Causes
What causes psoriatic arthritis is not known exactly. Of those with psoriatic arthritis, 40 percent have a family member with psoriasis or arthritis, suggesting heredity may play a role.
Psoriatic arthritis can also result from an infection that activates the immune system. While psoriasis itself is not infectious, it might be triggered by a streptococcal throat infection.
Who Gets Psoriatic Arthritis?
Psoriatic arthritis usually appears in people between the ages of 30 to 50, but can begin as early as childhood. Men and women are equally at risk.
Psoriatic arthritis typically affects the large joints, especially those of the lower extremities, distal joints of the fingers and toes, and can also affect the back and sacroiliac joints of the pelvis.
How Is Psoriatic Arthritis Diagnosed?
To diagnose psoriatic arthritis, rheumatologists look for swollen and painful joints, certain patterns of arthritis, and skin and nail changes typical of psoriasis. X-rays often are taken to look for joint damage. MRI or CT scans also can be used to look at the joints in more detail.
Occasionally skin biopsies (small samples of skin removed for analysis) and blood tests are done to rule out other types of arthritis that have similar signs and symptoms, including gout and rheumatoid arthritis. In patients with psoriatic arthritis, blood tests may reveal high levels of inflammation and mild anemia.
How Is Psoriatic Arthritis Treated?
Psoriatic Arthritis treatment varies depending on the level of pain. Those with very mild arthritis may require treatment only when their joints are painful and may stop therapy when they feel better.
Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin or Advil) or naproxen (Aleve) are used as initial treatment. If arthritis does not respond, disease-modifying anti-rheumatic drugs may be prescribed. These include sulfasalazine (Azulfidine), methotrexate (Rheumatrex), cyclosporine (Neoral, Sandimmune), leflunomide (Arava) and the more recently available “anti-TNF agents” such as etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). The anti-malarial drug hydroxychloroquine (Plaquenil) may help, but it usually is avoided as it can cause a flare of psoriasis.
Azathioprine (Imuran) may help those with severe forms of psoriatic arthritis. For severely swollen joints, corticosteroid injections can be useful. Surgery can be helpful to repair or replace badly damaged joints.
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