Psoriatic Arthritis

Diagnosis

To find out whether you have psoriatic arthritis, your healthcare professional typically begins with a physical exam. During the visit, your healthcare professional may look at your joints for swelling or tenderness, check your fingernails for pitting or peeling, and press on the bottoms of your feet or around your heels to identify sore spots.

Because no single test can confirm psoriatic arthritis, different tests are used to rule out other causes of joint pain such as rheumatoid arthritis or gout.

Imaging tests may be used to identify joint and tissue changes. X-rays can show patterns of joint damage that are common in psoriatic arthritis but not usually found in other forms of arthritis. MRI scans provide detailed images of bones, joints and soft tissues, and can be especially helpful for checking inflammation in tendons and ligaments, particularly in the feet and lower back.

Laboratory tests may also support diagnosis. A rheumatoid factor test checks for an antibody often found in people with rheumatoid arthritis. If the antibody is not present, it may help confirm psoriatic arthritis. A joint fluid test involves taking a small fluid sample from a swollen joint using a needle. If uric acid crystals are found, this indicates gout. Some people may have both gout and psoriatic arthritis.

More Information
MRI
Rheumatoid factor
X-ray

Treatment

There is no cure for psoriatic arthritis, but treatment can help manage symptoms, reduce inflammation and protect joints and skin from long-term damage. A key category of treatment is prescription medicine known as disease-modifying antirheumatic drugs, or DMARDs. Your treatment plan will depend on the severity of symptoms and which joints are involved. You may need to try several approaches to find the most effective option.

Medications are commonly used to control inflammation and prevent joint damage.

• NSAIDs can help lessen pain and swelling. Over-the-counter options include ibuprofen and naproxen sodium, while stronger versions may be prescribed. Side effects may include stomach upset, heart issues and damage to the liver or kidneys.

• Conventional DMARDs slow disease progression and help prevent joint damage. Methotrexate is the most widely used option. Other choices include leflunomide and sulfasalazine. These medicines may cause side effects such as liver damage, bone marrow suppression and lung inflammation.

• Biologic DMARDs target specific immune system pathways that cause inflammation. Options include adalimumab, certolizumab, etanercept, golimumab, infliximab, ustekinumab, secukinumab, ixekizumab, guselkumab and abatacept. Biologics can increase the risk of common and rare infections, including tuberculosis.

• Targeted synthetic DMARDs such as tofacitinib may be used if other treatments are not effective. Higher doses can increase the risk of blood clots, serious heart issues and cancer.

• Newer oral medicine such as apremilast helps reduce inflammation and is often used for mild to moderate psoriatic arthritis or when people prefer not to use conventional DMARDs or biologics. Side effects may include diarrhea, nausea and headaches.

Therapies can also play an important role in treatment. Physical and occupational therapy may help decrease pain, improve movement and make daily tasks easier. These therapies focus on teaching ways to move that reduce stress on the joints. Massage therapy may also provide relief by easing muscle tension.

Surgery and procedures may be recommended for severe cases. Steroid injections can reduce swelling and pain quickly when given directly into a painful joint, though they are used sparingly because repeated use may weaken tendons or cartilage. Joint replacement surgery may be considered if a joint has been severely damaged. Replacing the joint with a metal and plastic implant often improves mobility and reduces pain.