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Psoriatic Arthritis ˌsōr-ē-ˈat-ik, ˌsȯr-

By Apostolos Kontzias, MD, Assistant Professor of Medicine and Director, Autoinflammatory Clinic, Cleveland Clinic Foundation

Psoriatic arthritis is a spondyloarthritis and a form of joint inflammation that occurs in some people who have psoriasis of the skin or nails.

  • Joint inflammation can develop in people who have psoriasis.

  • Joints commonly involved include the hips, knees, and those closest to the tips of the fingers and toes.

  • The diagnosis is based on symptoms.

  • Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (such as methotrexate), cyclosporine, and tumor necrosis factor inhibitors can help.

Psoriatic arthritis is a type of spondyloarthritis.

Psoriatic arthritis resembles rheumatoid arthritis but does not produce the antibodies characteristic of rheumatoid arthritis. Psoriatic arthritis occurs in about 30% of people with psoriasis (a skin condition causing flare-ups of red, scaly rashes and thickened, pitted nails). People with a certain gene (HLA-B27) and those who have affected family members are at increased risk of psoriatic arthritis of the spine. The cause of psoriatic arthritis is unknown.

Symptoms

Inflammation often affects joints closest to the tips of the fingers and toes, although other joints, including the hips, knees, and spine, are often affected as well. Often, the joints of the upper extremities are affected more. Back pain may be present.

The joints may become swollen and deformed when inflammation is chronic. Psoriatic arthritis affects joints asymmetrically (more on one side of the body than the other), more so than rheumatoid arthritis, and involves fewer joints. Tendons or ligaments can become inflamed where they attach to bone around the joints (called enthesitis). Some people who have psoriatic arthritis also have fibromyalgia, which causes muscle pain, joint stiffness, and fatigue.

The psoriasis rash may appear before or after arthritis develops. Sometimes the rash is not noticed because it is hidden in the scalp, navel, or creases of the skin such as between the back of the buttocks and thigh. The skin and joint symptoms sometimes appear and disappear together, but often the skin symptoms are more severe than the joint symptoms or the joint symptoms are more severe.

Diagnosis

  • A doctor's evaluation

  • Blood tests

  • X-rays

The diagnosis of psoriatic arthritis is made by identifying the characteristic joint inflammation in a person who has arthritis and psoriasis. Doctors also ask people whether they have a family history of psoriasis.

There are no tests to confirm the diagnosis, but blood tests for rheumatoid factor are done to exclude rheumatoid arthritis, and x-rays are done to show the extent of joint damage.

Prognosis

The prognosis for psoriatic arthritis is usually better than that for rheumatoid arthritis because fewer joints are affected. Nonetheless, the joints can be severely damaged.

Treatment

  • Disease-modifying antirheumatic drugs

  • Tumor necrosis factor inhibitors

  • Ustekinumab, secukinumab, and apremilast

Treatment of psoriatic arthritis is aimed at controlling the rash and relieving the joint inflammation. Several drugs that are effective in treating rheumatoid arthritis (see Rheumatoid Arthritis (RA) : Drugs for Rheumatoid Arthritis) are also used to treat psoriatic arthritis, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs—especially methotrexate), cyclosporine, and tumor necrosis factor (TNF) inhibitors (such as adalimumab, etanercept, infliximab, certolizumab pegol, and golimumab). TNF inhibitors are particularly effective for psoriatic arthritis.

Ustekinumab, given by injection, and apremilast, taken by mouth, are other biologic agents that can be used to treat moderate to severe psoriatic arthritis.

Secukinumab, an interleukin-17A receptor antagonist, can also reduce inflammation and joint symptoms.

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Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • REMICADE
  • OTEZLA
  • NEORAL, SANDIMMUNE
  • STELARA
  • OTREXUP
  • HUMIRA
  • ENBREL
  • SIMPONI