psoriasis symptoms, and minimize joint pain.

Even though psoriatic arthritis is a lifelong, chronic, autoimmune disorder, this does not have to impact your quality of life. Get diagnosed early, have your doctor develop a treatment plan, and stick to it. These are the keys to living a healthy life with psoriatic arthritis.