A rheumatologist is a doctor trained to diagnose and treat conditions such as psoriatic arthritis. A rheumatologist can prescribe medications and recommend other treatments.
Psoriatic arthritis (PsA) is an autoimmune condition that often occurs alongside psoriasis. PsA causes swollen, painful, inflamed joints and itchy skin. It can also affect the organs. Untreated PsA can lead to abnormal joints and chronic pain.
Rheumatologists specialize in treating conditions that affect the musculoskeletal system. This article explains how rheumatologists can help people with PsA and outlines diagnosis and treatment. It also provides advice for living with PsA.
A rheumatologist is a healthcare professional who specializes in diagnosing and treating conditions that affect muscles, joints, ligaments, tendons, and bones. These conditions may result in swelling, stiffness, and long-term abnormality of the joint.
Rheumatologists specialize in system-wide autoimmune conditions. These are where the body’s immune system mistakenly attacks healthy cells and tissue. PsA is one type of autoimmune condition.
If a person has symptoms of PsA, they should contact a rheumatologist as soon as possible. PsA is easy to confuse with other diseases. However, as experts in musculoskeletal disorders, rheumatologists are more likely to make an accurate diagnosis.
After diagnosing PsA, a rheumatologist will plan a person’s treatment and set goals so they can assess how well the treatment plan is working. They will monitor a person’s progress and make adjustments to treatments if necessary.
A person should contact a rheumatologist as soon as possible if they develop symptoms of PsA. Early diagnosis and treatment can help prevent joint damage and slow disease progression.
If a person develops psoriasis before PsA, they will likely consult a dermatologist first. If they then develop symptoms of arthritis, the dermatologist or another doctor may refer them to a rheumatologist for further diagnosis and treatment.
According to a 2016 case study, dermatologists and rheumatologists sometimes co-treat a person. A rheumatologist will focus on systemic treatments, whereas a dermatologist will focus on treating the skin.
PsA can develop at any age. It most often develops between ages 30–50 years and about 10 years after a diagnosis of psoriasis. Children can also develop the condition.
Symptoms of PsA include:
- swollen toes and fingers that may resemble sausages, known as dactylitis or “sausage fingers”
- pain, tenderness, and swelling in the joints
- joint stiffness in the morning
- reduced range of joint motion
- fatigue
- eye pain and redness, known as uveitis
- changes to fingernails and toenails, including separation from the nail bed and pitting
A rheumatologist will diagnose PsA by:
- taking medical and family histories
- checking joints for tenderness or swelling
- checking nails for pitting or separation from the nail bed
- ordering blood tests to rule out rheumatoid arthritis, which may cause similar symptoms
- ordering X-rays of the hands and feet to check for signs of PsA
The National Psoriasis Foundation (NPF) recommends that a person tracks their symptoms before contacting a rheumatologist, particularly:
- location of the pain
- pain intensity, which they can rank from 1–10
- duration of pain and whether it is intermittent or constant
A person can also complete the Psoriasis Epidemiology Screening Tool and share their results with their rheumatologist. The NPF states that 41% of people who screen positive for PsA with the screening tool have no past diagnosis of PsA.
A rheumatologist will devise a treatment plan that takes account of a person’s situation.
The 2018 guidelines for treating PsA recommend that rheumatologists treat PsA aggressively with medication so it goes into remission. If one treatment does not work, they may prescribe another.
Treatment for PsA may include:
- medication
- surgery
- exercise and lifestyle changes
- physical therapies
- assistive devices
PsA can vary in severity and affect people differently. The condition can limit certain activities, and people may require mitigations in their work life and everyday living. However, with the right treatment plan, a person can enjoy a good quality of life.
To live well with PsA, a person can:
- Keep active: Exercise enables joints and tendons to keep their range of motion and can help reduce pain and inflammation. A person should aim to do gentle aerobic exercises to keep their heart healthy. Exercise may result in some discomfort, and a person may need to rest the next day. As the body adapts to exercise, a person can gradually increase the intensity of the exercise.
- Manage pain: A person should take medications as prescribed by a rheumatologist. They can also try complementary treatments for pain relief, such as mindfulness and acupuncture.
- Manage work life: A person with PsA may need adaptations to their workplace or changes to how they work. Depending on a person’s job, adaptations can include using assistive devices, taking extra breaks, or having help with heavy lifting. A person can research their rights before discussing their needs with a manager.
The relationship between a person with PsA and their rheumatologist should be a partnership. It is important that a person feels heard and is comfortable asking questions. From a
Although PsA is not curable, a person can reduce their symptoms and minimize flare-ups by sticking with their treatment plan.
A rheumatologist is a doctor who specializes in conditions that affect the musculoskeletal system. Although PsA can be difficult to diagnose, rheumatologists can order tests and ask questions that help them identify the condition.
Rheumatologists devise treatment plans tailored to an individual’s condition and situation. Treatment typically includes medication, physical therapies, and sometimes surgery.
A person with PsA should consider their rheumatologist a partner in tackling their condition. By working together to devise and stick with a treatment plan, a person with PsA can enjoy a good quality of life.