Psoriatic Arthritis

What is Psoriatic Arthritis?

Psoriatic Arthritis (PsA) is a chronic autoimmune condition where the body’s immune system, which normally protects us from infections, mistakenly turns against the body’s own tissues.

It begins to attack the joints, skin, nails, and sometimes even internal organs. This leads to:

  • Joint swelling and pain
  • Stiffness
  • Nail changes
  • Skin psoriasis
  • If not treated early, it can cause progressive joint and tissue damage
What Does It Affect?

Psoriatic arthritis can affect almost any part of the body:

In the Joints:

  • Fingers and toes may swell entirely – called “sausage digits” (dactylitis)
  • Hand joints, wrists, knees, hips, feet
  • Neck and spine may become stiff and painful (spondylitis)

In the Skin:

  • Psoriasis causes red, scaly patches
  • Often on the scalp, elbows, knees, and back
  • Skin may flake or peel with visible white or silver scales

In the Nails:

  • Nail pitting (small depressions)
  • Thickening, yellowing, or separation from the nail bed
How is Psoriatic Arthritis Diagnosed?

Typical signs and symptoms include:

  • Joint pain, swelling, and stiffness
  • Early morning stiffness > 30 minutes
  • Sausage-like swelling in fingers or toes
  • Heel or tendon pain (enthesitis)
  • Scalp psoriasis or other skin rashes
  • Nail changes (pitting, thickened nails)

Diagnosis is made by:

  1. Clinical examination of joints, skin, and nails
  2. Blood tests: ESR / CRP (inflammation markers), Rheumatoid Factor (usually negative)
  3. Imaging: X-rays, Ultrasound, or MRI of joints/tendons
Why Early Treatment is Critical

Psoriatic Arthritis is like a fire—if not treated early, it can spread rapidly, causing:

  • Irreversible joint damage and deformities
  • Widespread skin involvement
  • Increased risk of infections (especially if skin is cracked or inflamed)
Treatment Overview

1. NSAIDs

  • Reduce pain and swelling
  • Used short term for relief

2. Steroids

  • Oral or joint injections
  • Used during flare-ups or in early disease control

3. DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

  • Control the immune system and prevent joint damage
  • Common DMARDs include
    Methotrexate, Sulfasalazine, Leflunomide, Cyclosporine
  • These may be combined with skin treatments

Possible side effects:

Risk of infection – While there is a small risk of infection, the benefits of controlling the disease and preventing joint damage and skin disease far outweigh the risks. It is strongly advised to continue medication with proper monitoring by your doctor.

Patients are advised to:

  • Report fevers, infections, ulcers, recent onset cough or rashes
  • Do regular blood tests to monitor drug safety as advised by the doctor
  • Don’t continue drugs beyond the specified period without review
  • Keep the date given for review to avoid side effects and adjust medications correctly

4. Biologic & Targeted Therapies

If standard DMARDs do not work or if disease is moderate to severe, newer biologic injections or oral drugs may be used. Your doctor will discuss the most appropriate option. Screening for infections like TB or hepatitis is needed before starting.

  • Jak inhibitors – tofacitinib
  • TNF agents – adalimumab

Patients need TB and hepatitis screening before starting biologics – your doctor will do the necessary tests prior to commencing these.

Biologics are effective but more expensive – JAK inhibitors though expensive are cheaper than injectables

Lifestyle & Joint/Nail Protection
  • Avoid overusing inflamed joints
  • Use splints or orthotics for support
  • Gentle exercises to maintain flexibility
  • Maintain healthy body weight
  • Avoid smoking and reduce alcohol
  • Reduce body weight
Team Care: Rheumatologist + Dermatologist

Because PsA affects joints and skin, treatment is usually shared:

  • Rheumatologist – for joint and systemic treatment
  • Dermatologist – for skin and nail care

Continue regular follow-up and discuss treatment changes with your doctors.

Reproductive Planning

Patients planning pregnancy should discuss medications with their doctor. Methotrexate must be stopped at least 3 months before attempting to conceive.

When to Contact Your Doctor
  • New or worsening joint pain
  • Fever, cough, sore throat, or skin infections
  • Mouth ulcers or rashes
  • Side effects from medications