Symptoms of psoriatic arthritis include pain and tenderness in the joints. Difficulty moving or stiff joints and/or back. Approximately half of all patients have morning stiffness that lasts longer than 30 minutes. Skin patches that are dry or red, usually covered with white scales, which may have raised edges. Nail abnormalities, such as pitted, discolored, or crumbling nails. Some people with psoriatic arthritis experience more difficulty with stiffness and immobility than with joint pain. Fatigue is also common.
Psoriatic arthritis tends to affect certain groups of joints as distal arthritis, asymmetric oligoarthritis, symmetric polyarthritis, arthritis mutilans, or spondyloarthritis.
In addition to the joint pain and stiffness caused by psoriatic arthritis, there may also be swelling in the areas where the tendons attach to the bones, a condition called enthesitis. Commonly affected sites include the Achilles tendon attachment to the back of the heel, the attachment of the plantar fascia (the tendon on the bottom of the foot) to the heel, and the area where the tendons attach to the pelvic bones. Another condition, tenosynovitis, can occur when the sheaths surrounding certain tendons, especially those in the hands and arms, become swollen and inflamed.
Nearly half of people with psoriatic arthritis also experience dactylitis, which causes an entire finger or toe to swell (sometimes called a sausage-shaped finger or toe).
Between 80 and 90% of people with psoriatic arthritis have nail problems. They may develop pitted nails, which look as if someone has taken a pin and poked the nail several times, or there may be early separation of the nail from the nail bed.
In some cases, people with psoriatic arthritis also experience eye problems. Inflammation of the structures of the eye can cause pain and redness in the eye and is called uveitis or iritis.
The rheumatologist diagnoses psoriatic arthritis through a medical history, physical exam, and review of joint X-rays to check for inflammation and damage to the joints. Blood tests or joint fluid analysis may be done to rule out other diseases, such as rheumatoid arthritis and gout.
The treatment plan for psoriatic arthritis varies depending on the severity of the condition and the general health of the individual.
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen and naproxen can help relieve pain and inflammation.
Disease-modifying antirheumatic drugs (DMARDs) that are the cornerstone of treatment: DMARDs such as methotrexate, sulfasalazine, and leflunomide can help slow or stop the progression of psoriatic arthritis and prevent joint damage.
Biologics: Biologics such as TNF inhibitors (etanercept, adalimumab, infliximab, certolizumab, golimumab), IL-17 inhibitors (secukinumab, ixekizumab), IL-12/IL-23 inhibitor ustekinumab, IL-23 such as guselkumab or risankizumab or abatacept and JAK inhibitors such as tofacitinib, upadacitinib, can reduce inflammation and joint damage in psoriatic arthritis.
Physical therapy and exercise can help improve joint flexibility, reduce pain, and increase strength.
Lifestyle changes, such as maintaining a healthy weight, quitting smoking, and reducing stress, can help improve overall health and reduce psoriatic arthritis symptoms.
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