Psoriatic arthritis is a chronic, inflammatory, autoimmune condition that can occur with psoriasis. It can have a significant effect on a person’s life, but timely and appropriate treatment can help reduce its impact.
Psoriatic arthritis (PsA) and psoriasis are aspects of psoriatic disease, a systemic condition that can have symptoms throughout the body. In psoriasis, skin lesions result from the overgrowth of skin cells. PsA involves pain and swelling in the joints.
PsA usually develops between the ages of 30–50 years. It often appears around 10 years after a person first develops symptoms of psoriasis. Around 30% of people with psoriasis will experience PsA.
The symptoms of psoriatic disease come and go, worsening during flares and improving or disappearing during periods of remission. The symptoms can sometimes worsen over time.
In this article, we look at the outlook for people with PsA, its effect on their quality of life, and the solutions available.
How PsA progresses will depend on various factors, including the type of PsA, its stage at diagnosis, the treatment a person receives, and how they respond to it.
In the early stages, there may be few or no symptoms. Tissue damage might be present, but bone damage
When symptoms appear, they include inflammation, pain, swelling, and warmth in joints and surrounding tissues. In time, the spaces between the joints narrow, resulting in bone loss and possibly osteoporosis.
Bone erosion can affect the joints on one or both sides of the body. Symptoms can vary from mild pain to changes that affect daily activities. As erosion worsens, bone spurs can develop, and the joints become deformed.
Will symptoms worsen over time?
Some people with mild symptoms find their symptoms do not worsen over time and they can continue to function in their daily life. Others, however, may experience progressive, long-term damage.
The impact may be
- has high inflammation levels
- has erosive disease or dactylitis
- has highly active or rapidly progressing disease
- has symptoms that affect their ability to use one or more joints
An effective treatment plan can often prevent progressive damage and help manage symptoms.
In the early stages, however, it can be difficult to predict the course of the disease.
Progression of psoriasis and PsA
Most people who develop PSA will already have had psoriasis for around 10 years, but this is not always the case.
In 2016, researchers noted that among people who have both PsA and psoriasis,
Early diagnosis and treatment can help a person manage symptoms of psoriasis and PsA and reduce the risk of flares and future complications.
How PsA affects a person can vary depending on how severe the symptoms are and which part of the body they affect.
Here are some types of PsA a person might experience:
- Oligoarticular PsA affects up to four joints.
- Polyarticular PsA affects more than four joints and is more severe.
- Psoriatic spondylitis refers to inflammation of the spine. It affects 7–32% of people with PsA and can affect movement in the neck, the lower back, and where the pelvis meets the spine.
- Enthesitis is inflammation that affects the place where the tendons or ligaments meet the bone. Around half of those with PsA will experience enthesitis.
- Dactylitis causes swelling of a finger or toe due to inflammation in and around the small joints. Around 40% of people with PsA will experience it.
- Arthritis mutilans is a severe and uncommon type of PsA that develops in around 5% of those with the condition. Severe inflammation can cause joint damage and bone loss.
PsA is most likely to affect the joints in their arms and legs, but it can occur in the spine, hips, shoulders, and jaw.
PsA does not usually affect life expectancy, but a person with PsA may have a higher risk of other conditions, such as cardiovascular disease.
Comorbidities are conditions that can occur alongside another condition.
Comorbidities for PsA include aspects of metabolic syndrome:
The following conditions may also arise:
- reaching or maintaining a healthy body weight
- participating in suitable physical activity
- quitting smoking or avoiding secondhand smoke where possible
The guidelines also recommend screening for heart disease, diabetes, and other conditions that may occur with PsA and pose additional challenges.
There is some evidence that people with psoriatic disease have a higher risk of certain types of cancer, but it is unclear whether it is psoriasis or a combination of other factors, such as smoking, that increases the risk.
Reducing the risk of complications
People with psoriasis, PsA, or both can reduce their risk of complications by:
- maintaining a moderate weight
- following a varied diet with plenty of fresh fruit, vegetables, and fiber
- limiting alcohol consumption
- exercising regularly
- avoiding or quitting smoking
- seeking routine screening for cancer and other conditions
Prompt treatment of skin changes, high blood pressure, and other symptoms can help reduce the risk of further complications.
Two challenges for people with PsA are pain and mental well-being.
PsA can cause pain, stiffness, and other symptoms. If skin symptoms occur, these, too, can lead to discomfort. Severe symptoms can limit an individual’s ability to perform everyday activities.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help with mild pain.
If these do not work, a person can try the following:
- Talking to a doctor, who may help find new options for pain relief.
- Keeping a pain journal, with details of pain levels, activities that worsen it, and measures that relieve it.
- Doing physical therapy and exercise to help maintain joint flexibility and muscle strength.
- Seeing an occupational therapist, who can help find new ways to do things when daily tasks become difficult to carry out.
Activities that may be suitable for people with painful or swollen joints include:
- tai chi
- other water exercise
A doctor can recommend specific exercises for people with limited mobility.
The physical symptoms of psoriatic disease can have a
Anyone who finds that PsA is affecting their mental health should speak to their doctor, as treatment may be available.
A doctor might suggest:
- cognitive behavioral therapy
- joining a local support group
Other tips that might help include:
- Doing regular exercise and following a healthful diet to improve the overall sense of well-being.
- Learning about the condition and its treatment options, as this can increase a person’s sense of control.
- Doing yoga, meditation, or tai chi group to help manage stress.
Various medications can help manage PsA, depending on the severity of the symptoms and how they affect the individual.
Drug options for treating PsA include disease-modifying anti-rheumatic drugs (DMARDs). These can reduce inflammation and may help prevent flares, manage symptoms, and delay or prevent joint damage.
Types of DMARDs for PsA include:
- methotrexate, taken by mouth
- tofacitinib (Xeljanz), taken by mouth, suitable for people who have not responded well to other drugs
- biologics, such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade), taken by injection or infusion
- targeted DMARDs, taken by mouth
DMARDs affect the immune system, which can increase the risk of infection. They may not be suitable for everyone.
Corticosteroids can reduce pain and inflammation, but they can have adverse effects, making them unsuitable for long-term use.
Living with a chronic inflammatory condition can be challenging. Psoriatic disease, including psoriasis and PsA, can have a profound effect on a person’s physical and mental well-being.
For a person with PsA, early diagnosis and treatment are key to staying mobile and continuing to enjoy a good quality of life.
As scientists develop new treatment options, the outlook for people with PsA is improving. Some people may be interested in joining a clinical trial for PsA. Clinical trials can give a person access to new treatments that may not otherwise be available.