Early diagnosis of PsA is very important in preventing the onset of joint problems. Early diagnosis also helps doctors prescribe the right treatment. PsA requires a different therapeutic approach than psoriasis alone.
PsA is classified on a scale from mild to severe. Mild PsA affects four or fewer joints. Severe PsA, also known as polyarticular psoriatic arthritis, affects four or more joints. If you have severe PsA, you need to see a rheumatologist.
The following are some discussion points to bring up during your next appointment.
What do my laboratory, screening, or imaging tests mean?
To be diagnosed with PsA, you’ll need to have a series of tests done.
Laboratory tests that show high acute-phase C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) indicate PsA. High levels of CRP and erythrocytes in the blood can indicate acute inflammation. According to a review in the British Journal of Dermatology, 50 percent of individuals with PsA have elevated CRP and ESR.
Certain questionnaires are also used to screen for PsA. These include:
- Psoriatic Arthritis Screening and Evaluation
- Toronto Psoriatic Arthritis Screening
- Psoriatic Epidemiology Screening Tool
Imaging tests are usually used to verify that an individual has PsA and not a similar medical condition such as rheumatic arthritis. Common imaging techniques for diagnosis of PsA include X-rays, ultrasound, and MRI.
It’s also important that your rheumatologist investigates any skin and nail symptoms, as these can also be signs of PsA.
How can I prevent or reduce the onset of joint damage and disability?
If you have PsA, you’re likely to also have progressive joint damage and disability. Although you may not be able to prevent joint damage completely, your rheumatologist can suggest some techniques and medications that will help.
Exercises may also be suggested to help ease symptoms, maintain a healthy weight, and remove the stress from your joints.
When can I start treatment?
The earlier you start treatment for PsA the better. One study found that getting treated within two years of the onset of symptoms led to decreased disease progression.
What medications are best to treat my PsA?
Your treatment approach and medications will depend on the severity of your PsA. Here are some treatment options to discuss with your rheumatologist.
Synthetic Disease Modifying Anti-Rheumatic Drugs (DMARDs)
DMARDs are generally recommended for treatment of moderate to severe PsA. DMARDs used in the treatment of PsA include:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are recommended for treating mild PsA. There are selective- and non-selective NSAIDS. Some over-the-counter NSAIDs include aspirin, ibuprofen, and naproxen. An example of a prescription NSAID is celecoxib (Celebrex).
Glucocorticoid medications can be given via local or systemic routes. Doctors are usually cautious about prescribing corticosteroids since they can cause flare-ups. However, corticosteroids can be efficient in providing relief for inflamed or swollen joints.
According to The Annals of the Rheumatic Diseases, biologics that target the tumor necrosis factor (TNF) involved in psoriasis can control symptoms of PsA. These biologics are particularly helpful when NSAIDs and DMARDs are not working. Current TNF-inhibitors used to treat PsA include:
- etanercept (Enbrel)
- adalimumab (Humira)
- infliximab (Remicade)
- golimumab (Simponi)
- certolizumab pegol (Cimzia)
Another biologic, ustekinumab (Stelara), is not a TNF-inhibitor but is approved for individuals with moderate to severe psoriasis who are also candidates for phototherapy or systemic therapy. If other drugs are not working for you, ask your doctor if biologics are the answer.
Make sure you’re well prepared for your appointment. Keep a running list of your questions and jot down all of your symptoms. Being prepared is one of the best, and easiest, ways to find the treatment that’s best for you.