What is Psoriatic Arthritis?
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that affects both the joints and the skin. Like with other types of arthritis, patients with psoriatic arthritis experience pain, swelling and stiffness in the joints. It can also affect other parts of the body such as the feet, hips, knees, ribs and tendons. Along with joint problems, people develop itchy, scaly patches of inflamed skin called psoriasis.
Dr. Kam Shojania, MD FRCPC, Rheumatologist, discusses psoriatic arthritis.
Dr. Kam Shojania, MD FRCPC, Rheumatologist, discusses psoriatic arthritis symptoms.
Dr. Kam Shojania, MD FRCPC, Rheumatologist, discusses psoriatic arthritis and lifestyle.
Dr. Kam Shojania, MD FRCPC, Rheumatologist, discusses psoriatic arthritis management.
What Are the Symptoms of Psoriatic Arthritis?
In order to diagnose a patient with psoriatic arthritis, a physician will take a complete medical history and perform a physical examination. There are certain signs that a doctor or rheumatologist will look for, including dactylitis (swollen fingers and toes), painful joints and psoriasis.
Psoriatic arthritis can be difficult to diagnose, because symptoms vary between patients. In most cases, a physician will order blood tests and x-rays to confirm a diagnosis of PsA.
Psoriatic arthritis is an inflammatory disease, so blood tests often show abnormal results. Common tests that detect inflammation include a Complete Blood Count (CBC), C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR).
However, some patients may have normal results from certain blood tests, even though they have PsA. That’s why rheumatologists consider various factors when diagnosing a patient with psoriatic arthritis.
X-rays may be helpful in diagnosing psoriatic arthritis, because this disease can cause some specific changes not found in other types of arthritis.
How you treat Psoriatic Arthritis?
The earlier psoriatic arthritis is treated the better the outcome—even a few months can make a difference. Early treatment reduces the risk of long-term inflammation in the body such as stroke or heart attack.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
These medications reduce joint inflammation and reduce pain, but do not prevent the progression of psoriatic arthritis. With 20 different anti-inflammatory medications available, you can always try a different NSAID if one doesn’t work for you.
Disease Modifying Anti-Rheumatic Drugs (DMARDs)
Initially used to treat rheumatoid arthritis, these medications are also effective in treating psoriatic arthritis.
Methotrexate is the most common Disease Modifying Anti-Rheumatic Drug. It’s an effective treatment for both the arthritis and the psoriasis symptoms.
Other types of DMARDs include:
- Hydroxychloroquine (Plaquenil)
- Gold (Myochrisine)
- Leflunomide (Arava)
- Otezla (Apremilast)
However, these work well to treat the arthritis symptoms, but not skin-related PsA symptoms.
Psoriasis Skin Care
Along with joint care, skin care is an essential part of psoriatic arthritis treatment. It may be beneficial to work with a dermatologist in addition to your rheumatologist.
Treatments for psoriasis include:
- Topical creams and lotions
- Moderate exposure to sunlight (be sure to avoid sunburn)
- Corticosteroids (prednisone)
- Certain disease modifying anti-rheumatic drugs (DMARDs)
- Some biologics
Analgesic medications are used to control pain, but they don’t prevent further joint damage. Analgesics range from over-the-counter acetaminophen to stronger pain narcotics like morphine.
Some patients find relief from inflammation, pain and stiffness by using prednisone. However, because it can have side effects when used long-term, doctors generally prescribe it in high doses for short periods of time.
Cortisone injections are another option for some people with PsA.
If your joint pain and skin symptoms aren’t well-controlled by other medications, your rheumatologist may prescribe advanced therapeutics.
These medications are made up of biologic medications and small molecules. They’re given by an injection under the skin or by an intravenous infusion.
There are a number of effective Anti-Tumor Necrosis Factor biologics available, including:
- Humira (adalimumab)
- Remicade/Inflectra/Remsima (infliximab)
- Cimzia (certolizumab)
- Enbrel/Brenzys/Erelzi (etanercept)
- Simponi (golimumab)
There are other biologics that target a signalling protein called IL-17, which is involved in the inflammatory response of PsA. These medications include:
- Taltz (ixekizumab)
- Cosentyx (secukinumab)
Other biologics target the signalling proteins IL-12 and IL-23, which are also involved in the inflammatory response. However, these biologics, which include Stelara (ustekinumab), typically work better for psoriasis than they do for arthritis.
There is another class of advanced therapeutics called small molecules, which block other parts of the immune system. An example of small molecules used to treat PsA is Xeljanz (tofacitinib).
With many advanced therapeutics to choose from, if one doesn’t work for someone, their Local rheumatologist may suggest another.
People with psoriatic arthritis should discuss treatment options with their Local rheumatologist to determine the best options for managing pain and preventing the progression of the disease. Local Rheumatologists
Dr. John Wade, MD, FRCPC, Rheumatologist, talks about what Methotrexate is typically used for and the standard dosing schedules commonly used.