Don't Wait to Treat Psoriatic Arthritis

May is National Psoriatic Arthritis Month 

When you tell someone you have psoriatic arthritis, they may only hear the word arthritis which is likely familiar to them. So what makes psoriatic arthritis different?

Advanced Dermatology’s Dr. Rajiv Nathoo, who specializes in treating rare, difficult and complex dermatological conditions, explains that “psoriatic arthritis is an inflammatory form of arthritis that affects the joints. While it’s uncommon in the general population, almost 30% of those with psoriasis later develop psoriatic arthritis.

"One of the most important things about psoriatic arthritis is understanding that while it is not curable, it is manageable. Early diagnosis and management are crucial. Any inflammatory arthritis has the potential for irreversible joint damage," said Dr. Nathoo. "Studies have shown permanent damage can occur in as little as six months. You want to take action and schedule an appointment with your dermatologist as soon as you experience any possible symptoms."

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Born and raised in Orlando, Dr. Nathoo returned to his hometown after completing his dermatology training at the University of Florida, where he served as chief resident, and today he oversees Advanced Dermatology’s first Complex Dermatology Clinic from his office in Oviedo, FL.

So, what are the symptoms of psoriatic arthritis? How do they differ from other arthritis?

“Skin lesions usually precede the onset of psoriatic arthritis, however, about 15% of those with psoriatic arthritis actually experience pain, stiffness or other arthritis symptoms first,” he said.

“Joint problems most commonly occur in the fingertips toes, hips, knees, feet, back and/or neck, and create mild to severe pain. Like psoriasis, there may be periods of flares and remission,” said Dr. Nathoo.

Here are some of the common symptoms:

• Tender, swollen joints
• Stiffness (especially in the morning. This is very different than rheumatoid arthritis that usually lingers all day long)
• Swollen toes and fingers
• Pain in the upper and lower back and neck
• Plaques (red, scaly patches of skin)
• Pitting or separation of the nail from the nail bed (nail lesions occur in 80-90 percent of patients with psoriatic arthritis and are one way to help diagnose it)
• Fatigue

“To diagnose this disease, we do a thorough history and exam. There’s no blood work that tells you that you have psoriatic arthritis. However, radiologic findings are more unique,” said Dr. Nathoo. “A radiologist may be able to say whether images such as x-rays are more consistent with psoriatic or rheumatoid arthritis. The morning stiffness that eases during the day and psoriasis that affects the nails are both good clues of psoriatic arthritis.”

Types of psoriatic arthritis

While there are actually five types, the most common are:

Symmetric small joint polyarthritis – the most common type, affects about 50% of those with psoriatic arthritis. It strikes matching pairs of joints on both sides of the body.

Asymmetric oligoarthritis – which affects only one side (usually your lower body such as the knee, ankle or foot) is usually milder.

Distal (away from the center) small joint polyarthritis – most commonly affects the tips of the fingers from the first joint and sometimes the toes.

The last two, are rarer: axial spondyloarthritis mainly affects your back, and arthritis mutilans (the most severe and rarest type of psoriatic arthritis) can damage small joints and tissues in the ends of your hands and feet as well as your neck and back.

Treatment options

Regardless of the type of psoriatic arthritis you have, the goal of treatment is to control inflammation, reduce pain and prevent joint damage. Various medications can help and some also help manage psoriasis symptoms.

NSAIDs (non-steroidal anti-inflammatory drugs) inhibit your body from creating the chemicals that cause inflammation. Over the counter (ibuprofen, aspirin, etc.) and prescription options are available.

DMARDs (disease-modifying antirheumatic drugs) such as Methotrexate may be the next form of treatment.

Biologics, which are usually injected, go by brand names you may have seen advertised by the likes of Pro Golfer Phil Mickelson or singer Cyndi Lauper, such as Humira®, Cimzia, Cosentyx®, Taltz®, Stelara and Tremfya.

Many people can stay on these for a long time with sustained results. Close monitoring is required.

Lifestyle Changes

In addition to medications, lifestyle changes that help you protect your joints are fairly simple to implement. For example, carrying heavier items with two hands instead of your fingertips, using your body to close doors instead of just your hands, or enjoying lower-impact exercises like swimming or biking.

Heat can help relax stiff muscles and cold can help ease pain. And for many reasons, it’s important to try to maintain a healthy weight.

Regardless of where you are on your psoriatic arthritis journey, your dermatologist can help you decide
the best treatment plan for your specific needs.

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