Psoriatic arthritis is a condition that combines the painful, swollen joints of arthritis with the skin disease psoriasis that causes itchy red scaly patches on the skin and pitted, thickened nails.

Between 10 percent and 30 percent of those who have the skin disease will also develop psoriatic arthritis, which can range from mild to severe and affect one or more joints. Sometimes, joints problems appear before the skin condition, while other people with arthritic symptoms never develop psoriasis.

Men and women are equally affected by psoriatic arthritis, which usually appears during adulthood. The condition varies from person to person, and can easily be mistaken for other forms of arthritis.

The symptoms usually start slowly. Joint tissue becomes inflamed leading to pain, swelling and stiffness. Over time, the muscles and ligaments around the bone, the cartilage and the bones themselves become damaged, which can lead to joint deformities.

What are the symptoms of psoriatic arthritis?

• swollen fingers and toes
• pain in the buttocks,  lower back, or neck caused by inflammation in the spine (spondylitis)
• fatigue
• pain and/or swelling in the back of your heel caused by inflammation of the Achilles tendon
• eye inflammation (uveitis) causing pain, redness, light sensitivity, and blurred vision.

As with other inflammatory forms of arthritis, psoriatic arthritis occurs when your body’s immune system begins to attack healthy cells and tissue. Flare-ups can alternate with periods of remission.

Common triggers for psoriasis flare-ups include:

• stress
• injury to skin
• infections
• cold weather

Some people report that certain foods, alcohol, or allergies trigger symptoms.

How can I manage my psoriatic arthritis?

There is currently no cure for psoriatic arthritis, so the focus is on controlling symptoms and preventing damage to your joints. 

Medication

Those which treat arthritic symptoms include:

• non-steroidal anti-inflammatory drugs (NSAIDS) such as diclofenac, ibuprofen and naproxen relieve pain and stiffness by reducing inflammation but may have side-effects.
• disease-modifying anti-rheumatic drugs (DMARDS) gradually reduce pain, swelling and stiffness by slowing the disease’s progression. Some DMARDS affect the immune system, so you may be more likely to pick up infections.

• biological therapies (biologics) target proteins involved in the processes of inflammation and joint damage and are often given in combination with DMARDS. They include adalimumab, etanercept, golimumab and infliximab.  
• steroid injections can reduce pain and inflammation in the joints.

Treatments for psoriasis include:

• topical creams containing coal tar, steroids, vitamin A or D.
• light therapy – exposure to high-intensity ultraviolet (UVA) light.
• retinoids – substances related to Vitamin A, taken as tablets or applied in skin cream.

Lifestyle changes

Exercise

Physical activity helps keep your joints flexible and your muscles strong. Types of exercises that are less stressful on joints include biking, swimming and walking.

Preserve your energy

To manage fatigue, plan and pace daily activities, varying tasks and allowing time to rest and relax. Make sure you get enough sleep.

Protect your joints

Change the way you carry out daily tasks, or use gadgets or aids that support your joints.

Practise relaxation

There are numerous techniques you can try to relieve muscle tension and stress and reduce the likelihood of flare-ups.

Stop smoking

People with psoriatic arthritis are more likely to develop high blood pressure and cholesterol, obesity or diabetes. Smoking increases the risk of all these conditions.

Healthy eating

There is very little scientific evidence that diet has an effect on psoriatic arthritis, but a balanced diet is important for maintaining your general health and energy levels. Maintaining a healthy weight will place less strain on your joints, leading to reduced pain and increased energy and mobility.

Supplements

Whether or not supplements that have been studied for improving symptoms or disease activity of psoriatic arthritis actually do anything is unclear. There have been some pilot trials, but most of them haven’t been able to tell us much due to the nature of the study design, in particular; a small sample size, short duration, and/or lack of appropriate blinding. Blinding in a trial design is when the person who is treating and/or the person being treated knows whether they are giving/getting the treatment that is being tested, or the placebo that the treatment is being tested against. Blinding plays an important role in being able to come to a meaningful conclusion about a trial.

Social and emotional support

Any long-term condition can affect your moods and confidence, and impact your work, social life and relationships. Talk to your family, friends or healthcare team about how they can best support you, or contact a support group if you want to meet others with psoriatic arthritis.

Read more about psoriatic arthritis from Enbrel.