Psoriatic Arthritis
(PsA)
In this condition factsheet:
Diagnosing Psoriatic Arthritis
A doctor is able to diagnose psoriatic arthritis and eliminate other possible conditions using your medical history, a physical exam, X-rays, or tracking your symptoms over time. Often, the skin symptoms of psoriasis (present or past) are clear indicators, though occasionally these plaques are hidden on the scalp or in other non-obvious areas. Pitting of the fingernails is one sign that joint pain is probably caused by psoriatic arthritis and not some other form of arthritis.
The first step is to take an X-ray of the joints to see what changes are taking place. Next, a doctor may do blood tests and other evaluations to look for other possible causes. Tests of fluid in the joints can also rule out gout, which may have arthritic symptoms very similar to psoriatic arthritis. This process of elimination is necessary because there's no test that confirms a diagnosis of psoriasis or psoriatic arthritis. That's why diagnosis of psoriatic arthritis is usually based on the history and the characteristic presence of both skin and joint symptoms.
Blood tests are not helpful in diagnosis, but in 40% of cases the erythrocyte sedimentation rate (a measure of inflammation) is elevated and can be used to help determine how the disease is progressing.
Treating and Preventing Psoriatic Arthritis
Currently, there is no cure for psoriatic arthritis, but treatment can relieve pain, reduce swelling, and improve skin symptoms. The medications used to treat joint inflammation in psoriatic arthritis are similar to those used for rheumatoid arthritis.
Most people are started on a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen* or naproxen. In some cases, these medications are given with another medication to protect the stomach lining from the NSAID. For many people, these medications will control pain and inflammation but they will not stop the joint damage that can occur in psoriatic arthritis. Occasionally, they cause a flare-up in skin symptoms.
Local treatment of skin lesions with corticosteroid creams, phototherapy, and other skin treatments is very important.
Medications may be necessary to control symptoms and attempt to slow or stop joint damage. All medications have their own risks and side effects. You should discuss the benefits and risks of each medication with your doctor. Rheumatologists are doctors that specialize in the diagnosis and treatment of arthritis and other diseases that affect the joints, muscles, and bones. They have the most expert experience with medications that are used to treat psoriatic arthritis.
For many people with psoriatic arthritis, medications called disease-modifying antirheumatic drugs (DMARDs) are recommended. These medications affect the immune system, and can help slow down joint damage. Methotrexate is most often used.
Apremilast is a medication which blocks the activity of an enzyme in the body called phosphodiesterase 4. It is thought to work by decreasing inflammation.
Some people use a medication in the group called biologics or biologic response modifiers. These include agents like adalimumab, etanercept, golimumab, and infliximab, secukinumab, and ustekinumab. These medications help relieve the symptoms of psoriatic arthritis, improve physical function, and can help slow the progression of joint damage. There are significant risks of very serious side effects associated with biologics.
Corticosteroids in tablet (e.g., prednisone) or injection (e.g., trimacinolone) form can also be used to control inflammation. Corticosteroid injections are injected directly into the affected joints and can help relieve severe symptoms of both arthritis and tendinitis. There are serious side effects and risks with long-term use of oral corticosteroids that require careful consideration before use and regular monitoring.
Various types of splints can be used to ease the load on affected joints and keep them aligned. Many people find these extremely helpful. In cases of irreparable joint damage, surgery can substitute damaged joints with artificial joints – these are improving all the time.
Exercise and strength training is usually beneficial for people with arthritis to reduce pain and increase their range of movement. A doctor should be consulted about appropriate exercise programs. People with this condition must also protect their joints. Through stretching, exercise and the use of devices to simplify tasks, daily chores will cause less stress on joints and the body in general.
For skin symptoms, some people may try therapy known as PUVA, in which ultraviolet (type A) light is directed on the affected skin after a medication is given that increases the light sensitivity of the skin. Topical medications (such as creams, ointments, and gels) applied directly to the skin can help with the skin symptoms.
For more information about the treatment of skin symptoms, see the psoriasis condition article.
All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Psoriatic-Arthritis
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