Psoriatic Arthritis

• Psoriatic Arthritis (PsA) is a chronic autoimmune disease that causes joint pain, swelling, and stiffness, and it is often linked to psoriasis, a skin condition marked by red, scaly patches. PsA can affect any part of the body—fingers, toes, spine, knees, or even nails—and can range from mild to severe.

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• While there is no cure, medications can help manage symptoms, slow joint damage, and improve daily quality of life.

Psoriatic Arthritis occurs when the body’s immune system mistakenly attacks healthy joints and skin, leading to inflammation.

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Key Risk Factors Include:

• Genetics:

  • A family history of psoriasis or PsA increases your risk.

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• Immune System Dysfunction:

  • The immune system triggers inflammation in joints and skin.

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• Triggers Can Include:

  • Infections

  • Physical trauma or skin injury

  • Stress

  • Certain medications (e.g., beta-blockers, antimalarials)

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PsA usually appears in people already diagnosed with psoriasis, but sometimes joint issues start first.

• PsA is part of a group of diseases called seronegative spondyloarthropathies, meaning it affects the spine, joints, and ligaments, but without the rheumatoid factor in the blood.

• Common types of PsA include:

  • Symmetrical arthritis: Similar on both sides of the body

  • Asymmetrical arthritis: Affects joints on one side

  • Distal arthritis: Involves fingers and toes

  • Spondylitis: Involves the spine and sacroiliac joints

  • Arthritis mutilans: Rare and severe form that damages joints

• Symptoms can vary by person, but common signs include:

  • Joint pain, swelling, and stiffness (especially in the morning)

  • Swollen fingers or toes (sausage-like appearance)

  • Foot pain (especially at the heel or sole)

  • Lower back pain

  • Nail changes – pitting, discoloration, or separation from the nail bed

  • Fatigue or low energy

  • Flare-ups and remission phases (symptoms can come and go)

• Psoriatic Arthritis treatment aims to:

  • Reduce joint pain and stiffness

  • Prevent further joint damage

  • Control skin psoriasis

  • Improve daily function

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1. Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• Used for mild joint pain and swelling

  • Examples: Ibuprofen, Naproxen, Diclofenac

  • Reduce inflammation and pain

  • Long-term use may cause stomach ulcers or kidney issues

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2. Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

• Used to slow disease progression and prevent joint damage

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• Traditional DMARDs:

  • Methotrexate – Most common; reduces inflammation

  • Sulfasalazine, Leflunomide – Alternatives when methotrexate isn’t tolerated

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• May cause liver issues, nausea, or fatigue; requires regular blood tests

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3. Biologic DMARDs (Biologics)

• Target specific parts of the immune system

• Used for moderate to severe PsA

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• Examples include:

  • TNF-alpha inhibitors: Adalimumab (Humira), Etanercept (Enbrel), Infliximab (Remicade)

  • IL-17 inhibitors: Secukinumab (Cosentyx), Ixekizumab (Taltz)

  • IL-12/23 inhibitor: Ustekinumab (Stelara)

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• Very effective at reducing joint and skin symptoms

• May increase risk of infections; need monitoring

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4. Targeted Synthetic DMARDs (tsDMARDs)

• Oral options that target specific inflammatory pathways

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• Examples:

  • Apremilast (Otezla): Inhibits enzyme (PDE4) to reduce inflammation

  • Tofacitinib (Xeljanz), Upadacitinib (Rinvoq): JAK inhibitors (used when others fail)

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• May cause diarrhea, headache, and potential infection risks

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5. Corticosteroids

• Used for short-term relief during flare-ups

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• Example: Prednisone

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• Not recommended for long-term use due to side effects like weight gain, bone thinning, and high blood sugar

• There is no single test for PsA. Diagnosis usually involves:

  • Physical exam (checking joints, skin, nails)

  • Medical history (personal and family)

  • Blood tests: Rule out rheumatoid arthritis or infections

  • Imaging (X-ray, MRI, Ultrasound): Check for joint damage or inflammation

  • Skin biopsy (if psoriasis is suspected but not yet diagnosed)

• While PsA cannot be prevented entirely, flare-ups can be reduced with lifestyle adjustments:

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• Healthy Habits:

  • Maintain a balanced, anti-inflammatory diet

  • Stay active with low-impact exercises (yoga, swimming)

  • Avoid smoking and limit alcohol

  • Moisturize skin regularly to manage psoriasis

  • Manage stress through meditation, breathing exercises, or therapy

  • Keep a symptom journal to track flare-up patterns

1. Can PsA go into remission?

• Yes. With the right treatment, many people experience long periods without symptoms.

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2. Is PsA curable?

• No, but it's manageable. Medications can control symptoms and prevent joint damage.

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3. Are biologics safe long-term?

• Yes, but they suppress the immune system, so regular monitoring is needed to prevent infections.

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4. Can PsA affect daily life?

• Yes, but with proper treatment and self-care, many people live active, normal lives.

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5. How is PsA different from rheumatoid arthritis?

• PsA often affects both skin and joints, may involve nail changes, and can be asymmetrical, unlike RA.