Psoriatic arthritis (PsA) is a chronic inflammatory form of arthritis. It develops in the major joints of some people with psoriasis. In fact, up to 30 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. This is a doctor who specializes in rheumatic diseases.
The following are some questions to bring up to 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 C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) might indicate PsA. CRP and ESR are acute phase reactants. This means the amount of CRP in your blood and ESR are high when anything, such as PsA, causes inflammation in your body.
However, only approximately of people with PsA have elevated ESRs and CRP levels.
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:
- Psoriatic Arthritis Screening and Evaluation
- Toronto Psoriatic Arthritis Screening
- Psoriasis Epidemiology Screening Tool
To verify a PsA diagnosis, doctors will usually perform imaging tests. These tests can also rule out similar health conditions, such as rheumatoid arthritis. Common imaging tests for PsA include X-rays, ultrasound, and magnetic resonance imaging (MRI).
Your doctor may also look at your skin and nails. This is because most people with PsA have nail changes, like 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 drugs that can help.
For example, your doctor may suggest exercises. Exercise can help ease your symptoms, maintain a healthy weight, and remove stress from your joints. Ask your doctor what exercise is best for you.
The earlier you start treatment for PsA, the better. One study found that starting treatment within two years of the onset of symptoms reduced how much the illness progressed.
New guidelines recommend a “treat to target” approach. This involves creating a specific goal and an objective way to measure progress. The treatment plan is changed until the goal is achieved.
Doctors are also starting to take a more patient-centered approach to treating PsA, which means they’re more likely to consider factors like how the condition is affecting your daily life on a personal level. Talking openly about your symptoms and how they impact your ability to function or enjoy activities can help your doctor come up with a treatment plan that’s right for you.
Your treatment approach with drugs will likely depend on how severe your PsA is. Talk about the following treatment options with your doctor.
The most recent guidelines recommend using tumor necrosis factor inhibitor (TNFi) biologics as the first-line therapy in patients with active PsA. This is a change from previous guidelines in which methotrexate is the recommended first-line therapy followed by TNFi biologics.
According to a review published in Annals of the Rheumatic Diseases, biologic drugs that target the tumor necrosis factor (TNF) involved in psoriasis can control symptoms of PsA. TNF-inhibitor biologics used to treat PsA include:
- etanercept (Enbrel)
- adalimumab (Humira)
- infliximab (Remicade)
- golimumab (Simponi)
- certolizumab pegol (Cimzia)
Another biologic, ustekinumab (Stelara), isn’t a TNF inhibitor. However, it’s used for people with moderate to severe psoriasis who are also candidates for phototherapy or systemic therapy.
Synthetic disease modifying anti-rheumatic drugs (DMARDs)
DMARDs are used to treat moderate to severe PsA. The new guidelines recommend these drugs be used as second-line therapy if TNFi biologics aren’t effective. DMARDs used in the treatment of PsA include:
- methotrexate (Rasuvo, Otrexup)
- sulfasalazine (Azulfidine)
- leflunomide (Arava)
- cyclosporine A
Apremilast (Otezla) is a new oral drug used to treat PsA. If other drugs aren’t working for you, your doctor may consider this medication.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
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, and naproxen. An example of a prescription NSAID is celecoxib (Celebrex).
Glucocorticoid drugs can be injected directly into the affected joints or taken orally.
Oral forms aren’t recommended for PsA. This is because they can cause the disease to flare, and they increase the risk of developing a severe form of the condition called erythrodermic or pustular psoriasis. This condition causes raised bumps filled with pus (psoriatic pustules) on your skin and can be life-threatening.
Corticosteroid injections can be helpful when one or two of your joints are painful from a flare. When injected into a joint, they work well to relieve inflammation and swelling quickly. 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, and weight gain. Abruptly stopping oral steroids after taking them for more than 10 days can cause symptoms of withdrawal.
Showing up prepared for your doctor 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:
- Keep a running list of your questions before you get there.
- Jot down all of your symptoms.
- If your doctor suggests a medication, ask how well it usually works to treat PsA.
- Ask your doctor about any side effects the drug may cause.
- Share any concerns with your doctor.
You and your doctor can work together to create a plan to manage your PsA effectively.