What Is Psoriatic Arthritis?

If you have the skin condition psoriasis, you may also have painful joints, a condition called psoriatic arthritis. But sometimes the painful joints come first.

What is psoriatic arthritis?

Usually, you’ll first see the tell-tale signs of psoriasis — painful patches of skin, typically with silvery scales. About 20 to 30 percent of psoriasis patients have arthritis, too.

It’s not uncommon, however, for painful joints to arrive before you notice anything on your skin. If you have psoriatic arthritis, joints anywhere in your body, from your fingertips down your spine to your toes, can swell and become stiff. The problem may be mild or severe and come and go, with flare-ups that fade.

If four or fewer joints are affected, you’ll be diagnosed with oligoarticular psoriatic arthritis. Polyarticular affects four or more joints. Spondylitis, which is less common, involves the spine, hips, or shoulders.

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What are the first symptoms of psoriatic arthritis?

Especially if you have untreated or unresolved psoriasis, watch out for joint issues. Early treatment helps: Getting to a rheumatologist, a doctor who specializes in arthritis and immune disorders, even six months later can make your case more difficult.

• You may notice aching or tenderness first — especially in your hands, feet, wrists, ankles, or knees.
• Stiff joints may be most noticeable in the morning or after you’ve been sitting too long. You may have less range of motion.
• The joint issues may come alongside stiffness in your lower back, pain in your Achilles’ tendon, or sometimes sausage-like swelling of an entire finger or toe.
• Inflamed eyes, fatigue, and low iron in your blood can come with this problem.

Who gets psoriatic arthritis?

This condition affects men and women almost equally, typically starting in your 40s.

If you have psoriasis in more than three locations, compared to one, your chance of psoriatic arthritis doubles. Nail pits also make arthritis more likely.

A genetic vulnerability for immune dysfunction causes both psoriasis and psoriatic arthritis, but usually a trigger in your life sets off the symptoms.

Injuries, oral ulcers, taking antibiotics, and lifting heavy weights have all been identified as possible triggers for psoriatic arthritis. Obesity, which puts pressure on your joints, is a risk factor.

People with psoriatic arthritis are more likely to have osteopororsis, heart disease, type 2 diabetes, inflammatory bowel disease, and depression — all of which may be made worse or triggered by the chronic inflammation of psoriasis and psoriatic arthritis.

How is psoriatic arthritis treated?

• In the early stages, you’ll be offered over-the-counter nonsteroidal anti-inflammatory drugs (or NSAIDs). You may be advised to exercise and get training in how to move more efficiently. You may use heat and cold presses, or temporarily be given a splint on a joint. You might get a cortisone injection in a particular joint.
• Sometimes you’ll be prescribed an oral steroid, which may temporarily worsen psoriasis.
• Anti-rheumatism drugs that may treat psoriatic arthritis include methotrexate, sulfasalazine, and cyclosporine.
• Biologic drugs (see What Is Psoriasis?) may be prescribed in severe cases or when other treatments do not help. These drugs require injections or an IV drip.

Can your diet make a difference?

In general, the diet to treat psoriatic arthritis is a healthy diet for anyone. You want to cut inflammation and make sure you have needed nutrients.

• Alcohol, sugar, processed meats, fried foods, red meat, and dairy may increase inflammation.
• Berries, dark leafy greens, beans, and whole grains may do the opposite.
• Salmon and other cold-water fish, avocados, flaxseed oil, and olive oil are high in omega-3 fatty acids, which are linked to lower levels of inflammation.
• Turmeric, ginger, cayenne, and teas are also anti-inflammatory.

For more information, see

• The National Psoriasis Foundation
  www.psoriasis.org
• The Arthritis Foundation
  www.arthritis.org