Psoriatic Arthritis

Last Updated: August 16, 2022

Psoriatic arthritis is an autoimmune disease that causes chronic arthritis and typically occurs in people with psoriasis (a skin condition), but it can also occur in people without psoriasis, especially in those who have a relative with psoriasis. Although there is no cure for the disease, the right treatments can reduce pain and inflammation and prevent joint dysfunction.

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What is psoriatic arthritis?

Psoriasis is a skin disease that causes patches of itchy, red skin with a silver, scaly appearance. The lesions can occur on any part of the body, but common areas include elbows, knees, back, face, scalp, palms, and feet.

With psoriatic arthritis, people with psoriasis also have arthritis that causes pain, stiffness, and inflammation of the joints. Although the arthritis is typically mild with occasional flare-ups, in some people, it is continuous and can cause joint damage if not treated.

What are the signs and symptoms of psoriatic arthritis?

The signs and symptoms of psoriatic arthritis tend to vary from person to person. They can include any of the following:

  • Psoriasis
  • Swelling, stiffness, or pain in one or more joints
  • Fatigue (i.e., frequently feeling tired or having a general lack of energy)
  • ”Sausage-like” swelling of a whole finger or toe that is painful
  • Changes in nails such as tiny dents, crumbling, or separation from the nail bed
  • Eye inflammation that can cause pain, redness, and blurry vision
  • Inflammatory bowel disease
How is psoriatic arthritis diagnosed?

There is no specific test for psoriatic arthritis, but physicians will evaluate the following to diagnose the disease:

  • Family history of psoriasis or psoriatic arthritis
  • Signs such as swollen and tender joints, psoriasis skin lesions, and changes in nails
  • Blood tests to rule out other diseases with a similar presentation (e.g., rheumatoid arthritis, gout, Lyme arthritis)
  • Changes in joints or the spine using imaging tests such as x-rays, magnetic resonance imaging (MRI), or ultrasound
What are some of the main medical treatments for psoriatic arthritis?

There is no cure for psoriatic arthritis, but treatments are effective for reducing disease symptoms and their severity. The treatments selected depend on the individual’s signs and symptoms and their severity. Often different medications are tried alone or in combination until the physician finds something that works.

Treatments for milder forms of the disease:

  • Over the counter analgesics and anti-inflammatory medications to treat pain and swelling
  • Corticosteroid injections into affected joints

Treatments for more severe forms of the disease:

  • Disease-modifying anti-rheumatic drugs (DMARDS, oral therapies that broadly suppress the immune system)

  • Biologic response modifiers (i.e., therapies that target specific immune signals to reduce disease activity)

Have any supplements been studied for psoriatic arthritis?

The efficacy of different supplements for improving symptoms or disease activity is unclear. There have been some pilot trials, but most of them have been limited by a small sample size, short duration, and/or lack of appropriate blinding.

The following supplements have been studied in preliminary trials for psoriatic arthritis:[1]

How could diet affect psoriatic arthritis?

In some people with psoriatic arthritis, eating certain foods seems to trigger symptoms,[2] and certain diets, such as gluten free, low carbohydrate and Paleolithic are popular among patients.[3] Fasting, vegetarian, and Mediterranean-style diets have also been evaluated in patients with psoriatic arthritis, but the overall quality of evidence is low.

Although the effect of different diet interventions is not clear, obesity is associated with significantly higher disease activity in psoriatic arthritis patients.[4] Thus, any diet leading to weight loss may be helpful for controlling disease symptoms.

Are there any other treatments for psoriatic arthritis?

Several small studies and case-reports have tested the effect of acupuncture on psoriatic arthritis, with overall positive results. Although high quality evidence is lacking, acupuncture is conditionally recommended by the American College of Rheumatology and the National Psoriasis Foundation.[5]

Exercise, yoga, stretching, and aqua therapy (because it tends to be easier on the joints to move around in water) are also helpful to improve overall health and to keep joints flexible.[6] Physical and occupational therapy can also help to strengthen muscles and increase flexibility, which can protect joints from further damage.

What causes psoriatic arthritis?

The cause of the autoimmune activity responsible for psoriatic arthritis pathology is not well understood. Both genetic and environmental causes have been implicated.

  • Genes: many people with psoriatic arthritis have relatives with the disease, and researchers have identified some of the genes involved

  • Environment: stress, obesity, infection, and injury have all been implicated in triggering disease onset

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  1. ^John A Roberts 4th, Lisa A MandlComplementary and Alternative Medicine Use in Psoriatic Arthritis Patients: a ReviewCurr Rheumatol Rep.(2020 Sep 28)
  2. ^M Haugen, J Kjeldsen-Kragh, B Y Nordvåg, O FørreDiet and disease symptoms in rheumatic diseases--results of a questionnaire based surveyClin Rheumatol.(1991 Dec)
  3. ^Ladan Afifi, Melissa J Danesh, Kristina M Lee, Kevin Beroukhim, Benjamin Farahnik, Richard S Ahn, Di Yan, Rasnik K Singh, Mio Nakamura, John Koo, Wilson LiaoDietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National SurveyDermatol Ther (Heidelb).(2017 Jun)
  4. ^Anand Kumthekar, Alexis OgdieObesity and Psoriatic Arthritis: A Narrative ReviewRheumatol Ther.(2020 Sep)
  5. ^Jasvinder A Singh, Gordon Guyatt, Alexis Ogdie, Dafna D Gladman, Chad Deal, Atul Deodhar, Maureen Dubreuil, Jonathan Dunham, M Elaine Husni, Sarah Kenny, Jennifer Kwan-Morley, Janice Lin, Paula Marchetta, Philip J Mease, Joseph F Merola, Julie Miner, Christopher T Ritchlin, Bernadette Siaton, Benjamin J Smith, Abby S Van Voorhees, Anna Helena Jonsson, Amit Aakash Shah, Nancy Sullivan, Marat Turgunbaev, Laura C Coates, Alice Gottlieb, Marina Magrey, W Benjamin Nowell, Ana-Maria Orbai, Soumya M Reddy, Jose U Scher, Evan Siegel, Michael Siegel, Jessica A Walsh, Amy S Turner, James RestonSpecial Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic ArthritisArthritis Rheumatol.(2019 Jan)
  6. ^The content of this page was partially adapted from MedlinePlus of the National Library of Medicine
  7. ^Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RKPsoriatic arthritis (PSA)--an analysis of 220 patients.Q J Med.(1987-Feb)
  8. ^Tillett W, Jadon D, Shaddick G, Cavill C, Korendowych E, de Vries CS, McHugh NSmoking and delay to diagnosis are associated with poorer functional outcome in psoriatic arthritis.Ann Rheum Dis.(2013-Aug)
  9. ^Moll JM, Wright VPsoriatic arthritis.Semin Arthritis Rheum.(1973)
  10. ^Coates LC, Helliwell PSPsoriatic arthritis: state of the art review.Clin Med (Lond).(2017-Feb)
  11. ^Ogdie A, Gelfand JMClinical Risk Factors for the Development of Psoriatic Arthritis Among Patients with Psoriasis: A Review of Available Evidence.Curr Rheumatol Rep.(2015-Oct)
  12. ^Thumboo J, Uramoto K, Shbeeb MI, O'Fallon WM, Crowson CS, Gibson LE, Michet CJ, Gabriel SERisk factors for the development of psoriatic arthritis: a population based nested case control study.J Rheumatol.(2002-Apr)
  13. ^Pattison E, Harrison BJ, Griffiths CE, Silman AJ, Bruce INEnvironmental risk factors for the development of psoriatic arthritis: results from a case-control study.Ann Rheum Dis.(2008-May)
  14. ^Damiani G, Bragazzi NL, Karimkhani Aksut C, Wu D, Alicandro G, McGonagle D, Guo C, Dellavalle R, Grada A, Wong P, La Vecchia C, Tam LS, Cooper KD, Naghavi MThe Global, Regional, and National Burden of Psoriasis: Results and Insights From the Global Burden of Disease 2019 Study.Front Med (Lausanne).(2021)
  15. ^Bragazzi NL, Bridgewood C, Watad A, Damiani G, McGonagle DSex-Based Medicine Meets Psoriatic Arthritis: Lessons Learned and to Learn.Front Immunol.(2022)