Joint Pain? It Could be Psoriatic Arthritis

Although psoriasis makes itself known by affecting the surface of your skin, the autoimmune disease starts inside you at the cellular level. In fact, the same miscommunication between cells that causes your skin to form plaques can also bring on the pain and inflammation of psoriatic arthritis, when the immune system attacks joint tissues.

Affecting almost one in three people with psoriasis, psoriatic arthritis can target any part of the body, causing joint pain ranging from mild to severe. And it’s important to be aware of your risk and alert to the signs, since the earlier you get treatment, the better you can protect your joints.

When does it strike?

“Psoriatic arthritis can be more difficult to diagnose than psoriasis,” says M. Elaine Husni, MD, Vice Chair of Rheumatology and Director of the Arthritis and Musculoskeletal Treatment Center at the Cleveland Clinic. “It usually occurs years after the diagnosis of psoriasis—up to 10 years—sometimes with subtle findings of only one or two joints affected.” But sometimes the joint problems begin before skin lesions appear.

What to watch for

Symptoms of psoriatic arthritis may include joint pain and:

  • Sausage-like swelling of fingers and toes. Only one finger or toe may be swollen. If your psoriasis includes pitted or thickened fingernails, the joints at the fingertips are often affected.
  • Foot pain at the points where tendons and ligaments attach to bones—especially at the back of your heel or in the sole.
  • Back pain. Some people develop spondylitis, a condition that causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis.
Understanding treatment options

Current medications can treat the pain that makes activities harder and/or help slow joint damage.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can lessen pain, swelling and stiffness. However, they can’t slow joint destruction.
  • Systemic (body-wide) medications may relieve severe symptoms and help limit the amount of joint damage. Methotrexate is usually the first systemic treatment prescribed, especially if the skin is affected.
  • Biologic medications such as TNF-alpha inhibitors block an inflammatory protein called tumor necrosis factor (TNF), helping to control joint and skin symptoms. “These therapies help reset the immune system so it can slow down or halt inflammation,” says Dr. Husni. That means biologics may actually prevent the progression of joint disease. 
Prepare for your visit

If you think you have psoriatic arthritis, be prepared to explain:

  • What symptoms you're having
  • When you first noticed the symptoms
  • How frequently symptoms occur and how long they last
  • What makes you feel better
  • If you have any nail problems (e.g. pitting, ridges or lifting nails)
Published September 2013

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