Symptoms of Psoriatic Arthritis
The symptoms of psoriatic arthritis are similar to those of other kinds of arthritis. They include:
- Stiffness in the joints
- Pain or swelling in the joints
- Of course, the usual symptoms of psoriasis -- such as red, scaly patches of skin -- may make diagnosis of psoriatic arthritis easier.
In order to identify psoriatic arthritis, your doctor will perform a physical exam. Your doctor may also order blood tests, joint fluid tests, and X-rays in order to examine the affected areas and rule out other diseases.
Treatments for Psoriatic Arthritis
While some of the treatments for psoriasis will also help psoriatic arthritis, others will not. If you have psoriatic arthritis, you should be getting a treatment that works on both the joint pain and the skin lesions caused by the condition. Some common treatments include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These are a common class of painkillers that are typically the first choice for treating psoriatic arthritis. They include a number of over-the-counter drugs, such as Motrin and Advil (aspirin and ibuprofen). Many others are available by prescription.
Although you may think of drugs like Advil as harmless, you should talk to your doctor before using them to treat your arthritis. Chronic usage can be dangerous and cause gastrointestinal problems.
Up until recently, many people took prescription NSAIDs called Cox-2 inhibitors -- like Celebrex, Vioxx, and Bextra -- for psoriatic arthritis. However, because of evidence that Vioxx increased the risk of heart attacks and strokes, it was pulled from the market in 2004. In 2005, Bextra was withdrawn in the U.S. because of a risk of serious skin reactions. Celebrex is still available, but the FDA warns that it might raise the risk of heart attacks and strokes.
- Disease-modifying antirheumatic drugs (DMARDs). The DMARDs are more powerful drugs that are used for cases of psoriatic arthritis that don't respond to milder medications. Some of the drugs in this class are also used for systemic therapy of psoriasis, such as methotrexate, which helps fight psoriasis by suppressing the immune system. It can cause serious side effects and raise the risk of infection. Imuran is another drug that suppresses immune function and is sometimes prescribed for psoriatic arthritis. It can have serious effects on the bone marrow.
Another DMARD is Azulfidine, which is easier for many patients to tolerate than cyclosporine or methotrexate. Side effects include vomiting and nausea. Certain drugs used to prevent malaria, such as Plaquenil, can help with the symptoms of rheumatoid arthritis, and they are sometimes prescribed for psoriatic arthritis. However, in some people, antimalarial drugs can cause psoriasis to flare up.
Your doctor may also recommend a short prescription of oral steroids to help clear acute joint pain, although steroids cannot be used safely for long periods of time. Stopping treatment with steroids suddenly can also cause a flare-up of symptoms. In the past, doctors sometimes recommended using gold salts, such as Myochrysine and Solganal, although their side effects and the development of more effective medications have made them much less popular in recent years.
- Biologic therapy. The newest tools for treating psoriasis and psoriatic arthritis are biologic medications. Four of these drugs have been approved to treat psoriatic arthritis -- Enbrel, Humira, Remicade, and Simponi. Biologic medications may make the immune system more susceptible to infections.
- Phosphodieasterase-4 (PDE-4) inhibitor. Currently, Otezla is the only drug in this category FDA-approved to treat psoriatic arthritis. It's taken orally and side effects include diarrhea, nausea, weight loss, and depression.
- Other treatments. Guided physical therapy, which can improve strength and flexibility, is often helpful for people with psoriatic arthritis. Using hot and cold packs can also make a difference because cold can numb pain and heat can relax muscles. You should also try to eat a balanced diet high in fruits and vegetables, maintain a healthy weight, and get regular exercise, if possible. Do what you can to reduce stress, perhaps by practicing relaxation techniques.
- Assistive devices. If your arthritis is making it difficult for you to do everyday things -- buttoning your shirt, opening a bottle, or getting up from a chair -- ask your doctor about assistive devices -- tools or gadgets that make common tasks easier for people with debilitating arthritis.