A Closer Look at Psoriatic Arthritis: What is it, do I have it, and how is it managed?

Many people have heard of rheumatoid arthritis and psoriasis, but fewer are familiar with psoriatic arthritis. This contributes to the often substantial lag time between when symptoms first arise and when someone receives an official diagnosis. How can we bring something to our doctor’s attention when we don’t even know it’s a thing?

So, let’s take a close look at Psoriatic Arthritis here: What is it, how do you know if you have it, and what’s the best way to manage it?

Psoriatic Arthritis is an autoimmune inflammatory arthritis associated with the inflammatory skin disease, psoriasis. By itself, psoriasis is a complex skin disorder that can manifest in a variety of ways. It often appears as a red or purple raised rash with flakes or scales. This can typically happen on the scalp, hairline, elbows, knees, buttocks or even ears. It can appear as a large patch (you’ll hear doctor’s describe it as a “plaque”) or small papules. It can be itchy and made worse by certain foods, allergies or stress. It’s possible you know someone affected by psoriasis. It’s more common than you might think. Studies estimate that 1-3% of the population has this skin condition.

Approximately 30% of those with psoriasis develop psoriatic arthritis. However, this may be an underestimation, as doctors still don’t do a great job of recognizing when someone has psoriatic arthritis. There are risk factors that increase someone’s chance of developing psoriatic arthritis. For example, if you have a positive genetic marker, the HLA-B27, or have a family member with psoriatic arthritis, this increases your chances of having it. But many times we are unable to predict which psoriasis patients will over time develop arthritis. That’s why it’s important for anyone who has psoriasis to have regular doctor’s visits and to be informed about psoriatic arthritis.

Psoriatic vs. other kinds of arthritis

Psoriatic arthritis can manifest in many different ways. Some will have mainly hand and finger pain and swelling, while others will mainly experience back pain and stiffness. Still others will have a little bit of both.

Two features of psoriatic arthritis that are not seen in conditions such as RA are enthesitis and dactylitis. The enthesis is an area in the body where tendons attach to bones. When this area is inflamed, we call it enthesitis (-itis at the end of any word usually means “inflamed”). In people with psoriatic arthritis, this can often happen at the Achilles tendon, and around the elbows, knees or hips. Dactylitis is a feature characterized by diffuse swelling of an entire digit (either fingers or toes). This is swelling that goes beyond the joint and includes the soft tissues. This can lead to puffy-looking fingers or toes and difficulty bending the digit.

The severity of one’s joint pain usually does not correlate with the severity of the skin disease in psoriatic arthritis. This fact can lead to a lot of confusion among patients and doctors! Someone with mild skin disease can still develop psoriatic arthritis and have significant joint pain, while someone with severe skin disease might never suffer from arthritis. This is also true with flares. Skin flares don’t always travel with joint flares and vice versa.

Lifestyle Factors

Like most autoimmune conditions, psoriatic arthritis is influenced by our lifestyle. Diet, stress and sleep can all have a profound effect on our joint pain and our bodies’ inflammatory burden.

The good news is that with some tweaks to diet, sleep and stress management routines, those with psoriatic arthritis can substantially improve their quality of life and limit the medications they need.

Medications

The treatment options for psoriatic arthritis have exploded recently. These medications, generally referred to as “biologics,” target very specific components of inflammation. They target specific proteins to turn off, which then turns off the inflammatory cascade that is overactive in psoriatic arthritis. When that inflammation gets turned down, symptoms improve. Biologics have revolutionized the way we approach and treat psoriatic arthritis. But we shouldn’t forget that they are potent immune system modulators that should be treated with respect.

Deciding which medicine to start and when should be based on many factors, including your individual disease characteristics and lifestyle. Also, finding the best one for you can involve some trial and error. This requires in-depth conversations between you and your doctor. And they are conversations worth having! Without proper treatment, people can needlessly suffer today and put their body at risk for damage to their joints, heart and brain in the future.

These are discussions we welcome at Motto. Your health care team, built of rheumatologists, nurse practitioners, health coaches and dieticians, are here to help you manage all the elements of psoriatic arthritis.