Psoriatic arthritis (PsA) is a chronic inflammatory form of arthritis.
It develops in the major joints of some people with psoriasis. In fact, between 30 and 33 percent of people with psoriasis develop PsA.
Early diagnosis of PsA can prevent joint problems from starting. It also helps doctors prescribe the right treatment. PsA requires a different treatment approach than psoriasis alone does.
PsA can be classified from mild to severe. Mild PsA affects four or fewer joints. Severe PsA affects five or more joints and is also known as polyarticular psoriatic arthritis.
If you have severe PsA, you need to see a rheumatologist, a doctor who specializes in rheumatic diseases. The following are some questions to ask your doctor during your next visit.
To be diagnosed with PsA, you’ll need to have a series of tests done.
Laboratory tests that show a high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level might indicate PsA. ESR and CRP are acute phase reactants. This means your ESR and blood level of CRP are high when anything, such as PsA, causes inflammation in your body.
Your doctor may also ask you to fill out a questionnaire. Doctors use certain questionnaires as screening tools for PsA. Your answers can help your doctor decide if you need further testing to check for PsA.
Examples of these questionnaires include the:
- Psoriasis Epidemiology Screening Tool (PEST)
- Psoriatic Arthritis Screening and Evaluation (PASE)
- Toronto Psoriatic Arthritis Screening (ToPAS)
Questions you may be asked include “Have you ever had a swollen joint (or joints)?”
The PEST and PASE are intended to screen for PsA in people with psoriasis, while the ToPAS can also be used for people without psoriasis.
To verify a PsA diagnosis, doctors will usually perform imaging tests too. These tests can also help them rule out similar health conditions, such as rheumatoid arthritis. Common imaging tests for PsA include X-rays, ultrasounds, and MRIs.
Your doctor may also look at your skin and nails. This is because most people with PsA have nail changes, such as pitting, and the skin lesions typical of psoriasis.
If you have PsA, you’re likely to also have progressive joint damage and disability. You may not be able to prevent joint damage completely. However, your doctor can recommend techniques and medications that can help.
For example, your doctor may suggest exercises. Exercise can help ease your symptoms and remove stress from your joints. It can also help you maintain a moderate weight. Ask your doctor what types of exercise are best for you.
The earlier you start treatment for PsA, the better.
One 2011 report in the Annals of the Rheumatic Diseases found that starting treatment within 2 years of the onset of symptoms helped to slow disease progression. A 2014 report in the same journal concluded that starting treatment more than 6 months after symptom onset led to joint erosion and worse physical function over time.
Doctors are also starting to take a more patient-centered approach to treating PsA. This means they’re more likely to consider factors such as how the condition is affecting your daily life.
Talking openly about your symptoms and how they affect your ability to function or enjoy activities can help your doctor come up with a treatment plan that’s right for you.
The medications you take will likely depend on the severity of your PsA. Talk about the following treatment options with your doctor.
The most recent
Biologic drugs that target the TNF involved in psoriasis can also help you manage symptoms of PsA. They are:
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
Ustekinumab (Stelara) is another biologic that can be used to help treat psoriasis or PsA. However, it isn’t a TNF inhibitor.
Disease modifying anti-rheumatic drugs (DMARDs)
Disease modifying anti-rheumatic drugs (DMARDs) are used to treat moderate to severe PsA.
If your TNF inhibitor isn’t effective, then your healthcare provider may prescribe a different class of biologic instead. A DMARD may be added to your treatment regimen in order to boost the efficacy of the new biologic.
The DMARDs used in the treatment of PsA are:
- apremilast (Otezla)
- cyclosporine A, which is used for skin-related symptoms
- leflunomide (Arava)
- methotrexate (Rasuvo, Otrexup)
- sulfasalazine (Azulfidine)
The Food and Drug Administration (FDA) has approved the use of Otezla for people with PsA. However, the other medications are used off-label to treat the condition.
OFF-LABEL DRUG USE
Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for treating mild PsA. NSAIDs are available both as over-the-counter (OTC) drugs and as prescription drugs.
Examples of OTC NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
An example of a prescription NSAID is celecoxib (Celebrex), which is considered an off-label treatment for PsA.
Glucocorticoids, which are also known as corticosteroids, can be taken orally or injected directly into the affected joints.
Oral forms aren’t recommended for PsA. This is because they can cause the skin disease to flare up. They also increase the risk of a person developing a severe form of PsA called erythrodermic or pustular psoriasis. This condition causes raised bumps on the skin that are filled with pus (psoriatic pustules). It can be life threatening.
Injections can be helpful when a flare-up causes pain in one or two of your joints. When injected into a joint, these medications work well to quickly relieve inflammation and swelling. However, repeated injections can cause joint damage and other complications, so they should be given sparingly.
All steroids can cause significant side effects, such as:
- bone loss
- mood changes
- high blood pressure
- weight gain
Showing up prepared for your doctor’s visit is one of the best, and easiest, ways to find the treatment that’s right for you. Here are some steps you can take to make the most of your visit:
- Jot down all of your symptoms.
- Keep a running list of your questions before you get there.
- If your doctor suggests a medication, ask how well it usually works to treat PsA.
- Ask your doctor about any side effects a medication may cause.
- Share any concerns with your doctor.
You and your doctor can work together to create a plan to manage your PsA effectively.