Dear Doctor Column, March 7, 2005
Condition Links Psoriasis and Arthritis
Question:
I've had psoriasis for several years and now have developed arthritis. The doctor said my arthritis is linked to the psoriasis. What causes this? My doctor prescribed ibuprofen to see if it can control the joint swelling and pain, but that there are other drugs we can try if that doesn't work. What else is available?
Answer:
Psoriatic arthritis causes pain and swelling in joints and is related to psoriasis, a chronic skin condition characterized by a scaly, itchy skin rash, often on the elbows, knees, and scalp.
The joint pain caused by psoriatic arthritis often is associated with stiffness, especially in the morning. About 30% of people with psoriatic arthritis also have neck and/or back pain and stiffness, which may further limit movement. People who develop psoriatic arthritis may experience either the skin or joint symptoms first, or both symptoms may appear simultaneously.
Psoriatic arthritis affects about 5% to 8% of people who have psoriasis, according to the Arthritis Foundation. Men and women of all races are equally affected, usually between the ages of 20 and 50 years.
The cause of psoriatic arthritis is not yet known. It is believed that genetic factors, abnormalities of the body's immune system, and environmental factors play a role in developing the disease. Some scientists believe certain bacteria or fungal agents may cause chronic stimulation of the immune system, which, in turn, could cause arthritis in people with a genetic "susceptibility" to psoriatic arthritis.
Common symptoms of psoriasis and psoriatic arthritis include:
- Pain and swelling in one or more joints, usually the wrists, knees, ankles and/or joints at the ends of the fingers or toes
- Swelling of fingers and/or toes that gives them a "sausage-like" appearance
- Low back pain or pain in the buttocks
- Silver or gray scaly patches on the scalp, elbows, knees, and/or the lower end of the backbone
- Pitting, which is characterized by small depressions and/or detachment of fingernails and/or toenails.
Treatment goals are to reduce joint pain and swelling, control skin patches, and slow or prevent further joint damage. Medications can be divided into these categories:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) — includes over-the-counter medications such as aspirin and ibuprofen, as well as prescription products; the main purpose of these medications is to decrease inflammation, joint pain, and stiffness.
- Disease-modifying antirheumatic drugs (DMARDs) — relieve more severe joint symptoms and attempt to slow or stop joint and tissue damage.
- Biologics — new drugs that block specific components of the immune system from producing the inflammation that may lead to joint and tissue damage.
Additional treatment options may include topical ointments and ultraviolet light treatment for the skin lesions and heat and cold packs for the arthritis. Physical therapy and prescribed exercises can help with pain control, as well as maintenance of function and range of motion.
More information about psoriatic arthritis is available at the National Psoriasis Foundation Web site and the Arthritis Foundation Web site.