Psoriasis is a chronic condition that causes red, itchy scaly patches on the skin, most commonly found on the knees, elbows, trunk and scalp. It’s so common that more than 8 million Americans currently deal with the skin condition, as well as 125 million people worldwide, according to the World Psoriasis Day consortium.
Although many people are familiar with this common condition, many may not know that at an estimated 30% of individuals with psoriasis will develop psoriatic arthritis (PsA), an autoimmune disease that results in pain and swelling in the joints as well as where tendons and ligaments are attached to the bones. The disease, which hits men and women equally and usually happens to people in their 30s and 40s, can range from mild to severe cases, and impact places all over the body—even the spine.
In most instances, people with preexisting psoriasis develop psoriatic arthritis, but there are some cases where people develop psoriatic arthritis before experiencing any rash.
Common symptoms of PsA include:
- Patches of scaly, inflamed skin on the scalp, elbows, or knees
- Tenderness, pain and swelling over tendons
- Swollen fingers and toes that sometimes resemble sausages
- Pain, throbbing, swelling and tenderness in one or more joints
- Reduced range of motion and stiffness
- Nail changes, such as pitting or separation from the nail bed
- Lower back pain
- Eye pain (uveitis), redness, and blurry vision
- Inflammatory Bowel Disease
Like many other autoimmune disorders, the cause of psoriatic arthritis is still unknown. Although researchers know that PsA develops due to an overactive immune system, there is still no known reason as to what causes this overactivity. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma can help determine who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Although there is currently no cure for psoriatic arthritis, there are plenty of treatment options to help manage the condition and control its symptoms to lessen the damage to impacted areas.
“Some medications are more effective than others on particular body parts, so we pick a combination of drugs that will help the areas impacted,” said Petros Efthimiou, MD, a rheumatologist based in New York to Women’s Health.
Most common treatments for PsA include:
- Non-steroidal anti-inflammatory drugs (NSAIDs): The most common first option for treatment, NSAIDs are anti-inflammatory medications that can help reduce the symptoms of PsA, like joint pain and swelling. Available over the counter, these drugs include aspirin, ibuprofen (Advil), and naproxen sodium (Aleve).
- Disease-modifying antirheumatic drugs (DMARDs): DMARDS reduce immune system activity, which helps lessen inflammation. Not only do these drugs help manage pain, but they can reduce further joint damage, as they aim to stop the disease’s progression and rebalance the immune system. This class of drugs can be nonbiologic, like methotrexate, or biologic, like Humira or Remicade.
- Immunosuppressants: Because PsA is an autoimmune disease, immunosuppressant drugs like azathioprine and cyclosporine may slow the disease by reducing inflammation and inhibiting the immune attack against the body’s own cells. These drugs can also help ease joint pain and swelling. Common side effects may include nausea, vomiting, liver problems, kidney problems, stomach irritation, and rash.
- Medical procedures: At some point during people’s treatment journeys, medical surgery may be required to help relieve some of the discomfort caused by PsA. Steroid injections in a painful joint or joint replacement surgery are two of the most common surgical options.
- Alternative therapies; Because psoriasis and PsA are life-long chronic illnesses, it is common for many people to seek out alternative treatment options to help manage the symptoms and emotional toll that the condition can have. Mind-body techniques such as yoga, meditation, and tai chi are all good options to help control stress, a common trigger for PsA flare-ups. Additionally, keeping a balanced diet and regular exercise routine can help keep symptoms under control.