Diseases and Conditions

Psoriatic Arthritis

What is psoriatic arthritis?

Psoriatic arthritis is a form of arthritis associated with psoriasis. Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. Psoriatic arthritis is similar to rheumatoid arthritis (RA) in symptoms and joint inflammation. But it tends to affect fewer joints than RA. And it does not produce the typical RA antibodies. The arthritis of psoriatic arthritis comes in 5 forms:

  • Arthritis that affects the small joints in the fingers and/or toes
  • Asymmetrical arthritis of the joints in the hands and feet
  • Symmetrical polyarthritis, a type of arthritis similar to rheumatoid arthritis
  • Arthritis mutilans, a rare type of arthritis that destroys and deforms joints
  • Psoriatic spondylitis, arthritis of the lower back (sacroiliac sac) and the spine

What causes psoriatic arthritis?

The cause of psoriatic arthritis is unknown. But factors such as immunity, genes, and the environment may play a role.

What are the symptoms of psoriatic arthritis?

The skin condition psoriasis may start before or after the arthritis. Symptoms can occur a bit differently in each person. Psoriasis causes red, scaly rashes and thick, pitted fingernails. Symptoms of psoriatic arthritis may include:

  • Inflamed, swollen, and painful joints, often in the fingers and toes
  • Deformed joints from chronic inflammation
  • The symptoms of psoriatic arthritis can be like other health conditions. Make sure to see your health care provider for a diagnosis.

How is psoriatic arthritis diagnosed?

Psoriatic arthritis is easier to confirm if you already have psoriasis. If the skin symptoms have not yet occurred, diagnosis is more difficult. The process starts with a medical history and a physical exam. Your health care provider will ask about your symptoms. You may have blood tests to check:

  • Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
  • Uric acid. High blood uric acid levels are linked with psoriatic arthritis.

How is psoriatic arthritis treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is.

Treatment is done for both the skin condition and the joint inflammation. Some medications used to treat psoriatic arthritis include:

  • Nonsteroidal anti-inflammatory medications to relieve symptoms
  • Vitamins and minerals, such as calcium and vitamin D, to slow bone deformation
  • Immunosuppressive medications, such as methotrexate, to suppress inflammation if NSAIDs are not effective
  • Biologic medications, such as the drugs etanercept and adalimumab
  • Corticosteroids for inflammation

Other treatment may include:

  • Ultraviolet light treatment (UVB or PUVA)
  • Heat and cold
  • Splints
  • Exercise
  • Physical therapy to improve and maintain muscle and joint function
  • Occupational therapy to improve ability to perform activities of daily living
  • Management of psoriasis skin rash
  • Surgery to repair or replace a damaged joint (usually not needed until years after diagnosis)

What are the complications of psoriatic arthritis?

The condition may damage joints enough to change a person’s activity level. Lack of activity can lead to stiff joints and muscle weakness. Psoriatic arthritis can also cause fatigue and low red blood cell count (anemia). People with psoriatic arthritis are more likely to develop:

  • High blood pressure
  • High cholesterol
  • Obesity
  • Diabetes

Living with psoriatic arthritis

There is no cure for psoriatic arthritis. However, you can reduce your symptoms. This includes sticking to your treatment plan. Manage pain with medication, acupuncture, and meditation. Get enough exercise. Good exercises include yoga, swimming, walking, and bicycling. Work with a physical or occupational therapist. He or she can suggest devices to help you in your daily tasks.

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, let your health care provider know.

Key points about psoriatic arthritis

  • Psoriatic arthritis is a form of arthritis with a skin rash.
  • Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. The rash may come before or after the arthritis symptoms.
  • Psoriatic arthritis causes inflamed, swollen, and painful joints. It happens most often in the fingers and toes. It can lead to deformed joints.
  • Treatment may include medications, heat and cold, splints, exercise, physical therapy, and surgery.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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