Psoriatic Arthritis 101

Researchers don’t know what causes PsA, although your genes may play a part. About 2 out of 5 people with PsA have at least one close family member who also has PsA or psoriasis.

If you are already at genetic risk of developing PsA, it’s possible something in your environment (like an injury or infection) could trigger the disease.

For people living with psoriasis, where psoriasis shows up can be a risk factor for PsA. For example, people with scalp psoriasis are nearly four times more likely to have PsA than people who don’t have scalp psoriasis. And people with nail psoriasis are three times more likely to develop the disease.

Like psoriasis, PsA is an autoimmune disease. Normally, the immune system defends our bodies against “intruders” like bacteria and viruses by triggering reactions like inflammation designed to protect us.

With an autoimmune disease, the immune system mistakenly thinks a healthy part of the body is an intruder. Inflammation becomes harmful instead of protective because the body is essentially attacking itself. In the case of PsA, this inflammation affects your joints and skin.

PsA is often unpredictable. The disease can come on gradually or all at once, and symptoms may range from barely noticeable to debilitating. These symptoms include:

• Painful, swollen joints
• Scaly, inflamed patches of skin
• Extreme tiredness
• Swollen fingers and toes
• Lower back pain (spondylitis)
• Eye inflammation (uveitis)
• Tendon or ligament pain in the back of your heel or the soles of your feet
• Fingernail changes like pits, horizontal lines or discoloration

PsA usually develops after psoriasis, but sometimes joint issues appear first. Symptoms to look out for include Achilles pain, plantar fasciitis and joint stiffness in the morning that gets better as you move around.

Joints and skin aren’t the only parts of your body affected by PsA. People with this disease may be at higher risk of developing other health problems. These include:

• Anemia
• Depression
• Diabetes
• High blood pressure and cholesterol
• Obesity

Even if it’s only your joints that are affected, PsA can take a toll on your well-being. Pain, swelling and stiffness can make even the simplest tasks a struggle — and seriously lower your quality of life.

Either your primary care clinician or a rheumatologist (joint specialist) can help you with a PsA diagnosis. They’ll talk to you about your symptoms and ask you about any family history of the disease.

Next, they’ll likely use some combination of the following tools:

• Physical exam
• X-ray, ultrasound or other imaging test
• Blood test

The sooner PsA is caught, the better. Early diagnosis of PsA can keep the disease from getting worse and prevent irreversible damage.

Once you’ve been diagnosed with PsA, you have many options for treatment. Some of them are:

• NSAIDs, medicines that can reduce pain and swelling

• Conventional disease-modifying antirheumatic drugs (DMARDs) that help slow down the disease and prevent joint damage

• Biologic DMARDs (biologics), which target certain parts of the immune system that cause joint inflammation

• Targeted synthetic DMARDs, pills your clinician may prescribe that target immune pathways involved with PsA, particularly if conventional and biologic DMARDs aren’t helping

Which medicine is right for you will depend on your unique circumstances, including your symptoms, lifestyle and other health conditions.

Your clinician will go over your options and help you create a treatment plan.