Psoriatic Arthritis (PsA)

What is Psoriatic Arthritis (PsA)?

Psoriatic arthritis (PsA) is a condition that combines the swollen, sore joints of arthritis with psoriasis. Psoriasis causes itchy, scaly red patches to appear on your skin and scalp.

Why You Should Care:

About 7.5 million Americans have psoriasis and up to 30 percent of these people develop PsA.

Types of psoriatic arthritis:

• Symmetric PsA: This type affects the same joints on both sides of your body. About 50 percent of people with PsA have this type.
• Asymmetric PsA: This affects a joint or joints on one side of your body. It affects about 35 percent of people with PsA.
• Distal interphalangeal predominant PsA: This type involves the joints closest to your nails. It occurs in about 10 percent of people with PsA.
• Spondylitis PsA: This type of PsA involves your spine. Your entire spine from your neck to your lower back may be affected.
• Psoriatic arthritis mutilans: About 5 percent  of people with PsA have this type. Psoriatic arthritis mutilans usually affects your hands and feet.

Symptoms:

General symptoms of PsA include:

• Swollen, tender joints on one or both sides of your body
• Morning stiffness
• Swollen fingers and toes
• Painful muscles and tendons
• Scaly skin patches, which may get worse when joint pain flares up
• Flaky scalp
• Fatigue
• Nail Pitting
• Separation of your nail from the nail bed
• Eye redness (conjunctivitis)
• Eye pain (uveitis)

Spondylitis PsA, in particular, can also cause the following symptoms:

• Spinal pain and stiffness
• Pain, swelling, and weakness in your hips, knees, ankles, feet, elbow, hands, wrists, and other joints
• Swollen toes or fingers

Risk Factors:

You’re more likely to get PsA if you:

• Have psoriasis
• Have a parent, brother, or sister with PsA
• Are between the ages of 30 and 50 (though children can get it, too)
• Have had strep throat
• Have HIV

PsA puts you at risk for complications that include:

• Psoriatic arthritis mutilans
• Eye problems, such as conjunctivitis or uveitis
• Cardiovascular disease

Psoriatic Arthritis Triggers:

PsA flare-ups make the condition worse for a period of time. Certain things can set off PsA flares and these things are different for everybody.

Common PsA triggers include:

• Infections like strep throat and upper respiratory infection
• Injuries such as a cut, scrape, or sunburn
• Dry skin
• Stress
• Cold, dry weather
• Smoking
• Heavy drinking
• Excess weight
• Medicines such as lithium, beta-blockers, and antimalarial drugs

Although you can’t avoid all of these triggers, you can try to manage stress, stop smoking, and cut down on drinking.

Treatment:

The goal of PsA treatment is to improve symptoms like skin rash and joint inflammation. A typical treatment plan will include one or more of the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications help control joint pain and swelling. Over-the-counter (OTC) options include ibuprofen (Advil) and naproxen (Aleve).
• Disease-modifying antirheumatic drugs (DMARDs): These medications decrease inflammation to prevent joint damage and slow the progression of PsA. The most commonly prescribed DMARDs include:
  • Methotrexate (Trexall)
  • Leflunomide (Arava)
  • Sulfasalazine (Azulfidine)
  • Apremilast (Otezla)
• Biologics: Commonly prescribed biologic drugs include:
  • Adalimumab (Humira)
  • Certolizumab (Cimzia)
  • Golimumab (Simponi)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
• Steroids: These medications can bring down inflammation. For PsA, they’re usually injected into affected joints.
• Immunosuppressants: Medications like azathioprine (Imuran) and cyclosporine (Gengraf) calm the overactive immune response in PsA.
• Biologics: Commonly prescribed biologic drugs include:
• Topical treatments: Creams, gels, lotions, and ointments can relieve the itchy PsA rash. Options include:
  • Anthralin
  • Calcitriol or Calcipotriene, which are forms of vitamin D-3
  • Salicylic Acid
  • Steroid Creams
  • Tazarotene, which is a derivative of vitamin AA
• Light therapy and other PsA medicines: Light therapy uses medicine, followed by exposure to bright light, to treat psoriasis skin rashes.