Psoriatic (pronounced sor-ee-AT-ic) arthritis is a form of arthritis that is as unique as its name. It affects people with psoriasis, a condition that appears as patches of red, scaly skin, often on the elbows and knees. Both psoriasis and psoriatic arthritis are autoimmune diseases, triggered by the body’s immune system gone awry.

“Psoriatic arthritis affects only between 350,000 and 700,000 Americans,” says Peter Kent, MD, a rheumatologist with Park Nick Clinic Rheumatology. “Fewer than 3 percent of all Americans have psoriasis, and psoriatic arthritis affects only about 10 percent of them.”

Ironically, the severity of the skin condition has no bearing on the severity of the arthritis, and vice versa. “One patient had such a slight case of psoriasis that he never sought treatment,” Dr. Kent says. “When he developed joint pain, he had no idea it was related to psoriasis. At first, he tried to live with the pain, but his knee became so badly damaged that he ended up needing a new joint — even though he was still in his 30s.”

Today, when dermatologists diagnose psoriasis, they often inform patients about the related arthritis condition. And, when rheumatologists see patients, they stress the importance of seeking early treatment, before joint damage occurs.

Diagnosis
“Psoriatic arthritis should be strongly considered when a patient has both psoriasis and joint pain,” Dr. Kent says. What makes this condition difficult to diagnose is when the psoriasis is so mild it gets overlooked or it hides in the scalp or in other secluded places.

To confirm suspicions, doctors first determine whether a patient’s condition is “wear and tear” arthritis or inflammatory arthritis. Joints affected by inflammatory arthritis often are red, swollen and warm. If the arthritis is inflammatory, doctors may perform additional blood tests to help confirm which type.

They also watch for the telltale symptoms of psoriatic arthritis, such as:

• inflamed DIP joints (the end joint of fingers)
• low back pain unrelated to strains or injury accompanied by morning stiffness
• pain involving several large joints at once, such as an ankle, knee and wrist
• symmetric joint involvement, such as both hands and wrists, which does not meet the criteria for rheumatoid arthritis
• crippling of the joints, especially in the hands — a condition seldom seen in the United States today, thanks to earlier detection and improved treatments.

Treatment
Although psoriatic arthritis has no cure, Park Nicollet has specialists to help ease the symptoms and sometimes even put them into remission. For people with a mild form of psoriatic arthritis, doctors often prescribe pain relievers, such as non-steroidal anti-inflammatory drugs, such as Advil®, Motrin® and Aleve®. Moderate to severe cases may initially require treatment with steroid medications, such as oral prednisone or cortisone injections, which can quickly relieve pain and inflammation.

If the condition involves several joints, doctors often prescribe drugs to control the overactive immune system, such as methotrexate. For more severe cases, doctors may prescribe newer drugs, known as biologics or TNF blocking agents, such as Enbrel®, Humira® and Remicade®. All three are FDA-approved for treating psoriasis and psoriatic arthritis.

Many patients with psoriatic arthritis also find relief by working with a physical therapist, who can recommend certain exercises and stretches to loosen stiff joints. Others seek pain relief from a massage therapist, chiropractor or acupuncturist.

To find a doctor who treats psoriatic arthritis and other rheumatic conditions, call 952-993-5500, or visit parknicollet.com/rheumatology.