Psoriatic arthritis (PsA) can impact everyone differently. Some people will experience a gradual worsening of symptoms, but others will quickly develop severe symptoms.
PsA is a condition that causes joint pain and inflammation. It usually occurs in people who already have psoriasis but may also develop on its own. It
Read on to learn about the different symptoms and stages of psoriatic arthritis and how to slow the progression of the condition.
For around 80% of people with PsA, arthritic symptoms will occur after they experience psoriasis. PsA may develop around 10 years or more after the symptoms of psoriasis start. The remaining 20% of people with psoriatic arthritis will not have psoriasis beforehand.
Early symptoms of PsA may come and go. This means that people should consider keeping a note of their symptoms as and when they occur. This way, they can report everything to their doctor, who will monitor the situation accordingly.
Early symptoms of PsA include:
Nail changes
Nail problems occur in more than
Examples of nail changes include:
- Pitting: This is where small indentations develop on the surface of the nail bed.
- Ridges: The nails may develop shallow ridges on the surface.
- Splinter hemorrhages: These are small, line-shaped clots in the nail.
- Onycholysis: This is where the nail separates from the nail bed. It is usually painless.
Joint problems
Joint problems in people with psoriasis could include:
- Enthesitis: The connective tissues that attach tendons or ligaments to bone are called entheses. PsA can cause the entheses to become inflamed, causing pain and difficulty moving. This can occur in the backs of the ankles and the bottoms of the feet.
- Tenosynovitis: PsA can also cause inflammation to occur in the tendons of the hands. This is known as tenosynovitis.
- Range of motion: A person may notice that they cannot carry out typical daily tasks as easily as before. This reduced range of motion could impact movements that include bending over or raising the arms.
- Swelling: Joints can become swollen and difficult to move, such as in the fingers, toes, and elbows.
- Dactylitis: This issue is where the inflammation affects the fingers or toes, causing them to become sausage-shaped.
- Spinal pain: A person may experience pain in the back where inflammation affects the spine. This pain may improve with exercise but not with rest, and it may be worse at night or at the start of the day.
Other symptoms
Symptoms of PsA can expand beyond the joints and nails. Other symptoms of PsA include:
- Skin rash: People may experience rashes and plaques on their skin that are the result of psoriasis.
- Fatigue: Fatigue causes people to feel persistently tired regardless of their rest or sleep.
- Uveitis or conjunctivitis: People may experience inflammation of their eyes as a symptom of PsA.
It is important to diagnose PsA early to improve treatment outcomes.
The way in which psoriatic arthritis progresses varies from person to person.
The severity of their symptoms can increase and spread to new joints.
PsA can cause permanent damage to the joints without proper treatment, so treatment should start as early as possible.
The later stages of PsA can include:
- More frequent flare-ups: As PsA progresses, people may experience regular flare-ups of symptoms. Periods of remission will become less common, which can affect someone’s capacity to carry out daily activities.
- Fused spine: Some cases of PsA involve the spine. This is called axial spondyloarthritis of psoriasis, a condition where the spinal joints become inflamed and may eventually fuse together.
- Permanent bone damage: Bones can erode from periods of inflammation.
Structural deformities can also occur, meaning that it may be more difficult for people to use their joints.
- Significantly reduced mobility: The increasing frequency of flare-ups causes a higher likelihood of permanent changes to the bones. People may notice that they have a significantly reduced range of motion as a result of these changes.
Some people with PsA may go on to develop metabolic syndrome. This refers to a group of risk factors that includes obesity, high blood pressure, and unhealthy levels of cholesterol.
There is also an association between psoriatic arthritis and cardiovascular disease. According to a 2017 meta-analysis, people with PsA may have a
Treatments for psoriatic arthritis focus on:
- maintaining joint mobility
- relieving pain
- lowering inflammation
- slowing disease progression
- reducing skin symptoms
For some people, PsA will stay mild, and their symptoms may be manageable without intensive treatments. Other people may have to try many different strategies and medications to manage their symptoms.
Doctors will tailor treatment according to the part of the body involved and how severe the symptoms are.
Some medicines are better for certain areas of the body than others. As a result, doctors may also recommend a combination of treatments. They may sometimes need to try different medications to find the best one to control a person’s symptoms.
Creating a treatment plan may require a multidisciplinary approach involving a rheumatologist, a primary care physician, and a dermatologist.
Treatment options for PsA generally include the following:
Medication
Doctors may use the following types of medication to treat PsA:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen, aspirin, or naproxen can relieve pain and inflammation in people with PsA. These are available over the counter, and stronger versions are available on prescription. NSAIDs do not slow the progression of the disease.
- Disease-modifying antirheumatic drugs (DMARDs): These medications reduce inflammation and can prevent PsA from progressing. The main types of DMARDs are conventional and biologics, which target certain inflammatory proteins. Healthcare professionals will determine which types are most appropriate for each person.
- Corticosteroids: These are strong anti-inflammatory medications that can quickly reduce inflammation. People can take these medications orally or as an injection directly into the joints.
Lifestyle changes
Doctors might also recommend lifestyle changes that include:
- Exercise: People with PsA should discuss an appropriate exercise plan with their healthcare team. Different techniques can preserve strength and maintain as much of a person’s range of motion as possible.
- Weight maintenance: Maintaining a moderate weight can relieve pressure on the joints and reduce pain.
- Temperature therapy: Alternating hot and cold packs on the impacted areas can reduce swelling and pain in the joints. Always ensure that there is a barrier between the skin and the hot or cold pack, such as a cloth or towel.
It is essential to diagnose PsA and begin treatment early to prevent permanent damage to the body. There is currently no cure for PsA, but treatment can slow its progression.
PsA impacts many body parts. Being familiar with early signs of the condition increases the chances of a timely diagnosis.