Psoriatic arthritis (PsA) is a chronic autoimmune condition. It causes swollen, stiff, and painful joints. People with PsA can also have the itchy, scaly, and painful skin lesions of psoriasis. In fact, psoriasis is the greatest risk factor in developing PsA.
PsA symptoms can be debilitating. They can make it hard for someone to sleep, work, and do the activities they enjoy.
Getting treatment for PsA can help reduce disease activity and relieve the symptoms.
Read on to learn why PsA can be so painful and how to manage it.
In a 2018 review of research, scientists found that people with PsA report high levels of pain and functional disability. This affects their ability to work and do day-to-day activities. It may also have an impact on their sleep, levels of fatigue, and overall quality of life.
When scientists asked people from 13 countries to rank the impacts of PsA, they ranked pain as the most impactful. PsA may cause pain in the joints, the skin, and other body parts.
Pain and other symptoms tend to worsen during a flare, which is when the condition is active. Flares may last for a few days or months.
In PsA, the immune system attacks healthy tissues. This causes inflammation and tissue damage. Some common symptoms include:
- joint swelling, stiffness, tenderness, and pain
- painful swelling of entire fingers or toes
- back pain and limitation of motion
- pain in the heel or sole of the foot
Chronic inflammation can eventually cause permanent joint damage and disability.
Many people with PsA also have symptoms of psoriasis, including itchy and painful skin lesions.
People with PsA are also at increased risk of inflammation in other body parts, including the eyes and the digestive system. This can add to their discomfort.
There is very little research into PsA and weather. Some people with PsA find that it gets worse during the winter, report the National Psoriasis Foundation. Other people notice no difference in their symptoms from one season to another.
It is possible that having less exposure to UV light from the sun during winter may increase disease activity in PsA. When UV light hits the skin, the body produces vitamin D. Some research has linked low vitamin D to psoriasis and PsA.
Some experts believe that changes in atmospheric pressure may also play a role. Atmospheric pressure drops when a cold front is approaching. This may cause the joints to painfully expand.
Dry, cold air may also dry out the skin and aggravate psoriasis symptoms.
Doctors use two main types of medication to treat PsA: disease-modifying antirheumatic drugs (DMARDs) and symptomatic drugs. DMARDs may help reduce disease activity and relieve the symptoms, while symptomatic drugs target symptoms alone.
Doctors may prescribe a combination of both drugs.
DMARDs for PsA include:
- conventional DMARDs, such as methotrexate
- tumor necrosis factor inhibitors, including:
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
- interleukin 17 inhibitors, including:
- brodalumab (Siliq)
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
- interleukin 23 and interleukin 12/23 inhibitors, including guselkumab (Tremfya) and ustekinumab (Stelara)
- T cell inhibitors, including apremilast (Otezla)
- Janus kinase inhibitors, including tofacitinib (Xeljanz)
Symptomatic medications for PsA include:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
- corticosteroid injections, which may quickly reduce inflammation in the joints
- topical therapies, such as creams, for skin symptoms
The American College of Rheumatology and National Psoriasis Foundation also recommend regular, low impact exercise for people with PsA.
Physical therapy, occupational therapy, massage therapy, acupuncture, and weight loss may also help reduce pain or other symptoms.
PsA causes painful joint and skin symptoms, which can reduce quality of life and interfere with daily activities. The pain tends to be worse when the condition is active.
Doctors may prescribe one or more DMARDs to reduce disease activity and relieve symptoms such as pain. They may also recommend pain-relieving treatments such as NSAIDs, corticosteroid injections, or topical therapies.
People with PsA should let a doctor know how pain and other symptoms affect them. This can help inform their treatment options.