During the exam, your doctor may:
- Closely examine your joints for signs of swelling or tenderness
- Check your fingernails for pitting, flaking and other abnormalities
- Press on the soles of your feet and around your heels to find tender areas
No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout.
- X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
- Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.
- Rheumatoid factor (RF). RF is an antibody that's often present in the blood of people with rheumatoid arthritis, but it's not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.
- Joint fluid test. Using a needle, your doctor can remove a small sample of fluid from one of your affected joints — often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.
No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability.
Drugs used to treat psoriatic arthritis include:
NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription.
Side effects may include stomach irritation, heart problems, and liver and kidney damage.
Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage.
Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
Immunosuppressants. These medications act to tame your immune system, which is out of control in psoriatic arthritis.
Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune). These medications can increase your susceptibility to infection.
Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ixekizumab (Taltz), secukinumab (Cosentyx), tofacitinib (Xeljanz) and ustekinumab (Stelara).
These medications target specific parts of the immune system that trigger inflammation and lead to joint damage. These drugs can increase the risk of infections. Higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic agents can be used alone or combined with DMARDs, such as methotrexate.
- Newer oral medication. Apremilast (Otezla) decreases the activity of an enzyme in the body that controls the activity of inflammation within cells. Potential side effects include diarrhea, nausea and headaches.
Surgical and other procedures
- Steroid injections. This type of medication reduces inflammation quickly and is sometimes injected into an affected joint.
- Joint replacement surgery. Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic.
Lifestyle and home remedies
Protect your joints. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel.
For example, you can avoid straining your finger joints by using gadgets such as jar openers to twist the lids from jars, by lifting heavy pans or other objects with both hands, and by pushing doors open with your whole body instead of just your fingers.
Maintain a healthy weight. Maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility.
Losing weight if needed can also help your medications work better. Some psoriatic arthritis medications are less effective in people who have a body mass index of 25.0 to 29.9 (overweight).
The best way to increase nutrients while limiting calories is to eat more plant-based foods — fruits, vegetables and whole grains.
- Exercise regularly. Exercise can help keep your joints flexible and your muscles strong. Types of exercises that are less stressful on joints include biking, swimming and walking.
- Stop smoking. Smoking is associated with a higher risk of developing psoriasis and with more-severe symptoms of psoriasis.
- Limit alcohol use. Alcohol can increase your risk of psoriasis, decrease the effectiveness of your treatment and increase side effects from some medications, such as methotrexate.
Pace yourself. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue.
The key isn't to stop being active entirely, but to rest before you become too tired. Divide exercise or work activities into short segments. Find time to relax several times throughout the day.
Coping and support
Psoriatic arthritis can be particularly discouraging because the emotional pain that psoriasis can cause is compounded by joint pain and, in some cases, disability.
The support of friends and family can make a tremendous difference when you're facing the physical and psychological challenges of psoriatic arthritis. For some people, support groups can offer the same benefits.
A counselor or therapist can help you devise coping strategies to reduce your stress levels. The chemicals your body releases when you're under stress can aggravate both psoriasis and psoriatic arthritis.
Preparing for your appointment
You're likely to first discuss your signs and symptoms with your family doctor. He or she may refer you to a doctor specializing in the treatment of arthritis and related disorders (rheumatologist).
What you can do
Before your appointment, you may want to write a list of answers to the following questions:
- What types of symptoms are you having? When did they begin?
- Do you or any of your close family members have psoriasis?
- Has anyone in your immediate family ever had psoriatic arthritis?
- What medications and supplements do you take?
You may want to bring a friend or a family member with you to your appointment. It's hard to remember everything about a complicated condition, and another person may remember information that you miss.
What to expect from your doctor
Your doctor might ask some of the following questions:
- What joints are affected?
- Are there any activities or positions that make your symptoms better or worse?
- What treatments have you already tried? Have any of them helped?
Sept. 21, 2019