Products and services |
|
|
Visitor interest areas |
|
|
Facilities finder |
|
|
World of BUPA |
|
|
 |
|
|
|
 | health information | health factsheets
Psoriatic arthritis
Published by BUPA's health information team, healthinfo@bupa.com,August 2007.
This factsheet is for people with psoriatic arthritis, or who would like information about it.
Psoriatic arthritis is a condition related to psoriasis. Psoriasis is a disease that mostly affects your skin and nails. If you develop psoriatic arthritis, this means your joints are inflamed. About one in 50 people in the UK has psoriasis - of these, one in 14 may also develop some type of arthritis.
Psoriatic arthritis can be treated with medicines to control the inflammation and try to prevent it from getting worse.
What is psoriatic arthritis?
Arthritis means inflammation of the joints. In psoriatic arthritis, the inflammation is associated with the skin condition psoriasis. This causes red, scaly patches on your skin and leads to pitted, broken nails. Psoriatic arthritis usually only develops if you have psoriasis, although if you have psoriasis, it doesn't mean that you will definitely get psoriatic arthritis.
The chance of getting psoriasis or psoriatic arthritis is the same for men and women. It can occur at any age.
Psoriatic arthritis is different from osteoarthritis and rheumatoid arthritis.
Types of psoriatic arthritis
Psoriatic arthritis usually starts in people who already have psoriasis, but occasionally the arthritis comes first. There are five main types and most people can be classed as having one of the following.
-
Asymmetric arthritis - this affects different joints on each side of your body, for example a few finger joints and a knee joint.
-
Symmetric arthritis - this affects the same joints on each side of your body and you are likely to have symptoms in several joints.
-
Spondylitis - the arthritis develops in your spine and you will have back pain.
-
Distal interphalangeal predominant (DIP) arthritis - this is rare, and occurs in the joints closest to your fingernails and toenails.
-
Arthritis mutilans - this leads to serious deformity (ie changes to the shape) in your fingers and toes but is extremely rare.
Symptoms
Your symptoms may include:
-
joint pain and stiffness, especially when you get up in the morning or after resting
-
redness and swelling around your affected joints
-
one or more entire fingers or toes swelling up - this is called dactylitis and is caused by both your joints and tendons becoming inflamed
Causes
The exact reasons why you may develop psoriatic arthritis are not fully understood at present, but it's thought to be an autoimmune disorder. Usually your body's immune system produces certain cells that attack infections. In an autoimmune disorder, something has gone wrong and these cells attack your own body tissue. In psoriatic arthritis, these cells attack the joints, leading to inflammation.
There may be genetic causes for the disease as there is evidence that it occurs more commonly within families. It's also believed that environmental factors may be involved and that something outside your body sets off the immune system's reaction.
Diagnosis
Your GP may find it difficult to diagnose psoriatic arthritis because early on your symptoms may be mild. This means it can be a problem telling it apart from other types of arthritis. Also, your symptoms may be different to those of someone else with the condition. Your GP will ask about your symptoms and examine your joints. He or she may also ask you about your medical history and consider other factors, as follows.
-
If you developed psoriasis in the last few years and then a type of arthritis appears, it's likely to be psoriatic arthritis.
-
If a member of your family has psoriatic arthritis, this may indicate that you have also developed it.
-
Usually patients with psoriatic arthritis don't have a specific marker in the blood called rheumatoid factor, which is often found in rheumatoid arthritis. Therefore, your GP may do blood tests to help distinguish between these conditions.
-
You may have an X-ray - this can show up particular features of the disease, although usually only once you have had it for a while.
-
It's important that psoriatic arthritis is diagnosed as early as possible as it can lead to serious joint damage and disability if you don't get it treated.
Treatment
Self-help
There are a number of simple treatments that may help to relieve your symptoms. These include:
-
heat treatment or warm water soaks to ease joint stiffness
-
using ice to reduce swelling
splinting the affected joint and resting it if you have a severe flare-up
-
gentle exercise such as swimming - check with your GP as to what is most suitable for you
-
relaxation techniques
Try to eat a balanced diet with plenty of fruit and vegetables. If you are overweight, it's a good idea to try to lose excess weight to reduce the strain on your joints. This may lead to decreased inflammation. There is some evidence that eating more oily fish can help inflammatory arthritis.
It's important to keep doing exercise as otherwise the muscles around your joints will become weakened and stiff. However, you shouldn't try to do too much. A physiotherapist will be able to advise you on exercises to try and about finding the right balance between rest and exercise.
You may like to speak to an occupational therapist about ways to make life easier at home and at work. For example, if you find it difficult to hold things or to move around, they can provide advice and possibly splints and equipment to help you carry out everyday activities.
Medicines
There is a variety of medication that you can use to treat psoriatic arthritis.
-
You may find paracetamol useful as a painkiller.
-
Anti-inflammatory medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (eg Nurofen) help to relieve pain and stiffness. They reduce inflammation but don't actually stop the arthritis from progressing or affecting your joints. There are over 40 types of NSAID. They all vary slightly and have different side-effects. You may need to try a few before you find the one that suits you best.
-
If your arthritis is more severe, your GP may prescribe disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine. These slow down the progression of the arthritis and its effects, and also ease its symptoms. These medicines work in a number of ways. Unlike NSAIDs, they can take weeks or even months to have an effect, so it's important to carry on taking them even if they don't appear to be making any difference. Again, you may need to try one or more different DMARDs before you find one that suits you. As with all medicines, it's important to always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist or doctor for advice.
-
Recently, three new medicines have been approved for treating severe cases of psoriatic arthritis. If you have previously been prescribed DMARDs that haven't helped, you may be eligible to try etanercept, infliximab or adalimumab.
-
PUVA is a treatment involving a medicine called psoralen and ultraviolet A (UVA) light. It's usually used to treat the skin in psoriasis, but can also be effective for psoriatic arthritis. The psoralen is either given by mouth or applied to your skin. Your skin is then exposed to UVA light which activates the psoralen. This treatment can cause side-effects such as nausea and itching, and in the long-term you may have an increased risk of skin cancer. Therefore, PUVA is only recommended if other treatments haven't worked.
Non-surgical treatments
It's also possible that you will be offered a corticosteroid injection into a specific joint if you have a particularly bad flare-up. Corticosteroids help by reducing inflammation. They are quick, effective and safe methods of providing pain relief. You are unlikely to have any of the side-effects that are usually associated with taking steroids by mouth for long periods of time.
Living with psoriatic arthritis
You may find psoriatic arthritis upsetting and frustrating. It's important that you tell your doctor about how it's affecting you so he or she can make sure you get the most suitable treatment. You may need to make changes to your daily life, but there are people such as doctors, physiotherapists and occupational therapists, who can help to make this easier.
Further information
Sources
- Psoriatic arthritis. Arthritis Research Campaign
www.arc.org.uk
accessed 10 April 2007
- What is psoriatic arthritis? The Psoriasis Association
www.psoriasis-association.org.uk
accessed 21 February 2007
- What is psoriatic arthritis? The Psoriasis and Psoriatic Arthritis Alliance
www.paalliance.org
accessed 21 February 2007
- Psoriatic arthritis - the facts. Psoriasis Help Organisation
http://psoriasis-help.org.uk
accessed 23 February 2007
- Etanercept and infliximab for the treatment of adults with psoriatic arthritis. National Institute for Health and Clinical Excellence, July 2006, NICE technology appraisal guidance 104, [July 2006].
www.nice.org.uk
- Physiotherapy and exercise. The Psoriasis and Psoriatic Arthritis Alliance.
www.paalliance.org
accessed 10 April 2007
- Diet and arthritis. Arthritis Research Campaign.
www.arc.org.uk
accessed 10 April 2007
- Occupational therapy and arthritis. Arthritis Research Campaign.
www.arc.org.uk
accessed 10 April 2007
- Henry JA. The BMA new guide to medicines and drugs. 6th ed. London: Dorling Kindersley Ltd, 2004: 182
- Local steroid injections. Arthritis Research Campaign
www.arc.org.uk
accessed 10 April 2007
- Methotrexate treatment. National Patient Safety Agency.
www.npsa.nhs.uk
accessed 10 April 2007
- Methotrexate. Arthritis Research Campaign.
www.arc.org.uk
accessed 10 April 2007
- Sulfasalazine. Arthritis Research Campaign.
www.arc.org.uk
accessed 10 April 2007
- Leflunomide. Arthritis Research Campaign.
www.arc.org.uk
accessed 10 April 2007
- TA104 Psoriatic arthritis, etanercept and infliximab - information for the public. National Institute for Health and Clinical Excellence
www.nice.org.uk
accessed 2 March 2007
- Adalimumab - Humira. The Psoriasis Association
www.psoriasis-association.org.uk
accessed 10 April 2007
- Biologic drugs for the treatment of psoriasis. The Psoriasis Association.
www.psoriasis-association.org.uk
accessed 2 March 2007
Related topics
This information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Simon Bowman PhD FRCP, consultant rheumatologist, Selly Oak Hospital; Dr Daniel Fishman PhD FRCP, consultant rheumatologist, Luton and Dunstable NHS Foundation Trust; and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2007. Expected review date: August 2009.
|
|
|
![Print-friendly version [opens in a new window]](/images/icons/icn_printer.gif){kind=icon}
