Anyone who has psoriasis
and joint pain may have psoriatic arthritis. The signs and symptoms
of psoriatic arthritis are:
The red, inflamed
skin of psoriasis.
Pain and swelling
in the joints that is worse in the morning or after rest. Stiffness
lessens with activity.
appearance in the affected fingers and toes (in severe cases.)
indentations on the nail) or the nails may be pulling away from the
nail beds. Nails may have ridges or a yellowish-orange
is a lifelong condition that causes deterioration, pain, and
stiffness in the joints. Some people experience only joint
problems and never develop psoriasis. About 70% of people who
get psoriatic arthritis develop psoriasis first. Studies show
that in these cases, psoriasis usually precedes psoriatic arthritis
by about 10 years. However, a person can develop psoriatic
arthritis within a few months of getting psoriasis or decades later.
most commonly involves the fingers and toes. Joints in the neck,
back, knees, ankles, and other areas also may be affected. In
addition to being painful and stiff, the involved areas usually feel
hot. Affected joints tend to have a purplish discoloration.
Almost 90% of people who develop psoriatic arthritis see nail
involvement first. The nails may pull away from the nail bed or
develop pitting, ridges, or a yellowish-orange discoloration.
Dermatologists urge their patients who have psoriasis that involves
the nails to contact them if they experience any joint problems.
Joint deterioration can be prevented with treatment.
Early warning signs of psoriatic arthritis include hand pain, foot
pain, and "tennis elbow." These early warning signs may be
overlooked if psoriasis lesions are not present. Other indications
are shoulder, neck, or back pain.
Psoriatic arthritis ranges in severity. It can involve one digit or
an entire hand. It can become so severe that it is disabling.
According to the National Psoriasis Foundation, about 20% of
patients living with psoriatic arthritis have more than five totally
damaged joints, which significantly impairs their ability to perform
everyday tasks and reduces their quality of life.
Who Gets Psoriatic Arthritis
About 1 million people in the United State are living with psoriatic
arthritis, which occurs equally in men and women. Psoriatic
arthritis occurs most frequently in people with active psoriasis,
especially those who have pustular psoriasis. A higher incidence of
psoriatic arthritis is found in people who have psoriatic nails.
Psoriatic arthritis can begin at any age. However, swelling and
stiffness in the joints usually first appears between 30 and 50
years of age. People who have psoriasis usually experience skin
flare-ups months to years before the joints become stiff and
Children also can develop psoriatic arthritis. A pediatric form may
appear as early as 2 to 4 years of age in girls. A peak time for
psoriatic arthritis to occur in both boys and girls is 11 to 12
years of age. In rare cases, the arthritis appears before lesions on
Psoriatic arthritis may appear in children several years before
psoriasis. This can make recognizing psoriatic arthritis difficult,
especially if there is no known family history of psoriasis.
Like psoriasis, psoriatic arthritis is believed to be caused by an
abnormality in the immune system. Another similarity is that a
"trigger,” such as stress, can cause psoriatic arthritis to develop
in a genetically predisposed person.
What to Do if You Have Symptoms
Anyone who has psoriasis or a family history of psoriasis and
experiences joint stiffness and swelling should make an appointment
to see a dermatologist. Medication can help prevent joint
deformities and disability if used early. Without treatment, joint
degeneration and destruction can occur, making it painful if not
impossible to perform some daily activities.
Joint degeneration can develop quickly and is irreversible. More
than 50% of people living with psoriatic arthritis have some
limitations. More than 60% lose time from work. If allowed to
progress, morning stiffness can last for a few hours.
The goal is to diagnose psoriatic arthritis in its earliest stages.
Diagnosis usually begins with a review of the patient’s medical
history and examination of the patient’s skin, joints, and
fingernails. Since symptoms resemble those of rheumatoid arthritis,
blood and serum tests are often necessary to differentiate it from
rheumatoid arthritis and other autoimmune (person’s own immune
system develops a reaction against something in the person’s own
body) conditions. X-rays are sometimes taken to distinguish
psoriatic arthritis from other types of arthritis.
Years of research have given dermatologists a better understanding
of psoriatic arthritis. Today, new treatments and therapies offer
renewed hope to patients with this lifelong condition.
The goals of treatment are:
No single psoriatic
arthritis treatment works for everyone. Instead, the goal is to find
the treatment that works best for each patient with the fewest side
effects. Dermatologists will often recommend a treatment or a
combination of treatments based on the type and severity of the
Medications used to
treat psoriatic arthritis include:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can help
alleviate pain, swelling, and stiffness in the joints. Some NSAIDs
require a prescription. Others can be purchased over-the-counter and
include aspirin, ibuprofen, and naproxen sodium.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs) are an option
when the pain and swelling from psoriatic arthritis are more severe
or there is any sign of joint immobility. These medications are used
to control signs and symptoms. Due to the potential for serious side
effects, these are only available by prescription and should only be
taken following consultation with a physician experienced in
treating this condition.
methotrexate, and sulfasalazine are some of the DMARDs used to treat
psoriatic arthritis. Cyclosporine and methotrexate also can
effectively treat psoriasis.
One class of DMARD
is the biologics, which are prescription therapies that target a
specific part of the immune system to block the effects of the
psoriatic arthritis. Some biologics have been shown to not only
control symptoms but to slow progression of joint damage. Biologics
can be used with other medications.
Most observed side
effects from the biologics have been mild. However, long-term side
effects are still not known but may include increased risk of
malignancy and serious infections due to the ability of the
biologics to alter the immune system. These potential side effects
are not unique to biologics and have been demonstrated following use
of other DMARDs.
infliximab (two biologics) are proving effective for treating both
psoriatic arthritis and psoriasis. Etanercept has been approved by
the U.S. Food and Drug Administration (FDA) to treat both
conditions. Infliximab is FDA-approved to treat the signs and
symptoms of active psoriatic arthritis.
In clinical trials,
many patients taking etanercept experienced rapid and effective
treatment for their skin and joints. Etanercept has shown that it
can significantly inhibit joint destruction, bone erosion, and
narrowing of the joint spaces.
Clinical trials for
infliximab have shown that the drug can effectively clear the skin,
reduce swelling in the joints of toes and fingers, as well as
decrease inflammation of the tendons and ligaments. Before taking
infliximab, a person must be tested for tuberculosis (TB). If TB is
detected, it must be treated before infliximab therapy begins.
Patients taking infliximab should be closely monitored for signs of
infection. If infection begins, infliximab therapy should be
It is important to
remember that no one medication works for everyone. Equally
important is the fact that failure of one biologic does not predict
that other biologics will not work.
Medication is not
the only treatment for psoriatic arthritis. Other therapies that can
help people manage the pain include:
help patients keep up their strength, improve joint mobility, and
control weight. Obesity puts further strain on impaired and inflamed
occupational, and massage therapy involve physical treatment of
the joints, muscles, ligaments, and tendons by a licensed therapist
to reduce pain and improve joint function. Splints can be used
during physical or occupational therapy to hold joints in place and
reduce pain and swelling. In addition, temperature therapy may be
used. It may involve soaking in a hot bath or placing an ice pack on
painful joints to help reduce pain and swelling.
help psoriatic arthritis patients with badly damaged joints by
lessening pain and improving movement. However, this option is not
necessary for most people with psoriatic arthritis.
Recent advances are allowing many with psoriatic arthritis to
experience remarkable improvements. It is believed that ongoing
research will advance current treatments and continue to improve the
quality of life for people living with psoriatic arthritis.
American Academy of Dermatology. “Unique
Treatments Offer Relief to Nation's One Million Psoriatic Arthritis
Patients.” Accessed May 5, 2005.
Gladman, DD. “Psoriatic Arthritis” in Therapy of Moderate-Severe
Psoriasis. New York: NY. Marcel Dekker, Inc.; 2003.
National Psoriasis Foundation. Psoriasis and Psoriatic Arthritis: A
Treatment Guide for the Health Insurance Industry. 2004.
Strober, BE. “Psoriatic Arthritis: Diagnosis and Management.”
Presented at the 63rd Annual Meeting of the American Academy of
Dermatology: Focus Session 602. February 2005: New Orleans.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.