By Dr Kate Celkys, Rheumatologist

Psoriatic Arthritis (PsA) is a type of inflammatory arthritis caused by an overactive immune system, leading to joint inflammation and often occurring alongside psoriasis. I believe that with the right management, PsA doesn't have to get in the way of everyday life. When it's well-controlled, people with Psoriatic Arthritis can still lead an active and fulfilling lifestyle. It’s important to understand 🧐 what PsA is, how it’s diagnosed, and the various management options available, so those affected can take proactive steps toward living well with the condition.

Understanding Arthritis Types

When I talk about arthritis, I typically divide it into two categories: mechanical and inflammatory. Mechanical arthritis, like osteoarthritis, is a non-inflammatory condition that becomes more common with age. On the other hand, inflammatory arthritis results from the immune system attacking the joints. While rheumatoid arthritis is the most common form, affecting about 2% of the population, PsA is also quite common, impacting around 1% of people. 👫

Recognising Psoriatic Arthritis

One key difference between inflammatory and non-inflammatory arthritis is how the symptoms behave. With PsA, joint pain tends to improve with activity and worsen with rest. Morning stiffness that lasts an hour or more is also common, and fatigue can become a significant challenge.

PsA also tends to show up with skin symptoms. Around 80% of people with PsA also have psoriasis, although I think it’s important to point out that some might only notice nail changes or have a family history of psoriasis. Enthesitis, which is inflammation where tendons and ligaments attach to bones, is another hallmark of PsA that I commonly see. It usually affects the Achilles tendon or plantar fascia. 🦶

Dactylitis, often referred to as “sausage digits,” is also a characteristic sign. This causes swelling and tenderness in both fingers and toes, especially in the third and fourth digits. Nail changes, such as pitting or separation from the nail bed, are also common.

Diagnosing Psoriatic Arthritis

Diagnosing PsA can be challenging since there is no definitive blood test. Unlike rheumatoid arthritis, people with PsA are typically negative for rheumatoid factor and anti-CCP antibodies. Inflammatory markers may or may not be elevated, adding to the complexity.

Imaging is a crucial part of the diagnosis process. While X-rays can help detect long-term damage, I often recommend using MRI or ultrasound to spot early signs of inflammation. These scans don’t just identify joint inflammation but also help in identifying enthesitis and dactylitis, which I’ve found to be really helpful in making an accurate diagnosis.

Managing Psoriatic Arthritis

💊 Treatment for PsA is often approached stepwise, aiming for remission or low disease activity. Here’s how we typically proceed:

1. First-Line Treatments: NSAIDs (non-steroidal anti-inflammatory drugs) and short-term steroids provide relief but don’t prevent disease progression.
2. Conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Medications like methotrexate, leflunomide, and sulfasalazine are used to reduce inflammation and slow disease progression. Choosing the right DMARD depends on individual factors like liver health and pregnancy plans.
3. Biologic Therapies: For those who don’t respond to DMARDs, biologics are available. These medications target specific parts of the immune system responsible for inflammation. Options include TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors. The choice of biologic depends on a person’s specific symptoms and any comorbidities like inflammatory bowel disease or uveitis.
4. JAK Inhibitors: These oral medications work inside cells to block immune signals. While convenient, they come with specific risks like increased cardiovascular disease and shingles, making them a secondary option.

Addressing Comorbidities and Lifestyle

It’s essential to manage the other health issues that often accompany PsA, like high blood pressure, cholesterol, and cardiovascular 🫀 disease. Maintaining a healthy weight and staying active can be beneficial.

Exercise is particularly important. Low-impact activities like swimming or walking can support joint health and cardiovascular fitness. For those with enthesitis or dactylitis, a tailored exercise program may help reduce pain and improve mobility.

Final Thoughts

While PsA is a lifelong condition, advancements in treatment now allow for more effective management of symptoms and prevention of joint damage. By collaborating with a knowledgeable healthcare team, people living with PsA can achieve better outcomes and maintain their quality of life.

If you're dealing with joint pain, psoriasis, or fatigue, seeking professional advice can help. Early diagnosis and treatment can make a significant difference in managing psoriatic arthritis and supporting long-term health.

Watch the Full Talk
There’s so much more to explore, and if Psoriatic Arthritis is on your mind, I recommend watching my full talk on BJC Connect. I dive deeper into diagnosis, treatment options, and managing symptoms, plus answer real patient questions. Whether you're newly diagnosed or navigating treatment decisions, this session can offer valuable insights and confidence.