Psoriatic arthritis 

Introduction 

Do complementary therapies work?

There is not enough scientific research evidence to say that complementary therapies, such as balneotherapy (bathing in water containing minerals), works in treating psoriatic arthritis.

There is also not enough evidence to support taking any kind of food supplement as treatment.

Sometimes, complementary therapies can react with other treatments, so you should talk to your GP or pharmacist if you are thinking of using any.

Psoriatic arthritis affects up to one in five people with psoriasis. This type of arthritis is unpredictable, but flare-ups can be usually be managed with treatment.  

Like other types of arthritis, it means that one or more of your joints are inflamed and become swollen, stiff, painful, and difficult to move.

Read more about arthritis.

Psoriatic arthritis mostly affects your hands and feet, although any joint can be affected. The fingers can swell up and look like sausages – a condition known as dactylitis.

It can also make tendons and ligaments swollen and painful (tendons attach muscle to bone and ligaments attach bone to bone).

Who is affected?

Psoriatic arthritis is a long-term condition that can happen at any age, although it is most common in middle age.

It affects up to one in five people with psoriasis and usually develops within 10 years of psoriasis being diagnosed.

What to do

If you have been diagnosed with psoriasis and you have pain, swelling or stiffness in your joints, or you have back pain, see your GP as you might have psoriatic arthritis.

Your GP should refer you to a rheumatologist (a specialist in conditions of the joints) if you have psoriasis and:

  • stiffness in one or more of your joints in the morning
  • swelling or tenderness in some of your joints
  • dactylitis (swelling of a finger or toe)

Your GP or specialist may carry out some blood tests to check for signs of inflammation and to check the levels of different types of cells in your blood.

Treating psoriatic arthritis

If you have psoriatic arthritis, you may be treated by a team of health professionals, including:

  • a GP
  • a rheumatologist
  • a dermatologist (skin specialist)
  • a nurse
  • a physiotherapist
  • an occupational therapist 
  • a psychologist (it's not unusual for people with arthritis to develop depression)

You may be given a number of different types of medicine for psoriatic arthritis, some of which can treat the psoriasis too. These are summarised below.

NSAID painkillers

Your GP may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to help relieve pain and stiffness, while also reducing inflammation.

There are two types of NSAIDs and they work in slightly different ways:

  • traditional NSAIDs, such as ibuprofen, naproxen or diclofenac
  • COX-2 inhibitors (often called coxibs), such as celecoxib or etoricoxib

Read more about non-steroidal anti-inflammatory drugs (NSAIDs).

Steroid medication (corticosteroids)

Steroids help reduce pain, stiffness and swelling. They can be taken as a tablet (for example, prednisolone) or as an injection into the muscle, to help lots of joints. They are usually used when NSAIDs fail to provide relief.

However, doctors are generally cautious about giving steroid injections or tablets if the associated psoriasis is severe, as withdrawal of the steroids can cause the skin disease to flare up.

If you have a single inflamed or swollen joint, your doctor may inject the steroid directly into the joint. Relief is rapid and the effect can last from a few weeks to several months, depending on the severity of your condition.

Read more about corticosteroids.

Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs help to ease symptoms and slow the progression of psoriatic arthritis. When antibodies attack the tissue in the joints, they produce chemicals that can cause further damage to the bones, tendons, ligaments and cartilage. DMARDs work by blocking the effects of these chemicals. The earlier you start taking a DMARD, the more effective it will be.

Leflunomide is often the first drug given for psoriatic arthritis. Sulfasalazine or methotrexate may be considered as an alternative.

You can click on the above links for more information on these drugs, including the side effects.

It can take four to six months to notice a DMARD working. Therefore, it is important to keep taking the medication, even if it doesn't seem to be working at first.

Biological treatments

Biological drug treatments are a newer form of treatment for psoriatic arthritis. You may be offered treatment with a biological if:

  • your psoriatic arthritis has not responded to at least two different types of DMARD
  • you are not able to be treated with at least two different types of DMARD

Biological drugs work by stopping particular chemicals in the blood from activating your immune system to attack the lining of your joints.

Some of the biological medicines you may be offered are adalimumab, etanercept and infliximab injections. Read more about these drugs in the treatment of psoriasis.

Side effects from biological treatments are usually mild and include:

  • skin reactions at the site of injection
  • infections
  • nausea
  • fever
  • headaches

Managing related conditions

If you have psoriatic arthritis, you may be more likely to get some other diseases, such as heart disease, diabetes and depression.

Your doctor should carry out tests each year (such as blood pressure and cholesterol tests) to check if you are developing these diseases.

In the meantime, you can help yourself by:

  • having a good balance between rest and regular physical activity
  • losing weight if you are overweight
  • not smoking
  • only drinking moderate amounts of alcohol



Page last reviewed: 04/09/2012

Next review due: 04/09/2014

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Comments

The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Robert_Doyle said on 08 September 2014

In response to other comment "treatment in reality".. my experience was the exact opposite. Royal berks in reading were fantastic. I wouls suggest going to a different hospital.

During a routine medication review for my psoriasis (im 26 by the way), i happened to mention i was experiencing tenderness in certain joints. Upon inspection and after a brief chat she referred me to the royal berks... i was able to log in and schedule an appointment that was convenient for me (which was about a month away). After the consultant's chat and examination, which included what could only be described as a mini ultrsound, she confirmed it looked like psoriatic arthritis. Explained the options, prescribed me my meds and sent me for xrays and bloods (which she explained were so they have a bench mark for future, so they can tell if it is getting worse.)

Couldnt of asked for better care... and was suprised they were so confident at their indication as it is not like mine is obviously bad... very mild infact.. they put me on treatment that will help stop it getting worse.. and even prescribed something else to help counter the side effects..Granted i will be on the medication for the rest of my life, and arthritis isn't covered by medical cert, so i will have to pay for that.., which im not too happy about given it is a life long treatment... but the nhs were fantastic. Thank you royal berks and thank you priory avenue surgery.

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RachB11 said on 14 August 2014

Or treatment in reality. GP recognises that your joint is inflamed and arthritic and refers you. Specialist appointment not available for months. You lose the joint you went to the doctor with. Specialist consultant with awards in his name from his hospital at specialist hospital (Wrightington) mutters something about paracetamol, and you are poked and prodded so you are in much worse condition than when you arrived, blood tests taken and instead of a small plaster like the GPs use you get feet of tape stuck to your arm which you'll have to get someone else to get off as no arthritic person could manage. You get sent for for a few times, few tests. your deterioration is recorded, you are promised splints to make sleeping less painful and operations but they don't actually put you on the list and you are sent home no better off until they just don't make any more appointments for you and you cannot be bothered to get back onto the system. Forget anyone giving a toss what happens to you and all that list above. Might as well stay at home if you have this condition because the NHS will NOT help you at all and you'll just have to get used to constant pain and struggling to do everything..

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