Psoriatic Artritis (PsA)

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The rigours of daily life can be difficult enough without adding a constant feeling of soreness and discomfort. It can be difficult to wake up each morning, your knees, elbows and hands working against you, visible rashes a reminder of your pain. In people with psoriatic arthritis, the immune system targets its own joints causing pain, swelling, fatigue and stiffness in the joints. This may make even simple things difficult to do. But symptoms of PsA come and go, and through proper treatment and lifestyle changes, you can lessen this burden so that PsA doesn’t have to be a daily struggle.

What is Psoriatic Arthritis?

Psoriatic arthritis (PsA) is a chronic, immunological inflammatory disease that affects the joints. It is a form of arthritis that affects some people who have psoriasis. Although most people develop psoriasis first, joint problems can sometimes begin before skin patches appear. Nearly 80% of those with PsA also have psoriasis.

Because PsA stems from an issue with your immune system, you may also be more likely to develop other diseases, such as diabetes, cardiovascular disease, inflammatory intestinal disease, auto-immune eye disease, or fibromyalgia. Additionally, the emotional toll of feeling restricted and marked can lead many to develop depression.

Without proper disease management, PsA can become increasingly severe and eventually leave your joints permanently disabled.

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What are the symptoms of Psoriatic Arthritis?

The most common symptoms of PsA are pain, stiffness and swelling in your joints. PsA can affect any joint in your body, as well as create tender spots where tendons and ligaments join onto bones. Other symptoms may include fatigue, swelling in fingers and toes, changes in the appearance of your nails, difficulty sleeping, and red, painful eyes.

These physical symptoms will likely come and go and vary in severity as disease flares may alternate with periods of remission.,

There are five types of PsA, identified by which joints are affected.

Symmetrical polyarthritis PsA affects four or more joints, usually the same joints on both sides of the body. For example, feeling pain and stiffness in both of your knees, ankles or wrists.
Asymmetric oligoarticular PsA affects four or less different joints. For example, while your right wrist may feel healthy and normal, the left wrist may feel stiff and painful, and rashes may appear.
Distal interphalangeal PsA mainly affects the joints in your fingers and toes.
Spondylitis is a form of PsA that affects the joints between the sections of your spine.¹⁰ This means your symptoms will likely appear as stiffness and pain in your neck and back, however it may spread to joints elsewhere in your body.¹⁰
Arthritis Mutilans is the least common type, affecting just 5% of those with PsA.¹⁰ People with this type of PsA will not only develop red rashes and feel pain, but their joints will also begin to deform, further restricting their movements. In some cases, this type of PsA will deteriorate the bone as well.¹⁰

How common is Psoriatic Arthritis?

Among those with Psoriasis, a relatively common, chronic disease, affecting roughly 2-3% of the world’s population, nearly 30% will develop PsA.¹⁰,¹¹

Medical experts still do not know exactly what causes PsA. However, there are signs that it stems from a combination of your genes, immune system issues, and lifestyle. Psoriatic arthritis affects both genders equally, but is more likely to appear in people between 30 and 50 years old.

Unfortunately, there is no definitive test to positively confirm a PsA diagnosis. However, if your doctor believes your developing symptoms may be caused by PsA, they may request an MRI or X-ray, blood test, and physical examination, coupled with a series of questions, to try and eliminate other likely diseases such as rheumatoid arthritis.

Treatment and Care

Unfortunately, psoriatic arthritis is a chronic disease, which means no cure will get rid of it permanently. However, there are treatments available that can help reduce, or get rid of, symptoms so that you can lead a life unhindered by PsA.

For example, some anti-inflammatory medications will relieve pain and reduce swelling, while other drugs will work to tame your immune system so that it does not attack your joints as aggressively.¹² There are also certain surgical procedures, including joint replacement surgery, which are more invasive but can help in more severe cases.¹² It is important to discuss with your doctor what treatments are best suited for your type and severity of PsA before making a decision.

Living with Psoriatic Arthritis

The physical toll PsA takes on the body, being unable to perform what should be simple tasks, can be incredibly difficult to accept and handle emotionally. It is understandable that the constant pain, feelings of helplessness, and shame of how your body looks can develop into feelings of depression. Know that your feelings are valid, and you do not have to walk this path alone.

If you find yourself struggling, consult a mental health professional or contact a support group to share and work through your feelings. There are plenty of resources at your disposal, as well as others experiencing the same symptoms you are, who are willing and able to help carry you through the mental fog in which you may feel stuck.

Sometimes, education is the best way to unmask a monster. Learning more about PsA can help you take control of your life. Pay attention to your body, understand what might be causing your symptoms to return after a period of remission, and what life choices help keep them at bay. Each piece of information is a step toward you taking back control of your body and your life.

What to ask your doctor?

The list below includes example questions to help start a conversation with your health care provider. There may be other relevant questions based on your symptoms, stage, and medical history that are not listed here.

Does my type of PsA affect how often these symptoms will flare up?
How likely is it that my children will develop PsA?
What treatments are best for me?
How can I make sure that my symptoms resurface as few times as possible?
How long can remission go for?
How can I identify aspects of my life that trigger symptoms to come back?
Are some symptoms more likely to come back than others?
How likely am I to develop other inflammatory diseases?
What mental health services are available to me?
What kinds of complications can come from my PsA?
…

Glossary

Epidermis: the surface of your skin.
Dermatology: the branch of medicine concerned with the diagnosis and treatment of skin disorders.
Systemic therapy: Pills or injections that act throughout the entire body.
Biological therapy: Injections or infusions made from protein and that alter the immune system.
Spondylitis: When PsA affects the spine.¹³
Uveitis: redness and pain in the eye