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Definition
Psoriasis is a chronic skin condition. It can cause inflamed patches of skin topped with silvery, white scales. Some people who have psoriasis later develop psoriatic arthritis (PsA). PsA is a long-term condition that causes pain and swelling in the joints.
Causes
The exact cause is not known. But it may be due to factors like:
- Having an autoimmune disease
- Having certain genes
- Being exposed to triggers in the environment (eg, viruses)
Risk Factors
Risk factors include having:
- Psoriasis for 5-12 years
- Certain symptoms of psoriasis (eg, lesions on the scalp, pitted or dented nails)
- A gene variation that has been linked to PsA
- A family member with PsA
Symptoms
Common symptoms include:
- Joint pain and tenderness in one or more joints (can be any joint including knees, feet, hands, wrists, and elbows)
- Joint swelling
- Joint stiffness, especially in the morning
- Red or warm joints
- Changes in fingernails and toenails (pitting in the nails, crumbling nails, or nails separating from the nail bed)
- Back pain
- Fatigue
Diagnosis
Your doctor will:
- Ask about your symptoms
- Take your medical history (focusing on your history of psoriasis)
- Do a physical exam
Tests may include:
- Blood tests to find out if you have an autoimmune disease
- Analysis of the fluid in the joints
- Tests to check how the immune system is functioning
- Imaging tests (eg, x-ray , ultrasound , MRI )
Your doctor will rule out similar conditions by looking for certain symptoms, like:
- Psoriatic lesions
- Nail problems
- Swelling of the fingers and toes
Treatment
Your doctor will continue to treat your psoriasis. She will also create a treatment plan that focuses on your arthritis symptoms. You may be referred to a doctor who specializes in arthritis (called a rheumatologist).
Medications
Depending on the severity of your symptoms, your doctor may recommend:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease pain and inflammation
- Steroid injections into painful joints
- Disease-modifying anti-rheumatic drugs (DMARDS) to treat more severe symptoms and slow the progression of the disease (eg, sulfasalazine [eg, Azulfidine], leflunomide [eg, Arava], cyclosporine [eg, Neoral])
- Tumor necrosis factor (TNF) inhibitors (eg, adalimumab, etanercept, golimumab, infliximab) to treat more severe symptoms
- Other medicines, such as alefacept and methotrexate
Other Treatment
You may be referred to a physical or occupational therapist. These healthcare providers can help you to improve your range of motion and your ability to do everyday activities.
Working with a mental health therapist may also be helpful for your overall wellbeing. You can learn ways to better cope with your chronic condition.
Surgery
If you have severe pain and disability, your doctor may recommend:
- Joint replacement surgery
- Tendon surgery