What is Psoriatic Arthritis?

Psoriatic arthritis (Psa) is a form of inflammatory arthritis that causes pain and swelling in joints – and around joints. It often affects people who already have a skin condition called psoriasis (a skin condition that causes a red, scaly rash, especially on your elbows, knees, back, buttocks and scalp). However, some people do develop the arthritic symptoms before having, and without having psoriasis. It’s onset can vary and be unpredictable.

Psa onset can be unpredictable as it can affect any joint in the body at any time, and symptoms can vary from person to person.

It is not know what exactly causes Psa, however, having a family member with psoriasis or an existing inflammatory condition increases the possibility of having Psa. Psoriatic arthritis can also result from an infection that affects the immune system and triggers the inflammation, however, no specific infection has yet been found.

What are the symptoms?

The most common symptoms of Psoriatic Arthritis include:

• Pain and swelling in and around joints
• Swollen fingers or toes (dactylitis), caused by inflammation both in joints and tendons
• Pitting, discoloration and thickening of your nails
• Fatigue, which can be caused by the activity of the disease or the emotional effects of living with a long-term condition
• Buttock pain
• Stiff back or a stiff neck (spondylitis)
• Pain and swelling in heels
• Pain in other areas where tendons attach to bone (enthesitis), such as your knee, hip and chest

If you suspect that you have Psoriatic Arthritis, you should consult with your doctor ASAP to discuss you symptoms, organise relevant tests and guide your management..

How is it diagnosed?

Due to the variety of symptoms experienced by patients, diagnosing Psoriatic Arthritis can be complex. Doctors will confirm the diagnosis based on your symptoms, a physical examination of your swollen joints, the results of x-rays, scans, blood tests and Skin Biopies may also be taken to confirm the presence of Psoriasis. You may also be referred to a specialist (Rheumatologist) to confirm the diagnosis and receive treatment.

Blood tests

Blood tests you get will look at the short and long term inflammatory markers in your body that can indicate whether or not you have an inflammatory process happening in your body.

Creatine Reactive Protein (CRp) is used to assess the presence of inflammation in the body, to determine its severity, and to monitor response to treatment. It can be used to monitor acute or short term levels of inflammation in the body.

Erythrocyte Sedimentation Rate (ESR) is used to asses the amount of inflammation in the body. It is sometimes seen as a long term indicator of the level of inflammation in the body.

Rheumatoid Factor (RF) is an antibody found in the blood that attacks healthy tissue and leads to joint inflammation. RF is not found in people with Psa and so a negative RF result, confirmation of symptoms and other tests results will confirm the diagnosis.

Psoriasis Tests

Your doctor or dermatologist may be able to diagnose psoriasis by examining your skin. However, it is more than likely your doctor will remove a small sample of your skin and have it looked at under a microscope to confirm Psoriasis

X-rays

X-rays look at the condition of your joints to see if there are any signs of inflammation and joint damage.

Depending on the results of your investigations, your doctor should discuss with you whether or not you need to take medication, see a Rheumatology specialist or both.

Treatments for Psoriatic Arthritis

Depending on your symptoms your Doctor or Rheumatologist will use a combination of skin treatments and medication to treat your condition. The medications prescribed will depend on the severity and duration of your symptoms.

Treatment for Inflammation

Depending on your symptoms, blood tests and medical history, the medications commonly prescribed to manage pain and inflammation include:

• Pain killers/ analgesics
• Anti-inflammatories
• Cortico Steroid medications or injections
• DMARDS
• Biologics

Skin Treatments for Psoriasis

Your skin will usually be treated with a variety of ointments. These may vary from tar-based ointments, dithranol based ointment, steroid-based creams,vitamin D-like ointments and vitamin A-like (retinoid) gels such as tazarotene

If the creams and ointments don’t help your psoriasis, your doctor may suggest light therapy or retinoid tablets

What can I do about it (5 tips)?

Be Patient

One of the most important aspects of living with Psa is to remain patient. Getting a diagnosis and finding the most effective management plan for your Psa symptoms takes time. It can sometimes take weeks and months before conditions are clarified, treatments started and symptoms are settled. Having patience during the process, and with your body as it adjusts to the condition and any medications you may be prescribed, will make living with Psa much easier and less stressful.

Having patience with your doctors as they try to understand and settle your symptom, being patient with any medications while they try to work, and being patient with yourself as you adjust to your diagnosis, will have a more positive and healthy effect on your life with Psa. This will make your life with the condition much more manageable.

Adjusting physically, mentally, and socially to having the condition can be a challenge and will take time and effort too. Remaining patient during your journey will have many positive effects on your life with Psa.

Be Prepared

The symptoms of Psa can come and go, these periods are called ‘flare ups’. Having an effective ‘flare up’ management plan prepared will help reduce the discomfort and impact a flare up can have on your life.

The following factors should be considered in your flare up plan:

• Medical management – GP review for guidance medication if required
• Activity or Pacing management – How will you pace your day to day activities to remain active, remain productive and continue to enjoy life.
• Family Commitments – similar to Activity or Pacing management, how will you manage your family commitments around your symptoms..
• Employment Plan – How will you manage your job, studies or volunteer activities during a flare up?

Discussing your management plans with the relevant people, can help reduce any additional stress or difficulties that can arise if a flare up happens.

If you find it difficult to ‘Be Prepared’, discussing the challenges you face with your family, friends, Doctor, Physiotherapist, Occupational Therapist or counsellor may be beneficial.

Be Consistent and Balance Life

By maintaining a consistent healthy balance in your life while your condition stabilizes, will make life much easier and less stressful on you. Whether it is at the initial stages or during flare ups of Psa , being consistent with your activity levels, diet and lifestyle choices will help you monitor and manage your symptoms more effectively. Having poor or inconsistent habits with nutrition, smoking, drinking and inactivity can have a negative effect on the management of your condition.

Taking on major physical challenges (physical work commitments, fitness challenges, being more physical within family life) or psychological challenges (new roles at work, family challenges, increased stresses) while trying to get your symptoms under control, can make the process of getting symptom relief more challenging and less effective.

By ignoring the signs symptoms of Psa, doing little about your health, or trying to push through symptoms, you may actually be making the process of getting symptom relief harder for you and your medical team.

Applying techniques such as pacing/activity diaries, mindfulness, self awareness, or speaking to a health professional, can help make you more aware of the impact your lifestyle is having on your Psa and provide strategies to help you.

Be Active With Your Condition

When diagnosed with Psa it is important to be pro-active and fully involved in the management of your condition. This means both physically pro-active and mentally pro active. Having Psa does not condemn you to inactivity and when managed well can have minimal effect on your life.

Physically Pro active – While it is understandable and common to feel that doing very little helps your pain, protect your joints and helps your condition. However, over time, inactivity and disuse with have a detrimental effect on your physical and mental wellbeing. Maintaining good joint mobility and muscle condition through exercise and activity will maintain your joint, and heart health for longer, and will have many more health benefits over inactivity.

There are times when you may have to reduce the intensity at which you do your activities to a level that does not aggravate your symptoms. BUT keeping the joints moving through their range of movement, and maintaining good muscle condition (cardiac and body muscle) is essential for your health.

Being Mentally pro active – Structuring your days, having goals and being objective towards the management of your Psa will provide you with good foundations from which to measure, monitor and manage your condition effectively.

Applying practices such as training diaries, pain diaries, recording blood tests and monitoring your successes and challenges will help you plan your life around your condition effectively. Also, in doing this you can help your Doctors or health professionals identify changes in your condition, to help implement effective management plans more effectively.

Be Smart

When diagnosed with a Psa it is important to educate yourself on your condition and how best to live with it. By understanding your condition, learning about medications and treatment options, you will be able to make informed decisions about your health and treatment options. Also understanding how your lifestyle influences your condition, and your condition influences your lifestyle, will help you manage Psa effectively.

With good information you can plan and discuss with your health team, the most appropriate course of action and management strategy for your symptoms. This will ideally result in the reduction of any pain or difficulties caused by your Psa .

Many organisations and charities offer education and self-management courses for people with Psa. These can help you build skills and confidence in managing your health and rheumatoid arthritis. These courses often cover issues such as medication, exercise, managing day to day with Psa and accessing further resources that may be relevant.

What can other people do to help me?

The management of Psa can vary between individuals, however, early diagnosis and appropriate treatment are essential to relieve symptoms, reduce joint damage and help you continue to lead a normal life.

Doctors

Initially, the most important thing you can do is discuss your symptoms and diagnosis with your doctor. They may prescribe medications that can help your symptoms immediately, order tests to confirm your diagnosis and refer you to a specialist (Rheumatologist).

Finding the right doctor for you, is very important. For the long term outlook, it is important to find a Doctor you feel is approachable and effective in the management of your condition. You may have to call upon them at various times in your life, therefore having a positive relationship with them, and confidence in their management of you is importan.

The most common medications your doctor will manage are 

• Painkillers/ analgesics
• Anti-inflammatories
• Cortico Steroid medications or injections

Specialists / Consultant Rheumatologists

Rheumatologists are Doctors who have dedicated their professional lives to managing rheumatology conditions and have years of invaluable clinical experience in diagnosing and managing Rheumatoid conditions. They also have specialised medication prescribing rights and qualifications to help manage your condition.

The main roles of the specialist are to use their knowledge in conjunction with your GP and regular tests, to get your symptoms under control, and then monitor your condition over a longer period of time.

Rheumatology specialists appointments are often in high demand and can often be shorter than patients expect. However, rest assured your Rheumatologist understands your condition, understands what you are going through and is working hard to find the most effective management strategy for your symptoms. Due to the complex nature of Rheumatoid conditions and the effect they can have on the various systems of the body, finding the right medication and management can take time.

Depending on your symptoms, blood tests and medical history, the medications commonly prescribed by specialists in relation to Psa are one, or a combination of the following  medication groups:

• Painkillers / analgesics
• Anti-inflammatories
• Corticosteroids medications or injections
• DMARDS (Disease modifying anti rheumatic drugs)
• Biologic DMARDS (made from living protiens and may prescribed by Rheumatologists in certain clinical circumstances)

While the thought of taking any of these medication can be both daunting and unpleasant, the medications prescribed by your GP or Specialist will have the most evidence base and research backing their effectiveness.

Therapists

Based on the symptoms and issues you may be experiencing, your Specialist or GP may refer you to a variety of health professionals to help manage your condition. The most common Health professionals used by GPs and Rheumatologists, to help people with Psa are:

When choosing which therapist to see it is beneficial to discuss your plan with your GP, research the therapist you intend to see, and ensure the therapist applies some sort of evidence based practice to the treatments they are providing you.

Remember, there is no cure for Psa, so be cautious of anybody making unfounded claims to be able to cure your condition or resolve your symptoms completely.

Many people do try alternative approaches to help their Psa and its symptoms, with mixed effect. No matter what approach or therapist you see, it is a good idea to discuss your approach with your GP, Rheumatologist or relevant health professional. More importantly, please ensure you feel better after seeing them and have a clear plan on how your condition will be monitored and self-managed

More importantly, please ensure you feel better after seeing them, have a clear plan on how your progress will be monitored, and the plan for self management.

Family, Friends and Support Networks

The most important members of you Psa team are your family, friends or support network. Attending events, remaining active and living life can be a challenge at times for all of us, however, for people with Psa , the symptoms can flare up at times and can significantly impact your life. Therefore, having people to talk to and share your highs and lows with, is very important in maintaining good physical, mental and spiritual health.

Many organisations and charities offer support, education and self-management courses for people with Psa . These can help you connect with other people living with Psa , as well as build skills and confidence in managing your health and Psa .

Participating in physical activity with others can provide you with an opportunity to keep your joints and body healthy, while sharing positive experiences with others. Activities such as walking, hydrotherapy, Tai chi, Pilates or mindfulness sessions are all low impact activities that can be enjoyed at all stages of Psa.

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