Psoriatic Arthritis: An overview of the contition and the treatment options

Psoriatic Arthritis - What is it?

Psoriatic arthritis is an arthritis seen in those with psoriasis. We find that about 30% of individuals with psoriasis may have psoriatic arthritis to varying degrees. When you talk to a rheumatologist, or when you see patients from a rheumatologist, frequently there is a lot of arthritis but very little psoriasis. It may be that there is a sub-group of people with very little skin involvement, but their joints are very affected.

Typically, the patient will complain of pain in the joint and stiffness in the morning that may last for half an hour or an hour, and as the day goes on, their symptoms improve. There are a number of different subtypes of this arthritis-you can either define them as arthritis occurring along the spine, or arthritis that occurs on the fingers, the distal joints or perhaps on a single joint. There is often inflammation where tendons are attached to bones.

The difference in arthritis and psoriasis in the skin is that the skin can recover. You have a patch of psoriasis, you treat it, and the skin goes back to normal for all intents and purposes. A joint that has been inflamed potentially scars, and you have destruction of collagen that is life-long. It's very important for us as dermatologists to recognize the early signs of arthritis because we now know there are these biologics, which are probably much better than older drugs, in trying to prevent the destruction of joints.

Is it common?

It's thought to occur in about 30% of individuals with severe psoriasis. We also see it on the other end of people who don't have much psoriasis but have lots of arthritis but small patches of psoriasis.

When to see a doctor

Anybody with psoriasis who has a single joint that has become swollen and painful and stiff, and this does not respond to Advil or one of these over the counter anti-inflammatories, I think they should see a physician. I think that individuals with psoriasis who have complaints about stiffness or pain in the lower back and loss of mobility because of arthritis in the lower back-they too, need to see a rheumatologist.

I'm impressed by how often we see patients who are treated for their psoriasis using a biologic, and after they get better, they say, "I never realized how sore, stiff, and uncomfortable I was before that." We do adapt to circumstances and often ignore these things. My message is, be careful not to ignore the signs of pain, swelling, and stiffness in the joints in people who have psoriasis.

What are the treatment options?

The first thing is, as a dermatologist, I rely on our rheumatological colleagues to treat this. I think it depends on the severity and the responsiveness to the drugs. Non-inflammatories used, if they fail, there are drugs called DMARDS, there is Hydroxychloroquine, then there is Methotraxate, and then in cases of failure, they go on to Biologics. In some circumstances when the problem is acute, they may even start with the newer TNF inhibitors, which are front line drugs for psoriatic arthritis.

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