If you are one of the 7 million people in the United States who have the skin condition psoriasis, you should know the signs and symptoms of psoriatic arthritis. As many as 40 percent of people with psoriasis also have psoriatic arthritis.
We don’t completely understand the causes of psoriasis and psoriatic arthritis. Genetics, the environment, and your immune system are all thought to play roles. Some scientist believe that your immune system attacks your skin when you have psoriasis. When you have psoriatic arthritis, it attacks the joints, causing inflammation.
It can be hard to find out you have psoriatic arthritis. “There are no significant tests that can be done to support diagnosis. Doctors must exclude other types of arthritis, and patients must have a history of psoriasis or have active psoriasis to get the diagnosis,” says Erin Boh, MD, chairman of dermatology at Tulane University Health Sciences Center in New Orleans.
Your joint symptoms may be mild, so your doctor may suspect other typical causes of pain, says Eric Matteson, MD, rheumatology chair at Mayo Clinic in Rochester, MN.
The first symptoms may not seem related to your skin condition, Matteson says. But that stiffness in your back may be caused by spine inflammation. It’s important to get a correct diagnosis so that you can be treated before your joints have permanent damage.
The condition can develop very slowly. In most cases, a person will have psoriasis before he has signs of psoriatic arthritis.
In the less common cases where joint problems show up before the skin symptoms, it can be even more difficult to diagnose. “When it does affect the joints of the arms and legs, it can cause swelling that looks like rheumatoid arthritis and be confused with this disease,” Matteson says.
Your doctor will ask you questions about your medical and family histories, as well as examine you for swollen and tender joints. You may have an X-ray to see if you have joint damage, and blood tests can help rule out other diseases.
Skin specialists, known as dermatologists, are often the first to suspect psoriatic arthritis in people they’re treating for psoriasis.
“I examine the joints, particularly the hands and feet and elbows, which are commonly affected,” Boh says. “This may take a minute or two extra, but it is not time-consuming It is easy and should be incorporated into the exam.”
Nail changes to the fingers and toes, such as small pits or splitting from the nail bed, are common in people with psoriatic arthritis. Also, swelling of the fingers or toes, and inflammation where the ligaments and tendons attach to bone, can occur, Boh says.
Typically, if psoriatic arthritis is suspected, patients are referred to a rheumatologist, a doctor who specializes in the treatment of all types of arthritis.
Treatment of Psoriatic Arthritis
Your pain level can vary with psoriatic arthritis. Treatment aims to reduce joint damage as well as pain and inflammation. You may get pain relief and reduced inflammation from over-the-counter medications like ibuprofen. If that’s not enough, your doctor can prescribe arthritis drugs that will help. If your joints are badly damaged and you have trouble moving, surgery may be an option.