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Psoriatic Arthritis is a type of arthritis associated with the common skin condition called psoriasis. Since psoriasis occurs frequently, patients may suffer from a common type of arthritis called osteoarthritis, without psoriatic arthritis. This leaflet only deals with psoriatic arthritis.

What is Psoriatic Arthritis?

Psoriatic arthritis affects about one in ten people who have psoriasis and can occur years after you get the skin condition. However, the arthritis can sometimes develop first before the skin condition.

The arthritis affects the lining of joints, causing swelling, pain and stiffness; it commonly also affects tendons and the surface of bones called the enthesis. In this condition, the arthritis is usually limited to just a few joints. Sometimes it affects the spine, giving a painful stiff back, or neck or end joints of the fingers and toes. It can also occur in other joints such as the knees. Sometimes, a whole finger or toe is swollen and painful. Frequently, finger and toenails develop discoloration, thickening and pits.

Outlook

People with psoriatic arthritis usually do very well. It is not a crippling disease as a general rule, although some people do get a more severe form of the condition. People with psoriatic arthritis often do well using a combination of lifestyle changes and medication treatments.

Treatment

The skin is treated with ointments, which are often tar-based. Occasionally steroid creams are needed, but they should be used sparingly as they may cause thinning of the skin. Sometimes treatment with a special wave band of ultraviolet light is given after patients have received a medication known as psoralens (this is called PUVA treatment). There is no specific treatment for the nails. Some people use nail varnish to improve the appearance of their nails.

Pain and stiffness from this arthritis is usually well controlled with drugs called non-steroidal, anti-inflammatory drugs (NSAIDS). These work quickly and are not addictive, but they do have side effects. The commonest side effect is indigestion. If you notice this, make sure you tell your doctor. Always take your NSAIDS after meals or with a milky drink to try to avoid problems.

Should your arthritis be more severe, your doctor may give you disease modifying medicines like methotrexate, sulphasalazine or leflunomide. Sometimes a local steroid injection may be used to treat an inflamed joint. There is also a new class of medicine called biologics, which are reserved for severe cases that are resistant to usual treatment. Biologics are usually very effective but are also very expensive. These treatments must be supervised by a hospital clinic doctor, as they require regular blood tests and monitoring.

Exercise

Exercise maintains mobility of your joints and strengthens muscles to protect the joints. The physiotherapist can give you a plan and advice on home exercises. It is most important to maintain the mobility of the joints with these exercises and to build up strong muscles since they provide strength and protection for your joints. However, if an exercise becomes painful, reduce it a little.

Rest

If the joints in your hands are affected, wearing a splint at night or a working splint during the day will keep your hands in a comfortable position. Avoid carrying heavy objects which drag down your shoulders or strain your fingers. You should have sufficient rest. It is difficult to say how much you need, since no individual needs the same amount to rest as another.

Diet

Research has found no convincing evidence that special diets are effective in psoriatic arthritis. However, a balanced diet is important in promoting overall good health. If you are overweight, you need to diet because of the strain this puts on the leg joints.

Pregnancy

If you are planning to start a family, make sure you see your doctor beforehand. He/She will advise you on which drugs are safe to continue during pregnancy, and which are not.

 ** this info was taken from the Arthritis Foundation of Malaysia website**